Citation
Emotional imagery in high and low dentally fearful children

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Title:
Emotional imagery in high and low dentally fearful children a test of Lang's bio-informational theory
Creator:
Cohn, Lauren Kaplan, 1958-
Publication Date:
Language:
English
Physical Description:
viii, 175 leaves : ill. ; 29 cm.

Subjects

Subjects / Keywords:
Adults ( jstor )
Child psychology ( jstor )
Children ( jstor )
Dentists ( jstor )
Fear ( jstor )
Galvanic skin response ( jstor )
Heart rate ( jstor )
Lawn chairs ( jstor )
Memory ( jstor )
Physiological stimulation ( jstor )
Clinical and Health Psychology thesis Ph.D ( mesh )
Dental Stress Analysis ( mesh )
Dissertations, Academic -- Clinical and Health Psychology -- UF ( mesh )
Emotions -- Child ( mesh )
Emotions -- Infant ( mesh )
Pediatric Dentistry ( mesh )
Genre:
bibliography ( marcgt )
non-fiction ( marcgt )

Notes

Thesis:
Thesis (Ph.D.)--University of Florida, 1987.
Bibliography:
Bibliography: leaves 168-174.
General Note:
Typescript.
General Note:
Vita.
Statement of Responsibility:
by Lauren Kaplan Cohn.

Record Information

Source Institution:
University of Florida
Holding Location:
University of Florida
Rights Management:
Copyright [name of dissertation author]. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.
Resource Identifier:
022919578 ( ALEPH )
17889876 ( OCLC )
AEL1995 ( NOTIS )

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Full Text









EMOTIONAL IMAGERY IN HIGH AND LOW DENTALLY
FEARFUL CHILDREN: A TEST OF LANG'S
BIO-INFORMATIONAL THEORY



By

LAUREN KAPLAN COHN


A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF DOCTOR OF PHILOSOPHY

UNIVERSITY OF FLORIDA


1987




EMOTIONAL IMAGERY IN HIGH AND LOW DENTALLY
FEARFUL CHILDREN: A TEST OF LANG'S
BIO-INFORMATIONAL THEORY
By
LAUREN KAPLAN COHN
A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA
1987


To my parents, Doris and Irwin Kaplan, who taught me to
believe that I could do anything, and then gave me the love,
support and friendship I needed to do it.


ACKNOWLEDGEMENTS
I wish to thank my major professor, Dr. Barbara G. Melamed,
for her direction in the completion of this dissertation. Her support
and guidance during my graduate training are greatly
appreciated. Dr. Russell Bauer, Dr. Suzanne B. Johnson, Dr. Peter
Lang, and Dr. Marjorie White served with Dr. Melamed on my
doctoral committee, and I thank them for their time and for their
helpful comments. I am indebted to Robyn Ridley-Johnson, Ed Cook
and Lisa Pistone for their invaluable work on this study. Several
research assistants participated in this study. I would
particularly like to thank John Eisler, Jamie Goodman, Sanjiv
Patel, and Godard van Reede for their contributions. Thanks are
also due Paul Greenbaum and Rich Steinkohl for their help during
the final stages of manuscript preparation. I would like to express
my gratitude to Dr. Carroll Bennett, Dr. Frank Courts, Dr. Roy
Jerrell and Dr. Clara Turner who served as the dentists in this
study, and to the staff of the Pediatric Dentistry clinic at the
University of Florida for its assistance in this research. The
cooperation of the School Board of Alachua County and the parents
and children who participated in the study are thankfully
acknowledged.
iii


My parents, sister and grandparents played a special role in
the completion of this dissertation. Their enthusiasm about my work
and their pride in my accomplishments really helped me to achieve
my goal. I especially want to thank my husband, Alan, for his
helpful ideas and for the love and support he has given me.
The work for this dissertation was conducted while I was a
fellow on the National Institute of Dental Research Training Grant
No. 5 T32 DE07133-02.
IV


TABLE OF CONTENTS
PAGE
ACKNOWLEDGEMENTS iii
ABSTRACT vii
INTRODUCTION 1
Physiological Responsivity to Imagery 3
Lang's Bio-informational Theory 15
Responsivity to Internally Induced Imagery 27
Imagery Ability in Children 30
Affect and Memory 43
Children's Responsivity to Imagined Stimuli 49
Children and the Bio-informational Theory 53
Statement of the Problem 56
METHOD 59
Design 59
Subjects 60
Apparatus 60
Procedure 63
Screening 63
Session 1 64
Session 2 67
Data Scoring 69
Physiological Measures 69
Self-Report Measures 70
Observational Measures 71
Data Analysis 72
RESULTS 74
Study I: Pilot Study of Scene Contents 74
Pleasure 75
Arousal 75
Dominance 75
Fear 76
Similarity to Past Experience 76
Similarity to Possible Future Experiences 76
Study II: Tests of Hypotheses 77
Subject Demographic Data 77
Imaginal Responses to Affective and Neutral Content 79
Effects of Fear Level and Imagery Training 86
v


DISCUSSION 94
Discrimination of Affective Valence 94
The Effects of Fear Level and Imagery Training 97
Implications for Lang's Bio-informational Theory 99
Methodological Considerations 102
Suggestions for Future Research 104
Conclusions 106
APPENDICES
A IMAGERY SCENES 109
B CHILDREN'S FEAR SURVEY SCHEDULE-
DENTAL SUBSCALE 112
C INFORMED CONSENT TO PARTICIPATE IN RESEARCH 116
D SUBJECT DATA FORM 119
E CHILDREN'S FEAR SURVEY SCHEDULE 120
F DENTIST RATING FORM 123
G BEHAVIOR PROFILE RATING SCALE 124
H QUESTIONNAIRE UPON MENTAL IMAGERY CHILDREN... 127
I MEASURE OF ELEMENTARY COMMUNICATION
APPREHENSION 130
J RELAXATION TRAINING 131
K STIMULUS IMAGERY TRAINING 136
L RESPONSE IMAGERY TRAINING 140
M IMAGERY PROCEDURE INSTRUCTIONS 145
N PILOT STUDY OF SCENE CONTENTS 153
O TABLES OF MEANS FOR AFFECTIVE RATINGS,
HEART RATE AND SKIN CONDUCTANCE 160
REFERENCES 168
BIOGRAPHICAL SKETCH 175
vi


Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy
EMOTIONAL IMAGERY IN HIGH AND LOW DENTALLY
FEARFUL CHILDREN: A TEST OF LANG'S
BIO-INFORMATIONAL THEORY
By
Lauren Kaplan Cohn
May, 1987
Chairman: Barbara G. Melamed
Major Department: Clinical Psychology
In a test of Lang's bio-informational theory, physiological
responses to emotional imagery were studied in 6- to 12-year-old
children who reported high or low dental fear. In the first
experimental session, each child was given a restorative dental
treatment. Next, each child was given a relaxation exercise and
then trained in one of two kinds of imagery. Stimulus training
involved teaching children to focus on descriptive aspects of the
imagined situations, while response training instructed children to
focus on their bodily responses during imagery. Measures of social
anxiety and imagery ability were also taken. In the second
session, the relaxation exercise was repeated, and then
physiological recordings were taken while children imagined
neutral, dental fear and school fear situations. Children rated
their emotional responses to each scene. This assessment was
followed by a second dental treatment. Both treatment sessions were
videotaped for later scoring of disruptive behaviors. It was found
that children do discriminate between fearful and neutral content
vn


both in their physiology and in affective ratings. Children showed
heart rate acceleration to fearful content and deceleration to
neutral content. Fear scenes were rated as lower in pleasure and
in perceived control than were the neutral scenes. The study
revealed that for children, the imagery task requires two steps of
processing. In the first step, children attend to the material being
presented and show a physiology concordant with attention. In the
second step, once the emotional memory network has been accessed,
children respond to the affective content of the material, showing
a physiology that varies with the affective valence of the text.
vm


INTRODUCTION
Fears and phobias in children are generally held to be fairly
common occurrences. Estimates suggest that approximately 40% of
children ages 6 to 12 years have as many as seven fears (Lapouse
& Monk, 1959; Miller, 1983; Miller, Barrett, Hampe & Noble, 1972).
Children are often referred to clinics for the treatment of their
fears, although estimates of the frequency of referrals vary from 6
to 8% (Graziano & DeGiovanni, 1979) to as much as 30-40% (Miller,
1983). Many of the therapies used with fearful children involve the
use of imagery. These treatments include hypnosis, systematic
desensitization, implosive therapy and flooding. For example,
Lazarus and Abramovitz (1962) reported on the use of "emotive
imagery" with fearful children, ages 7-14 years. This treatment is
quite similar to systematic desensitization used with adults;
however, the child's own hero or alter ego is incorporated into the
stories. This procedure was successful in ameliorating the fears of
seven of nine children treated.
Although numerous studies attest to the effectiveness of
imaginal treatment with adults, there is a relative paucity of
empirical data on the utility of these techniques with children
(Elliot & Ozolins, 1983; Graziano, DeGiovanni & Garcia, 1979;
Ollendick & Cerny, 1981). Many of the procedures used in the
1


2
treatment of adults have been applied to children with little
modification (Elliot & Ozolins, 1983; Graziano, DeGiovanni &
Garcia, 1979; Harris, 1983). However, this may not be appropriate.
Several important issues must be considered when using imagery
based treatments with children. The most obvious of these is the
developmental level of the child (Elliot & Ozolins, 1983; Rosenstiel
& Scott, 1977). There is some evidence to suggest that children as
young as 4 to 6 years old can use imagery to change their
behavior (Mischel, Ebbesen & Zeiss, 1972). It cannot be assumed,
however, that children are uniformly able to use imagery in
therapy. For example, Tasto (1969) was unsuccessful in his attempt
to use imaginal desensitization to treat a 4-year-old boy with a
fear of loud noises. In vivo desensitization did result in
elimination of the child's symptoms. Furthermore, there are data to
suggest that important changes in imagery ability occur between
the ages of 6 to 8 years (Paivio, 1970; Reese, 1970; Rohwer, 1970).
This would coincide with movement into Piaget's stage of concrete
operations.
The purpose of this paper is to describe a study of children's
responses to imagery. The study addresses factors that have been
shown to be important to therapeutic improvement in adults. Three
lines of research are reviewed. First, in the absence of adequate
research on imaginal therapies with children, studies on adult's
responses to imagery are considered. In this context, Lang's
bio-informational theory of emotional imagery will be described.


3
This theory has provided useful information regarding variables
that have influenced improvement in adult phobic patients through
the use of imaginal treatments (Lang, 1977, 1979). Second,
research on imagery ability in children will be described. Work to
be described comes primarily from the area of learning and
memory, since, as noted above, the clinical literature has
produced few studies of imagery in children. Third, studies of
children's responsivity to imagery will be presented.
Physiological Responsivity to Imagery
The use of systematic desensitization is based on the
assumption that visualized stimuli produce fear responses that are
similar to, but less intense than, those produced by the actual
situation. Relaxation is then elicited, in order to inhibit or
extinguish this fear response (Grossberg & Wilson, 1968).
Systematic desensitization and procedures like it have
stimulated a great deal of research on the physiological effects of
imagery. Specifically, investigators have questioned whether
imagined stimuli actually do evoke a fear response, whether the
response varies with the fearfulness of the stimulus, and whether
the pattern of responsivity seen in phobic subjects differs from
that seen in non-phobic subjects.
Grossberg and Wilson (1968) designed an experiment to
determine whether fearful imagery truly does generate more "initial
tension" than neutral imagery. The authors suggest that such a
difference is basic to the theory underlying systematic


4
desensitization, and note that if no difference were found, "it
would be difficult to maintain that something was being inhibited,
replaced or extinguished with repeated visualizations" (Grossberg &
Wilson, 1968, p. 124).
The investigators compared the physiological responses of high
and low anxious female undergraduates to fearful and neutral
scenes. Fear scenes were individualized for each experimental
subject. A control group listened to tape recorded presentations of
the scenes selected for her matched experimental counterpart.
Control subjects reported low fear for the items tested.
The authors found that both high and low anxious subjects
showed increases in heart rate and skin conductance during both
the reading and visualization of the scenes. Fear scenes produced
greater arousal than neutral scenes during the image period only.
Both heart rate and skin conductance decreased over repeated
scene readings, while skin conductance also showed a decrease
over imaging trials.
Comparison of experimental and control subjects indicated that
the experimental subjects showed a greater heart rate increase
during the reading of the fearful scenes. Imagining fear scenes
resulted in significant heart rate and skin conductance increases
to fear scenes for both groups, although no difference between
scenes had been expected for the controls. The experimental group
showed significant habituation of the heart rate response over
trials for the reading of fear scenes. Both groups showed skin


5
conductance habituation for the presentation of neutral scenes.
The authors concluded that imagery does have measurable
physiological effects, and that fearful imagery produced more
arousal than neutral imagery. Some habituation was noted over
repetitions, suggesting that habituation can occur even without
relaxation training. They note that these results were obtained
with a non-phobic population and suggest that phobic subjects
would be likely to produce greater differential responding.
Haney and Euse (1976) examined physiological responsivity to
positive scenes as well as to negative (fearful) and neutral scenes
in a sample of college students. They found that during imagery,
heart rate was larger fc1' the negative scenes than for the positive
or neutral scenes. Skin conductance responses were larger for both
the positive and negative scenes than for the neutral scenes, while
the former were not significantly different from each other. There
was a significant decrease in skin conductance across time for the
neutral image.
Positive images were rated as more intense and higher in
clarity than either the neutral or negative images. Negative images
were rated as more intense than neutral images. The relationship
between clarity, intensity and physiological responsivity was not
examined.
Results of this study are similar to those obtained by Grossberg
and Wilson (1968), since fearful scenes produced increases in heart
rate and skin conductance. It is not clear, however, why the


6
positive scenes in the Haney and Euse (1976) study also produced
increases in skin conductance. The authors did not specify the
content of the positive scenes. Thus, it is not possible to
determine whether the scenes were of an arousing nature (i.e.,
physical exertion) which may have resulted in increased skin
conductance responding.
The studies described above yielded information about
physiological responsivity to imagery that has relevance to the
theory of systematic desensitization; however, subjects in these
studies were all non-phobic. Van Egeren, Feather, and Hein (1971)
studied a group of speech phobic college students in order to
evaluate a number of hypotheses about systematic desensitization.
Half of the subjects (all male) were given instruction in
relaxation, and all subjects received visual imagery training. The
details of this imagery training are not specified. The authors
note only that "his visualization procedure was discussed and
suggestions made, emphasizing vividness of the imagery, constancy
of the image, and realistic projection of the self into the
situation" (Van Egeren et al., 1971, p. 215). Each subject
imagined the scenes on his individual hierarchy during the next
two experimental sessions.
Fearful imagery was associated with significant autonomic
responses; specifically, subjects showed increases in heart rate,
skin conductance, respiration, and digital vasoconstriction. These
responses were greater than those occurring to neutral stimuli. The


7
investigators found a positive relationship between the degree of
responsivity and the fear level of the scene, although this was
true only for digital vasoconstriction and the number and
magnitude of skin conductance responses.
Habituation of responses with repetition of stimuli was observed
for digital vasoconstriction both within and across sessions.
VanEgeren et al. (1971) expected that the least threatening scenes
would lead to more rapid extinction of responses; however, this
hypothesis was not supported by the data.
Relaxation had limited effects on physiological responding.
Relaxed subjects showed a faster habituation of digital
vasoconstriction throughout the experiment and of skin conductance
responses during Session 1. It was also found that relaxation
produced more facilitation of habituation (skin conductance
response and vasoconstriction) for the most threatening scenes. An
interesting result obtained in this study was that decreases in
autonomic responding were not accompanied by comparable
decreases in the subjective reports of anxiety. Thus, these subjects
may have shown improvement in their anxiety reactions, but yet,
may not "feel better." This discordance between physiological,
subjective, and behavioral indices of anxiety has been described
by Lang (1968).
The study by Van Egeren et al.(1971) addressed several
important points. First, the authors found some evidence that
greater levels of physiological arousal occur to scenes rated higher


8
in fearfulness. They showed that physiological habituation does
occur over repeated presentations of feat stimuli and that
relaxation is not absolutely essential for habituation to take
place. Finally, the finding of discordance between self-report and
physiological measures of anxiety is a common one in the literature
(Lang, 1968) and points to the importance of comprehensive
assessment of anxiety.
Similar findings were noted by Marks and Huson (1973) in their
summary of six treatment studies that included a physiological
assessment of imagery ability in phobic patients. Responses to
scenes with phobic and neutral content were compared. Patients
exhibited increases in heart rate and skin conductance to phobic,
scenes, although these results were not obtained consistently in all
six studies. Subjective ratings of anxiety did discriminate between
fearful and neutral scenes in all studies. After the completion of
treatment, differences in responsivity to phobic and neutral scenes
were decreased. Interestingly patients in four of the studies
continued to rate the phobic scenes as more anxiety provoking.
Few correlations between the physiological measures or between
physiological and subjective measures were obtained, providing
additional support for the notion that there may be some
independence between response systems in phobic patients.
Waters and McDonald (1973) noted that the type of stimulus
presented to subjects may influence the degree of fear decrement. A
number of studies had indicated that exposure to the feared


9
stimulus in vivo results in greater autonomic reactivity and more
improvement in phobic concerns. Thus, Waters and McDonald
examined autonomic reactivity and differences in response
decrement to fear provoking stimuli in three modalities. Rat phobic
undergraduate females were given systematic desensitization. At
each level of the hierarchy subjects heard a description of the
fear stimulus (auditory mode), saw a slide depicting the feared
stimulus (visual mode), and then closed their eyes and imagined
the stimulus (imagery mode). Each subject was exposed to each
modality in this between subjects design. Imagined stimuli
produced significantly more responsivity than either the visual or
auditory stimuli in the case of heart rate, skin resistance and
skin potential. Vasomotor response showed more responsivity to the
auditory stimuli. There were no significant differences between
stimulus modalities in the degree of response decrement over trials,
with two exceptions. Imagery produced greater decreases in skin
potential than did auditory presentation, while skin resistance
showed greater decrease to visual than auditory stimuli. When
response decrements did occur over trials, these occurred more
frequently to visual and imagined stimuli. No habituation was
produced for heart rate, and only one stimulus produced
habituation of skin resistance and skin potential. The authors
concluded that exposure to stimuli in either the visual or imaginal
mode would be sufficient to produce a decrease in the physiological
component of phobic disorders.


10
There is a serious confound in this study. Subjects all received
exposure to the three stimulus modalities, and all in the same
order. It is very possible that the increased responsivity to the
visual and imaginal stimuli was a result of an incremental effect
of these modalities when given subsequent to the auditory
modality. In fact, the authors note that a "small minority of
subjects indicated that their imagery occasionally was an
exaggerated form of the auditory and visual images. Effects of
each modality need to be tested separately.
In a study designed to evaluate the effectiveness of a device
for automated desensitization, Lang, Melamed and Hart (1970)
presented some interesting data on patterns of physiological
responsivity over the course of treatment. Snake phobic
undergraduate women were given eleven sessions of systematic
desensitization with the automated device. The authors examined
physiological responses across all sessions on those trials during
which the subject signaled fear. These trials were compared with
the one previous trial and two subsequent trials during which no
fear was indicated. Consistent with prediction, subjects showed
significantly greater heart rate, skin conductance and respiration
on trials during which fear was reported. Further, those subjects
manifesting the greatest improvement in the degree of fearfulness
after treatment were those who demonstrated the highest heart rates
on fear signaled trials. These same subjects showed greater heart
rate habituation to repeated presentations of a fearful stimulus.


11
Respiration and skin conductance data did not yield a similar
pattern of results.
In a second study, Lang et al. (1970) investigated the nature
of an anxiety hierarchy. Specifically, the authors questioned
whether the degree of anxiety manifested physiologically and in
verbal report would correspond to the ranking of each item in the
hierarchy. The relationships between image clarity, hierarchy
position and anxiety were also considered. Public speaking and
spider phobic subjects participated in this study. Scenes were
presented in a random order so as to control for any effect of
sequential presentation of the scenes on responses. There was no
significant relationship between hierarchy rank and image
vividness. Subjective ratings of anxiety were greater for items
higher in the hierarchy. Heart rate and skin conductance yielded
the predicted result: responsivity on these measures was greater
for those items ranked as highly fearful. A significant linear
trend was obtained for heart rate for both groups of subjects,
while only the spider phobics produced such a trend for skin
conductance. No relationship between respiration responses and
hierarchy rank was obtained. Both groups evidenced a significant
relationship between heart rate increments and anxiety ratings.
Vividness correlated with heart rate changes for the combined
groups and for the public speaking phobics alone, but not for the
spider phobics.


12
The studies by Lang et al. (1970) complement the results of
studies already described. It had previously been shown that both
normal and phobic subjects produce more physiological and
self-reported anxiety to phobic content than neutral content. These
investigators demonstrated that scenes rated as higher or lower in
fearfulness produce differential physiological responses. Further, it
was found that habituation of heart rate responding was associated
with a favorable treatment outcome. This then suggests that
habituation is a mechanism that may underlie the effectiveness of
this therapeutic approach. The study also provided support for the
notion of a fear hierarchy, in that greater physiological
responsivity and greater subjective anxiety occurred to those items
with higher ranks.
In a thought provoking paper, Grayson (1982) described two
studies that could provide an explanatory model for differential
responsiveness to phobic and neutral stimuli, as well as for the
mechanism underlying systematic desensitization. Grayson postulated
that a stimulus that was paired with a phobic stimulus would
elicit defensive responses in fearful subjects. He noted that it
would be necessary to study second-by-second heart rate responses
in order to evaluate this phenomenon.
In the first experiment described, Grayson presented speech
anxious subjects with a slide of either a phobic or neutral
stimulus, and then asked subjects to form a visual image of that
stimulus. For one group of subjects, each slide was preceded by


13
the presentation of a tone: high frequencies for phobic scenes, and
low frequency tones for neutral scenes. Another group of subjects
had no signal preceding the slides. For the fear stimuli, heart
rate wave forms characteristic of a defensive response occurred to
presentation of the signal and of the slide for only those subjects
receiving a signal. Defensive responses occurred to visualization of
fear scenes regardless of whether a signal was given. Contrary to
expectation, orienting responses were not obtained when neutral
stimuli were presented. These data support Grayson's notion that
that the increased heart rates observed when subjects imagine
fearful stimuli are manifestations of a defensive response.
Grayson's second experiment investigated two models that could
explain the incremental stimulus intensity effect. This effect is "a
demonstration that habituation to repeated intense stimulation is
more rapid when the stimuli are presented with gradually
increasing intensity than when an equal number of presentations of
the most intense stimulus are given" (Grayson, 1982, p.104).
Grayson presented subjects with a hierarchy of phobic stimuli (the
incremental series) or with a constant series which consisted of
repetitions of the stimulus item at the high end of the hierarchy.
Results of the study were expected to provide support for one of
two theories. Groves and Thompson's dual process theory predicts
that greater habituation would occur with an incremental series
since any sensitization or arousal would be small and would
habituate over a few trials. A constant series would be expected to


14
produce marked, lasting sensitization. Sokolov's neuronal
comparator model, however, would predict that greater habituation
would occur to the constant series, assuming that presentation of a
new stimulus could elicit an orienting response, or possibly even a
defensive response.
Speech anxious college students were presented with either four
presentations each of four graded fearful stimuli (incremental
series condition), or sixteen presentations of the most fearful
stimulus (constant series condition). Comparisons were made on
responses to the last four presentations, since these were identical
for both groups. The method of stimulus presentation was the same
as in the first study.
Some support was obtained for the use of graded hierarchies,
since the constant series produced larger and more durable heart
rate accelerations in the pre-slide period and a greater number of
spontaneous fluctuations in skin conductance during visualization.
Clear empirical support was not obtained for either the dual
process or neuronal comparator model. Both experimental groups
evidenced heart rate wave forms and cephalic vasomotor
constriction characteristic of a defensive response. Nevertheless,
this study is an important one, since it points to the defensive
response as a potential explanation of the increased physiological
responsivity that has been observed to occur to phobic stimuli.


15
Lang's Bio-Informational Theory
In his bio-informational theory, Lang (1977, 1979, 1985)
suggests that images are not pictures in the mind's eye, but
rather that images are the product of a propositional structure in
memory. An image consists of information units, or propositions,
that are linked together into an informational network. There are
stimulus propositions, which refer to the descriptive features of the
situation, response propositions, which refer to the subject's
behavior in the situation, and meaning propositions, which refer to
the subject's appraisal of the stimulus and response data (Lang,
1985). There are three types of response propositions: overt motor
behavior (i.e., I run away), verbal report of subjective
experience (i.e., I feel afraid), and patterns of visceral
reactivity and somatomotor tonus (i.e., my heart pounds). The
network is processed as a unit when a critical number of the
propositions are accessed. Propositions can be accessed in a
variety of ways, such as through actual exposure to the feared
stimulus, through pictures or stories of the stimulus, and even
through thoughts. Since the different propositions are linked
together in memory, accessing, or activating one proposition in the
network increases the probability that a proposition linked to it
will also be accessed via a spread of activation (Bower, 1981).
Thus, if a person imagines a snake, remembers that he/she is
afraid of snakes and typically runs away from them, then


16
physiological responses associated with this fear behavior (i.e.,
increased heart rate) are likely to be evoked as well.
The bio-informational theory has important implications for the
treatment of phobic disorders. It has been shown that treatments
such as systematic desensitization can decrease physiological
responding to phobic stimuli (Lang, Melamed & Hart, 1970; Marks &
Huson, 1973). Lang posulates that these treatments work by
weakening the associations between propositions, such as "SNAKE"
and "MY HEART BEATS FASTER." Foa and Kozak (1986) suggest three
mechanisms for these effects. First, short term habituation results
in a dissociation of responses from stimulus propositions. Second,
there is a change in the meaning of the stimulus, and third there
is long term habituation.
According to Lang (1977; Lang et al., 1980) it is important
that the images formed be as vivid as possible if they are to have
this therapeutic value. Vividness is defined as completeness of the
evoked propositional structure. One way to maximize image
vividness is to train subjects to include response propositions in
the images that they form. This is expected, then, to lead to
enhanced physiological responsivity to imagined stimuli. Recall
that Lang et al. (1970) found maximal therapeutic improvement in
those subjects who showed the largest heart rate increases in
response to fearful images.
To best this hypothesis, Lang et al. (1980) trained one group
of subjects to attend to specific stimulus details of the imagined


17
scene (the stimulus-trained group), and the other group of subjects
to focus on their physiological responses during imagery (the
response-trained group). Subjects were then asked to imagine a
series of neutral, active and fearful scenes. For both groups,
neutral scenes contained only stimulus propositions. Fearful scenes
differed for the two groups. Scenes for the stimulus group
contained only stimulus propositions, while scenes for the response
group contained both stimulus and response propositions.
Physiological responses were examined at three points during each
trial: during the reading of the scene (READ), while subjects
imagined the scene (IMAGE), and while subjects relaxed after
imagining the scene (RECOVER).
Both groups showed minimal responsivity to neutral scenes.
However, a training effect was obtained for the fearful and neutral
scenes. Response subjects showed significant increases in heart
rate, respiration, and muscle tension during the image period.
This group also showed a marginally significant increase in eye
movement. The pattern of responsivity for the response group was
an inverted V: there was a slight increase in responding during
the read period, a further increase during the image period, and
a decrease during the recover period. Response curves for the
stimulus-trained subjects were essentially flat. Skin conductance
showed a slight tendency to decrease during imagery trials,
although all subjects showed less of a decline during fear scenes.
The distribution of responses during a given scene seemed to


18
mirror the content of the script. Thus, muscle tension responding
was greater for action scenes than for fear scenes, while the
reverse was true for respiration.
Lang et al. (1980) noted that in this experiment there was a
confound between training and script. In other words,
stimulus-trained subjects were tested on stimulus scripts, and
response-trained subjects were bested on response scripts. This
made it impossible to determine whether the observed responses
were a function of training, script, or both. Thus, the
investigators did a second study in order to replicate and extend
their findings. Four groups of subjects were used in a 2 (Stimulus
vs. Response Training) X 2 (Stimulus vs. Response Script) design.
The Stimulus-Stimulus and Response-Response groups provided for
replication, while the remaining two groups permitted study of the
independent effects of training and script. A second change was
made in the experimental design. Response propositions were
distributed equally across scenes so that, for example, action
scenes would not be confounded with muscle tension propositions,
or fear scenes with heart rate response propositions. Thus, each
scene contained one response proposition from each physiological
system.
Replication of the findings of the first study was obtained for
the Stimulus-Stimulus and Response-Response groups. Examination of
all four groups indicated that response propositions produced
significant increases in responsivity only if both response training


19
and response scripts were combined. Stimulus-Response and
Response-Stimulus groups had patterns of responsivity very much
like those seen for the Stimulus-Stimulus group.
As was seen in the first experiment, muscle tension responses
were greater for action scenes than for fear scenes. Respiration
was slightly higher for fear scenes. Lang and his colleagues
(Lang et al., 1980; Lang et al. 1983) note that the finding of
differential reactivity of individual response systems in spite of
the equal distribution of response propositions across scene types
suggests that the imagery response is not just a function of the
script. Rather, it is a function of propositional elements relevant
to the situation that were accessed from the subject's own long
term memory.
Robinson and Reading (1985) studied small animal phobics in
order to examine the effects of imagery training and script content
on physiological and subjective arousal, concordance between
physiological systems, and habituation of responding over repeated
presentations of fearful stimuli. They compared stimulus and
response trained subjects after one presentation and after four
successive presentations of fear scenes. They found that response
trained subjects did show greater physiological arousal than
stimulus trained subjects for muscle tension, heart rate and skin
conductance, but not for finger temperature. Reported arousal was
significantly correlated with image vividness for both groups. For
the response trained subjects arousal and vividness were correlated


20
with muscle tension and heart rate, but not with skin conductance.
Muscle tension and heart rate were correlated for the response
group only. Finally, there was some tentative support for the
notion that response trained subjects show slower habituation. This
was not a clear finding however, because stimulus trained subjects
showed a pattern of small and inconsistent responding.
Bauer and Craighead (1979) investigated the effects of
instructions on physiological responses to fearful and neutral
imagery. In a two-way factorial design, subjects were given one of
two instructional sets (focus on scene details versus focus on
bodily reactions to the scene) and one of two orientation sets
(imagine actually participating in the scene versus imagine
viewing it as an observer). Imagery training was not given.
Scenes used were selected for each subject on the basis of
responses to a fear questionnaire. Fearful and non-fearful
(neutral) scenes were presented.
As was expected, fearful scenes produced greater heart rate
lability and marginally greater skin conductance responses than
did neutral scenes. A marginally significant main effect for
orientation was obtained for skin conductance, with participant
subjects showing greater reactivity than those imagining themselves
to be observers. Attentional focus produced significantly different
heart rate lability scores for the two groups; consistent with the
findings of Lang et al. (1980), subjects focusing on their bodily
reactions to the stimuli manifested greater heart rate changes.


21
Finger pulse volume did not differentiate between any of the
conditions. Although Lang (1977; Lang et al., 1980) suggests that
response training serves to "amplify" physiological responses so
that they can be detected, results of this study suggest that
training may not be necessary to produce these responses. A
problem in the Bauer and Craighead study is that there was no
check on the actual images generated by each subject, particularly
those in the body focus group. Such a check would be important
because the scenes presented to the subjects contained only
stimulus propositions. It would be helpful to know whether the
subjects had a tendency to include response propositions only from
certain systems in their images. Failure to find consistency
between physiological measures may have resulted from
inter-subject variation on the number and type of bodily responses
imagined.
The actual content of images was assessed in a study by
Anderson and Borkovec (1980). These investigators presented speech
anxious subjects with either stimulus or stimulus plus response
imagery scripts. After the first scene presentation, subjects were
asked to describe their images. This permitted scoring of scene
content, in terms of stimulus and response propositions. Following
four more presentations of each scene, subjects again described the
content of each image. Physiological assessment was conducted
during each scene presentation.


22
The authors found that greater response detail was reported by
subjects in the stimulus plus response group. However, both groups
of subjects reported a decreased number of stimulus details with a
concomitant increase in response details over the course of the
study. Interestingly, the amount of response detail reported was
significantly correlated with both heart rate responses and
post-scene fear ratings. This finding provides additional support
for the notion that imagining response propositions is associated
with greater physiological responding. Anderson and Borkovec note,
however, that the two script conditions did not provide clear
differentiation between reported images and warn investigators that
it is important to insure that the manipulation is successful in
providing different conditions for each group. Repeated
presentations of the scenes led to a steady decline in heart rate
responding for the stimulus group and a more variable decline in
responding for the stimulus plus response group.
Carroll, Marzillier, and Merian (1982) raised a number of
questions about the effects of response propositions on
physiological responses to imagery. Specifically, these researchers
questioned the necessity of response training, the specificity of
response propositions for each of the response systems, and the
effect of response propositions for relaxing imagery.
Non-phobic adults were used as subjects in this study. Half the
subjects imagined scenes containing stimulus propositions; the other
half imagined scenes containing response propositions. Imagery


23
training was not given. Three scenes for each group were
arousing, exciting, or anxiety-provoking, while three scenes were
either relaxing or tranquil. The authors do not specify the exact
content of each scene. Each scene presented to the response group
emphasized responses in only one response system: either cardiac,
respiratory, or electrodermal activity. Each scene was imagined
twice.
The response group showed greater heart rate and respiration
responses (but not skin resistance) to the arousing scenes than did
the stimulus group. This finding is consistent with previous
research. The groups did not differ in responses to relaxing
scenes. Thus, response propositions do not seem to have an effect
on relaxation.
An interesting result in the study was that there was a lack of
specificity in the types of physiological responding occurring to
scripts emphasizing a particular response system. Thus, heart rate
increases were produced to scripts focusing on cardiac responses
as well as to those emphasizing respiratory activity. Similar
findings were obtained for respiratory and electroderm al responses.
Thus, as was noted by Lang et al. (1980; Lang et al., 1983) the
content of the script itself is likely to play a role in determining
which response systems are involved in responses to imagery, by
accessing the subjects' own propositional network about such
events. This network, then, may have an influence beyond that of
the specific response propositions included in the script.


24
Unfortunately, Carroll et al. (1982) did not elaborate upon the
content of their scripts, making it difficult to examine the effects
of specific contents.
Lang, Levin, Miller and Kozak (1983) conducted an extensive
investigation of aspects of the bio-informational theory in speech
anxious and snake phobic subjects. The study addressed two
important issues. First, the study examined the specificity of
responses of phobic subjects. That is, whether phobics respond to
all fearful contents in the same way or discriminate between their
own fear content and other fear contents. The second question
considered in the study was the similarity of response physiologies
for actual tasks and imagery of the tasks.
Snake phobic and speech anxious subjects participated in the
study. Each group underwent physiological assessment during
imagery and during actual exposure to the two feared situations.
Snake phobic subjects showed visceral responses to scenes depicting
both snake and speech content. The largest heart rate change
occurred to the snake scene. Positive skin conductance responses
were obtained to the snake scene as well as to a scene describing
physical exercise. Speech anxious subjects, however, showed heart
rate increases only to public speaking scenes. Additionally, these
subjects showed less skin conductance habituation to the speech
scenes than to the snake scenes. Physiological responses during in
vivo exposure mirrored these results. None of these comparisons
was statistically significant.


25
Responsivity to imagery was assessed a second time, after
subjects had been exposed to fear stimuli in vivo. It was assumed
that subjects would have stronger memories of both their own and
the opposite fear stimuli following exposure. The pattern of results
obtained was the same as that for pre-exposure imagery; again,
none of the comparisons were statistically significant.
In a second study, Lang et al. (1983) investigated the effects
of stimlus and response training on a new sample of speech
anxious and snake phobic subjects. Half of the subjects in each
fear group were given stimulus training, while the remainder of
each group received response training. All subjects were tested on
scripts that contained both stimulus and response propositions.
An analysis of the effect of scene content yielded a finding
consistent with those obtained in Study 1. The snake phobic
subjects showed the highest heart rate response to snake scenes,
but showed a heart rate response to the speech scene comparable
to that seen in the speech anxious subjects. This was a significant
effect.
Imagery training led to effects similar to those described in
earlier studies (Lang et al., 1980). Response trained subjects
showed the inverted V pattern, while stimulus trained subjects
showed minimal responsivity to imagery. Patterns of physiological
reactivity for response trained subjects were the same as those
obtained in Study 1. That is, snake phobics showed increased
physiological responsivity to both fear scenes, while speech


26
phobics responded only to their relevant fear scene. Stimulus
trained subjects showed the same pattern of responses; however,
the differences between group and scene content were greatly
accentuated in response trained subjects.
Results of the Lang et al. (1983) studies provide support for
earlier findings on the effects of stimulus and response training on
imagery. These studies also indicate that there is some specificity
in the responses of phobic subjects. Speech anxious subjects did
not respond in a phobic manner during snake imagery. The fact
that snake phobic subjects responded with increased physiology to
the speech scenes most likely represents the task demands of
giving a speech. This is consistent with the study's findings of
similarity of responding during imaginal and in vivo exposure.
The findings of this study support the hypothesis that response
information is stored within a propositional network. Even though
the majority of the snake phobic subjects did not report speech
anxiety, their propositional network for giving speeches still
contains information about physiological responding that
accompanies this task. This raises the question of what differences
exist between propositional networks for phobics and non-phobics.
Lang et al. (1983) suggest that phobia networks are higher in
coherence than other networks. That is, the links between nodes in
a phobia network may be stronger. According to the authors, these
"emotion prototypes" require fewer matches in order to be
activated. This is supported by the finding of response sterotypy


27
in this study. That is, the subjects reporting the highest degree
of fear on the snake questionnaire were more likely to score high
on performance, other verbal and physiological measures of fear,
both in exposure and imagery.
Responsivity to Internally Induced Imagery
It is important to consider the impact that internally induced
thoughts and images can have on phobic patients. Phobics often
ruminate about fear producing situations. If phobia networks are
especially coherent, as is predicted by the bio-informational
theory, then it is likely that even thoughts about feared situations
can evoke the fear network and produce the full pattern of
physiological responses to the stimulus. Physiological changes in
response to such thoughts and images are likely to reinforce
perceptions of the situation as a fearful one. Further, this
ruminative thinking and the associated fear reaction may result in
continued avoidance of the phobic situation, thus preventing the
phobic individual from obtaining information about the situation
that could serve to disconfirm his or her notions about its danger
(May, 1977b)
Schwartz (1971) noted that in studies such as those described
thus far, it is not possible to determine whether observed
responses were a function of the external stimulus, the
hypothesized mental processing, or both. Schwartz developed a
methodology that allows precise measurement of responses to
internal stimuli generated by the subject, that are under his or


28
her control. A series of tones is presented to the subject at
regular intervals. The subject is asked to repeat a series of
numbers (i.e., 1, 2, 3, 4), one per tone. He or she is given the
option of repeating the series of numbers one, two or three times.
After the number series is completed the subject generates one of
two thought sequences in synchrony with the tones. Thought
sequences are memorized prior to the start of the experiment. Some
studies using the Schwartz paradigm instruct subjects to form
images to each thought sequence; again, in synchrony with the
tones. Subjects press a button to signal the end of a trial. Data
can be analyzed by evaluating responses occurring after the last
number sequence. Thus, by choosing how many times to repeat the
number sequence, the subject controls the onset of the experimental
thought sequences.
Using this time-locked imagery, Schwartz (1971) found that
subjects showed heart rate accelerations when thinking of affective
stimuli (words such as sex, rape and death) but not to neutral
stimuli (letters, such as A, B, C). A problem with this study is
that the word stimuli were more likely to be meaningful and
perhaps to produce more vivid imagery than would simple letter
stimuli. May and Johnson (1973), using the same paradigm, found
that subjects showed greater heart rate and respiration when
imagining arousing words than when imagining neutral words.
Relaxing words (such as peaceful and tranquil) did not produce
the predicted heart rate decelerations.


29
The responses of phobic and non-phobic individuals were
compared in a study by May (1977b). Using the time-locked
procedure, subjects were told to think of a number series, then a
sentence (snake versus non-snake content), and then to form an
image to that sentence. Phobic subjects showed greater heart rate
responses to both the sentence and to the image, with the greatest
increases occurring to the snake stimuli. There was a signficant
heart rate habituation over trials, although phobic subjects did
not return to baseline. Phobic subjects also showed greater
respiration amplitude when producing an image of a snake.
Finally, phobics showed greater skin conductance level increases
and more frequent skin conductance responses than non-phobics
during snake imagery. This study indicates that phobic subjects do
generate autonomic responses to internally controlled phobic
thoughts. These subjects also reported greater image clarity and
greater emotional reactions to the imagery than non-phobics. Some
subjects commented that it was difficult to "turn off" the images.
May (1977a) compared autonomic responsivity to three types of
stimulus presentation modes. Using Schwartz's (1971) time-locked
procedure, phobic subjects either saw a slide, heard a sentence,
or produced a thought depicting phobic or non-phobic content.
Subjects then generated images to the stimuli. Heart rate
responding during imagery was greatest for subjects exposed to
either internal or visual stimuli. While all stimuli produced some
habituation over trials, subjects never returned to


30
baselineparticularly subjects in the internal and visual groups.
Respiration amplitude was greatest for those subjects forming
images to visual stimuli. Respiration rate did not differ between
groups. Electrodermal activity appeared to be most responsive to
the visual mode; subjects in the visual group showed greater skin
conductance level increases and more rapid habituation than did
subjects in the other groups.
Internally controlled thoughts, then, have been shown to
produce autonomic responses comparable to those produced to visual
representations of feared stimuli. These data support the notion
discussed earlier that imagery and ruminative thoughts can play
an important role in the maintenance of phobic disorders. May's
(1977b) finding that some of his phobic subjects could not "turn
off" the images is an interesting example of this effect. A likely
explanation for this phenomenon is the cohesiveness of
propositional networks in phobics, as was suggested by Lang et
al. (1983).
Imagery Ability in Children
As noted earlier, many imaginal treatments used with adults
are used with children with little or no modification. Reviews of
the child treatment literature (Graziano, DeGiovanni & Garcia,
1979; Hatzenbuehler & Schroeder, 1978) have noted that the
majority of reports are case studies. The few well controlled
studies do not provide strong support for the effectiveness of
imaginal treatments with children. It is important to consider


31
developmental factors that can influence the ability of children to
benefit from such therapies. The discussion now turns to a
consideration of children's ability to use imagery.
Piaget and Inhelder (1971) noted that mental images and
symbolic schemata are the basis for conceptual thought. They
describe two types of imagery: reproductive imagery and
anticipatory imagery. Reproductive imagery refers to an
internalized representation of an overt sensory or motor event,
while anticipatory imagery is the manipulation of these mental
images. Anticipatory imagery ability develops at 7 to 8 years of
age. Piaget and Inhelder observed an improvement in children's
memory for changes in physical stimuli at approximately age seven
and suggested that this improvement was a function of storage of
this information in the form of images.
Much of the work on children's ability to use imagery is found
in the literature on learning and memory. One issue in this
literature is whether children's mental representations are pictorial
in nature, with imagery ability developing later, or whether the
reverse is true. The investigators typically hold a view of mental
images as pictures in the mind but it will be seen that many of
the results can be re-interpreted in terms of a propositional
network theory of memory.
Investigations of the effects of imagery as an aid to paired
associate learning generally have shown that younger children do
not benefit from the use of imagery to the same degree seen in


32
older children and adults. For example, Paivio and Yuille (1966)
found that children's memory for paired associates was not
enhanced when the items were concrete rather than abstract,
although the concrete items were assumed to be more readily
imaginable (Paivio, 1970).
Paivio and Yarmey (1966) compared the effectiveness of pictures
and concrete noun labels on performance of college students on a
paired associate learning task. They found that picture-word pairs
resulted in better performance than picture-picture pairs. Dilley
and Paivio (1968) noted that the superiority of picture-word pairs
was even greater in 4- to 6-year old children. Paivio and his
coileages suggested that the picture-word pairs were superior to
the picture-picture pairs because the pictures required decoding
before the child could make a response. They concluded that
children less than 7 or 8 years old, who have not yet developed
the ability to use anticipatory imagery, may have difficulty
making transformations between words and images, and vice versa.
Rohwer (1970) posed an alternative explanation for Paivio1 s
findings. He hypothesized that pictures are easier to remember, but
only when verbal labels are stored with them. He assumed that
younger children are unable to simultaneously store visual
information and verbal information, and that this ability increases
with age. He thus predicted that the superiority of pictures to
words in enhancing paired associate learning would increase with
age.


33
Rohwer (1968? cited in Rohwer, 1970) studied kindergarten, first
and third grade children and found that picture pair performance
was better than word pair performance? this difference was
increased with grade level. Performance on picture-aural
presentation pairs was compared with performance on
picture-picture pairs. Supplying the verbal label yielded superior
performance? however the magnitude of this superiority decreased
with increasing grade level. This supports the notion that the
children are increasingly able to provide their own verbal label
as they get older. A similar study was conducted on a group of
older children: third and sixth graders (Rohwer, Lynch, Levin &
Suzuki, 1967). Pairs of words were presented either as pictures or
as printed words. All subjects heard the words read aloud. For
both grades, better performance was obtained for the picture pairs
than for the word pairs. The superiority of the pictures was
greater in the third grade group.
Rohwer (1970) concluded that if imaginal representations of
items are more likely to be elicited with pictorial than verbal
items, then imagery facilitates learning in children. He suggested
three possible explanations for the developmental trends observed:
1) the probability that imagery will be evoked is lower in younger
children than in older children? 2) the capacity for obtaining some
benefit from imaginal representations develops later than that for
verbal representations, and 3) the ability of imaginal storage bo
facilitate learning is dependent on concurrent storage of a verbal


34
label for that image, and that this ability is more likely to be
seen in older children. Note that Rohwer's data contradict the
notion that the ability for pictorial representation develops earlier
than the ability to learn from verbal representations of
information.
Rohwer and his colleages also studied the influence of
elaboration of images on paired associate learning in children. In
the Rohwer, Lynch, Levin and Suzuki (1967) study described
above, subjects heard one of three different verbalizations along
with the pictures. These verbalizations differed on the type of
connective used to link members of the noun pair. Thus, subjects
heard either a conjunction (i.e., the shoe and the chair), a
preposition (i.e., the shoe under the chair), or a verb (i.e., the
shoe taps the chair). The verb condition produced the most correct
responses, with prepositions being the next most effective. Rohwer
(1970) suggests that the three kinds of connectives evoke different
types of imagery and reasons that action imagery (verb) is more
memorable than static imagery and that locational static images
(preposition) are more memorable than coincidental static
(conjunction) images. For the third graders, there was a linear
relationship between type of connective and learning. For the sixth
grade subjects, the preposition facilitated learning to the same
degree as the verb connective. The researchers suggested that
older children have a lower threshold for the use of facilitory
processes than do younger children.


35
Rohwer, Lynch, Suzuki and Levin (1967) compared the effects of
verbal and pictorial elaboration. Elaborations used in both
conditions corresponded to those used in the study just described.
In the verbal mode, verb connectives produced the best
performance, while in the depiction mode, the greatest facilitation
of learning occurred with action pictures. There were no
developmental differences in the relative efficacy of the verbal and
visual response modes.
A closer study of these trends (Rohwer, Lynch, Levin & Suzuki,
1968) examined the effects of only four verbal-visual conditions
used in the previous study. These were naming-coincidental,
naming-action, verb-coincidental, and verb-action (the coincidental
condition refers to the two items pictured together, but not
interacting). For all three grade levels, the elaboration conditions
produced better recall than the naming-coincidental condition. A
grade by condition interaction was obtained. For kindergarten and
and first grade children, the verb-coincidental condition produced
more facilitation than the naming-action condition. The reverse was
true for the third and sixth graders. The authors suggested that
the older children are better able to make use of the imagery
evoked by the action depiction. A possible explanation for this is
that younger children do not store an appropriate verbal label
with the action image. Thus, younger children obtain more benefit
from hearing a sentence with the picture than do the older
children. This explanation is consistent with the data.


36
The studies just described provide support for Rohwer's (1970)
contention that while action imagery can facilitate performance, the
ability to obtain full benefit from this imagery develops later than
the ability to benefit from verbal elaboration. Rohwer suggests
that this developmental trend is due to the fact that the well
organized linguistic system develops earlier than the less
organized imaginal mode. This view is counter to the more widely
accepted notion that the capacity for visual representation develops
earlier than that for verbal representation.
Reese (1970) notes that imagery facilitates learning in older
children and adults, but that less faciliatation is observed in
younger (i.e., preschool) children. He suggests several possible
explanations for this observed developmental trend. The first is
that facilitation depends on covert verbalization of the image and
that young children are less able to do this. However, Reese notes
that this view contradicts the notion that young children's thought
is primarily iconic, and that one would expect sentences to
interfere with retention. A second explanation is that visual
memory is less effective than verbal memory in young children.
This view also contradicts the belief that young children's thought
is primarily imagery based. A third explanation is that young
children ignore pictured interactions between objects and code the
information as if no elaboration was presented. Thus, younger
children may have difficulty with the production of mediators.


37
Another alternative explanation is that young children can
encode information visually, but that they are unable to decode it
verbally. The work by Paivio and his colleagues provides some
support for this notion. However, some work cited suggests that
young children have difficulty producing mediators, rather than
that they have problems decoding the mediator. Further, Reese
points out that in mediation studies, in which a deficiency is
observed, the mediator is conditioned to the stimulus and response;
yet in paired associate studies, the mediator is not conditioned,
but suggested by the image. Control subjects have an equal
opportunity to learn the links, but perform less well than imagery
groups. A fifth alternative proposed by Reese is that the materials
used to evoke images are deficient in detail, and thus are not
adequate to evoke imagery in younger children, or at least not to
produce images that are sufficiently vivid to enhance memory. The
final alternative presented does not hold that imagery is less
effective with young children, but rather, that young children fail
to "read" the pictorial materials used to evoke images. The child
may form images of the stimulus and response items, but even a
picture of the objects interacting fails to produce an image of this
interaction. Reese suggests that a sentence can produce imagery
since the elements and their interaction are explicitly named.
Reese concludes that facilitation of memory does not result from
imagery per se, but from integrated imagery, which provides
contextual meaning for the object to be remembered.


38
Reese's (1970) point regarding the inability of certain materials
to evoke imagery in children supports the contention of many
clinical researchers (Elliot & Ozolins, 1983; Graziano, DeGiovanni,
& Garcia, 1979; Harris, 1983). A study by Wolff and Levin (1972)
shows that children may need more powerful, or more elaborate,
stimuli in order to be able to use imagery. They studied the role
of overt motor activity in the formulation of mental images.
Kindergarten and third grade children were presented with pairs of
actual toys in a paired-associate learning task. Four learning
conditions were investigated. In the first, the control condition,
children were simply instructed to remember which toys go
together. In the imagery condition, children were told to form an.
interactive image of the toys. In the third condition, the child
watched the experimenter manipulate the toys in an interactive
way, while in the fourth condition, the child was encouraged to
manipulate the toys on his own. Memory was tested by recognition.
The children were asked to select the response toy from an array
of several toys. This method avoided the necessity of having the
child decode a visual image to a verbal response. Wolff and Levin
found that the two manipulation conditions produced significantly
better performance than the imagery and control conditions. For
kindergarten students, the manipulation conditions did not differ
significantly from one another. For the third grade subjects,
performance in the two manipulation conditions and the imagery
condition was significantly greater than the control condition.


39
These three conditions were not significantly different. The
findings provide support for the notion that dynamic imagery does
not develop until the age of seven.
A second study of kindergarten and first grade children showed
that it was the actual manipulation of the objects and not just
observation of the interaction that produced enhanced memory. The
authors concluded that up until the age of five, the formation of a
dynamic image depends on concomitant motor output, that
duplicates the form of the percept. With development, formation of
images becomes less dependent on overt motor activity. Although
results of other studies described indicate that children are able
to generate imagery upon instruction, with the aid of pictures or
even without external cues, these findings emphasize the need for
researchers and clinicians alike to attend to children's special
abilities when using imagery.
Kosslyn (1976) examined the question of whether children use
imagery to retrieve semantic information. First graders, fourth
graders and college students participated in a pair verification
task. For example, a subject might be asked to verify whether "a
mouse has whiskers" was true. Kosslyn looked at two dimensions of
the properties to be verified: size of the detail and the association
strength. He hypothesized that if imagery was used, a longer
*
reaction time would be found for smaller details than for large
details. Further, with imagery, it was expected that the strength
of the association would be related to reaction time. Kosslyn


40
assumed that adults would use non-imaginal methods, while
children would use imagery to complete the task. Thus, no
difference was expected for children with or without imagery
instructions, while adults were expected to be slower when forced
to use less effective imagery. Subjects completed two blocks of pair
verifications, first without imagery and then with instructions to
use imagery. The true properties were either high association/low
area or low association/high area. Area refers to the size of the
imagined object, while association refers to the strength of the
relationship between a property and a noun (i.e., whiskers and
cat).
Kosslyn's hypotheses were borne out by the data: reaction times
decreased with age. Imagery instruction did not influence
performance of the younger children, while adults performed more
slowly. In addition, in the no imagery condition, high
associationAow area properties had faster reaction times, while low
association/high area properties were responded to more quickly in
the imagery condition. Kosslyn inquired to the strategies subjects
used in the no imagery condition. The number of subjects reporting
the spontaneous use of imagery decreased with age. Those first
graders reporting that they did not use imagery showed a similar
effect of item type as was seen with the adults, that is; high
associationAow area properties were verified more quickly. The
results of this study suggest that adults who do use imagery
spontaneously do it more quickly than children. Perhaps the adults


41
use the imagery more efficiently, imaging, for example, only the
relevant parts of the object. Furthermore, the fact that first
graders did not respond most quickly to the high association items
as did the fourth graders and adults suggests that there are some
qualitative changes in memory with development.
Prawat and Kerasotes (1979) extended Kosslyn's work with a
few methodological changes. Different subjects participated in the
imagery and no imagery conditions, and pictures were used in the
imagery condition. In addition, Prawat and Kerasotes defined two
types of meaning: perceptual and functional meaning. It was
expected that if children used imagery to retrieve semantic
information, perceptual properties would be responded to more
quickly, since these should be more easily imaged. This hypothesis
is based on the view of images as pictures in the mind. An
interaction was expected between type of meaning and saliency
(association) such that for perceptual features large sizeAow
saliency properties would have faster reaction times, while for the
functional properties, small size/high saliency items would be
responded to more quickly. Second grade students served as
subjects in this study.
There was a main effect of property type, with perceptual items
having faster reaction times, supporting the view that children do
use imagery. However, children in the imagery condition did not
retrieve semantic information more quickly. The authors suggest
two possible explanations for this; either subjects cannot make


42
effective use of the induced imagery, or control subjects
spontaneously used imagery in an effective manner. Additional
comparisons showed that the imagery group took longer than the
control group to respond to perceptual items; however, there were
no differences between groups on reaction time for large versus
small items. The authors suggest that induced imagery may
interfere with spontaneous imagery. The authors also found that
high saliency items were responded to more quickly than low
saliency items, while there was no such difference for the
perceptual items.
The studies discussed in this section suggest that children are
able to use imagery to enhance memory, to a limited extent. Young
children may have difficulty with the transformations required to
form images from verbal information and to decode images to
language. Young children may not be as likely to use imagery
spontaneously, and stimulus materials may need to be richer in
detail than those typically used with adults. The findings obtained
in the studies reviewed can be discussed in terms of a
propositional theory of memory. It seems that memory networks in
children may be less well organized or more immature than those
in adults. Wolff and Levin's (1972) finding that overt motor
activity is important to image formation suggests that more
powerful stimuli are needed to evoke the image network or to form
associative links. However, research is needed to determine what
"more powerful stimuli" really means. It could be that children


43
need to have stimuli that are as realistic or as detailed as
possible, such as actual objects or films. It may mean that
children may be better able to imagine objects or situations for
which they already have a propositional memory network. Or, it
could mean that to-be-imagined stimuli need to be more emotionally
salient for children. Viewing the findings of Kosslyn (1976) and
Prawat and Kerasotes (1979) in terms of network theory suggest
that the more rapid performance of adult subjects could be a
function of the better organization and stronger associative links
in their memory networks. The fact that high association stimuli
were responded to more quickly in the Kosslyn (1976) study
supports the notion that the spread of activation along strong
associative links in the memory network facilitated responding.
That some children also responded more quickly to high association
items suggests that propositional memory networks are present in
children. Subjects were first graders, approaching Piaget's stage
of concrete operations. Perhaps some of the subjects had already
reached this stage, and concomitantly had developed the capacity
for better organized propositional networks of memory.
Affect and Memory
Thus far, this paper has examined relationships between
imagery and memory in order to understand developmental
considerations that may be relevant to the use of imagery in
treatment of children. Since these treatments can require that the
child retrieve memories of emotionally laden situations, it is


44
important to consider the influence of affect on memory.
Bower (1981) noted that an adult subject's affective state can
serve as a contextual cue that can aid recall of material learned
while in that state. He used hypnosis to vary the mood of his
subjects during learning and recall of two word lists. He found
that recall was improved when the mood at learning and recall
were congruent, and that recall was impaired if the moods at each
point were opposites. Using a propositional theory of memory
(Anderson & Bower, 1974), Bower suggested that when a subject
stores information in memory, that affect can serve as a context,
and that contextual information is stored in propositional nodes.
When a subject attempts to recall information when in the same,
mood as during learning, activation from the affect nodes spreads
throughout the network, summing with activation from the context
nodes, thus facilitating recall.
Similar results have been obtained with children. Bartlett,
Burleson and Santrock (1982) conducted an experiment to determine
whether memory traces for verbal stimuli included information
about the subjects' emotional state during learning. They
hypothesized that if this was so, then the subjects' emotional state
could serve as an effective cue for the retrieval of information.
Subjects were 5- and 8-year-old children. Subjects learned two
lists of words and recalled them immediately and again following a
ten minute delay. Prior to learning each list, either a happy or
sad mood was induced by having the child think of a personal


45
experience appropriate to the mood. The opposite mood was induced
prior to learning of the second list. For recall, half the subjects
in each condition then experienced a happy mood, the other half
experienced a sad mood. Thus, there were four conditions of happy
(H) and sad (S) moods; H-S-H, H-S-S, S-H-H, S-H-S.
In the first experiment a relaxation exercise preceded all other
procedures. No state dependent learning effect was obtained.
Relaxation was omitted in the second experiment. In this
experiment, a clear state dependent effect was observed, with
greater recall occurring for the list learned in the mood equivalent
to the mood at recall. This effect occurred for both age groups.
This affect dependence was asymmetrical; a happy mood at test
produced greater recall than a sad mood for a list learned while
happy; no such effect was obtained for lists learned in a sad
mood. Bartlett et al. (1982) concluded that affect can serve as an
effective retrieval cue, but noted that relaxation can preclude this
state dependent effect. They suggested that the perception of
emotional arousal is a prerequisite for the experience of emotion
and that relaxation seems to decrease the intensity of the emotion.
Nasby and Yando (1980) conducted a similar study; they
examined the influence of mood on the recall of affectively valent
information. Subjects in this study were fifth graders who were at
least 10 years old. Moods were induced in the same manner as in
the Bartlett et al. (1982) study. A happy or sad mood was induced
prior to list learning. Either the same or opposite mood was


46
induced for the free recall test condition. Only one word list was
used; these words were slightly positive, highly positive, slightly
negative and highly negative. Mood at retrieval had no effect on
recall; however mood at encoding did affect performance for girls
only. Happy mood at encoding facilitated learning of slightly and
highly positive words, and disrupted learning of slightly negative
words. Sad mood at encoding disrupted learning of positive
material, but did not facilitate learning of negative words. This
asymmetrical effect is similar to that seen in the Bartlett et al.
(1982) study. Nasby and Yando (1980) noted that studies in the
literature have reported that mood at retrieval (rather than at
encoding) influences recall in adults, and they suggest that there
may be an age related shift in ability to regulate the influence of
mood on encoding and retention of affective materials.
In another study, Nasby and Yando (1982) repeated the same
design, but also varied the frequency of word usage, and position
of the word on the list. Fifth graders (mean age = 10.75 years)
were used as subjects. As in the previous study, a selective
encoding effect was obtained for the medium and high frequency
words only. A happy mood at encoding resulted in the recall of
more high and medium frequency positive words. A sad mood at
encoding disrupted recall of positive words. No selective encoding
of negative material was observed. Unlike the previous study, a
selective retrieval effect was also found. Happy mood at retrieval
facilitated the recall of positive words, while sad mood did not


47
disrupt recall of positive material. No selective retrieval occurred
for negative material. Congruence of mood at encoding and
retrieval did not produce superior recall to incongruent moods;
thus there was no affective state dependent effect. Note that
studies with adults (Gil ligan & Bower, 1984) obtained state
dependent effects only when two word lists were used. So, while
moods do have some impact on memory in children, the effects seen
in this study do not mirror those obtained with adults.
A second experiment reported by Nasby and Yando (1982)
examined the influence of an angry mood on recall. Angry mood at
encoding disrupted recall of positive words, but facilitated recall
of highly negative words. Anger at retrieval did not have any
effect on performance. No state dependent effect was obtained with
the angry mood.
The authors note that the pattern of results obtained differs for
children and adults. For both, positive mood facilitates the recall
of positive material. For children, negative mood inhibits the
recall of positive information, while this is not the case for
adults. Nasby and Yando suggest that the ability to regulate mood
states could be an important quality that changes with
development. Thus, adults may be better able to maintain positive
moods and avoid or eliminate negative moods. They point out that
this ability to regulate the effect of moods can have an important
influence on the learning of overt behavior. These findings also


48
support the contention that memory networks in children are less
well organized than those in adults.
The studies just described focused on affect-dependent memory
for isolated word lists. Bartlett and Santrock (1979) examined the
influence of mood on episodic memory. This approach can yield
more information relevant to clinical issues. Preschoolers (mean
age 5 years 7 months) were tested for memory of a list of words
presented in the context of a story. Pictures were presented to aid
recall. A 2 X 2 factorial design was used, with happy vs. sad
mood at input and happy vs. sad mood at recall. Mood was
induced at input by having the experimenter tell a story that was
either happy or sad. The same words were incorporated into both
happy and sad stories. Mood at recall was induced by having the
child look at a series of happy or sad pictures. As a manipulation
check, children were asked to point to one of two faces (smiling or
frowning) to indicate how each story made him feel. At both input
and retrieval, the experimenter acted in a manner appropriate to
the mood being induced. A variety of retention tests were given.
The free recall data indicated that subjects who learned words
while in a happy mood had better recall when tested in a happy
mood than when tested in a sad mood. There was no significant
difference between test moods for subjects who learned words while
in a sad mood. These results indicate that a change in affect can


49
influence children's ability to generate appropriate retrieval cues.
As in the other studies discussed, an asymmetric effect was
obtained.
Children's Responsivity to Imagined Stimuli
Studies reviewed thus far have shown that imaginal treatments
can be very effective in the treatment of adult phobic disorders,
and that it is important to consider the patient's physiological
responses during imaginal treatment. This area is poorly
researched with children (Johnson & Melamed, 1979). A review of
the literature on imagery and memory in children reveals that
while children do have an ability to use imagery to enhance their
memory, they do not do this as effectively as adults. They may
have difficulty with transformations between verbal and imaginal
materials (Paivio, 1970), they may not use imagery spontaneously
(Kosslyn, 1976) or they may need very detailed stimuli in order to
evoke imagery (Wolff & Levin, 1972).
When using imagery to treat child patients developmental
factors must be taken in to consideration. For example, the
therapist cannot assume that children create images in the manner
in which they were instructed. Children may elaborate upon the
images, and these elaborations themselves may be important. The
meaning assigned to a given image must be considered as well, as
this may vary from child to child. For example, one child asked
to imagine a teacher at school might image a positive situation,
with a benevolent teacher providing positive reinforcement. A


50
second child, however, may imagine himself being punished by the
teacher; this child is likely to find the imagery experience to be
quite unpleasant.
Rosenstiel and Scott (1977) recommend that imagery scenes be
tailored to the age of the child. They also suggest that involving
the child's existing fantasies into an imagery procedure may
decrease the complexity of the scenes and may help to maintain the
child's interest during the procedure. Having the child report
specific details of the procedure is expected to enhance image
clarity for the child. Finally, Rosenstiel and Scott (1977) suggest
that children may have difficulty describing their behavior and
images. Thus, attending to non-verbal cues such as fidgeting, skin
flushes, or heart rate change may provide the therapist with
useful information about the effects of the scene on the child
(i.e., changes in anxiety level).
All of the treatment studies described thus far have examined
physiological responsivity of adult subjects. Only two studies in
the literature have considered children's physiological responses to
imagery. It is important to investigate this issue in children for
two reasons. First, children present to treatment centers with a
variety of phobic concerns. Although imagery is used in a number
of treatments for children, there are few data on the effectiveness
of these approaches (Hatzenbuehler & Schroeder, 1978). Second, an
understanding of developmental changes in the phenomena described
in this paper may yield important information on the etiology of


51
phobic disorders and on the structure of phobic disorders in
children.
Tal and Miklich (1976) studied 10- to 15-year old children with
chronic asthma. The children were asked to imagine neutral,
fearful, and anger-arousing situations. Increased heart rate and
decreased expiratory flow rates during imagery occurred in the
fear and anger sessions. Neutral images resulted in slowed heart
rate and increased expiratory flow rates. The heart rate increases
suggest that the imagined scenes (fear and anger) did produce
arousal, which was associated with pulmonary function.
Hermecz and Melamed (1984) used Lang's paradigm (Lang, 1977,
1979; Lang et al., 1980) to study imagery in 6- to 12-year-old
dental patients. It was expected that children would not be able
to generate emotions as effectively as adults and that they may
need additional aids, such as a modeling film, to generate
appropriate emotional imagery (Lang, 1977).
Children were given either stimulus or response imagery
training. Imagery training included two trials on each of two
action oriented scenes: riding a bicycle and flying a kite.
Following imagery training, the child viewed a film about dental
treatment. Each group saw the same videotape; however, the
soundtracks differed according to the type of imagery training
given. Thus, the sound track for stimulus subjects focused on
descriptive aspects of dental treatment, while the response film
focused on expected physiological responses to treatment. After film


52
viewing the child was taken to a dental operatory, where
restorative treatment was performed.
Results indicated that there was a borderline interaction
between condition and scene, with response subjects showing
greater heart rate increases to the first practice action scene. On
trial two of scene one, response subjects showed an increase in
heart rate during imagery with decreased heart rate during the
subsequent recovery period. This pattern is consistent with that
seen in adult patients. Similar results were obtained with the
respiration data. Response subjects indicated greater image clarity
across scene types, while clarity decreased across scene types for
stimulus subjects. While there were no significant differences in
physiological responsivity during film viewing, response subjects
showed differential responding across scene contents. Stimulus
subjects responded in the same way across scenes. In the
operatory, response subjects were more disruptive than stimulus
subjects during dental treatment. For the response subjects, there
was a significant correlation between overall disruption and
self-reported dental fear. These children thus showed concordance
between self-report and behavior following response training. Thus,
children do appear to be able to generate physiological responses
to imagined scenes. Support was obtained for the notion that
response training is more effective in eliciting these responses
than is stimulus training.


53
Children and the Bio-informational Theory
The studies described in the previous two sections support the
notion that children do store emotional information in memory. As
was the case with the adults studied by Bower and his colleagues
(Bower, 1981; Gilligan & Bower, 1984), affective information
appears to function as a contextual cue that can influence memory
performance in children. However, the results of studies described
in this paper suggest that there are some differences in the
imagery ability of adults and children, as well as in the
emotional memory functions of these two age groups. For example,
adults may be able to perform a paired associate learning task by
forming an interactive image; children, however, need to
manipulate actual objects in order to form such an image.
Klingman, Melamed, Cuthbert and Hermecz (1984) obtained similar
results in an emotionally laden situation. They found that children
about to undergo dental treatment benefitted more from a modeling
film that allowed them to actually practice coping skills than from
a film that only told them what techniques they could use to cope
with treatment. Thus, children may need to engage in motor
behaviors in order to store some types of information in their
emotional networks.
Some researchers (Gilligan & Bower, 1984; Kagan, 1984) suggest
that infants ar born with an innate emotional structure. They
note however, that the fact that there are changes in the structure
and function of the nervous system throughout development makes it


54
unlikely that emotional functions in children and adults are alike.
Rather, the emotional systems of children are modified throughout
develpraent via the processes of learning and acculturation.
Nevertheless, there is research that suggests that emotions and
memory are linked together even in infancy. It has been widely
reported (Lewis & Rosenblum, 1974) that infants develop a fear of
strangers at approximately eight months. It is generally held that
certain cognitive changes are required for the development of this
fear; the infant needs to develop a memory schema for familiar
people, and then to be able to compare the stranger with his
schema for familiar people (Schaffer, 1974). A discrepancy between
the stranger and the schema leads to fearful reactions. This
phenomenon is important to the bio-informational theory for two
reasons. First, it shows that emotional reactions are linked to
memory even at a very young age. Second, the fact that infants
develop this fear at a fairly predictable time suggests that
maturational factors are involved in the development of emotions.
Many of the studies on imagery and memory described in this
paper found that changes in the abilities of children occurred at
approximately age seven or eight, concurrent with movement into
Piaget's stage of concrete operations. It is likely then, that
research on children's emotions will find some qualitative
differences between emotions in children and adults; these
differences are likely to be diminished throughout childhood.


55
With regard to the bio-informational theory, several differences
between children and adults can be postulated. First, there is
likely to be less information in the emotional networks of children,
by virtue of the fact that they have fewer experiences that can be
stored in memory. It may be that subtle nuances of various
situations are absent in the networks of children, and this
information may not be understood. Second, the links between
propositions in children's memories may be less well organized,
and the associations between propositions may be less coherent
than is the case in adults. Children may need stronger stimuli
than do adults in order to access the emotional networks. The
studies by Wolff and Levin (1972) and Klingman et al. (1984)
suggest that motoric information is integrally bound to the other
information stored in children's memories. Finally, children may
not be able to use imagery as effectively as adults. Imagery
ability for emotional stimuli is likely to vary with age, as is the
case for imagery ability in memory tasks. There is evidence (Tal &
Miklich, 1976) that older children can generate emotional images.
The results of the Hermecz and Melamed study suggest that
children may be able to benefit from imagery training. That study
did not do a physiological assessment of emotional imagery;
however, response training did influence children's responses to a
film about dental treatment.


56
Statement of the Problem
The literature reviewed in this paper suggests that imagery
ability in children follows clear developmental trends. Young
children are often not able to use imagery in memory tasks;
further they may not be able to transform information from the
verbal mode to the visual (or imaginal) mode, and vice versa.
These findings have important implications for the use of imagery
in child treatment. Specifically, therapists need to evaluate the
efficacy of these treatments and to attempt to specify the ways in
which children actually apply imagery instructions.
It has also been seen that physiological responses during
imagery play a significant role in the efficacy of treatments such
as systematic desensitization. However, with only two exceptions,
this research has not been applied to children.
The purpose of the study presented here was to extend the work
done by Hermecz and Melamed (1984) on emotional imagery in
children. This study demonstrated that children can generate
physiological responses to action scenes. It is not clear, however,
whether children can show differential responding across different
scene contents, or whether the results obtained are simply artifacts
of the imagery task demands. In addition, subjects in the Hermecz
and Melamed (1984) study were not selected for fearfulness.
The present study compared the responsivity of high and low
dentally fearful children to three imagery contents: dental fear,
school fear, and neutral. Children were given either stimulus or


57
response imagery training. The study was designed to address
three major issues:
1) Can children imagine scenes from structured stimuli (text)
and generate physiological responses appropriate to scene content?
Do they show differential responsivity to the different scene
contents?
2) Do fearful and non-fearful children show different patterns
of responsivity?
3) Do stimulus and response training have a differential effect
on responsivity?
In addition to these issues, the study also examined changes in
self-reported and observer rated fear as a result of exposure to
the imaginal materials. The relationship between reported imagery
ability and responsivity was investigated in an exploratory
fashion.
Hypothesized results were as follows:
1) Fear scenes would evoke greater heart rate responses than
would neutral scenes.
2) Responses to dental fear scenes would be greater in the
fearful versus non-fearful children.
3) Responses to fear scenes would be greater in response
trained versus stimulus trained subjects.
4) There would we an interaction between fear level and
training, such that high fear response trained subjects would show


58
greater response magnitudes than high fear-stimulus trained
subjects.
Although skin conductance was assessed during the study, no
specific predictions were made about skin conductance responsibity,
as some studies reported that skin conductance increases during
fearful imagery (i.e., Grossberg & Wilson, 1968), while other
studies reported that skin conductance decreases were observed
during imagery (Lang et al., 1983).


METHOD
Design
The basic study design included a 2 (fear level) x 2 (imagery
training) x 3 (scene content) design. Fear level (high vs. low
dental fear) and imagery training (stimulus vs. response) were
between subjects variables. Scene content served as a within
subjects variable. The scene contents (Appendix A) were dental
fear (examination and injection), school/social fear (going to the
principal, speaking in class) and neutral scenes (sitting in the
living room, sitting in a lawn chair). The neutral scenes were
designed to be without affective content or physiological response
demands. The school scenes were included for the purpose of
comparison. Since children were selected for dental fear, it was
expected that children would show differential responsivity to
dental content. Examination of responsivity to the school scenes
provided information about whether dentally fearful children are
generally responsive no fearful items, or whether they can
discriminate between contents that are fearful for them and those
that are not. Further, it was expected that some of the children
who were not dentally fearful would show increased responsivity to
the school related scenes. However, no group differences in
responses to the school fear scenes were expected a priori.
59


60
Subjects
Subjects were 24 children ranging in age from 6 to 12 years
old selected by their scores on the Children's Fear Survey
ScheduleDental Subscale (Melamed, Hawes, Heiby & Glick, 1975;
Scherer & Nakamura, 1968; see Appendix B). This measure has been
shown to be useful as a screening instrument to identify children
high in dental fear (Cuthbert & Melamed, 1982). This questionnaire
was distributed to children in a variety of community organizations
and schools. Children scoring one standard deviation above or
below the mean for their age and sex were asked to participate in
additional screening activities to determine eligibility for the
study. Children with obvious physical or mental handicaps or
cardiovascular problems were excluded from the study.
Apparatus
Heart rate was measured using two Beckman Standard Size
Ag-AgCl electrodes placed on opposite sides of the lower rib cage.
Electrolyte gel was placed inside the electrodes. These were
attached to a Coulbourn Instruments Hi-Gain Bioamplifier/Coupler
Model S75-01. Skin conductance was measured with two Coulbourn
standard Ag-AgCl electrodes placed on the hypothenar eminence of
the left hand. These electrodes were filled with Johnson & Johnson
K-Y Jelly and were connected to a Coulbourn Instruments Skin
Conductance Coupler, Model S71-22. Data collection was controlled
by an MDB microcomputer. Ratings of emotion were made using the


Figure 1. The Self-Assessment Mannequin


PLEASURE
AROUSAL
DOMINANCE


63
Self-Assessment Mannequin (SAM; Green wald, 1987; Lang, 1980;
Figure 1). Visual presentations of the SAM figure were presented
by computer on an Amdek Video-300 in the subject room. All tape
recordings were played via speaker using a Eumig cassette player.
Procedure
Each subject participated in three sessions: an initial
screening session and two experimental sessions. All dental
treatment in this study was provided by faculty dentists from the
Department of Pediatric Dentistry at the University of Florida.
Screening
Parents of children scoring in the appropriate range on the
Dental Subscale were contacted and asked to bring their child to
the dental clinic for a screening examination. After informed
consent was obtained (Appendix C), each child was given a brief
examination to determine whether he or she had at least two
cavities that could be filled as part of the study. Children
meeting this criterion were then given the Peabody Picture
Vocabulary Test (Dunn & Dunn, 1981). Children scoring below 85
were excluded from the study. Next, bitewing x-rays were taken.
Finally, parents completed the Subject Data Form (Appendix D),
which provided demographic information as well as information
about the previous dental experience of the child. Parents were
asked to rate their child's fear and cooperation during past dental
examinations and dental injections.


64
Session 1
Upon arrival at the clinic, each child was administered the
full version of the Children's Fear Survey Schedule (Melamed,
Weinstein, Hawes & Katin-Borland, 1975; Scherer & Nakamura, 1968;
Appendix E). This provided a measure of general fearfulness as
well as dental fearfulness; the Dental Subscale is embedded within
this measure. This measure also includes items about school and
social situations. A subscore based on these items was compared
with the children's physiological responsivity to the school scenes.
Next, children saw the dentist to have a filling done. This was a
standard procedure for all children, involving an anesthetic
injection, placement of a rubber dam, and drilling. When treatment
was completed, the dentist rated the child's cooperation and
fearfulness using two ten-point scales (Appendix F). Dentists were
blind to each subject's fear level and group assignment. Dental
treatment was videotaped. These tapes were later scored for the
child's disruptive behaviors with the Behavior Profile Rating Scale
(Melamed, Hawes, Heiby & Glick, 1975; Appendix G).
Following dental treatment, the child was taken to the
laboratory for imagery training. First, the child completed the
Sheehan (1967) version of the Betts (1909) Questionnaire Upon
Mental Imagery (QMI; Appendix H). Some modifications were made
in the use of the QMI for this study. Children rated the vividness
of imagery to a variety of items by pointing to one of a series of
photographs of keys. The photographs varied in the degree of


65
focus, from very clear to extremely blurry. If a word on the
questionnaire was unclear to the child, a definition was provided
from a standard list. The QMI has been shown to be predictive of
physiological responsivity and reported image vividness in adults
(Miller et al., 1981), but the scale has not been used with
children. Thus, test-retest reliabilty was determined on a separate
sample of children. Reliability on a sample of 11 children was
r=.83, pC.OOl. There was an average of 27.8 days between testing
sessions for the reliability study, although for most children,
sessions were one to two weeks apart.
Next, the child completed the Measure of Communication
Apprehension (MECA; Garrison & Garrison, 1979; Appendix I). This
measure of public speaking anxiety was used in an exploratory
fashion, in order to determine whether there was a relationship
between reported public speaking anxiety and physiological
responsivity to the school related scenes during imagery. The MECA
has been shown to be both reliable and valid (Garrison &
Garrison, 1979) and to be sensitive to changes in public speaking
anxiety resulting from behavior therapy (Harris & Brown, 1982). As
only half of the children in this study completed this
questionnaire, results will not be discussed here.
After completion cf these measures, the child was given a
relaxation exercise (Koeppen, 1974; Appendix J). This exercise was
designed for use with children, and involves tension-relaxation
cycles for eight muscle groups. Relaxation training was given


66
during Session 1 to familiarize the child with this procedure since
it was used during the second session. During this exercise, the
child was seated in a reclining chair. The overhead light was
turned off, and a dim floor lamp was turned on.
After the relaxation exercise, the child was given imagery
training. Half of the children in each dental fear group were
given a "response" imagery set, while the remaining children were
trained so as to provide a "stimulus" imagery set. Children in
each fear group were matched for sex, age, race and dentist and
then randomly assigned to a condition. Two action scenes were
presented twice to each child. One scene described flying a kite,
the other, riding a bicycle. Action scenes were used because they
have been shown to generate physiological responsivity when they
contain response propositions, yet they are not affectively
frightening.
Stimulus group
Each scene was tape recorded and presented to the child via a
speaker. The child was instructed to close his or her eyes and to
imagine the scene as it was being read. The stimulus oriented
instructions encouraged the child to create a detailed mental
picture of the situation, including as many descriptive aspects as
possible. The child continued to imagine the scene after the
presentation for an additional 20 seconds. The child was then told
to relax his or her muscles (20 seconds). Next, the child was
asked a series of questions about the imagery experience. These


67
focused on the stimulus aspects of the situation (i.e., Could you
see the kite dancing in the wind?). Verbal praise was provided
each time the child reported having imagined a stimulus aspect of
the scene. The same imagery script was then repeated, followed by
two trials for the second script. These imagery training procedures
are listed in Appendix K.
Response group
The procedures used for the response group were nearly
identical to those used for the stimulus group (see Appendix L).
However, the scenes required that the child focus on his/her own
physiological responses during the imagined scene rather than on
stimulus aspects. Each scene contained one response proposition
from each of the following systems: heart rate, sweating,
breathing, muscle tension and eye movement. Questions presented to
the child concerned the reponse aspects of the imagery (i.e., Did
you feel the sweat dripping down your face?). Verbal praise was
given contingent upon the child's report of response propositions
in imagery. As was the case for the stimulus group, each scene
was repeated twice.
Session 2
Session 2 took place approximately one week after Session 1 in
which all subjects had undergone routine restorative dental
treatment. In the laboratory, children were seated in the reclining
chair. Following electrode placement the lights in the room were
dimmed. Next, the imagery procedure was explained to the child


68
(Appendix M). The child was questioned to insure complete
understanding. In addition, an experimenter remained in the room
with the child to answer questions and to encourage maximal
cooperation with the procedures. Before beginning physiological
assessment the child completed the same relaxation exercise given
in Session 1. Children were rewarded with a sticker for cooperation
during electrode placement and again following cooperation with
the imagery procedure.
The imagery assessment consisted of seven scenes; a practice
neutral (data for this scene were discarded) and two scenes each
of dental fear (dental exam and dental injection), school fear
(blackboard and principal) and neutral (lawn chair and living,
room) content. Children's emotional responses to these scenes were
evaluated in a pilot study on a separate sample of children. This
study is described in Appendix N. The scripts for all subjects
were identical, and all contained response propositions. Twelve
scene sequences were determined at the start of the study. Each
child in each of the four groups had a different scene order. The
scene orders were constructed so that each of the six scenes
appeared in a given ordinal position two times.
Data was collected during a pre-image baseline phase (rest
period). Each child was then instructed to imagine each scene as
it was read (read period). When the tape finished, the child
continued to imagine the scene until a tone was presented (image
period). When the child heard the tone, he/she then stopped


69
imagining, and relaxed all of his/her muscles (recovery period).
When a second tone was presented, the child opened his/her eyes
and made ratings of his/her feelings during imagery. This was
accomplished using the Self-Assessment Mannequin (SAM; Lang,
1980). SAM was presented by the computer, and appeared on a
video monitor on a counter near the subject. Three affective
dimensions were rated: pleasure, arousal and dominance. The child
used a joystick to adjust the picture of SAM until it best
represented his/her feelings. In addition, the child rated the
vividness of his/her image by moving an arrow along a rating
line. Children were shown the array of pictures used with the QMI
to help them make this rating. When the ratings were completed,
the child closed his/her eyes and waited for the presentation of
the next scene.
After completion of the imagery assessment procedure the child
was returned to the dental clinic for treatment of a second filling.
The same dentist performed both treatments for a given child.
Again, the session was videotaped. The dentist provided ratings of
the child's cooperation and fearfulness using the ten-point scales.
Finally, the Dental Subscale of the Children's Fear Survey
Schedule was administered to the child.
Data Scoring
Physiological Measures
Physiological measures were taken during each of the imagery
scenes, with separate values obtained for each phase of the image


70
presentation. This consisted of a 30 second rest period (baseline),
a 30 second read period, a 30 second image period, and a 30
second recovery period. Up to 50 seconds were provided for the
actual reading of the scene; however, data were collected only
during the final 30 seconds of this 50 second period. Difference
scores were computed in two ways. One method was to subtract the
value of the rest period baseline score from the value for the
period under consideration. For most of the analyses to be
described the read period was used as baseline with change scores
computed in the same manner.
Self-Report Measures
Items on the Children's Fear Survey Schedule and the Dental
Subscale are rated on a five point scale, with a score of 1
representing low fear, and a score of 5 representing high fear.
Scores on the full CFSS range from 50 to 250. Scores on the Dental
Subscale range from 15 to 75. The score for the question on
injection fear was used separately in correlational analyses. Items
on the QMI are rated on a seven-point scale, with a score of 1
representing maximum image clarity, and a score of 7
representing poor imagery. Scores range from 35 to 245, with lower
scores indicative of better imagery ability. Items on the MECA are
rated on a 1 to 5 scale, with a rating of 1 meaning "very happy/I
like it a lot" and a rating of 5 meaning "very unhappy/I really
don't like it". Scores on this measure range from 20 to 100, with
higher scores indicating greater public speaking anxiety. SAM


71
ratings and vividness ratings are scored by the computer using a
scale ranging from 1 (low pleasure, arousal or dominance) to 29
(high pleasure, arousal or dominance).
Observational Measures
Children's behavior during dental treatment was scored by
observers using the Behavior Profile Rating Scale (Melamed et al.,
1975). This scale consists of a variety of behaviors reported by
dentists to be disruptive to dental treatment. Each item is
weighted by the degree of disruptiveness it represents. Weights
range from 1 (i.e., inappropriate mouth closing) to 5 (i.e.,
leaving chair). Scores are based on the average score for the time
period in question, ie overall session, injection, rubber dam
placement and drilling. Independent observers, who were blind to
subject group, used an interval sampling procedure to record
behavior. Two minute intervals were used to record the occurrence
or non-occurence of a given behavior. Times were marked on each
videotape using a time-date generator. This helped to maximize
accuracy by allowing the observer to review a difficult portion of
the tape. Raters scored eight practice videotapes before beginning
to make actual ratings. Further, regular discussions were held
with the raters to discuss problems in order to insure accuracy.
Table 1 lists the Spearman-Brown reliability coefficients for the
scores on the Behavior Profile Rating Scale. All reliabilities were
in the acceptable range, with the exception of BPRS for the rubber
dam and drilling during the second treatment session.


72
TABLE 1
BEHAVIOR PROFILE RATING SCALE: INTER-RATER RELIABILITY
Session 1
Spearm an-Brown
Correlation Coefficient
Overall Disruptiveness
.8947*
Injection Disruptiveness
.9030*
Rubber Dam Disruptiveness
.9257*
Drilling Disruptivenss
.9501*
Mean, Session 1
.9184*
Session 2
Spearman-Brown
Correlation Coefficient
Overall Disruptiveness
.8753*
Injection Disruptiveness
.8584*
Rubber Dam Disruptiveness
.6675
Drilling Disruptiveness
.2821
Mean, Session 2
.6708*
*p<.001


73
Data Analysis
The data of this study were analyzed by Analysis of Variance.
All of these ANOVAs included Fear and Training as factors. Fear X
Training X Scene ANOVAs were computed for the SAM ratings.
ANOVAs for the physiological data (heart rate and skin
conductance) also included the factor of imagery period. Thus, the
analyses of the physiological data were Fear X Training X Scene X
Period. These ANOVAs were also repeated for each image period
individually. Thus, a Fear X Training X Scene ANOVA was run for
the read, image and recover periods for both heart rate and skin
conductance. The ANOVAs for the physiological data were repeated
a second time; this time the read period heart rate was used as
the baseline (instead of rest period heart rate). Since resting
heart rate was found to be correlated with age, Analysis of
Covariance was used for all analyses involving heart rate. Data
for the dental subscale, BPRS and dentist ratings were analyzed
with Fear X Training X Session ANOVAs. Comparisons between means
were made using the least significant difference test (LSD test).


RESULTS
Results of this study indicate that children do differentiate
between fearful and neutral imagery, both through their verbal
report of emotion and through their physiological responses.
Following a discussion of a pilot study of the scene contents,
demographic data and data relevant to each of the hypotheses
tested in the study will be presented. First data regarding the
main effects of scene content will be discussed. The effects of fear
level and of imagery training will then be considered.
Study I: Pilot Study of Scene Contents
In order to insure that children viewed the scenes used for
physiological assessment in accordance with the experimenter's a
priori designations as fearful or neutral, a pilot study was
conducted on separate sample of 22 children. There were seven
first graders, eight third graders and seven fifth graders. The
method and complete results of this study are described in
Appendix N. Children were asked to rate their emotional responses,
using SAM, to each of the scenes used in the main study. They
were also asked to rate the fearfulness of each scene. In addition,
children rated the similarity of each scene both to past
experiences and to situations that could happen in the future.
Results validated the manipulation of providing phobic dental and
74


75
social (school) scenes as compared to neutral scenes.
Pleasure
There was a main effect of scene on pleasure ratings
(F(5,95)=14.65, pC.0001). The ranking of scenes from most to least
unpleasant, is as follows: principal, dental injection, dental
exam, blackboard, living room and lawn chair. The blackboard
scene was rated the least unpleasant of all four fear scenes. This
scene was rated as significantly more pleasant than the dental
injection scene (LSD p<.05) and the principal scene (LSD p<.01).
The principal scene was rated as significantly more unpleasant
than all other scenes, including the dental fear scenes (LSD
p<.01).
Arousal
Again there was a main effect of scene (F(5,95)=2.46, p<.04).
The ranking of scenes from most to least arousing is: dental
injection, lawn chair, blackboard, dental exam, principal and
living room. The dental injection scene was rated as significantly
more arousing than the dental exam (LSD p<.05), principal (LSD
p<.05) and living room scenes (LSD p<.01).
Dominance
Dominance ratings also yielded a main effect for scene
(F(5,95)=5.93, pC.0001). The ranking of scenes from lowest to
highest dominance is as follows: principal, dental injection, dental
exam, living room, lawn chair, and blackboard. The blackboard
scene received significantly greater dominance ratings than did the


76
dental exam (LSD p<.05), dental injection (LSD p<.05) and
principal (LSD pC.Ol) fear scenes. The principal (LSD pC.Ol),
dental exam (LSD pC.Ol) and dental injection (LSD p<.05) scenes
were rated as significantly lower in dominance than the two
neutral scenes.
Fear
There was a significant main effect of scene on fear ratings
(F(5,95)=9.92, p<.00001). The ranking of scenes from most to least
fearful is: principal, dental injection, blackboard, dental exam,
living room and lawn chair. The principal and dental injection
scenes were rated as being significantly more fearful than all
other scenes (LSD pC.Ol).
Similarity to Past Experience
The ranking of scenes from most to least similar to past
experience is as follows: dental exam, lawn chair, dental
injection, blackboard, living room and principal (main effect of
Scene: F(5,95)=2.79, pC.02). The dental exam scene was
significantly more similar to past experience than the living room
(LSD pC.05) and principal (LSD pC.Ol) scenes. The principal scene
was significantly less similar to past experience than were the
dental injection (LSD pC.05), lawn chair (LSD pC.Ol) and dental
exam (LSD pC.Ol) scenes.
Similarity to Possible Future Experiences
Analyses of Variance on the children's ratings of the likelihood
that each of the situations could happen to them in the future


77
yielded no significant main effect of scene.
Study II; Tests of Hypotheses
Subject Demographic Data
Table 2 shows demographic data for subjects in each of the
four groups in the study. The high dental fear children had
significantly higher scores on the CFSS-DS across all three
measurement points than did the low dental fear children
(F(l,19)=44.04, p<. 00001, LSD pC.01). There were no significant
differences in fear scores between stimulus and response trained
subjects within each fear group.
High fear children in the study were significantly older than
the low fear children 'F( 1,20) =6.96, p<.02; 9.75 years vs. 8.25
years, LSD p<.05). It was difficult to control for this, as subjects
were self-selected to fear groups by their report of dental fear.
Further, this age effect is likely to represent the true nature of
this population, as there is a suggestion in the literature that
older children tend to report greater dental fear (Cuthbert &
Melamed, 1982; Winer, 1982).
Parent ratings were consistent with the childrens' own report of
fear. Thus the high fear children were rated as being
significantly more fearful than the low fear children during
previous dental examinations (F(l,17)=14.17, p<.002, LSD pC.01)
and previous dental injections (F(l,9)=11.43, p<.008, LSD p<.01).
Similarly, the high fear group was rated by their parents as
being significantly less cooperative than their low fear


78
TABLE 2
SUBJECT DEMOGRAPHIC DATA*
HIGH F
Stimulus
EAR
Response
LOW F
Stimulus
EAR
Response
N
7
6
6
5
AGE (years)
9.06
(1.40)
10.56
(1.40)
8.36
(1.90)
8.08
(0.87)
DENTAL FEAR
44.86
45.00
17.50
25.40
Pre-screening
(5.46)
(4.73)
(2.35)
(3.78)
Pre-Treatment 1
44.00
(6.98)
41.00
(6.07)
32.40
(11.59)
30.80
(12.59)
Post-Treatment 2
48.57
(12.39)
35.17
(10.05)
25.80
(8.53)
26.49
(11.48)
RACE
White
6
5
3
3
Black
1
1
3
2
SEX
Female
6
4
4
4
Male
1
2
2
0
PREVIOUS EXPERIENCE
Yes
3
6
5
5
No
4
0
1
0
* Means for each group are listed,
in parentheses below each mean.
Standard
deviations
are listed


79
counterparts during these past examinations (F(l,17)=8.60, p<.009,
LSD p<.01) and dental injections (F(l,9)=4.66, p<.06, LSD p<.05).
As was the case with the child's report of dental fear, parent
ratings of fear and cooperation were also correlated with age.
Thus older children were rated as being more fearful during both
examinations and injections (r=.5469, p<.02 and r=.7951, p<.01
respectively), and as less cooperative during injections (r.7758,
p<.01). The dentists' ratings of fear and cooperation were
unrelated to the children's fear level. This is an interesting
result, which suggests that dentists' perceptions of their child
patients' fearfulness is not always in accordance with the child's
own self-report of fear.
The high dentally fearful children also reported greater general
fearfulness as measured by the CFSS (F( 1,19) =9.63, p<.006, LSD
pC.Ol). The high fear and low fear groups did not differ on the
number of children who had previous experience with dental
treatment. The groups did not differ in scores on the Questionnaire
Upon Mental Imagery or on a subset of questions from the CFSS
measuring social anxiety. There were no differences between groups
on the number of days between experimental sessions (chi-squared
test did not reach significance).
Imaqinal Responses to Affective and Neutral Content
Analyses of the main effects of scene content revealed that the
subjects did discriminate between fearful and neutral contents.
Fear scenes were rated as more unpleasant, and as lower in


80
perceived dominance, than were neutral scenes. Further, the
subjects showed a differential pattern of heart rate responding to
the two types of scenes. Specifically, children showed heart rate
acceleration during imagery of fear scenes and deceleration during
imagery of neutral scenes. Skin conductance responses also showed
differentiation between scene contents, with higher read period
skin conductance levels occurring to the fearful scenes. Tables of
means for affective ratings, heart rate and skin conductance can
be found in Appendix 0. Correlations between affective ratings and
physiology are also included.
Affective ratings
Pleasure. All four fear scenes were rated as significantly less
pleasant than the two neutral scenes (main effect of Scene:
(F(5,100)=23.49, p<.00001; LSD pC.01). The principal scene was
rated as more unpleasant than all other scenes (LSD p<.01). The
dental examination, blackboard and dental injection scenes (listed
in descending order of pleasantness) received intermediate ratings
on the pleasure dimension. There was a positive correlation (r=.78,
pC.01) for pleasure ratings on the dental examination and dental
injection scenes. Thus, children giving low pleasure ratings to one
dental scene tended to give low pleasure ratings for the other
dental scene.
Arousal. No significant differences between scenes were obtained
for arousal ratings. It is possible that the children did not
understand the concept; observations suggested that some subjects


81
may have associated "excited" with "happy". Review of the data
indicates that the pattern of ratings was not consistent with the
designations of scenes as fearful and neutral.
Dominance. As was the case with pleasure ratings, dominance
ratings differed for fearful and neutral scene contents (main effect
of Scene: F(5,100)=9.26, p<.00001). The ranking of scenes on the
dominance dimension closely parallels that for pleasure. Scenes
rated as most unpleasant tended to receive lower ratings of
controllability. Thus, the ranking of scenes from highest to lowest
dominance ratings is lawn chair, living room, blackboard, dental
exam, dental injection and principal. The dental exam, dental
injection and principal scenes were rated as significantly lower in
dominance than the lawn chair and living room scenes (LSD pC.01).
These three fear scenes did not differ significantly from one
another, nor did the two neutral scenes. There were significant
positive correlations between ratings of pleasure and dominance for
three of the scenes: dental injection (r=.4424, p<.05), blackboard,
(r=.5800, p<.01) and principal (r=.4127, p<.05). These correlation
suggest that children do not view pleasure and dominance as
distinct emotions, but rather that they discriminate only between
"good" and "bad". Significant correlations between the ratings
averaged across all six scenes support the notion of a lack of
independence between these emotional dimensions (pleasure &
dominance: r=.4368, p<.05; dominance & arousal: r=.4743, p<.02;
pleasure & arousal: r=.2119, ns).


82
Vividness. There were no significant effects of scene content on
vividness ratings.
Heart rate
Older children had lower resting heart rates. Negative
correlations between age and rest period heart rates are as
follows: lawn chair r=-.4987 (pC.Ol), living room r=-.4114 (p<.05),
dental exam r.5676 (pC.Ol), dental injection r=-.5805(p<.01),
blackboard r=-.5362 (pC.Ol), principal r=-.4993 (p<.02). Therefore,
age was used as a covariate in all analyses involving heart rate.
When faced with an imagery task, adults typically show heart
rate acceleration during the reading of the scene, further
acceleration during the imagery period, and deceleration during
the recovery phase. Figure 2 shows that children in the present
study tended to show heart rate deceleration during the read
period (Scene X Period interaction: F( 10,200) =2.14, p<.02). Subjects
showed a significant deceleration during the read period of the
principal scene (LSD p<.01). This deceleration was significantly
greater than that occurring to all other scenes (LSD p<.05 for
difference between principal and dental exam and dental injection;
LSD p<.01 for all other differences). However, as with adult
subjects, within scene analyses showed that significant heart rate
acceleration occurred for the dental injection scenes from the read
to the recovery period (LSD p<.05). Similarly subjects showed heart
rate acceleration from the read to image periods of the blackboard
scene (LSD p<.05) and from read to recover for the principal scene


Heart Rate
Change
in
Beats per
Minute
Dental
Lawn Chair Living Room Dental Exam Injection Blackboard Principal
1 Read
2 Image
3 Recover
Figure 2. Mean heart rate changes during imagery (rest period used as
baseline).


84
(LSD p<. 05). Heart rate deceleration is typically associated with
attention (Lacey, 1967). Thus, these data suggest that unlike
adults, who show affective responses during the read period,
children need time to attend to the stimulus and then to access the
emotional network related to the scene being presented before they
can show any affective response. Children use the read period to
attend to the material and to access the appropriate network;
affective responses can then occur during the image and recovery
periods. For children then, the read period appears to represent
processing that is quite different from that occurring during the
image and recovery periods. Since imagery for children is a dual
process task, all subsequent analyses of physiological responding
will use the read period physiology, rather than rest period, as a
baseline.
Figure 3 shows that when the read period is used as the
baseline, children showed heart rate increases to the fear scenes
and heart rate decreases to the neutral scenes (main effect of
Scene: F(5,100)=2.84, p<.02). There were no differences between the
image and recovery periods. An examination of the data for the
read and image periods separately reveals that this main effect is
due to the recovery period (main effect of Scene for recovery:
F(5,100)=3.44, p<.007). The heart rate increment during the dental
exam, dental injection and principal scenes was significantly
different from the heart rate decrement occurring to the two
neutral scenes (all LSD p<.05).


Heart Rate
Change
In
Beats per
Minute
CD
U1
Scene Name
Figure 3. Mean heart
used as baseline).
rate changes during the recovery period (read period


86
Skin conductance
The heart rate data indicated that the imagery task is
comprised of two processes: mental processing and accessing of the
emotional network during read, and affective responding during the
image and recover periods. Thus, skin conductance data were
examined separately for the read period, using rest as the
baseline, and for the image and recovery periods using read as
the baseline. During the read period, subjects did show some effect
of the affective content (marginal main effect of Scene:
F(5,100)=1.97, p<.09). Skin conductance decrease was less for the
fear scenes than for the neutral scenes. Using the read period as
baseline for the image and recovery periods reveals no further
effects of scene on skin conductance. The habituation typically
seen across imagery periods did not occur. This suggests that the
affective content of the scenes did have an effect on physiology.
Although there was no elevation in skin conductance levels during
image and recovery, the absence of a decrease suggests that the
affective nature of the scenes may have prevented the habituation
that is often observed. This is consistent with the results of other
research (Lang et al., 1983).
Effects of Fear Level and Imagery Training
In addition to the hypothesis that children would show
differential responding to fearful and neutral imagery, it was
hypothesized that physiological responses to fear scenes would be
greater in fearful than non-fearful children. It was also predicted


87
that physiological responses would be greater in response trained
children than in stimulus trained children. An interaction between
fear level and imagery training was also expected. That is, it was
predicted that responsiveness would be greatest in high fear
children who had received response training. Dividing the sample
into groups based on fear level or training reduces the sample
sizes; thus, these results must be viewed with caution.
Dental fear
Scores on the Dental Subscale at the three measurement points
(Screening, pre-Treatment 1 and post-Treatment 2) were all
positively intercorrelated (r=.5369, p<.01 and r=.5311, p<.05
between Screening and Treatments 1 and 2 respectively; r=.6016,
p<.05 between Treatments 1 and 2). The high fear children did not
show any significant changes in reported dental fear across the
study. The low fear children, however, showed a significant
increase in reported dental fear from the screening to
pre-Treatment 1 (Session X Fear: F(2,38)=3.84, p<.03; LSD p<.01).
There was a decline in fear level from Treatment 1 to Treatment 2,
however this fear level is not significantly different from that at
the screening or at Treatment 1. The low fear children reported
higher levels of dental fear when actually faced with dental
treatment.
Affective ratings
Pleasure. High fear children rated the two dental scenes as more
unpleasant than did low fear children, with response trained


88
children giving lower pleasure ratings than stimulus trained
children within each fear group (Scene X Fear X Training:
F(5,100) =2.16, p<.06). Ratings given by the high fear response
trained children were significantly different from those given by
the low fear stimulus trained children (LSD p<.01). The high fear
response trained subjects rated all four of the fear scenes as
being significantly more unpleasant than the two neutral scenes
(LSD p<.01). The high fear stimulus trained subjects rated the
principal (LSD p<.05), dental injection (LSD p<.01), and dental
exam (LSD pC.01) scenes as significantly lower in pleasure than
the lawn chair scene. Low fear stimulus trained subjects made
some differentiation between fearful and neutral scenes as well,
rating the principal (LSD p<.01), blackboard (LSD p<.05) and
dental injection (LSD p<.05) scenes as more unpleasant than the
two neutral scenes. The differentiation between fearful and neutral
content was less clear for the low fear response trained subjects.
These subjects did rate the principal (LSD p<.01) and dental
injection (LSD p<.05) scenes as lower in pleasure than the lawn
chair scene.
Dominance. A similar effect was obtained for affective ratings of
dominance (Scene X Fear X Training: F(5,100) =2.39, p<.04). Figure
4 shows that the high fear response trained subjects made the
strongest discriminations between fearful and neutral content, so
that ratings for all four fear scenes were significantly lower than
those for the two neutral scenes (LSD pC.01 for all differences).


High Fear Subjects
Stimulus Trained
Response Trained
In Control 28
24
20
16
Dominance
Ratings ^
8
4 jjii{jji{j§jjj
Controlled 0 *-* '
Lawn Living Dental Dental Blackboard Principal Lawn Living Dental Dental Blackboard Principal
Chair Room Exam Injection Chair Room Exam Injection
Figure 4. Mean dominance ratings for high fear subjects
trained groups.
stim ulus and response


90
The high fear stimulus trained group also made some
differentiation between fearful and neutral scenes on dominance
ratings. For this group, the ratings for the dental injection and
principal scenes were significantly lower than those given for the
lawn chair scene (LSD p<.05). The high fear, response trained
group reported the least dominance for all four fear scenes. Low
fear subjects reported the highest dominance for each fear scene.
Response training consistently produced lower dominance ratings for
fear scenes in the high fear subjects; however, there was no such
effect within the low fear group.
Heart rate
None of the hypothesized effects of fear level and imagery
training on heart rate were obtained. However, imagery training
was seen to have an effect on heart rate responses when
self-reported imagery ability was taken in to consideration. All
good imagers and the poor imagers with response training showed
heart rate declaration during imagery (across periods and across
scenes) while poor imagers with stimulus training showed heart
rate acceleration (QMI X Training interaction: F(l,18)=10.10,
p<.005). Although LSD tests did not reveal any significant
differences between the means, these data suggest that response
training serves to make poor imagers respond in a manner similar
to that seen in good imagers.


91
Skin conductance
Fear level and imagery training interacted to produce an
interesting effect on read period skin conductance (Scene X Fear X
Training: F(5,100)=2.21, p<.06). The subjects in the high fear
response trained group were the only ones to show increased skin
conductance to the reading of the dental fear scenes and decreased
skin conductance to all other scenes (see Figure 5). The skin
conductance increase occurring to the dental exam scene was
significantly different from the decrease occurring to the lawn
chair and living room scenes (LSD p<.05). This effect represents a
more microscopic view of the main effect of scene on read period
skin conductance that was described earlier. Recall that skin
conductance decreases were less to fear scenes than to neutral
scenes. Here it can be seen that when children report a high
degree of dental fear and receive response training, they actually
do show increased skin conductance to the presentation of dental
fear scenes.
Dental operatory behavior
There were no differences between fear groups for
disruptiveness during the injection at Treatment 1. However, at
Treatment 2 the high fear subjects showed significantly greater
disruptiveness than the low fear subjects (Session X Fear
interaction: F( 1,19) =4.09, p<.06; LSD p<.05). This effect appears to
be due to the fact that the high fear group showed a slight
non-significant increase in disruptiveness across sessions while the


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EMOTIONAL IMAGERY IN HIGH AND LOW DENTALLY
FEARFUL CHILDREN: A TEST OF LANG'S
BIO-INFORMATIONAL THEORY
By
LAUREN KAPLAN COHN
A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA
1987

To my parents, Doris and Irwin Kaplan, who taught me to
believe that I could do anything, and then gave me the love,
support and friendship I needed to do it.

ACKNOWLEDGEMENTS
I wish to thank my major professor, Dr. Barbara G. Melamed,
for her direction in the completion of this dissertation. Her support
and guidance during my graduate training are greatly
appreciated. Dr. Russell Bauer, Dr. Suzanne B. Johnson, Dr. Peter
Lang, and Dr. Marjorie White served with Dr. Melamed on my
doctoral committee, and I thank them for their time and for their
helpful comments. I am indebted to Robyn Ridley-Johnson, Ed Cook
and Lisa Pistone for their invaluable work on this study. Several
research assistants participated in this study. I would
particularly like to thank John Eisler, Jamie Goodman, Sanjiv
Patel, and Godard van Reede for their contributions. Thanks are
also due Paul Greenbaum and Rich Steinkohl for their help during
the final stages of manuscript preparation. I would like to express
my gratitude to Dr. Carroll Bennett, Dr. Frank Courts, Dr. Roy
Jerrell and Dr. Clara Turner who served as the dentists in this
study, and to the staff of the Pediatric Dentistry clinic at the
University of Florida for its assistance in this research. The
cooperation of the School Board of Alachua County and the parents
and children who participated in the study are thankfully
acknowledged.
iii

My parents, sister and grandparents played a special role in
the completion of this dissertation. Their enthusiasm about my work
and their pride in my accomplishments really helped me to achieve
my goal. I especially want to thank my husband, Alan, for his
helpful ideas and for the love and support he has given me.
The work for this dissertation was conducted while I was a
fellow on the National Institute of Dental Research Training Grant
No. 5 T32 DE07133-02.
IV

TABLE OF CONTENTS
PAGE
ACKNOWLEDGEMENTS iii
ABSTRACT vii
INTRODUCTION 1
Physiological Responsivity to Imagery 3
Lang's Bio-informational Theory 15
Responsivity to Internally Induced Imagery 27
Imagery Ability in Children 30
Affect and Memory 43
Children's Responsivity to Imagined Stimuli 49
Children and the Bio-informational Theory 53
Statement of the Problem 56
METHOD 59
Design 59
Subjects 60
Apparatus 60
Procedure 63
Screening 63
Session 1 64
Session 2 67
Data Scoring 69
Physiological Measures 69
Self-Report Measures 70
Observational Measures 71
Data Analysis 72
RESULTS 74
Study I: Pilot Study of Scene Contents 74
Pleasure 75
Arousal 75
Dominance 75
Fear 76
Similarity to Past Experience 76
Similarity to Possible Future Experiences 76
Study II: Tests of Hypotheses 77
Subject Demographic Data 77
Imaginal Responses to Affective and Neutral Content 79
Effects of Fear Level and Imagery Training 86
v

DISCUSSION 94
Discrimination of Affective Valence 94
The Effects of Fear Level and Imagery Training 97
Implications for Lang's Bio-informational Theory 99
Methodological Considerations 102
Suggestions for Future Research 104
Conclusions 106
APPENDICES
A IMAGERY SCENES 109
B CHILDREN'S FEAR SURVEY SCHEDULE-
DENTAL SUBSCALE 112
C INFORMED CONSENT TO PARTICIPATE IN RESEARCH 116
D SUBJECT DATA FORM 119
E CHILDREN'S FEAR SURVEY SCHEDULE 120
F DENTIST RATING FORM 123
G BEHAVIOR PROFILE RATING SCALE 124
H QUESTIONNAIRE UPON MENTAL IMAGERY — CHILDREN... 127
I MEASURE OF ELEMENTARY COMMUNICATION
APPREHENSION 130
J RELAXATION TRAINING 131
K STIMULUS IMAGERY TRAINING 136
L RESPONSE IMAGERY TRAINING 140
M IMAGERY PROCEDURE INSTRUCTIONS 145
N PILOT STUDY OF SCENE CONTENTS 153
O TABLES OF MEANS FOR AFFECTIVE RATINGS,
HEART RATE AND SKIN CONDUCTANCE 160
REFERENCES 168
BIOGRAPHICAL SKETCH 175
vi

Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy
EMOTIONAL IMAGERY IN HIGH AND LOW DENTALLY
FEARFUL CHILDREN: A TEST OF LANG'S
BIO-INFORMATIONAL THEORY
By
Lauren Kaplan Cohn
May, 1987
Chairman: Barbara G. Melamed
Major Department: Clinical Psychology
In a test of Lang's bio-informational theory, physiological
responses to emotional imagery were studied in 6- to 12-year-old
children who reported high or low dental fear. In the first
experimental session, each child was given a restorative dental
treatment. Next, each child was given a relaxation exercise and
then trained in one of two kinds of imagery. Stimulus training
involved teaching children to focus on descriptive aspects of the
imagined situations, while response training instructed children to
focus on their bodily responses during imagery. Measures of social
anxiety and imagery ability were also taken. In the second
session, the relaxation exercise was repeated, and then
physiological recordings were taken while children imagined
neutral, dental fear and school fear situations. Children rated
their emotional responses to each scene. This assessment was
followed by a second dental treatment. Both treatment sessions were
videotaped for later scoring of disruptive behaviors. It was found
that children do discriminate between fearful and neutral content
vn

both in their physiology and in affective ratings. Children showed
heart rate acceleration to fearful content and deceleration to
neutral content. Fear scenes were rated as lower in pleasure and
in perceived control than were the neutral scenes. The study
revealed that for children, the imagery task requires two steps of
processing. In the first step, children attend to the material being
presented and show a physiology concordant with attention. In the
second step, once the emotional memory network has been accessed,
children respond to the affective content of the material, showing
a physiology that varies with the affective valence of the text.
vm

INTRODUCTION
Fears and phobias in children are generally held to be fairly
common occurrences. Estimates suggest that approximately 40% of
children ages 6 to 12 years have as many as seven fears (Lapouse
& Monk, 1959; Miller, 1983; Miller, Barrett, Hampe & Noble, 1972).
Children are often referred to clinics for the treatment of their
fears, although estimates of the frequency of referrals vary from 6
to 8% (Graziano & DeGiovanni, 1979) to as much as 30-40% (Miller,
1983). Many of the therapies used with fearful children involve the
use of imagery. These treatments include hypnosis, systematic
desensitization, implosive therapy and flooding. For example,
Lazarus and Abramovitz (1962) reported on the use of "emotive
imagery" with fearful children, ages 7-14 years. This treatment is
quite similar to systematic desensitization used with adults;
however, the child's own hero or alter ego is incorporated into the
stories. This procedure was successful in ameliorating the fears of
seven of nine children treated.
Although numerous studies attest to the effectiveness of
imaginal treatment with adults, there is a relative paucity of
empirical data on the utility of these techniques with children
(Elliot & Ozolins, 1983; Graziano, DeGiovanni & Garcia, 1979;
Ollendick & Cerny, 1981). Many of the procedures used in the
1

2
treatment of adults have been applied to children with little
modification (Elliot & Ozolins, 1983; Graziano, DeGiovanni &
Garcia, 1979; Harris, 1983). However, this may not be appropriate.
Several important issues must be considered when using imagery
based treatments with children. The most obvious of these is the
developmental level of the child (Elliot & Ozolins, 1983; Rosenstiel
& Scott, 1977). There is some evidence to suggest that children as
young as 4 to 6 years old can use imagery to change their
behavior (Mischel, Ebbesen & Zeiss, 1972). It cannot be assumed,
however, that children are uniformly able to use imagery in
therapy. For example, Tasto (1969) was unsuccessful in his attempt
to use imaginal desensitization to treat a 4-year-old boy with a
fear of loud noises. In vivo desensitization did result in
elimination of the child's symptoms. Furthermore, there are data to
suggest that important changes in imagery ability occur between
the ages of 6 to 8 years (Paivio, 1970; Reese, 1970; Rohwer, 1970).
This would coincide with movement into Piaget's stage of concrete
operations.
The purpose of this paper is to describe a study of children's
responses to imagery. The study addresses factors that have been
shown to be important to therapeutic improvement in adults. Three
lines of research are reviewed. First, in the absence of adequate
research on imaginal therapies with children, studies on adult's
responses to imagery are considered. In this context, Lang's
bio-informational theory of emotional imagery will be described.

3
This theory has provided useful information regarding variables
that have influenced improvement in adult phobic patients through
the use of imaginal treatments (Lang, 1977, 1979). Second,
research on imagery ability in children will be described. Work to
be described comes primarily from the area of learning and
memory, since, as noted above, the clinical literature has
produced few studies of imagery in children. Third, studies of
children's responsivity to imagery will be presented.
Physiological Responsivity to Imagery
The use of systematic desensitization is based on the
assumption that visualized stimuli produce fear responses that are
similar to, but less intense than, those produced by the actual
situation. Relaxation is then elicited, in order to inhibit or
extinguish this fear response (Grossberg & Wilson, 1968).
Systematic desensitization and procedures like it have
stimulated a great deal of research on the physiological effects of
imagery. Specifically, investigators have questioned whether
imagined stimuli actually do evoke a fear response, whether the
response varies with the fearfulness of the stimulus, and whether
the pattern of responsivity seen in phobic subjects differs from
that seen in non-phobic subjects.
Grossberg and Wilson (1968) designed an experiment to
determine whether fearful imagery truly does generate more "initial
tension" than neutral imagery. The authors suggest that such a
difference is basic to the theory underlying systematic

4
desensitization, and note that if no difference were found, "it
would be difficult to maintain that something was being inhibited,
replaced or extinguished with repeated visualizations" (Grossberg &
Wilson, 1968, p. 124).
The investigators compared the physiological responses of high
and low anxious female undergraduates to fearful and neutral
scenes. Fear scenes were individualized for each experimental
subject. A control group listened to tape recorded presentations of
the scenes selected for her matched experimental counterpart.
Control subjects reported low fear for the items tested.
The authors found that both high and low anxious subjects
showed increases in heart rate and skin conductance during both
the reading and visualization of the scenes. Fear scenes produced
greater arousal than neutral scenes during the image period only.
Both heart rate and skin conductance decreased over repeated
scene readings, while skin conductance also showed a decrease
over imaging trials.
Comparison of experimental and control subjects indicated that
the experimental subjects showed a greater heart rate increase
during the reading of the fearful scenes. Imagining fear scenes
resulted in significant heart rate and skin conductance increases
to fear scenes for both groups, although no difference between
scenes had been expected for the controls. The experimental group
showed significant habituation of the heart rate response over
trials for the reading of fear scenes. Both groups showed skin

5
conductance habituation for the presentation of neutral scenes.
The authors concluded that imagery does have measurable
physiological effects, and that fearful imagery produced more
arousal than neutral imagery. Some habituation was noted over
repetitions, suggesting that habituation can occur even without
relaxation training. They note that these results were obtained
with a non-phobic population and suggest that phobic subjects
would be likely to produce greater differential responding.
Haney and Euse (1976) examined physiological responsivity to
positive scenes as well as to negative (fearful) and neutral scenes
in a sample of college students. They found that during imagery,
heart rate was larger fc1' the negative scenes than for the positive
or neutral scenes. Skin conductance responses were larger for both
the positive and negative scenes than for the neutral scenes, while
the former were not significantly different from each other. There
was a significant decrease in skin conductance across time for the
neutral image.
Positive images were rated as more intense and higher in
clarity than either the neutral or negative images. Negative images
were rated as more intense than neutral images. The relationship
between clarity, intensity and physiological responsivity was not
examined.
Results of this study are similar to those obtained by Grossberg
and Wilson (1968), since fearful scenes produced increases in heart
rate and skin conductance. It is not clear, however, why the

6
positive scenes in the Haney and Euse (1976) study also produced
increases in skin conductance. The authors did not specify the
content of the positive scenes. Thus, it is not possible to
determine whether the scenes were of an arousing nature (i.e.,
physical exertion) which may have resulted in increased skin
conductance responding.
The studies described above yielded information about
physiological responsivity to imagery that has relevance to the
theory of systematic desensitization; however, subjects in these
studies were all non-phobic. Van Egeren, Feather, and Hein (1971)
studied a group of speech phobic college students in order to
evaluate a number of hypotheses about systematic desensitization.
Half of the subjects (all male) were given instruction in
relaxation, and all subjects received visual imagery training. The
details of this imagery training are not specified. The authors
note only that "his visualization procedure was discussed and
suggestions made, emphasizing vividness of the imagery, constancy
of the image, and realistic projection of the self into the
situation" (Van Egeren et al., 1971, p. 215). Each subject
imagined the scenes on his individual hierarchy during the next
two experimental sessions.
Fearful imagery was associated with significant autonomic
responses; specifically, subjects showed increases in heart rate,
skin conductance, respiration, and digital vasoconstriction. These
responses were greater than those occurring to neutral stimuli. The

7
investigators found a positive relationship between the degree of
responsivity and the fear level of the scene, although this was
true only for digital vasoconstriction and the number and
magnitude of skin conductance responses.
Habituation of responses with repetition of stimuli was observed
for digital vasoconstriction both within and across sessions.
VanEgeren et al. (1971) expected that the least threatening scenes
would lead to more rapid extinction of responses; however, this
hypothesis was not supported by the data.
Relaxation had limited effects on physiological responding.
Relaxed subjects showed a faster habituation of digital
vasoconstriction throughout the experiment and of skin conductance
responses during Session 1. It was also found that relaxation
produced more facilitation of habituation (skin conductance
response and vasoconstriction) for the most threatening scenes. An
interesting result obtained in this study was that decreases in
autonomic responding were not accompanied by comparable
decreases in the subjective reports of anxiety. Thus, these subjects
may have shown improvement in their anxiety reactions, but yet,
may not "feel better." This discordance between physiological,
subjective, and behavioral indices of anxiety has been described
by Lang (1968).
The study by Van Egeren et al.(1971) addressed several
important points. First, the authors found some evidence that
greater levels of physiological arousal occur to scenes rated higher

8
in fearfulness. They showed that physiological habituation does
occur over repeated presentations of fear stimuli and that
relaxation is not absolutely essential for habituation to take
place. Finally, the finding of discordance between self-report and
physiological measures of anxiety is a common one in the literature
(Lang, 1968) and points to the importance of comprehensive
assessment of anxiety.
Similar findings were noted by Marks and Huson (1973) in their
summary of six treatment studies that included a physiological
assessment of imagery ability in phobic patients. Responses to
scenes with phobic and neutral content were compared. Patients
exhibited increases in heart rate and skin conductance to phobic,
scenes, although these results were not obtained consistently in all
six studies. Subjective ratings of anxiety did discriminate between
fearful and neutral scenes in all studies. After the completion of
treatment, differences in responsivity to phobic and neutral scenes
were decreased. Interestingly patients in four of the studies
continued to rate the phobic scenes as more anxiety provoking.
Few correlations between the physiological measures or between
physiological and subjective measures were obtained, providing
additional support for the notion that there may be some
independence between response systems in phobic patients.
Waters and McDonald (1973) noted that the type of stimulus
presented to subjects may influence the degree of fear decrement. A
number of studies had indicated that exposure to the feared

9
stimulus in vivo results in greater autonomic reactivity and more
improvement in phobic concerns. Thus, Waters and McDonald
examined autonomic reactivity and differences in response
decrement to fear provoking stimuli in three modalities. Rat phobic
undergraduate females were given systematic desensitization. At
each level of the hierarchy subjects heard a description of the
fear stimulus (auditory mode), saw a slide depicting the feared
stimulus (visual mode), and then closed their eyes and imagined
the stimulus (imagery mode). Each subject was exposed to each
modality in this between subjects design. Imagined stimuli
produced significantly more responsivity than either the visual or
auditory stimuli in the case of heart rate, skin resistance and
skin potential. Vasomotor response showed more responsivity to the
auditory stimuli. There were no significant differences between
stimulus modalities in the degree of response decrement over trials,
with two exceptions. Imagery produced greater decreases in skin
potential than did auditory presentation, while skin resistance
showed greater decrease to visual than auditory stimuli. When
response decrements did occur over trials, these occurred more
frequently to visual and imagined stimuli. No habituation was
produced for heart rate, and only one stimulus produced
habituation of skin resistance and skin potential. The authors
concluded that exposure to stimuli in either the visual or imaginal
mode would be sufficient to produce a decrease in the physiological
component of phobic disorders.

10
There is a serious confound in this study. Subjects all received
exposure to the three stimulus modalities, and all in the same
order. It is very possible that the increased responsivity to the
visual and imaginal stimuli was a result of an incremental effect
of these modalities when given subsequent to the auditory
modality. In fact, the authors note that a "small minority of
subjects indicated that their imagery occasionally was an
exaggerated form of the auditory and visual images. Effects of
each modality need to be tested separately.
In a study designed to evaluate the effectiveness of a device
for automated desensitization, Lang, Melamed and Hart (1970)
presented some interesting data on patterns of physiological
responsivity over the course of treatment. Snake phobic
undergraduate women were given eleven sessions of systematic
desensitization with the automated device. The authors examined
physiological responses across all sessions on those trials during
which the subject signaled fear. These trials were compared with
the one previous trial and two subsequent trials during which no
fear was indicated. Consistent with prediction, subjects showed
significantly greater heart rate, skin conductance and respiration
on trials during which fear was reported. Further, those subjects
manifesting the greatest improvement in the degree of fearfulness
after treatment were those who demonstrated the highest heart rates
on fear signaled trials. These same subjects showed greater heart
rate habituation to repeated presentations of a fearful stimulus.

11
Respiration and skin conductance data did not yield a similar
pattern of results.
In a second study, Lang et al. (1970) investigated the nature
of an anxiety hierarchy. Specifically, the authors questioned
whether the degree of anxiety manifested physiologically and in
verbal report would correspond to the ranking of each item in the
hierarchy. The relationships between image clarity, hierarchy
position and anxiety were also considered. Public speaking and
spider phobic subjects participated in this study. Scenes were
presented in a random order so as to control for any effect of
sequential presentation of the scenes on responses. There was no
significant relationship between hierarchy rank and image
vividness. Subjective ratings of anxiety were greater for items
higher in the hierarchy. Heart rate and skin conductance yielded
the predicted result: responsivity on these measures was greater
for those items ranked as highly fearful. A significant linear
trend was obtained for heart rate for both groups of subjects,
while only the spider phobics produced such a trend for skin
conductance. No relationship between respiration responses and
hierarchy rank was obtained. Both groups evidenced a significant
relationship between heart rate increments and anxiety ratings.
Vividness correlated with heart rate changes for the combined
groups and for the public speaking phobics alone, but not for the
spider phobics.

12
The studies by Lang et al. (1970) complement the results of
studies already described. It had previously been shown that both
normal and phobic subjects produce more physiological and
self-reported anxiety to phobic content than neutral content. These
investigators demonstrated that scenes rated as higher or lower in
fearfulness produce differential physiological responses. Further, it
was found that habituation of heart rate responding was associated
with a favorable treatment outcome. This then suggests that
habituation is a mechanism that may underlie the effectiveness of
this therapeutic approach. The study also provided support for the
notion of a fear hierarchy, in that greater physiological
responsivity and greater subjective anxiety occurred to those items
with higher ranks.
In a thought provoking paper, Grayson (1982) described two
studies that could provide an explanatory model for differential
responsiveness to phobic and neutral stimuli, as well as for the
mechanism underlying systematic desensitization. Grayson postulated
that a stimulus that was paired with a phobic stimulus would
elicit defensive responses in fearful subjects. He noted that it
would be necessary to study second-by-second heart rate responses
in order to evaluate this phenomenon.
In the first experiment described, Grayson presented speech
anxious subjects with a slide of either a phobic or neutral
stimulus, and then asked subjects to form a visual image of that
stimulus. For one group of subjects, each slide was preceded by

13
the presentation of a tone: high frequencies for phobic scenes, and
low frequency tones for neutral scenes. Another group of subjects
had no signal preceding the slides. For the fear stimuli, heart
rate wave forms characteristic of a defensive response occurred to
presentation of the signal and of the slide for only those subjects
receiving a signal. Defensive responses occurred to visualization of
fear scenes regardless of whether a signal was given. Contrary to
expectation, orienting responses were not obtained when neutral
stimuli were presented. These data support Grayson's notion that
that the increased heart rates observed when subjects imagine
fearful stimuli are manifestations of a defensive response.
Grayson's second experiment investigated two models that could
explain the incremental stimulus intensity effect. This effect is "a
demonstration that habituation to repeated intense stimulation is
more rapid when the stimuli are presented with gradually
increasing intensity than when an equal number of presentations of
the most intense stimulus are given" (Grayson, 1982, p.104).
Grayson presented subjects with a hierarchy of phobic stimuli (the
incremental series) or with a constant series which consisted of
repetitions of the stimulus item at the high end of the hierarchy.
Results of the study were expected to provide support for one of
two theories. Groves and Thompson's dual process theory predicts
that greater habituation would occur with an incremental series
since any sensitization or arousal would be small and would
habituate over a few trials. A constant series would be expected to

14
produce marked, lasting sensitization. Sokolov's neuronal
comparator model, however, would predict that greater habituation
would occur to the constant series, assuming that presentation of a
new stimulus could elicit an orienting response, or possibly even a
defensive response.
Speech anxious college students were presented with either four
presentations each of four graded fearful stimuli (incremental
series condition), or sixteen presentations of the most fearful
stimulus (constant series condition). Comparisons were made on
responses to the last four presentations, since these were identical
for both groups. The method of stimulus presentation was the same
as in the first study.
Some support was obtained for the use of graded hierarchies,
since the constant series produced larger and more durable heart
rate accelerations in the pre-slide period and a greater number of
spontaneous fluctuations in skin conductance during visualization.
Clear empirical support was not obtained for either the dual
process or neuronal comparator model. Both experimental groups
evidenced heart rate wave forms and cephalic vasomotor
constriction characteristic of a defensive response. Nevertheless,
this study is an important one, since it points to the defensive
response as a potential explanation of the increased physiological
responsivity that has been observed to occur to phobic stimuli.

15
Lang's Bio-Informational Theory
In his bio-informational theory, Lang (1977, 1979, 1985)
suggests that images are not pictures in the mind's eye, but
rather that images are the product of a propositional structure in
memory. An image consists of information units, or propositions,
that are linked together into an informational network. There are
stimulus propositions, which refer to the descriptive features of the
situation, response propositions, which refer to the subject's
behavior in the situation, and meaning propositions, which refer to
the subject's appraisal of the stimulus and response data (Lang,
1985). There are three types of response propositions: overt motor
behavior (i.e., I run away), verbal report of subjective
experience (i.e., I feel afraid), and patterns of visceral
reactivity and somatomotor tonus (i.e., my heart pounds). The
network is processed as a unit when a critical number of the
propositions are accessed. Propositions can be accessed in a
variety of ways, such as through actual exposure to the feared
stimulus, through pictures or stories of the stimulus, and even
through thoughts. Since the different propositions are linked
together in memory, accessing, or activating one proposition in the
network increases the probability that a proposition linked to it
will also be accessed via a spread of activation (Bower, 1981).
Thus, if a person imagines a snake, remembers that he/she is
afraid of snakes and typically runs away from them, then

16
physiological responses associated with this fear behavior (i.e.,
increased heart rate) are likely to be evoked as well.
The bio-informational theory has important implications for the
treatment of phobic disorders. It has been shown that treatments
such as systematic desensitization can decrease physiological
responding to phobic stimuli (Lang, Melamed & Hart, 1970; Marks &
Huson, 1973). Lang posulates that these treatments work by
weakening the associations between propositions, such as "SNAKE"
and "MY HEART BEATS FASTER." Foa and Kozak (1986) suggest three
mechanisms for these effects. First, short term habituation results
in a dissociation of responses from stimulus propositions. Second,
there is a change in the meaning of the stimulus, and third there
is long term habituation.
According to Lang (1977; Lang et al., 1980) it is important
that the images formed be as vivid as possible if they are to have
this therapeutic value. Vividness is defined as completeness of the
evoked propositional structure. One way to maximize image
vividness is to train subjects to include response propositions in
the images that they form. This is expected, then, to lead to
enhanced physiological responsivity to imagined stimuli. Recall
that Lang et al. (1970) found maximal therapeutic improvement in
those subjects who showed the largest heart rate increases in
response to fearful images.
To best this hypothesis, Lang et al. (1980) trained one group
of subjects to attend to specific stimulus details of the imagined

17
scene (the stimulus-trained group), and the other group of subjects
to focus on their physiological responses during imagery (the
response-trained group). Subjects were then asked to imagine a
series of neutral, active and fearful scenes. For both groups,
neutral scenes contained only stimulus propositions. Fearful scenes
differed for the two groups. Scenes for the stimulus group
contained only stimulus propositions, while scenes for the response
group contained both stimulus and response propositions.
Physiological responses were examined at three points during each
trial: during the reading of the scene (READ), while subjects
imagined the scene (IMAGE), and while subjects relaxed after
imagining the scene (RECOVER).
Both groups showed minimal responsivity to neutral scenes.
However, a training effect was obtained for the fearful and neutral
scenes. Response subjects showed significant increases in heart
rate, respiration, and muscle tension during the image period.
This group also showed a marginally significant increase in eye
movement. The pattern of responsivity for the response group was
an inverted V: there was a slight increase in responding during
the read period, a further increase during the image period, and
a decrease during the recover period. Response curves for the
stimulus-trained subjects were essentially flat. Skin conductance
showed a slight tendency to decrease during imagery trials,
although all subjects showed less of a decline during fear scenes.
The distribution of responses during a given scene seemed to

18
mirror the content of the script. Thus, muscle tension responding
was greater for action scenes than for fear scenes, while the
reverse was true for respiration.
Lang et al. (1980) noted that in this experiment there was a
confound between training and script. In other words,
stimulus-trained subjects were tested on stimulus scripts, and
response-trained subjects were bested on response scripts. This
made it impossible to determine whether the observed responses
were a function of training, script, or both. Thus, the
investigators did a second study in order to replicate and extend
their findings. Four groups of subjects were used in a 2 (Stimulus
vs. Response Training) X 2 (Stimulus vs. Response Script) design.
The Stimulus-Stimulus and Response-Response groups provided for
replication, while the remaining two groups permitted study of the
independent effects of training and script. A second change was
made in the experimental design. Response propositions were
distributed equally across scenes so that, for example, action
scenes would not be confounded with muscle tension propositions,
or fear scenes with heart rate response propositions. Thus, each
scene contained one response proposition from each physiological
system.
Replication of the findings of the first study was obtained for
the Stimulus-Stimulus and Response-Response groups. Examination of
all four groups indicated that response propositions produced
significant increases in responsivity only if both response training

19
and response scripts were combined. Stimulus-Response and
Response-Stimulus groups had patterns of responsivity very much
like those seen for the Stimulus-Stimulus group.
As was seen in the first experiment, muscle tension responses
were greater for action scenes than for fear scenes. Respiration
was slightly higher for fear scenes. Lang and his colleagues
(Lang et al., 1980; Lang et al. 1983) note that the finding of
differential reactivity of individual response systems in spite of
the equal distribution of response propositions across scene types
suggests that the imagery response is not just a function of the
script. Rather, it is a function of propositional elements relevant
to the situation that were accessed from the subject's own long
term memory.
Robinson and Reading (1985) studied small animal phobics in
order to examine the effects of imagery training and script content
on physiological and subjective arousal, concordance between
physiological systems, and habituation of responding over repeated
presentations of fearful stimuli. They compared stimulus and
response trained subjects after one presentation and after four
successive presentations of fear scenes. They found that response
trained subjects did show greater physiological arousal than
stimulus trained subjects for muscle tension, heart rate and skin
conductance, but not for finger temperature. Reported arousal was
significantly correlated with image vividness for both groups. For
the response trained subjects arousal and vividness were correlated

20
with muscle tension and heart rate, but not with skin conductance.
Muscle tension and heart rate were correlated for the response
group only. Finally, there was some tentative support for the
notion that response trained subjects show slower habituation. This
was not a clear finding however, because stimulus trained subjects
showed a pattern of small and inconsistent responding.
Bauer and Craighead (1979) investigated the effects of
instructions on physiological responses to fearful and neutral
imagery. In a two-way factorial design, subjects were given one of
two instructional sets (focus on scene details versus focus on
bodily reactions to the scene) and one of two orientation sets
(imagine actually participating in the scene versus imagine
viewing it as an observer). Imagery training was not given.
Scenes used were selected for each subject on the basis of
responses to a fear questionnaire. Fearful and non-fearful
(neutral) scenes were presented.
As was expected, fearful scenes produced greater heart rate
lability and marginally greater skin conductance responses than
did neutral scenes. A marginally significant main effect for
orientation was obtained for skin conductance, with participant
subjects showing greater reactivity than those imagining themselves
to be observers. Attentional focus produced significantly different
heart rate lability scores for the two groups; consistent with the
findings of Lang et al. (1980), subjects focusing on their bodily
reactions to the stimuli manifested greater heart rate changes.

21
Finger pulse volume did not differentiate between any of the
conditions. Although Lang (1977; Lang et al., 1980) suggests that
response training serves to "amplify" physiological responses so
that they can be detected, results of this study suggest that
training may not be necessary to produce these responses. A
problem in the Bauer and Craighead study is that there was no
check on the actual images generated by each subject, particularly
those in the body focus group. Such a check would be important
because the scenes presented to the subjects contained only
stimulus propositions. It would be helpful to know whether the
subjects had a tendency to include response propositions only from
certain systems in their images. Failure to find consistency
between physiological measures may have resulted from
inter-subject variation on the number and type of bodily responses
imagined.
The actual content of images was assessed in a study by
Anderson and Borkovec (1980). These investigators presented speech
anxious subjects with either stimulus or stimulus plus response
imagery scripts. After the first scene presentation, subjects were
asked to describe their images. This permitted scoring of scene
content, in terms of stimulus and response propositions. Following
four more presentations of each scene, subjects again described the
content of each image. Physiological assessment was conducted
during each scene presentation.

22
The authors found that greater response detail was reported by
subjects in the stimulus plus response group. However, both groups
of subjects reported a decreased number of stimulus details with a
concomitant increase in response details over the course of the
study. Interestingly, the amount of response detail reported was
significantly correlated with both heart rate responses and
post-scene fear ratings. This finding provides additional support
for the notion that imagining response propositions is associated
with greater physiological responding. Anderson and Borkovec note,
however, that the two script conditions did not provide clear
differentiation between reported images and warn investigators that
it is important to insure that the manipulation is successful in
providing different conditions for each group. Repeated
presentations of the scenes led to a steady decline in heart rate
responding for the stimulus group and a more variable decline in
responding for the stimulus plus response group.
Carroll, Marzillier, and Merian (1982) raised a number of
questions about the effects of response propositions on
physiological responses to imagery. Specifically, these researchers
questioned the necessity of response training, the specificity of
response propositions for each of the response systems, and the
effect of response propositions for relaxing imagery.
Non-phobic adults were used as subjects in this study. Half the
subjects imagined scenes containing stimulus propositions; the other
half imagined scenes containing response propositions. Imagery

23
training was not given. Three scenes for each group were
arousing, exciting, or anxiety-provoking, while three scenes were
either relaxing or tranquil. The authors do not specify the exact
content of each scene. Each scene presented to the response group
emphasized responses in only one response system: either cardiac,
respiratory, or electrodermal activity. Each scene was imagined
twice.
The response group showed greater heart rate and respiration
responses (but not skin resistance) to the arousing scenes than did
the stimulus group. This finding is consistent with previous
research. The groups did not differ in responses to relaxing
scenes. Thus, response propositions do not seem to have an effect
on relaxation.
An interesting result in the study was that there was a lack of
specificity in the types of physiological responding occurring to
scripts emphasizing a particular response system. Thus, heart rate
increases were produced to scripts focusing on cardiac responses
as well as to those emphasizing respiratory activity. Similar
findings were obtained for respiratory and electroderm al responses.
Thus, as was noted by Lang et al. (1980; Lang et al., 1983) the
content of the script itself is likely to play a role in determining
which response systems are involved in responses to imagery, by
accessing the subjects' own propositional network about such
events. This network, then, may have an influence beyond that of
the specific response propositions included in the script.

24
Unfortunately, Carroll et al. (1982) did not elaborate upon the
content of their scripts, making it difficult to examine the effects
of specific contents.
Lang, Levin, Miller and Kozak (1983) conducted an extensive
investigation of aspects of the bio-informational theory in speech
anxious and snake phobic subjects. The study addressed two
important issues. First, the study examined the specificity of
responses of phobic subjects. That is, whether phobics respond to
all fearful contents in the same way or discriminate between their
own fear content and other fear contents. The second question
considered in the study was the similarity of response physiologies
for actual tasks and imagery of the tasks.
Snake phobic and speech anxious subjects participated in the
study. Each group underwent physiological assessment during
imagery and during actual exposure to the two feared situations.
Snake phobic subjects showed visceral responses to scenes depicting
both snake and speech content. The largest heart rate change
occurred to the snake scene. Positive skin conductance responses
were obtained to the snake scene as well as to a scene describing
physical exercise. Speech anxious subjects, however, showed heart
rate increases only to public speaking scenes. Additionally, these
subjects showed less skin conductance habituation to the speech
scenes than to the snake scenes. Physiological responses during in
vivo exposure mirrored these results. None of these comparisons
was statistically significant.

25
Responsivity to imagery was assessed a second time, after
subjects had been exposed to fear stimuli in vivo. It was assumed
that subjects would have stronger memories of both their own and
the opposite fear stimuli following exposure. The pattern of results
obtained was the same as that for pre-exposure imagery; again,
none of the comparisons were statistically significant.
In a second study, Lang et al. (1983) investigated the effects
of stimlus and response training on a new sample of speech
anxious and snake phobic subjects. Half of the subjects in each
fear group were given stimulus training, while the remainder of
each group received response training. All subjects were tested on
scripts that contained both stimulus and response propositions.
An analysis of the effect of scene content yielded a finding
consistent with those obtained in Study 1. The snake phobic
subjects showed the highest heart rate response to snake scenes,
but showed a heart rate response to the speech scene comparable
to that seen in the speech anxious subjects. This was a significant
effect.
Imagery training led to effects similar to those described in
earlier studies (Lang et al., 1980). Response trained subjects
showed the inverted V pattern, while stimulus trained subjects
showed minimal responsivity to imagery. Patterns of physiological
reactivity for response trained subjects were the same as those
obtained in Study 1. That is, snake phobics showed increased
physiological responsivity to both fear scenes, while speech

26
phobics responded only to their relevant fear scene. Stimulus
trained subjects showed the same pattern of responses; however,
the differences between group and scene content were greatly
accentuated in response trained subjects.
Results of the Lang et al. (1983) studies provide support for
earlier findings on the effects of stimulus and response training on
imagery. These studies also indicate that there is some specificity
in the responses of phobic subjects. Speech anxious subjects did
not respond in a phobic manner during snake imagery. The fact
that snake phobic subjects responded with increased physiology to
the speech scenes most likely represents the task demands of
giving a speech. This is consistent with the study's findings of
similarity of responding during imaginal and in vivo exposure.
The findings of this study support the hypothesis that response
information is stored within a propositional network. Even though
the majority of the snake phobic subjects did not report speech
anxiety, their propositional network for giving speeches still
contains information about physiological responding that
accompanies this task. This raises the question of what differences
exist between propositional networks for phobics and non-phobics.
Lang et al. (1983) suggest that phobia networks are higher in
coherence than other networks. That is, the links between nodes in
a phobia network may be stronger. According to the authors, these
"emotion prototypes" require fewer matches in order to be
activated. This is supported by the finding of response sterotypy

27
in this study. That is, the subjects reporting the highest degree
of fear on the snake questionnaire were more likely to score high
on performance, other verbal and physiological measures of fear,
both in exposure and imagery.
Responsivity to Internally Induced Imagery
It is important to consider the impact that internally induced
thoughts and images can have on phobic patients. Phobics often
ruminate about fear producing situations. If phobia networks are
especially coherent, as is predicted by the bio-informational
theory, then it is likely that even thoughts about feared situations
can evoke the fear network and produce the full pattern of
physiological responses to the stimulus. Physiological changes in
response to such thoughts and images are likely to reinforce
perceptions of the situation as a fearful one. Further, this
ruminative thinking and the associated fear reaction may result in
continued avoidance of the phobic situation, thus preventing the
phobic individual from obtaining information about the situation
that could serve to disconfirm his or her notions about its danger
(May, 1977b)
Schwartz (1971) noted that in studies such as those described
thus far, it is not possible to determine whether observed
responses were a function of the external stimulus, the
hypothesized mental processing, or both. Schwartz developed a
methodology that allows precise measurement of responses to
internal stimuli generated by the subject, that are under his or

28
her control. A series of tones is presented to the subject at
regular intervals. The subject is asked to repeat a series of
numbers (i.e., 1, 2, 3, 4), one per tone. He or she is given the
option of repeating the series of numbers one, two or three times.
After the number series is completed the subject generates one of
two thought sequences in synchrony with the tones. Thought
sequences are memorized prior to the start of the experiment. Some
studies using the Schwartz paradigm instruct subjects to form
images to each thought sequence; again, in synchrony with the
tones. Subjects press a button to signal the end of a trial. Data
can be analyzed by evaluating responses occurring after the last
number sequence. Thus, by choosing how many times to repeat the
number sequence, the subject controls the onset of the experimental
thought sequences.
Using this time-locked imagery, Schwartz (1971) found that
subjects showed heart rate accelerations when thinking of affective
stimuli (words such as sex, rape and death) but not to neutral
stimuli (letters, such as A, B, C). A problem with this study is
that the word stimuli were more likely to be meaningful and
perhaps to produce more vivid imagery than would simple letter
stimuli. May and Johnson (1973), using the same paradigm, found
that subjects showed greater heart rate and respiration when
imagining arousing words than when imagining neutral words.
Relaxing words (such as peaceful and tranquil) did not produce
the predicted heart rate decelerations.

29
The responses of phobic and non-phobic individuals were
compared in a study by May (1977b). Using the time-locked
procedure, subjects were told to think of a number series, then a
sentence (snake versus non-snake content), and then to form an
image to that sentence. Phobic subjects showed greater heart rate
responses to both the sentence and to the image, with the greatest
increases occurring to the snake stimuli. There was a signficant
heart rate habituation over trials, although phobic subjects did
not return to baseline. Phobic subjects also showed greater
respiration amplitude when producing an image of a snake.
Finally, phobics showed greater skin conductance level increases
and more frequent skin conductance responses than non-phobics
during snake imagery. This study indicates that phobic subjects do
generate autonomic responses to internally controlled phobic
thoughts. These subjects also reported greater image clarity and
greater emotional reactions to the imagery than non-phobics. Some
subjects commented that it was difficult to "turn off" the images.
May (1977a) compared autonomic responsivity to three types of
stimulus presentation modes. Using Schwartz's (1971) time-locked
procedure, phobic subjects either saw a slide, heard a sentence,
or produced a thought depicting phobic or non-phobic content.
Subjects then generated images to the stimuli. Heart rate
responding during imagery was greatest for subjects exposed to
either internal or visual stimuli. While all stimuli produced some
habituation over trials, subjects never returned to

30
baseline—particularly subjects in the internal and visual groups.
Respiration amplitude was greatest for those subjects forming
images to visual stimuli. Respiration rate did not differ between
groups. Electrodermal activity appeared to be most responsive to
the visual mode; subjects in the visual group showed greater skin
conductance level increases and more rapid habituation than did
subjects in the other groups.
Internally controlled thoughts, then, have been shown to
produce autonomic responses comparable to those produced to visual
representations of feared stimuli. These data support the notion
discussed earlier that imagery and ruminative thoughts can play
an important role in the maintenance of phobic disorders. May's
(1977b) finding that some of his phobic subjects could not "turn
off" the images is an interesting example of this effect. A likely
explanation for this phenomenon is the cohesiveness of
propositional networks in phobics, as was suggested by Lang et
al. (1983).
Imagery Ability in Children
As noted earlier, many imaginal treatments used with adults
are used with children with little or no modification. Reviews of
the child treatment literature (Graziano, DeGiovanni & Garcia,
1979; Hatzenbuehler & Schroeder, 1978) have noted that the
majority of reports are case studies. The few well controlled
studies do not provide strong support for the effectiveness of
imaginal treatments with children. It is important to consider

31
developmental factors that can influence the ability of children to
benefit from such therapies. The discussion now turns to a
consideration of children's ability to use imagery.
Piaget and Inhelder (1971) noted that mental images and
symbolic schemata are the basis for conceptual thought. They
describe two types of imagery: reproductive imagery and
anticipatory imagery. Reproductive imagery refers to an
internalized representation of an overt sensory or motor event,
while anticipatory imagery is the manipulation of these mental
images. Anticipatory imagery ability develops at 7 to 8 years of
age. Piaget and Inhelder observed an improvement in children's
memory for changes in physical stimuli at approximately age seven
and suggested that this improvement was a function of storage of
this information in the form of images.
Much of the work on children's ability to use imagery is found
in the literature on learning and memory. One issue in this
literature is whether children's mental representations are pictorial
in nature, with imagery ability developing later, or whether the
reverse is true. The investigators typically hold a view of mental
images as pictures in the mind but it will be seen that many of
the results can be re-interpreted in terms of a propositional
network theory of memory.
Investigations of the effects of imagery as an aid to paired
associate learning generally have shown that younger children do
not benefit from the use of imagery to the same degree seen in

32
older children and adults. For example, Paivio and Yuille (1966)
found that children's memory for paired associates was not
enhanced when the items were concrete rather than abstract,
although the concrete items were assumed to be more readily
imaginable (Paivio, 1970).
Paivio and Yarmey (1966) compared the effectiveness of pictures
and concrete noun labels on performance of college students on a
paired associate learning task. They found that picture-word pairs
resulted in better performance than picture-picture pairs. Dilley
and Paivio (1968) noted that the superiority of picture-word pairs
was even greater in 4- to 6-year old children. Paivio and his
coileages suggested that the picture-word pairs were superior to
the picture-picture pairs because the pictures required decoding
before the child could make a response. They concluded that
children less than 7 or 8 years old, who have not yet developed
the ability to use anticipatory imagery, may have difficulty
making transformations between words and images, and vice versa.
Rohwer (1970) posed an alternative explanation for Paivio1 s
findings. He hypothesized that pictures are easier to remember, but
only when verbal labels are stored with them. He assumed that
younger children are unable to simultaneously store visual
information and verbal information, and that this ability increases
with age. He thus predicted that the superiority of pictures to
words in enhancing paired associate learning would increase with
age.

33
Rohwer (1968? cited in Rohwer, 1970) studied kindergarten, first
and third grade children and found that picture pair performance
was better than word pair performance; this difference was
increased with grade level. Performance on picture-aural
presentation pairs was compared with performance on
picture-picture pairs. Supplying the verbal label yielded superior
performance; however the magnitude of this superiority decreased
with increasing grade level. This supports the notion that the
children are increasingly able to provide their own verbal label
as they get older. A similar study was conducted on a group of
older children: third and sixth graders (Rohwer, Lynch, Levin &
Suzuki, 1967). Pairs of words were presented either as pictures or
as printed words. All subjects heard the words read aloud. For
both grades, better performance was obtained for the picture pairs
than for the word pairs. The superiority of the pictures was
greater in the third grade group.
Rohwer (1970) concluded that if imaginal representations of
items are more likely to be elicited with pictorial than verbal
items, then imagery facilitates learning in children. He suggested
three possible explanations for the developmental trends observed:
1) the probability that imagery will be evoked is lower in younger
children than in older children; 2) the capacity for obtaining some
benefit from imaginal representations develops later than that for
verbal representations, and 3) the ability of imaginal storage bo
facilitate learning is dependent on concurrent storage of a verbal

34
label for that image, and that this ability is more likely to be
seen in older children. Note that Rohwer's data contradict the
notion that the ability for pictorial representation develops earlier
than the ability to learn from verbal representations of
information.
Rohwer and his colleages also studied the influence of
elaboration of images on paired associate learning in children. In
the Rohwer, Lynch, Levin and Suzuki (1967) study described
above, subjects heard one of three different verbalizations along
with the pictures. These verbalizations differed on the type of
connective used to link members of the noun pair. Thus, subjects
heard either a conjunction (i.e., the shoe and the chair), a
preposition (i.e., the shoe under the chair), or a verb (i.e., the
shoe taps the chair). The verb condition produced the most correct
responses, with prepositions being the next most effective. Rohwer
(1970) suggests that the three kinds of connectives evoke different
types of imagery and reasons that action imagery (verb) is more
memorable than static imagery and that locational static images
(preposition) are more memorable than coincidental static
(conjunction) images. For the third graders, there was a linear
relationship between type of connective and learning. For the sixth
grade subjects, the preposition facilitated learning to the same
degree as the verb connective. The researchers suggested that
older children have a lower threshold for the use of faciUtory
processes than do younger children.

35
Rohwer, Lynch, Suzuki and Levin (1967) compared the effects of
verbal and pictorial elaboration. Elaborations used in both
conditions corresponded to those used in the study just described.
In the verbal mode, verb connectives produced the best
performance, while in the depiction mode, the greatest facilitation
of learning occurred with action pictures. There were no
developmental differences in the relative efficacy of the verbal and
visual response modes.
A closer study of these trends (Rohwer, Lynch, Levin & Suzuki,
1968) examined the effects of only four verbal-visual conditions
used in the previous study. These were naming-coincidental,
naming-action, verb-coincidental, and verb-action (the coincidental
condition refers to the two items pictured together, but not
interacting). For all three grade levels, the elaboration conditions
produced better recall than the naming-coincidental condition. A
grade by condition interaction was obtained. For kindergarten and
and first grade children, the verb-coincidental condition produced
more facilitation than the naming-action condition. The reverse was
true for the third and sixth graders. The authors suggested that
the older children are better able to make use of the imagery
evoked by the action depiction. A possible explanation for this is
that younger children do not store an appropriate verbal label
with the action image. Thus, younger children obtain more benefit
from hearing a sentence with the picture than do the older
children. This explanation is consistent with the data.

36
The studies just described provide support for Rohwer's (1970)
contention that while action imagery can facilitate performance, the
ability to obtain full benefit from this imagery develops later than
the ability to benefit from verbal elaboration. Rohwer suggests
that this developmental trend is due to the fact that the well
organized linguistic system develops earlier than the less
organized imaginal mode. This view is counter to the more widely
accepted notion that the capacity for visual representation develops
earlier than that for verbal representation.
Reese (1970) notes that imagery facilitates learning in older
children and adults, but that less faciliatation is observed in
younger (i.e., preschool) children. He suggests several possible
explanations for this observed developmental trend. The first is
that facilitation depends on covert verbalization of the image and
that young children are less able to do this. However, Reese notes
that this view contradicts the notion that young children's thought
is primarily iconic, and that one would expect sentences to
interfere with retention. A second explanation is that visual
memory is less effective than verbal memory in young children.
This view also contradicts the belief that young children's thought
is primarily imagery based. A third explanation is that young
children ignore pictured interactions between objects and code the
information as if no elaboration was presented. Thus, younger
children may have difficulty with the production of mediators.

37
Another alternative explanation is that young children can
encode information visually, but that they are unable to decode it
verbally. The work by Paivio and his colleagues provides some
support for this notion. However, some work cited suggests that
young children have difficulty producing mediators, rather than
that they have problems decoding the mediator. Further, Reese
points out that in mediation studies, in which a deficiency is
observed, the mediator is conditioned to the stimulus and response;
yet in paired associate studies, the mediator is not conditioned,
but suggested by the image. Control subjects have an equal
opportunity to learn the links, but perform less well than imagery
groups. A fifth alternative proposed by Reese is that the materials
used to evoke images are deficient in detail, and thus are not
adequate to evoke imagery in younger children, or at least not to
produce images that are sufficiently vivid to enhance memory. The
final alternative presented does not hold that imagery is less
effective with young children, but rather, that young children fail
to "read" the pictorial materials used to evoke images. The child
may form images of the stimulus and response items, but even a
picture of the objects interacting fails to produce an image of this
interaction. Reese suggests that a sentence can produce imagery
since the elements and their interaction are explicitly named.
Reese concludes that facilitation of memory does not result from
imagery per se, but from integrated imagery, which provides
contextual meaning for the object to be remembered.

38
Reese's (1970) point regarding the inability of certain materials
to evoke imagery in children supports the contention of many
clinical researchers (Elliot & Ozolins, 1983; Graziano, DeGiovanni,
& Garcia, 1979; Harris, 1983). A study by Wolff and Levin (1972)
shows that children may need more powerful, or more elaborate,
stimuli in order to be able to use imagery. They studied the role
of overt motor activity in the formulation of mental images.
Kindergarten and third grade children were presented with pairs of
actual toys in a paired-associate learning task. Four learning
conditions were investigated. In the first, the control condition,
children were simply instructed to remember which toys go
together. In the imagery condition, children were told to form an.
interactive image of the toys. In the third condition, the child
watched the experimenter manipulate the toys in an interactive
way, while in the fourth condition, the child was encouraged to
manipulate the toys on his own. Memory was tested by recognition.
The children were asked to select the response toy from an array
of several toys. This method avoided the necessity of having the
child decode a visual image to a verbal response. Wolff and Levin
found that the two manipulation conditions produced significantly
better performance than the imagery and control conditions. For
kindergarten students, the manipulation conditions did not differ
significantly from one another. For the third grade subjects,
performance in the two manipulation conditions and the imagery
condition was significantly greater than the control condition.

39
These three conditions were not significantly different. The
findings provide support for the notion that dynamic imagery does
not develop until the age of seven.
A second study of kindergarten and first grade children showed
that it was the actual manipulation of the objects and not just
observation of the interaction that produced enhanced memory. The
authors concluded that up until the age of five, the formation of a
dynamic image depends on concomitant motor output, that
duplicates the form of the percept. With development, formation of
images becomes less dependent on overt motor activity. Although
results of other studies described indicate that children are able
to generate imagery upon instruction, with the aid of pictures or
even without external cues, these findings emphasize the need for
researchers and clinicians alike to attend to children's special
abilities when using imagery.
Kosslyn (1976) examined the question of whether children use
imagery to retrieve semantic information. First graders, fourth
graders and college students participated in a pair verification
task. For example, a subject might be asked to verify whether "a
mouse has whiskers" was true. Kosslyn looked at two dimensions of
the properties to be verified: size of the detail and the association
strength. He hypothesized that if imagery was used, a longer
*
reaction time would be found for smaller details than for large
details. Further, with imagery, it was expected that the strength
of the association would be related to reaction time. Kosslyn

40
assumed that adults would use non-imaginal methods, while
children would use imagery to complete the task. Thus, no
difference was expected for children with or without imagery
instructions, while adults were expected to be slower when forced
to use less effective imagery. Subjects completed two blocks of pair
verifications, first without imagery and then with instructions to
use imagery. The true properties were either high association/low
area or low association/high area. Area refers to the size of the
imagined object, while association refers to the strength of the
relationship between a property and a noun (i.e., whiskers and
cat).
Kosslyn's hypotheses were borne out by the data: reaction times
decreased with age. Imagery instruction did not influence
performance of the younger children, while adults performed more
slowly. In addition, in the no imagery condition, high
associationAow area properties had faster reaction times, while low
association/high area properties were responded to more quickly in
the imagery condition. Kosslyn inquired to the strategies subjects
used in the no imagery condition. The number of subjects reporting
the spontaneous use of imagery decreased with age. Those first
graders reporting that they did not use imagery showed a similar
effect of item type as was seen with the adults, that is; high
associationAow area properties were verified more quickly. The
results of this study suggest that adults who do use imagery
spontaneously do it more quickly than children. Perhaps the adults

41
use the imagery more efficiently, imaging, for example, only the
relevant parts of the object. Furthermore, the fact that first
graders did not respond most quickly to the high association items
as did the fourth graders and adults suggests that there are some
qualitative changes in memory with development.
Prawat and Kerasotes (1979) extended Kosslyn's work with a
few methodological changes. Different subjects participated in the
imagery and no imagery conditions, and pictures were used in the
imagery condition. In addition, Prawat and Kerasotes defined two
types of meaning: perceptual and functional meaning. It was
expected that if children used imagery to retrieve semantic
information, perceptual properties would be responded to more
quickly, since these should be more easily imaged. This hypothesis
is based on the view of images as pictures in the mind. An
interaction was expected between type of meaning and saliency
(association) such that for perceptual features large sizeAow
saliency properties would have faster reaction times, while for the
functional properties, small size/high saliency items would be
responded to more quickly. Second grade students served as
subjects in this study.
There was a main effect of property type, with perceptual items
having faster reaction times, supporting the view that children do
use imagery. However, children in the imagery condition did not
retrieve semantic information more quickly. The authors suggest
two possible explanations for this; either subjects cannot make

42
effective use of the induced imagery, or control subjects
spontaneously used imagery in an effective manner. Additional
comparisons showed that the imagery group took longer than the
control group to respond to perceptual items; however, there were
no differences between groups on reaction time for large versus
small items. The authors suggest that induced imagery may
interfere with spontaneous imagery. The authors also found that
high saliency items were responded to more quickly than low
saliency items, while there was no such difference for the
perceptual items.
The studies discussed in this section suggest that children are
able to use imagery to enhance memory, to a limited extent. Young
children may have difficulty with the transformations required to
form images from verbal information and to decode images to
language. Young children may not be as likely to use imagery
spontaneously, and stimulus materials may need to be richer in
detail than those typically used with adults. The findings obtained
in the studies reviewed can be discussed in terms of a
propositional theory of memory. It seems that memory networks in
children may be less well organized or more immature than those
in adults. Wolff and Levin's (1972) finding that overt motor
activity is important to image formation suggests that more
powerful stimuli are needed to evoke the image network or to form
associative links. However, research is needed to determine what
"more powerful stimuli" really means. It could be that children

43
need to have stimuli that are as realistic or as detailed as
possible, such as actual objects or films. It may mean that
children may be better able to imagine objects or situations for
which they already have a propositional memory network. Or, it
could mean that to-be-imagined stimuli need to be more emotionally
salient for children. Viewing the findings of Kosslyn (1976) and
Prawat and Kerasotes (1979) in terms of network theory suggest
that the more rapid performance of adult subjects could be a
function of the better organization and stronger associative links
in their memory networks. The fact that high association stimuli
were responded to more quickly in the Kosslyn (1976) study
supports the notion that the spread of activation along strong
associative links in the memory network facilitated responding.
That some children also responded more quickly to high association
items suggests that propositional memory networks are present in
children. Subjects were first graders, approaching Piaget's stage
of concrete operations. Perhaps some of the subjects had already
reached this stage, and concomitantly had developed the capacity
for better organized propositional networks of memory.
Affect and Memory
Thus far, this paper has examined relationships between
imagery and memory in order to understand developmental
considerations that may be relevant to the use of imagery in
treatment of children. Since these treatments can require that the
child retrieve memories of emotionally laden situations, it is

44
important to consider the influence of affect on memory.
Bower (1981) noted that an adult subject's affective state can
serve as a contextual cue that can aid recall of material learned
while in that state. He used hypnosis to vary the mood of his
subjects during learning and recall of two word lists. He found
that recall was improved when the mood at learning and recall
were congruent, and that recall was impaired if the moods at each
point were opposites. Using a propositional theory of memory
(Anderson & Bower, 1974), Bower suggested that when a subject
stores information in memory, that affect can serve as a context,
and that contextual information is stored in propositional nodes.
When a subject attempts to recall information when in the same,
mood as during learning, activation from the affect nodes spreads
throughout the network, summing with activation from the context
nodes, thus facilitating recall.
Similar results have been obtained with children. Bartlett,
Burleson and Santrock (1982) conducted an experiment to determine
whether memory traces for verbal stimuli included information
about the subjects' emotional state during learning. They
hypothesized that if this was so, then the subjects' emotional state
could serve as an effective cue for the retrieval of information.
Subjects were 5- and 8-year-old children. Subjects learned two
lists of words and recalled them immediately and again following a
ten minute delay. Prior to learning each list, either a happy or
sad mood was induced by having the child think of a personal

45
experience appropriate to the mood. The opposite mood was induced
prior to learning of the second list. For recall, half the subjects
in each condition then experienced a happy mood, the other half
experienced a sad mood. Thus, there were four conditions of happy
(H) and sad (S) moods; H-S-H, H-S-S, S-H-H, S-H-S.
In the first experiment a relaxation exercise preceded all other
procedures. No state dependent learning effect was obtained.
Relaxation was omitted in the second experiment. In this
experiment, a clear state dependent effect was observed, with
greater recall occurring for the list learned in the mood equivalent
to the mood at recall. This effect occurred for both age groups.
This affect dependence was asymmetrical; a happy mood at test
produced greater recall than a sad mood for a list learned while
happy; no such effect was obtained for lists learned in a sad
mood. Bartlett et al. (1982) concluded that affect can serve as an
effective retrieval cue, but noted that relaxation can preclude this
state dependent effect. They suggested that the perception of
emotional arousal is a prerequisite for the experience of emotion
and that relaxation seems to decrease the intensity of the emotion.
Nasby and Yando (1980) conducted a similar study; they
examined the influence of mood on the recall of affectively valent
information. Subjects in this study were fifth graders who were at
least 10 years old. Moods were induced in the same manner as in
the Bartlett et al. (1982) study. A happy or sad mood was induced
prior to list learning. Either the same or opposite mood was

46
induced for the free recall test condition. Only one word list was
used; these words were slightly positive, highly positive, slightly
negative and highly negative. Mood at retrieval had no effect on
recall; however mood at encoding did affect performance for girls
only. Happy mood at encoding facilitated learning of slightly and
highly positive words, and disrupted learning of slightly negative
words. Sad mood at encoding disrupted learning of positive
material, but did not facilitate learning of negative words. This
asymmetrical effect is similar to that seen in the Bartlett et al.
(1982) study. Nasby and Yando (1980) noted that studies in the
literature have reported that mood at retrieval (rather than at
encoding) influences recall in adults, and they suggest that there
may be an age related shift in ability to regulate the influence of
mood on encoding and retention of affective materials.
In another study, Nasby and Yando (1982) repeated the same
design, but also varied the frequency of word usage, and position
of the word on the list. Fifth graders (mean age = 10.75 years)
were used as subjects. As in the previous study, a selective
encoding effect was obtained for the medium and high frequency
words only. A happy mood at encoding resulted in the recall of
more high and medium frequency positive words. A sad mood at
encoding disrupted recall of positive words. No selective encoding
of negative material was observed. Unlike the previous study, a
selective retrieval effect was also found. Happy mood at retrieval
facilitated the recall of positive words, while sad mood did not

47
disrupt recall of positive material. No selective retrieval occurred
for negative material. Congruence of mood at encoding and
retrieval did not produce superior recall to incongruent moods;
thus there was no affective state dependent effect. Note that
studies with adults (Gil ligan & Bower, 1984) obtained state
dependent effects only when two word lists were used. So, while
moods do have some impact on memory in children, the effects seen
in this study do not mirror those obtained with adults.
A second experiment reported by Nasby and Yando (1982)
examined the influence of an angry mood on recall. Angry mood at
encoding disrupted recall of positive words, but facilitated recall
of highly negative words. Anger at retrieval did not have any
effect on performance. No state dependent effect was obtained with
the angry mood.
The authors note that the pattern of results obtained differs for
children and adults. For both, positive mood facilitates the recall
of positive material. For children, negative mood inhibits the
recall of positive information, while this is not the case for
adults. Nasby and Yando suggest that the ability to regulate mood
states could be an important quality that changes with
development. Thus, adults may be better able to maintain positive
moods and avoid or eliminate negative moods. They point out that
this ability to regulate the effect of moods can have an important
influence on the learning of overt behavior. These findings also

48
support the contention that memory networks in children are less
well organized than those in adults.
The studies just described focused on affect-dependent memory
for isolated word lists. Bartlett and Santrock (1979) examined the
influence of mood on episodic memory. This approach can yield
more information relevant to clinical issues. Preschoolers (mean
age 5 years 7 months) were tested for memory of a list of words
presented in the context of a story. Pictures were presented to aid
recall. A 2 X 2 factorial design was used, with happy vs. sad
mood at input and happy vs. sad mood at recall. Mood was
induced at input by having the experimenter tell a story that was
either happy or sad. The same words were incorporated into both
happy and sad stories. Mood at recall was induced by having the
child look at a series of happy or sad pictures. As a manipulation
check, children were asked to point to one of two faces (smiling or
frowning) to indicate how each story made him feel. At both input
and retrieval, the experimenter acted in a manner appropriate to
the mood being induced. A variety of retention tests were given.
The free recall data indicated that subjects who learned words
while in a happy mood had better recall when tested in a happy
mood than when tested in a sad mood. There was no significant
difference between test moods for subjects who learned words while
in a sad mood. These results indicate that a change in affect can

49
influence children's ability to generate appropriate retrieval cues.
As in the other studies discussed, an asymmetric effect was
obtained.
Children's Responsivity to Imagined Stimuli
Studies reviewed thus far have shown that imaginal treatments
can be very effective in the treatment of adult phobic disorders,
and that it is important to consider the patient's physiological
responses during imaginal treatment. This area is poorly
researched with children (Johnson & Melamed, 1979). A review of
the literature on imagery and memory in children reveals that
while children do have an ability to use imagery to enhance their
memory, they do not do this as effectively as adults. They may
have difficulty with transformations between verbal and imaginal
materials (Paivio, 1970), they may not use imagery spontaneously
(Kosslyn, 1976) or they may need very detailed stimuli in order to
evoke imagery (Wolff & Levin, 1972).
When using imagery to treat child patients developmental
factors must be taken in to consideration. For example, the
therapist cannot assume that children create images in the manner
in which they were instructed. Children may elaborate upon the
images, and these elaborations themselves may be important. The
meaning assigned to a given image must be considered as well, as
this may vary from child to child. For example, one child asked
to imagine a teacher at school might image a positive situation,
with a benevolent teacher providing positive reinforcement. A

50
second child, however, may imagine himself being punished by the
teacher; this child is likely to find the imagery experience to be
quite unpleasant.
Rosenstiel and Scott (1977) recommend that imagery scenes be
tailored to the age of the child. They also suggest that involving
the child's existing fantasies into an imagery procedure may
decrease the complexity of the scenes and may help to maintain the
child's interest during the procedure. Having the child report
specific details of the procedure is expected to enhance image
clarity for the child. Finally, Rosenstiel and Scott (1977) suggest
that children may have difficulty describing their behavior and
images. Thus, attending to non-verbal cues such as fidgeting, skin
flushes, or heart rate change may provide the therapist with
useful information about the effects of the scene on the child
(i.e., changes in anxiety level).
All of the treatment studies described thus far have examined
physiological responsivity of adult subjects. Only two studies in
the literature have considered children's physiological responses to
imagery. It is important to investigate this issue in children for
two reasons. First, children present to treatment centers with a
variety of phobic concerns. Although imagery is used in a number
of treatments for children, there are few data on the effectiveness
of these approaches (Hatzenbuehler & Schroeder, 1978). Second, an
understanding of developmental changes in the phenomena described
in this paper may yield important information on the etiology of

51
phobic disorders and on the structure of phobic disorders in
children.
Tal and Miklich (1976) studied 10- to 15-year old children with
chronic asthma. The children were asked to imagine neutral,
fearful, and anger-arousing situations. Increased heart rate and
decreased expiratory flow rates during imagery occurred in the
fear and anger sessions. Neutral images resulted in slowed heart
rate and increased expiratory flow rates. The heart rate increases
suggest that the imagined scenes (fear and anger) did produce
arousal, which was associated with pulmonary function.
Hermecz and Melamed (1984) used Lang's paradigm (Lang, 1977,
1979; Lang et al., 1980) to study imagery in 6- to 12-year-old
dental patients. It was expected that children would not be able
to generate emotions as effectively as adults and that they may
need additional aids, such as a modeling film, to generate
appropriate emotional imagery (Lang, 1977).
Children were given either stimulus or response imagery
training. Imagery training included two trials on each of two
action oriented scenes: riding a bicycle and flying a kite.
Following imagery training, the child viewed a film about dental
treatment. Each group saw the same videotape; however, the
soundtracks differed according to the type of imagery training
given. Thus, the sound track for stimulus subjects focused on
descriptive aspects of dental treatment, while the response film
focused on expected physiological responses to treatment. After film

52
viewing the child was taken to a dental operatory, where
restorative treatment was performed.
Results indicated that there was a borderline interaction
between condition and scene, with response subjects showing
greater heart rate increases to the first practice action scene. On
trial two of scene one, response subjects showed an increase in
heart rate during imagery with decreased heart rate during the
subsequent recovery period. This pattern is consistent with that
seen in adult patients. Similar results were obtained with the
respiration data. Response subjects indicated greater image clarity
across scene types, while clarity decreased across scene types for
stimulus subjects. While there were no significant differences in
physiological responsivity during film viewing, response subjects
showed differential responding across scene contents. Stimulus
subjects responded in the same way across scenes. In the
operatory, response subjects were more disruptive than stimulus
subjects during dental treatment. For the response subjects, there
was a significant correlation between overall disruption and
self-reported dental fear. These children thus showed concordance
between self-report and behavior following response training. Thus,
children do appear to be able to generate physiological responses
to imagined scenes. Support was obtained for the notion that
response training is more effective in eliciting these responses
than is stimulus training.

53
Children and the Bio-informational Theory
The studies described in the previous two sections support the
notion that children do store emotional information in memory. As
was the case with the adults studied by Bower and his colleagues
(Bower, 1981; Gilligan & Bower, 1984), affective information
appears to function as a contextual cue that can influence memory
performance in children. However, the results of studies described
in this paper suggest that there are some differences in the
imagery ability of adults and children, as well as in the
emotional memory functions of these two age groups. For example,
adults may be able to perform a paired associate learning task by
forming an interactive image; children, however, need to
manipulate actual objects in order to form such an image.
Klingman, Melamed, Cuthbert and Hermecz (1984) obtained similar
results in an emotionally laden situation. They found that children
about to undergo dental treatment benefitbed more from a modeling
film that allowed them to actually practice coping skills than from
a film that only told them what techniques they could use to cope
with treatment. Thus, children may need to engage in motor
behaviors in order to store some types of information in their
emotional networks.
Some researchers (Gilligan & Bower, 1984; Kagan, 1984) suggest
that infants are born with an innate emotional structure. They
note however, that the fact that there are changes in the structure
and function of the nervous system throughout development makes it

54
unlikely that emotional functions in children and adults are alike.
Rather, the emotional systems of children are modified throughout
develpraent via the processes of learning and acculturation.
Nevertheless, there is research that suggests that emotions and
memory are linked together even in infancy. It has been widely
reported (Lewis & Rosenblum, 1974) that infants develop a fear of
strangers at approximately eight months. It is generally held that
certain cognitive changes are required for the development of this
fear; the infant needs to develop a memory schema for familiar
people, and then to be able to compare the stranger with his
schema for familiar people (Schaffer, 1974). A discrepancy between
the stranger and the schema leads to fearful reactions. This
phenomenon is important to the bio-informational theory for two
reasons. First, it shows that emotional reactions are linked to
memory even at a very young age. Second, the fact that infants
develop this fear at a fairly predictable time suggests that
maturational factors are involved in the development of emotions.
Many of the studies on imagery and memory described in this
paper found that changes in the abilities of children occurred at
approximately age seven or eight, concurrent with movement into
Piaget's stage of concrete operations. It is likely then, that
research on children's emotions will find some qualitative
differences between emotions in children and adults; these
differences are likely to be diminished throughout childhood.

55
With regard to the bio-informational theory, several differences
between children and adults can be postulated. First, there is
likely to be less information in the emotional networks of children,
by virtue of the fact that they have fewer experiences that can be
stored in memory. It may be that subtle nuances of various
situations are absent in the networks of children, and this
information may not be understood. Second, the links between
propositions in children's memories may be less well organized,
and the associations between propositions may be less coherent
than is the case in adults. Children may need stronger stimuli
than do adults in order to access the emotional networks. The
studies by Wolff and Levin (1972) and Klingman et al. (1984)
suggest that motoric information is integrally bound to the other
information stored in children's memories. Finally, children may
not be able to use imagery as effectively as adults. Imagery
ability for emotional stimuli is likely to vary with age, as is the
case for imagery ability in memory tasks. There is evidence (Tal &
Miklich, 1976) that older children can generate emotional images.
The results of the Hermecz and Melamed study suggest that
children may be able to benefit from imagery training. That study
did not do a physiological assessment of emotional imagery;
however, response training did influence children's responses to a
film about dental treatment.

56
Statement of the Problem
The literature reviewed in this paper suggests that imagery
ability in children follows clear developmental trends. Young
children are often not able to use imagery in memory tasks;
further they may not be able to transform information from the
verbal mode to the visual (or imaginal) mode, and vice versa.
These findings have important implications for the use of imagery
in child treatment. Specifically, therapists need to evaluate the
efficacy of these treatments and to attempt to specify the ways in
which children actually apply imagery instructions.
It has also been seen that physiological responses during
imagery play a significant role in the efficacy of treatments such
as systematic desensitization. However, with only two exceptions,
this research has not been applied to children.
The purpose of the study presented here was to extend the work
done by Hermecz and Melamed (1984) on emotional imagery in
children. This study demonstrated that children can generate
physiological responses to action scenes. It is not clear, however,
whether children can show differential responding across different
scene contents, or whether the results obtained are simply artifacts
of the imagery task demands. In addition, subjects in the Hermecz
and Melamed (1984) study were not selected for fearfulness.
The present study compared the responsivity of high and low
dentally fearful children to three imagery contents: dental fear,
school fear, and neutral. Children were given either stimulus or

57
response imagery training. The study was designed to address
three major issues:
1) Can children imagine scenes from structured stimuli (text)
and generate physiological responses appropriate to scene content?
Do they show differential responsivity to the different scene
contents?
2) Do fearful and non-fearful children show different patterns
of responsivity?
3) Do stimulus and response training have a differential effect
on responsivity?
In addition to these issues, the study also examined changes in
self-reported and observer rated fear as a result of exposure to
the imaginal materials. The relationship between reported imagery
ability and responsivity was investigated in an exploratory
fashion.
Hypothesized results were as follows:
1) Fear scenes would evoke greater heart rate responses than
would neutral scenes.
2) Responses to dental fear scenes would be greater in the
fearful versus non-fearful children.
3) Responses to fear scenes would be greater in response
trained versus stimulus trained subjects.
4) There would we an interaction between fear level and
training, such that high fear response trained subjects would show

58
greater response magnitudes than high fear-stimulus trained
subjects.
Although skin conductance was assessed during the study, no
specific predictions were made about skin conductance responsibity,
as some studies reported that skin conductance increases during
fearful imagery (i.e., Grossberg & Wilson, 1968), while other
studies reported that skin conductance decreases were observed
during imagery (Lang et al., 1983).

METHOD
Design
The basic study design included a 2 (fear level) x 2 (imagery
training) x 3 (scene content) design. Fear level (high vs. low
dental fear) and imagery training (stimulus vs. response) were
between subjects variables. Scene content served as a within
subjects variable. The scene contents (Appendix A) were dental
fear (examination and injection), school/social fear (going to the
principal, speaking in class) and neutral scenes (sitting in the
living room, sitting in a lawn chair). The neutral scenes were
designed to be without affective content or physiological response
demands. The school scenes were included for the purpose of
comparison. Since children were selected for dental fear, it was
expected that children would show differential responsivity to
dental content. Examination of responsivity to the school scenes
provided information about whether dentally fearful children are
generally responsive no fearful items, or whether they can
discriminate between contents that are fearful for them and those
that are not. Further, it was expected that some of the children
who were not dentally fearful would show increased responsivity to
the school related scenes. However, no group differences in
responses to the school fear scenes were expected a priori.
59

60
Subjects
Subjects were 24 children ranging in age from 6 to 12 years
old selected by their scores on the Children's Fear Survey
Schedule—Dental Subscale (Melamed, Hawes, Heiby & Glick, 1975;
Scherer & Nakamura, 1968; see Appendix B). This measure has been
shown to be useful as a screening instrument to identify children
high in dental fear (Cuthbert & Melamed, 1982). This questionnaire
was distributed to children in a variety of community organizations
and schools. Children scoring one standard deviation above or
below the mean for their age and sex were asked to participate in
additional screening activities to determine eligibility for the
study. Children with obvious physical or mental handicaps or
cardiovascular problems were excluded from the study.
Apparatus
Heart rate was measured using two Beckman Standard Size
Ag-AgCl electrodes placed on opposite sides of the lower rib cage.
Electrolyte gel was placed inside the electrodes. These were
attached to a Coulbourn Instruments Hi-Gain Bioamplifier/Coupler
Model S75-01. Skin conductance was measured with two Coulbourn
standard Ag-AgCl electrodes placed on the hypothenar eminence of
the left hand. These electrodes were filled with Johnson & Johnson
K-Y Jelly and were connected to a Coulbourn Instruments Skin
Conductance Coupler, Model S71-22. Data collection was controlled
by an MDB microcomputer. Ratings of emotion were made using the

Figure 1. The Self-Assessment Mannequin

PLEASURE
AROUSAL
DOMINANCE

63
Self-Assessment Mannequin (SAM; Green wald, 1987; Lang, 1980;
Figure 1). Visual presentations of the SAM figure were presented
by computer on an Amdek Video-300 in the subject room. All tape
recordings were played via speaker using a Eumig cassette player.
Procedure
Each subject participated in three sessions: an initial
screening session and two experimental sessions. All dental
treatment in this study was provided by faculty dentists from the
Department of Pediatric Dentistry at the University of Florida.
Screening
Parents of children scoring in the appropriate range on the
Dental Subscale were contacted and asked to bring their child to
the dental clinic for a screening examination. After informed
consent was obtained (Appendix C), each child was given a brief
examination to determine whether he or she had at least two
cavities that could be filled as part of the study. Children
meeting this criterion were then given the Peabody Picture
Vocabulary Test (Dunn & Dunn, 1981). Children scoring below 85
were excluded from the study. Next, bitewing x-rays were taken.
Finally, parents completed the Subject Data Form (Appendix D),
which provided demographic information as well as information
about the previous dental experience of the child. Parents were
asked to rate their child's fear and cooperation during past dental
examinations and dental injections.

64
Session 1
Upon arrival at the clinic, each child was administered the
full version of the Children's Fear Survey Schedule (Melamed,
Weinstein, Hawes & Katin-Borland, 1975; Scherer & Nakamura, 1968;
Appendix E). This provided a measure of general fearfulness as
well as dental fearfulness; the Dental Subscale is embedded within
this measure. This measure also includes items about school and
social situations. A subscore based on these items was compared
with the children's physiological responsivity to the school scenes.
Next, children saw the dentist to have a filling done. This was a
standard procedure for all children, involving an anesthetic
injection, placement of a rubber dam, and drilling. When treatment
was completed, the dentist rated the child's cooperation and
fearfulness using two ten-point scales (Appendix F). Dentists were
blind to each subject's fear level and group assignment. Dental
treatment was videotaped. These tapes were later scored for the
child's disruptive behaviors with the Behavior Profile Rating Scale
(Melamed, Hawes, Heiby & Glick, 1975; Appendix G).
Following dental treatment, the child was taken to the
laboratory for imagery training. First, the child completed the
Sheehan (1967) version of the Betts (1909) Questionnaire Upon
Mental Imagery (QMI; Appendix H). Some modifications were made
in the use of the QMI for this study. Children rated the vividness
of imagery to a variety of items by pointing to one of a series of
photographs of keys. The photographs varied in the degree of

65
focus, from very clear to extremely blurry. If a word on the
questionnaire was unclear to the child, a definition was provided
from a standard list. The QMI has been shown to be predictive of
physiological responsivity and reported image vividness in adults
(Miller et al., 1981), but the scale has not been used with
children. Thus, test-retest reliabilty was determined on a separate
sample of children. Reliability on a sample of 11 children was
r=.83, pC.OOl. There was an average of 27.8 days between testing
sessions for the reliability study, although for most children,
sessions were one to two weeks apart.
Next, the child completed the Measure of Communication
Apprehension (MECA; Garrison & Garrison, 1979; Appendix I). This
measure of public speaking anxiety was used in an exploratory
fashion, in order to determine whether there was a relationship
between reported public speaking anxiety and physiological
responsivity to the school related scenes during imagery. The MECA
has been shown to be both reliable and valid (Garrison &
Garrison, 1979) and to be sensitive to changes in public speaking
anxiety resulting from behavior therapy (Harris & Brown, 1982). As
only half of the children in this study completed this
questionnaire, results will not be discussed here.
After completion cf these measures, the child was given a
relaxation exercise (Koeppen, 1974; Appendix J). This exercise was
designed for use with children, and involves tension-relaxation
cycles for eight muscle groups. Relaxation training was given

66
during Session 1 to familiarize the child with this procedure since
it was used during the second session. During this exercise, the
child was seated in a reclining chair. The overhead light was
turned off, and a dim floor lamp was turned on.
After the relaxation exercise, the child was given imagery
training. Half of the children in each dental fear group were
given a "response" imagery set, while the remaining children were
trained so as to provide a "stimulus" imagery set. Children in
each fear group were matched for sex, age, race and dentist and
then randomly assigned to a condition. Two action scenes were
presented twice to each child. One scene described flying a kite,
the other, riding a bicycle. Action scenes were used because they
have been shown to generate physiological responsivity when they
contain response propositions, yet they are not affectively
frightening.
Stimulus group
Each scene was tape recorded and presented to the child via a
speaker. The child was instructed to close his or her eyes and to
imagine the scene as it was being read. The stimulus oriented
instructions encouraged the child to create a detailed mental
picture of the situation, including as many descriptive aspects as
possible. The child continued to imagine the scene after the
presentation for an additional 20 seconds. The child was then told
to relax his or her muscles (20 seconds). Next, the child was
asked a series of questions about the imagery experience. These

67
focused on the stimulus aspects of the situation (i.e., Could you
see the kite dancing in the wind?). Verbal praise was provided
each time the child reported having imagined a stimulus aspect of
the scene. The same imagery script was then repeated, followed by
two trials for the second script. These imagery training procedures
are listed in Appendix K.
Response group
The procedures used for the response group were nearly
identical to those used for the stimulus group (see Appendix L).
However, the scenes required that the child focus on his/her own
physiological responses during the imagined scene rather than on
stimulus aspects. Each scene contained one response proposition
from each of the following systems: heart rate, sweating,
breathing, muscle tension and eye movement. Questions presented to
the child concerned the reponse aspects of the imagery (i.e., Did
you feel the sweat dripping down your face?). Verbal praise was
given contingent upon the child's report of response propositions
in imagery. As was the case for the stimulus group, each scene
was repeated twice.
Session 2
Session 2 took place approximately one week after Session 1 in
which all subjects had undergone routine restorative dental
treatment. In the laboratory, children were seated in the reclining
chair. Following electrode placement the lights in the room were
dimmed. Next, the imagery procedure was explained to the child

68
(Appendix M). The child was questioned to insure complete
understanding. In addition, an experimenter remained in the room
with the child to answer questions and to encourage maximal
cooperation with the procedures. Before beginning physiological
assessment the child completed the same relaxation exercise given
in Session 1. Children were rewarded with a sticker for cooperation
during electrode placement and again following cooperation with
the imagery procedure.
The imagery assessment consisted of seven scenes; a practice
neutral (data for this scene were discarded) and two scenes each
of dental fear (dental exam and dental injection), school fear
(blackboard and principal) and neutral (lawn chair and living
room) content. Children's emotional responses to these scenes were
evaluated in a pilot study on a separate sample of children. This
study is described in Appendix N. The scripts for all subjects
were identical, and all contained response propositions. Twelve
scene sequences were determined at the start of the study. Each
child in each of the four groups had a different scene order. The
scene orders were constructed so that each of the six scenes
appeared in a given ordinal position two times.
Data was collected during a pre-image baseline phase (rest
period). Each child was then instructed to imagine each scene as
it was read (read period). When the tape finished, the child
continued to imagine the scene until a tone was presented (image
period). When the child heard the tone, he/she then stopped

69
imagining, and relaxed all of his/her muscles (recovery period).
When a second tone was presented, the child opened his/her eyes
and made ratings of his/her feelings during imagery. This was
accomplished using the Self-Assessment Mannequin (SAM; Lang,
1980). SAM was presented by the computer, and appeared on a
video monitor on a counter near the subject. Three affective
dimensions were rated: pleasure, arousal and dominance. The child
used a joystick to adjust the picture of SAM until it best
represented his/her feelings. In addition, the child rated the
vividness of his/her image by moving an arrow along a rating
line. Children were shown the array of pictures used with the QMI
to help them make this rating. When the ratings were completed,
the child closed his/her eyes and waited for the presentation of
the next scene.
After completion of the imagery assessment procedure the child
was returned to the dental clinic for treatment of a second filling.
The same dentist performed both treatments for a given child.
Again, the session was videotaped. The dentist provided ratings of
the child's cooperation and fearfulness using the ten-point scales.
Finally, the Dental Subscale of the Children's Fear Survey
Schedule was administered to the child.
Data Scoring
Physiological Measures
Physiological measures were taken during each of the imagery
scenes, with separate values obtained for each phase of the image

70
presentation. This consisted of a 30 second rest period (baseline),
a 30 second read period, a 30 second image period, and a 30
second recovery period. Up to 50 seconds were provided for the
actual reading of the scene; however, data were collected only
during the final 30 seconds of this 50 second period. Difference
scores were computed in two ways. One method was to subtract the
value of the rest period baseline score from the value for the
period under consideration. For most of the analyses to be
described the read period was used as baseline with change scores
computed in the same manner.
Self-Report Measures
Items on the Children's Fear Survey Schedule and the Dental
Subscale are rated on a five point scale, with a score of 1
representing low fear, and a score of 5 representing high fear.
Scores on the full CFSS range from 50 to 250. Scores on the Dental
Subscale range from 15 to 75. The score for the question on
injection fear was used separately in correlational analyses. Items
on the QMI are rated on a seven-point scale, with a score of 1
representing maximum image clarity, and a score of 7
representing poor imagery. Scores range from 35 to 245, with lower
scores indicative of better imagery ability. Items on the MECA are
rated on a 1 to 5 scale, with a rating of 1 meaning "very happy/I
like it a lot" and a rating of 5 meaning "very unhappy/I really
don't like it". Scores on this measure range from 20 to 100, with
higher scores indicating greater public speaking anxiety. SAM

71
ratings and vividness ratings are scored by the computer using a
scale ranging from 1 (low pleasure, arousal or dominance) to 29
(high pleasure, arousal or dominance).
Observational Measures
Children's behavior during dental treatment was scored by
observers using the Behavior Profile Rating Scale (Melamed et al.,
1975). This scale consists of a variety of behaviors reported by
dentists to be disruptive to dental treatment. Each item is
weighted by the degree of disruptiveness it represents. Weights
range from 1 (i.e., inappropriate mouth closing) to 5 (i.e.,
leaving chair). Scores are based on the average score for the time
period in question, ie , overall session, injection, rubber dam
placement and drilling. Independent observers, who were blind to
subject group, used an interval sampling procedure to record
behavior. Two minute intervals were used to record the occurrence
or non-occurence of a given behavior. Times were marked on each
videotape using a time-date generator. This helped to maximize
accuracy by allowing the observer to review a difficult portion of
the tape. Raters scored eight practice videotapes before beginning
to make actual ratings. Further, regular discussions were held
with the raters to discuss problems in order to insure accuracy.
Table 1 lists the Spearman-Brown reliability coefficients for the
scores on the Beha vior Profile Rating Scale. All reliabilities were
in the acceptable range, with the exception of BPRS for the rubber
dam and drilling during the second treatment session.

72
TABLE 1
BEHAVIOR PROFILE RATING SCALE: INTER-RATER RELIABILITY
Session 1
Spearm an-Brown
Correlation Coefficient
Overall Disruptiveness
.8947*
Injection Disruptiveness
.9030*
Rubber Dam Disruptiveness
.9257*
Drilling Disruptivenss
.9501*
Mean, Session 1
.9184*
Session 2
Spearman-Brown
Correlation Coefficient
Overall Disruptiveness
.8753*
Injection Disruptiveness
.8584*
Rubber Dam Disruptiveness
.6675
Drilling Disruptiveness
.2821
Mean, Session 2
.6708*
*p<.001

73
Data Analysis
The data of this study were analyzed by Analysis of Variance.
All of these ANOVAs included Fear and Training as factors. Fear X
Training X Scene ANOVAs were computed for the SAM ratings.
ANOVAs for the physiological data (heart rate and skin
conductance) also included the factor of imagery period. Thus, the
analyses of the physiological data were Fear X Training X Scene X
Period. These ANOVAs were also repeated for each image period
individually. Thus, a Fear X Training X Scene ANOVA was run for
the read, image and recover periods for both heart rate and skin
conductance. The ANOVAs for the physiological data were repeated
a second time; this time the read period heart rate was used as
the baseline (instead of rest period heart rate). Since resting
heart rate was found to be correlated with age, Analysis of
Covariance was used for all analyses involving heart rate. Data
for the dental subscale, BPRS and dentist ratings were analyzed
with Fear X Training X Session ANOVAs. Comparisons between means
were made using the least significant difference test (LSD test).

RESULTS
Results of this study indicate that children do differentiate
between fearful and neutral imagery, both through their verbal
report of emotion and through their physiological responses.
Following a discussion of a pilot study of the scene contents,
demographic data and data relevant to each of the hypotheses
tested in the study will be presented. First data regarding the
main effects of scene content will be discussed. The effects of fear
level and of imagery training will then be considered.
Study I: Pilot Study of Scene Contents
In order to insure that children viewed the scenes used for
physiological assessment in accordance with the experimenter's a
priori designations as fearful or neutral, a pilot study was
conducted on separate sample of 22 children. There were seven
first graders, eight third graders and seven fifth graders. The
method and complete results of this study are described in
Appendix N. Children were asked to rate their emotional responses,
using SAM, to each of the scenes used in the main study. They
were also asked to rate the fearfulness of each scene. In addition,
children rated the similarity of each scene both to past
experiences and to situations that could happen in the future.
Results validated the manipulation of providing phobic dental and
74

75
social (school) scenes as compared to neutral scenes.
Pleasure
There was a main effect of scene on pleasure ratings
(F(5,95)=14.65, pC.0001). The ranking of scenes from most to least
unpleasant, is as follows: principal, dental injection, dental
exam, blackboard, living room and lawn chair. The blackboard
scene was rated the least unpleasant of all four fear scenes. This
scene was rated as significantly more pleasant than the dental
injection scene (LSD p<.05) and the principal scene (LSD p<.01).
The principal scene was rated as significantly more unpleasant
than all other scenes, including the dental fear scenes (LSD
p<.01).
Arousal
Again there was a main effect of scene (F(5,95)=2.46, p<.04).
The ranking of scenes from most to least arousing is: dental
injection, lawn chair, blackboard, dental exam, principal and
living room. The dental injection scene was rated as significantly
more arousing than the dental exam (LSD p<.05), principal (LSD
p<.05) and living room scenes (LSD p<.01).
Dominance
Dominance ratings also yielded a main effect for scene
(F(5,95)=5.93, pC.0001). The ranking of scenes from lowest to
highest dominance is as follows: principal, dental injection, dental
exam, living room, lawn chair, and blackboard. The blackboard
scene received significantly greater dominance ratings than did the

76
dental exam (LSD p<.05), dental injection (LSD p<.05) and
principal (LSD pC.Ol) fear scenes. The principal (LSD pC.Ol),
dental exam (LSD pC.Ol) and dental injection (LSD p<.05) scenes
were rated as significantly lower in dominance than the two
neutral scenes.
Fear
There was a significant main effect of scene on fear ratings
(F(5,95)=9.92, p<.00001). The ranking of scenes from most to least
fearful is: principal, dental injection, blackboard, dental exam,
living room and lawn chair. The principal and dental injection
scenes were rated as being significantly more fearful than all
other scenes (LSD pC.Ol).
Similarity to Past Experience
The ranking of scenes from most to least similar to past
experience is as follows: dental exam, lawn chair, dental
injection, blackboard, living room and principal (main effect of
Scene: F(5,95)=2.79, pC.02). The dental exam scene was
significantly more similar to past experience than the living room
(LSD pC.05) and principal (LSD pC.Ol) scenes. The principal scene
was significantly less similar to past experience than were the
dental injection (LSD pC.05), lawn chair (LSD pC.Ol) and dental
exam (LSD pC.Ol) scenes.
Similarity to Possible Future Experiences
Analyses of Variance on the children's ratings of the likelihood
that each of the situations could happen to them in the future

77
yielded no significant main effect of scene.
Study II; Tests of Hypotheses
Subject Demographic Data
Table 2 shows demographic data for subjects in each of the
four groups in the study. The high dental fear children had
significantly higher scores on the CFSS-DS across all three
measurement points than did the low dental fear children
(F(l,19)=44.04, p<. 00001, LSD pC.01). There were no significant
differences in fear scores between stimulus and response trained
subjects within each fear group.
High fear children in the study were significantly older than
the low fear children 'F( 1,20) =6.96, p<.02; 9.75 years vs. 8.25
years, LSD p<.05). It was difficult to control for this, as subjects
were self-selected to fear groups by their report of dental fear.
Further, this age effect is likely to represent the true nature of
this population, as there is a suggestion in the literature that
older children tend to report greater dental fear (Cuthbert &
Melamed, 1982; Winer, 1982).
Parent ratings were consistent with the childrens' own report of
fear. Thus the high fear children were rated as being
significantly more fearful than the low fear children during
previous dental examinations (F(l,17)=14.17, p<.002, LSD pC.01)
and previous dental injections (F(l,9)=11.43, p<.008, LSD p<.01).
Similarly, the high fear group was rated by their parents as
being significantly less cooperative than their low fear

78
TABLE 2
SUBJECT DEMOGRAPHIC DATA*
HIGH F
Stimulus
EAR
Response
LOW F
Stimulus
EAR
Response
N
7
6
6
5
AGE (years)
9.06
(1.40)
10.56
(1.40)
8.36
(1.90)
8.08
(0.87)
DENTAL FEAR
44.86
45.00
17.50
25.40
Pre-screening
(5.46)
(4.73)
(2.35)
(3.78)
Pre-Treatment 1
44.00
(6.98)
41.00
(6.07)
32.40
(11.59)
30.80
(12.59)
Post-Treatment 2
48.57
(12.39)
35.17
(10.05)
25.80
(8.53)
26.49
(11.48)
RACE
White
6
5
3
3
Black
1
1
3
2
SEX
Female
6
4
4
4
Male
1
2
2
0
PREVIOUS EXPERIENCE
Yes
3
6
5
5
No
4
0
1
0
* Means for each group are listed,
in parentheses below each mean.
Standard
deviations
are listed

79
counterparts during these past examinations (F(l,17)=8.60, p<.009,
LSD p<.01) and dental injections (F(l,9)=4.66, p<.06, LSD p<.05).
As was the case with the child's report of dental fear, parent
ratings of fear and cooperation were also correlated with age.
Thus older children were rated as being more fearful during both
examinations and injections (r=.5469, p<.02 and r=.7951, p<.01
respectively), and as less cooperative during injections (r—.7758,
p<.01). The dentists' ratings of fear and cooperation were
unrelated to the children's fear level. This is an interesting
result, which suggests that dentists' perceptions of their child
patients' fearfulness is not always in accordance with the child's
own self-report of fear.
The high dentally fearful children also reported greater general
fearfulness as measured by the CFSS (F( 1,19) =9.63, p<.006, LSD
pC.Ol). The high fear and low fear groups did not differ on the
number of children who had previous experience with dental
treatment. The groups did not differ in scores on the Questionnaire
Upon Mental Imagery or on a subset of questions from the CFSS
measuring social anxiety. There were no differences between groups
on the number of days between experimental sessions (chi-squared
test did not reach significance).
Imaqinal Responses to Affective and Neutral Content
Analyses of the main effects of scene content revealed that the
subjects did discriminate between fearful and neutral contents.
Fear scenes were rated as more unpleasant, and as lower in

80
perceived dominance, than were neutral scenes. Further, the
subjects showed a differential pattern of heart rate responding to
the two types of scenes. Specifically, children showed heart rate
acceleration during imagery of fear scenes and deceleration during
imagery of neutral scenes. Skin conductance responses also showed
differentiation between scene contents, with higher read period
skin conductance levels occurring to the fearful scenes. Tables of
means for affective ratings, heart rate and skin conductance can
be found in Appendix 0. Correlations between affective ratings and
physiology are also included.
Affective ratings
Pleasure. All four fear scenes were rated as significantly less
pleasant than the two neutral scenes (main effect of Scene:
(F(5,100)=23.49, p<.00001; LSD pC.01). The principal scene was
rated as more unpleasant than all other scenes (LSD p<.01). The
dental examination, blackboard and dental injection scenes (listed
in descending order of pleasantness) received intermediate ratings
on the pleasure dimension. There was a positive correlation (r=.78,
pC.01) for pleasure ratings on the dental examination and dental
injection scenes. Thus, children giving low pleasure ratings to one
dental scene tended to give low pleasure ratings for the other
dental scene.
Arousal. No significant differences between scenes were obtained
for arousal ratings. It is possible that the children did not
understand the concept; observations suggested that some subjects

81
may have associated "excited" with "happy". Review of the data
indicates that the pattern of ratings was not consistent with the
designations of scenes as fearful and neutral.
Dominance. As was the case with pleasure ratings, dominance
ratings differed for fearful and neutral scene contents (main effect
of Scene: F(5,100)=9.26, p<.00001). The ranking of scenes on the
dominance dimension closely parallels that for pleasure. Scenes
rated as most unpleasant tended to receive lower ratings of
controllability. Thus, the ranking of scenes from highest to lowest
dominance ratings is lawn chair, living room, blackboard, dental
exam, dental injection and principal. The dental exam, dental
injection and principal scenes were rated as significantly lower in
dominance than the lawn chair and living room scenes (LSD pC.01).
These three fear scenes did not differ significantly from one
another, nor did the two neutral scenes. There were significant
positive correlations between ratings of pleasure and dominance for
three of the scenes: dental injection (r=.4424, p<.05), blackboard,
(r=.5800, p<.01) and principal (r=.4127, p<.05). These correlation
suggest that children do not view pleasure and dominance as
distinct emotions, but rather that they discriminate only between
"good" and "bad". Significant correlations between the ratings
averaged across all six scenes support the notion of a lack of
independence between these emotional dimensions (pleasure &
dominance: r=.4368, p<.05; dominance & arousal: r=.4743, p<.02;
pleasure & arousal: r=.2119, ns).

82
Vividness. There were no significant effects of scene content on
vividness ratings.
Heart rate
Older children had lower resting heart rates. Negative
correlations between age and rest period heart rates are as
follows: lawn chair r=-.4987 (pC.Ol), living room r=-.4114 (p<.05),
dental exam r—.5676 (pC.Ol), dental injection r=-.5805(p<.01),
blackboard r=-.5362 (pC.Ol), principal r=-.4993 (p<.02). Therefore,
age was used as a covariate in all analyses involving heart rate.
When faced with an imagery task, adults typically show heart
rate acceleration during the reading of the scene, further
acceleration during the imagery period, and deceleration during
the recovery phase. Figure 2 shows that children in the present
study tended to show heart rate deceleration during the read
period (Scene X Period interaction: F( 10,200) =2.14, p<.02). Subjects
showed a significant deceleration during the read period of the
principal scene (LSD p<.01). This deceleration was significantly
greater than that occurring to all other scenes (LSD p<.05 for
difference between principal and dental exam and dental injection;
LSD p<.01 for all other differences). However, as with adult
subjects, within scene analyses showed that significant heart rate
acceleration occurred for the dental injection scenes from the read
to the recovery period (LSD p<.05). Similarly subjects showed heart
rate acceleration from the read to image periods of the blackboard
scene (LSD p<.05) and from read to recover for the principal scene

Heart Rate
Change
in
Beats per
Minute
Dental
Lawn Chair Living Room Dental Exam Injection Blackboard Principal
1 Read
2 Image
3 Recover
Figure 2. Mean heart rate changes during imagery (rest period used as
baseline).

84
(LSD p<. 05). Heart rate deceleration is typically associated with
attention (Lacey, 1967). Thus, these data suggest that unlike
adults, who show affective responses during the read period,
children need time to attend to the stimulus and then to access the
emotional network related to the scene being presented before they
can show any affective response. Children use the read period to
attend to the material and to access the appropriate network;
affective responses can then occur during the image and recovery
periods. For children then, the read period appears to represent
processing that is quite different from that occurring during the
image and recovery periods. Since imagery for children is a dual
process task, all subsequent analyses of physiological responding
will use the read period physiology, rather than rest period, as a
baseline.
Figure 3 shows that when the read period is used as the
baseline, children showed heart rate increases to the fear scenes
and heart rate decreases to the neutral scenes (main effect of
Scene: F(5,100)=2.84, p<.02). There were no differences between the
image and recovery periods. An examination of the data for the
read and image periods separately reveals that this main effect is
due to the recovery period (main effect of Scene for recovery:
F(5,100)=3.44, p<.007). The heart rate increment during the dental
exam, dental injection and principal scenes was significantly
different from the heart rate decrement occurring to the two
neutral scenes (all LSD p<.05).

Heart Rate
Change
In
Beats per
Minute
CD
Ui
Scene Name
Figure 3. Mean heart
used as baseline).
rate changes during the recovery period (read period

86
Skin conductance
The heart rate data indicated that the imagery task is
comprised of two processes: mental processing and accessing of the
emotional network during read, and affective responding during the
image and recover periods. Thus, skin conductance data were
examined separately for the read period, using rest as the
baseline, and for the image and recovery periods using read as
the baseline. During the read period, subjects did show some effect
of the affective content (marginal main effect of Scene:
F(5,100)=1.97, p<.09). Skin conductance decrease was less for the
fear scenes than for the neutral scenes. Using the read period as
baseline for the image and recovery periods reveals no further
effects of scene on skin conductance. The habituation typically
seen across imagery periods did not occur. This suggests that the
affective content of the scenes did have an effect on physiology.
Although there was no elevation in skin conductance levels during
image and recovery, the absence of a decrease suggests that the
affective nature of the scenes may have prevented the habituation
that is often observed. This is consistent with the results of other
research (Lang et al., 1983).
Effects of Fear Level and Imagery Training
In addition to the hypothesis that children would show
differential responding to fearful and neutral imagery, it was
hypothesized that physiological responses to fear scenes would be
greater in fearful than non-fearful children. It was also predicted

87
that physiological responses would be greater in response trained
children than in stimulus trained children. An interaction between
fear level and imagery training was also expected. That is, it was
predicted that responsiveness would be greatest in high fear
children who had received response training. Dividing the sample
into groups based on fear level or training reduces the sample
sizes; thus, these results must be viewed with caution.
Dental fear
Scores on the Dental Subscale at the three measurement points
(Screening, pre-Treatment 1 and post-Treatment 2) were all
positively inbercorrelated (r=.5369, p<.01 and r=.5311, p<.05
between Screening and Treatments 1 and 2 respectively; r=.6016,
p<.05 between Treatments 1 and 2). The high fear children did not
show any significant changes in reported dental fear across the
study. The low fear children, however, showed a significant
increase in reported dental fear from the screening to
pre-Treatment 1 (Session X Fear: F(2,38)=3.84, p<.03; LSD p<.01).
There was a decline in fear level from Treatment 1 to Treatment 2,
however this fear level is not significantly different from that at
the screening or at Treatment 1. The low fear children reported
higher levels of dental fear when actually faced with dental
treatment.
Affective ratings
Pleasure. High fear children rated the two dental scenes as more
unpleasant than did low fear children, with response trained

88
children giving lower pleasure ratings than stimulus trained
children within each fear group (Scene X Fear X Training:
F(5,100) =2.16, p<.06). Ratings given by the high fear response
trained children were significantly different from those given by
the low fear stimulus trained children (LSD p<.01). The high fear
response trained subjects rated all four of the fear scenes as
being significantly more unpleasant than the two neutral scenes
(LSD p<.01). The high fear stimulus trained subjects rated the
principal (LSD p<.05), dental injection (LSD p<.01), and dental
exam (LSD pC.01) scenes as significantly lower in pleasure than
the lawn chair scene. Low fear stimulus trained subjects made
some differentiation between fearful and neutral scenes as well,
rating the principal (LSD p<.01), blackboard (LSD p<.05) and
dental injection (LSD p<.05) scenes as more unpleasant than the
two neutral scenes. The differentiation between fearful and neutral
content was less clear for the low fear response trained subjects.
These subjects did rate the principal (LSD p<.01) and dental
injection (LSD p<.05) scenes as lower in pleasure than the lawn
chair scene.
Dominance. A similar effect was obtained for affective ratings of
dominance (Scene X Fear X Training: F(5,100) =2.39, p<.04). Figure
4 shows that the high fear response trained subjects made the
strongest discriminations between fearful and neutral content, so
that ratings for all four fear scenes were significantly lower than
those for the two neutral scenes (LSD pC.01 for all differences).

High Fear Subjects
Stimulus Trained
Response Trained
In Control 28
24
20
16
Dominance
Ratings ^
8
Controlled 0 i
Lawn Living Dental Dental Blackboard Principal Lawn Living Dental Dental Blackboard Principal
Chair Room Exam Injection Chair Room Exam Injection
Figure 4. Mean dominance ratings for high fear subjects —
trained groups.
stim ulus and response

90
The high fear stimulus trained group also made some
differentiation between fearful and neutral scenes on dominance
ratings. For this group, the ratings for the dental injection and
principal scenes were significantly lower than those given for the
lawn chair scene (LSD p<.05). The high fear, response trained
group reported the least dominance for all four fear scenes. Low
fear subjects reported the highest dominance for each fear scene.
Response training consistently produced lower dominance ratings for
fear scenes in the high fear subjects; however, there was no such
effect within the low fear group.
Heart rate
None of the hypothesized effects of fear level and imagery
training on heart rate were obtained. However, imagery training
was seen to have an effect on heart rate responses when
self-reported imagery ability was taken in to consideration. All
good imagers and the poor imagers with response training showed
heart rate declaration during imagery (across periods and across
scenes) while poor imagers with stimulus training showed heart
rate acceleration (QMI X Training interaction: F(l,18)=10.10,
p<.005). Although L5D tests did not reveal any significant
differences between the means, these data suggest that response
training serves to make poor imagers respond in a manner similar
to that seen in good imagers.

91
Skin conductance
Fear level and imagery training interacted to produce an
interesting effect on read period skin conductance (Scene X Fear X
Training: F(5,100)=2.21, p<.06). The subjects in the high fear
response trained group were the only ones to show increased skin
conductance to the reading of the dental fear scenes and decreased
skin conductance to all other scenes (see Figure 5). The skin
conductance increase occurring to the dental exam scene was
significantly different from the decrease occurring to the lawn
chair and living room scenes (LSD p<.05). This effect represents a
more microscopic view of the main effect of scene on read period
skin conductance that was described earlier. Recall that skin
conductance decreases were less to fear scenes than to neutral
scenes. Here it can be seen that when children report a high
degree of dental fear and receive response training, they actually
do show increased skin conductance to the presentation of dental
fear scenes.
Dental operatory behavior
There were no differences between fear groups for
disruptiveness during the injection at Treatment 1. However, at
Treatment 2 the high fear subjects showed significantly greater
disruptiveness than the low fear subjects (Session X Fear
interaction: F(l,19)=4.09, p<.06; LSD p<.05). This effect appears to
be due to the fact that the high fear group showed a slight
non-significant increase in disruptiveness across sessions while the

Skin
Conductance
Change in
pmhos
Injection
VO
N>
Scene Name
Figure 5. Mean skin conductance changes during the read period for
high fear response trained subjects.

93
low fear group showed a slight non-significant decrease in
disruption.
All children showed a significant decrease in disruptiveness
during placement of the rubber dam over sessions (main effect of
Session: F(l,18)=8.17, pC.Ol). The response trained subjects showed
significantly greater disruptiveness during Treatment 1 rubber dam
placement than did the stimulus trained subjects (Session X
Training interaction: F(l,18)=5.90, p<.04; LSD p<.01). The response
trained subjects showed a significant decrease in disruptiveness
during rubber dam placement across sessions (LSD pC.Ol). Although
response training was associated with decreased disruptiveness
during rubber dam placement, response trained subjects showed
greater disruptiveness during drilling when disruptiveness scores
were averaged across sessions (main effect of Training:
F( 1,19)=4.79, p<.04).
Response training and fear level interacted so that low fear
children who received response training showed significantly
greater disruptiveness during drilling than low fear stimulus
trained subjects (Fear X Training interaction: F( 1,19) =4.99, p.<.04;
LSD p<.05).

DISCUSSION
The findings of this study support the hypothesis that children
would respond differentially to fearful and neutral imagery, both
through verbal report and through physiology. Children reported
experiencing lower pleasure and lower feelings of dominance to
fear scenes than to neutral scenes. Children showed heart rate
increases and an inhibition of skin conductance habituation during
imagery of fear scenes but not neutral scenes. An important
finding was that children differ from adults in their processing of
information during imagery. Adults show affective responses while
the scene information is being presented; however, for children the
imagery task is a two step process. The first step involves
information processing or attention to the stimulus, while the
second step involves affective responding. The discussion that
follows will review the findings and their implications for Lang's
bio-informational theory, and then consider suggestions for future
research.
Discrimination of Affective Valence
The data of the study clearly support the first hypothesis of
the study, that is, that children would discriminate between
fearful and neutral content in imagery. The fear scenes received
lower ratings of pleasure and dominance than did the neutral
94

95
scenes. As predicted, children showed heart rate increases to fear
scenes, and heart race decreases to neutral scenes during an
imagery task. Skin conductance increases were not observed during
imagery; there were slight, non-significant decreases in skin
conductance. Other researchers (Lang et al., 1983; May, 1977a)
however, have reported that skin conductance typically is
responsive to external stimuli and that skin conductance decreases
are observed during imagery. The children in the present study,
like the adult subjects in the Lang et al. (1983) study showed an
absence of this habituation during imagery of fearful content. With
one exception, subjects in the study did not discriminate between
dental fear and school ;sar scenes. The exception was that high
fear response trained subjects showed increased skin conductance
to the reading of dental fear but not school fear scenes.
Some very interesting findings came from the scene content
data. The principal scene seems to be the most potent as a fear
scene for all subjects in the study, even more so than the dental
fear scenes. This scene was given the lowest ratings of pleasure
and dominance by all children, even those who reported high
degrees of dental fear. Additionally, the principal scene may have
been more complex than the other scenes used in the study. Figure
2 indicates that subjects had the largest heart rate decelerations
during the read period of this scene. As heart rate deceleration is
associated with attention, this suggests that this scene may have
made greater attentional demands on the children. Further

96
consideration of the properties of this scene support this notion.
First, children in the pilot study sample reported that the
principal scene was less similar to past experiences than all other
scenes. The children may not have had an adequate memory
network about this experience that could be accessed during
imagery. Second, the structure of the principal scene may have
been very complex. For example, this scene had fewer sentences
per one hundred words than the other scenes. Sentences per one
hundred words is one factor in estimating the readability of
written materials (Fry, 1968). The content of this scene was
different from the other scenes as well. Examination of this scene
(Appendix A) reveals that, in fact, this scene depicts the child
walking from one place to another, while the other scenes depict
the child sitting still.
The blackboard scene seems to differ in some ways from the
other fear scenes. This scene received high dominance ratings and
moderate pleasure ratings in both the main study and in the pilot
study. While the blackboard scene may have some fear provoking
properties, this situation may also involve feelings of importance
and competence. The heart rate data in Figure 2 show that unlike
the other three fear scenes, children show heart rate deceleration
during the recovery period of the blackboard scene. It may be
that the anxiety produced by this situation is less persistent, and
more controllable, as evidenced by the dominance ratings. In

97
future studies this scene should be replaced by a scene more
consistently rated as fearful, ie., low pleasure, and low
dominance.
While the children's ratings of pleasure and dominance did
differentiate between scene contents, the children do not appear to
have used the two affective rating scales as independent
dimensions. The effects of scene content on these two dimensions
were quite similar, and there were positive correlations between
pleasure and dominance ratings. No significant effects were
obtained for ratings of arousal. It seems that the children did not
understand the arousal dimension.
The Effects of Fear Level and Imagery Training
There were few differences between high fear and low fear
subjects. Recall that while the high fear subjects reported
significantly greater levels of dental fear than the low fear
subjects at all three measurement points, the low fear subjects
showed a significant increase in dental fear prior to the first
treatment session. Additionally, the fact that that all children
were exposed to the dental setting prior to imagery assessment
ensured that all children were able to store information about
dental treatment in their affective memory networks. This
information could then be accessed during imagery. It could be
then, that this increase in pre-treatment dental fear combined with
the recent dental experience may have obscured differences between
the two fear groups on the physiological measures.

98
Imagery training influenced heart rate responding only when
self-reported imagery ability was taken into consideration.
Poor imagers who received response training showed heart rate
responses similar to those seen in good imagers. This result
suggests that imagery ability may be an important consideration in
the use of imagery with children, and should be investigated in
future studies. Response training also influenced behavior in the
dental operatory. Response trained subjects showed a decrease in
disruptiveness during rubber dam placement across sessions.
However, response trained subjects showed greater disruptivness
during drilling than did stimulus trained subjects. It is not clear
why response training would result in increased disruptiveness for
one dental stressor and decreased disruptiveness for another.
Hermecz and Melamed (1984) found that response trained subjects
showed greater disruptiveness than stimulus trained subjects for
the whole session, for the injection and for drilling (the difference
was non-significant during drilling). It may be that the nature of
the dental stressor in some way affects the influence of response
training. Further research on the effects of response training is
needed.
The interaction of fear and imagery training produced some
interesting effects on SAM ratings of pleasure and dominance. High
fear children tended to give lower ratings of pleasure and
dominance for the two dental scenes than did low fear children.
Within each fear group, response trained children tended to give

99
lower pleasure ratings than did stimulus trained children. High
levels of dental fear, when combined with response training, seem
to have resulted in very clear discriminations between fearful and
neutral scenes, perhaps because response training helped to access
the fear network and make the scenes more salient for these
subjects. A high level of dental fear combined with response
training produced increased skin conductance during the read
period of the two dental fear scenes and skin conductance
decreases to all other scenes. None of the other subject groups
displayed such an effect.
Implications for Lang's Bio-informational Theory
The results of studies described earlier in this paper do
support the notion that emotion is stored in the memories of
children, and that emotional information does help to access
information stored in memory (Nasby & Yando, 1980; Nasby &
Yando, 1982; Bartlett & Santrock, 1979). The results of the present
study also provide data to suggest that Lang's bio-informational
theory (Lang, 1977, 1979, 1980) applies to children. Children
responded differentially to neutral and fearful scenes, showing
heart rate increases to fear scenes and heart rate deceleration to
neutral scenes.
It is interesting that children showed heart rate deceleration
during the read period, and did not show any heart rate
acceleration until the image and recovery periods. As noted
earlier, this suggests that children, unlike adults, need to process

100
the information before an affective response can occur. It is also
possible that children require more time for physiological
activation to occur, and thus show this activation at a later time
than do adults. No difference in heart rate was observed between
the image and recovery periods, indicating that the children did
not show the heart rate deceleration seen in adult subjects during
the recovery period. The fact that children continued to show heart
rate acceleration during the recovery period for three of the four
fear scenes is also an interesting finding. It seems that children
could not "turn off" the emotional imagery when instructed to do
so. It may be that the children did not follow the instructions,
and continued to imagine the scenes during the recovery period,
which in turn would have led to continued accessing of the
emotional network. It is more likely however, that since the
children needed more time to show activation, they may have
needed more time to inhibit responding. May (1977a) observed that
some of his phobic subjects could not "turn off" phobic thoughts
after each trial. Perhaps this was the case with the subjects in
the present study. Gilligan and Bower (1984) suggest that feedback
from activated emotion nodes causes arousal to persist. It may be
that the immature nervous systems of young children are not well
equipped to cope with this arousal, and that children require more
time for this activation to dissipate.
It is helpful to examine the heart rate more closely in order to
gain a better understanding of the processes occurring during

101
imagery. Lacey (1967) noted that cardiac deceleration accompanies
attentional processes. Melamed (1982) reports that this is also true
in children. Hermecz and Melamed (1984) also found heart rate
deceleration as children watched another child undergoing local
anesthetic injection. This then is consistent with the deceleration
in heart rate noted during the read period of imagery trials in
the present study. Heart rate acceleration occurs during the image
and recovery periods. Two processes can explain this acceleration.
First, mental effort has been shown to produce heart rate
acceleration (Lacey, 1967). Second, numerous studies have
demonstrated that exposure to fearful stimuli produces heart rate
acceleration as well. During the imagery period, the observed
heart rate acceleration is a function of both mental effort and the
response to the affective stimuli. During the recovery period,
cardiac acceleration persists in spite of the fact that subjects were
instructed to stop imagining. This residual arousal can be
attributed to the arousing nature of the stimulus, since the subject
is no longer exerting mental effort. The occurrence of heart rate
deceleration during imagery of neutral scenes is also appropriate
to the attentional processing required. The continued deceleration
during image and recover, however, can be attributed to the
non-arousing nature of the scene content. The scenes describe the
child in a non-active situation, and no response propositions were
included in the text. These data then, provide support for Lang's
theory (Lang, 1977, 1979, 1985), in that physiological responses

102
appropriate to scene content are produced, which in turn suggests
that imagery scripts are able to access emotion networks in
children.
The skin conductance responses observed lend tentative support
to the bio-informational theory. The fact that high fear response
trained subjects showed an increase in skin conductance during the
reading of dental fear scenes suggests that these subjects in
particular had accessed their fear networks for this content. The
skin conductance decreases during imagery that were observed in
this study can thus be explained in terms of the fact that the
subjects were required to tune out the external environment during
the imagery task (Lacey, 1967). The absence of the skin
conductance habituation that is typically found during imagery
could be attributed to the affective nature of the scenes. This
supports the hypothesis that scene content does influence
physiology by accessing the emotional network.
Methodological Considerations
Some modifications in the experimental procedures used in this
study might yield a clearer set of results. Elimination of the
relaxation exercises, or changes in imagery assessment protocol
might help to address some of the problems raised in this study.
The relaxation exercises used in this study required the
children to engage in a series of tension-relaxation cycles. The
children were instructed to attend to the tension in their muscles,
and to the feeling of being relaxed (See Appendix J). These

103
exercises may have mimicked response training, in that both had
an emphasis on bodily responses. Thus, it could be argued that
both stimulus and response trained children were taught to focus
on physiological changes during imagery. This, combined with the
fact that all subjects were tested on scripts containing response
propositions, may have obscured some differences between the
stimulus and response groups. Further, Bartlett, Burleson and
Santrock (1982) found that relaxation exercises obscured an
affective state dependent learning effect. For these two reasons, it
would be important to repeat this study without administering
relaxation exercises to the subjects.
It was noted earlier that the principal scene may have been
more complex than the other scenes. The complexity of materials
used in physiological assessment needs to be controlled. The
readability of the materials (Fry, 1968) is one way to assess
complexity. Other factors that may need to be considered when
controlling for scene complexity are: activity level described in
the scene, change of setting, anticipation of an impending event in
the scene, and familiarity of the situation to the children in the
study.
One problem in this study was that the high fear children were
significantly older than the low fear children. In the present
investigation, this effect was managed through analysis of
covariance. The age effect appears to be a confound, but the
literature suggests that this is not the case. Both Cuthbert and

104
Melamed (1982) and Winer (1982) report that older children tend to
report higher levels of dental fear. One way to deal with this
problem in an experimental situation would be to limit the sample
to older children. Thus, differences between fearful and nonfearful
children could be compared without concern for the effects of age.
Once the nature of emotional networks for fear are more clearly
understood in older children, then the investigation could be
extended downward to younger children. In this way, researchers
could work with a clearer sense of whether emotional networks in
young children conform to the patterns seen in older children and
adults, and whether any differences seen in young children are
due to the fact that they are unable to complete the experimental
task.
Suggestions for Future Research
The results of the present study raise some very interesting
questions. Studies are needed to clarify the issue of why there
were few differences between high and low fear children and why
response training did not influence heart rate. A first step in
clarifying some of the issues raised would be a replication study
that incorporated the methodological refinements suggested above.
That is, the study could be repeated using older children.
Or, a larger sample could be used, allowing for a comparison of
children of different ages. Relaxation exercises should be
eliminated. The present finding that children seem to need more
time to generate physiological responses to imagery suggests that

105
future studies of children's responsivity to imagery should allow
more time for the children to complete the imagery task. One way
to do this would be to give two presentations of the imaginal
materials, with the first presentation being just for the purpose of
listening to the information. A second approach would be to
lengthen each period of an imagery trial; that is allow forty-five
or sixty seconds rather than thirty seconds for the image period,
etc.
It was suggested earlier that exposure to dental treatment at
the start of the study may have minimized group differences, since
all subjects were assumed to have stored emotional information in
their memory networks. Elimination of the first dental treatment or
a comparison of dentally experienced and naive children could help
to address this question.
The subjects in this investigation were selected for fear level,
but the high fear subjects were not a clinical population. It would
be interesting to study children referred to mental health
practitioners for treatment of a specific phobia. It is likely that
clinic referred children would have an especially cohesive
emotional network. The effects of imagery may be more clearly
understood in this population. It is likely that these children
would show greater physiological activation to fearful imagery than
to neutral imagery, and that this activation would be greater in
these children than in a non-clinic population. Study of a clinic

106
population would provide a basis for comparison of results
obtained with the non-clinic children in the present study.
A variety of media have been used in studies of physiological
responses to fear stimuli. It could be that tape recorded scripts do
not maximally evoke the fear network in children. Future studies
should compare responsiveness to a variety of media. For example,
children could be presented with an audiotape recording of a
scene, or a videotape recording that provides the same soundtrack
with the addition of visual information. Physiological responses to
the presentation could be assessed. Such studies would yield data
on the effectiveness of each medium for generating physiological
responses to fearful stimuli, and for producing the best therapeutic
outcome.
Conclusions
The purpose of the study presented here was to investigate
Lang's bio-informational theory as it applies to children. Support
was obtained for the notion that children store emotional
information in memory in the form of propositional networks and
that this information can be accessed via imagery. Children showed
heart rate acceleration to fearful imagery but not to neutral
imagery. They also differed in emotional ratings to fear and
neutral scenes. These data are consistent with the hypothesis that
response information is stored in the memory network along with

107
contextual information, and that accessing the network activates
the entire response program, including physiological output and
subjective feelings.
Another important finding of this study was that for children,
the imagery task requires two steps in processing. In the first
step, children attend to the material being presented. Children
show a physiology consistent with the attentional process, that is,
cardiac deceleration. In the second step, once the emotional
network has been accessed, the children respond to the affective
content of the material, showing a physiology that varies with the
affective valence of the text.
The fact that few fenr group differences were obtained does not
challenge the Lang theory supposition that fear networks are more
coherent in fearful subjects and that greater responsivity would
result. Since all children were given dental treatment just one
week prior to imagery assessment, it is likely that this experience
was stored in the memory of each subject. This memory then could
be readily accessed by all children during imagery, thus
minimizing group differences. As noted earlier, methodological
changes would allow a more robust test of this hypothesis.
Response training has been shown to amplify physiological
responses to imagery scenes, and to increase concordance between
response systems. In the present study, response training appears
to have increased the salience of the fear scenes for the children,
particularly those who reported high dental fear. These subjects

108
showed a pattern of affective ratings that was consistent with the
emotional content of the scenes. Additionally, high fear subjects
who received response training showed skin conductance increases
during the reading of the dental fear scenes but not the other
scenes. These findings support the contention that response
training more fully evokes the fear network in high fear subjects,
producing the appropriate fear responses.
The Lang theory has given us a viable bool for examining
similarities and differences between imaginal processing of emotion
in children and adults. The findings of this study should be
considered when children are asked to use imagery. They suggest
that children are likely to be able to use imagery in treatment.
However, it was seen that modifications are needed before using
adult treatments with youngsters. Children will need more time to
access the emotional network before the response code can be
activated. Studies are suggested that can increase the
understanding of fears in children and of additional considerations
that may be necessary when using imaginal treatments with
children.

APPENDIX A
IMAGERY SCENES
BUS STOP NEUTRAL (PRACTICE)
You are sitting at a bus stop on the corner of a quiet, tree
lined street. It is a bright summer day and birds are flitting
among the tree branches. You feel peacefully at ease under the
trees and the white fluffy clouds which float slowly by in the blue
sky. Across the street, a man in a brown shirt sleeps on his
patio, while a sprinkler sprays sparkling drops of water over his
lawn.
LAWN CHAIR NEUTRAL
You are sitting in a lawn chair on your porch on a summer
afternoon. Leaning back, relaxed, you feel a soft warm breeze
blowing across the porch. A green lawn stretches out before you,
and scattered trees sway gently with the wind. Comfortable and
happy, you are so relaxed, you hardly move, while you sit in the
chair enjoying the pleasant summer day.
LIVING ROOM NEUTRAL
You are in your living room on a Sunday afternoon. Leaning
back in your chair, relaxed, you look out of your window. It is a
sunny autumn day. Red and brown leaves float slowly down from
109

no
the trees. A gentle breeze picks up a little spiral of leaves, which
dances for a moment in the middle of the street before settling
again on the ground.
DENTAL EXAMINATION FEAR
You are in a dentist's chair waiting for an examination. You
glance around the room and see a tray of needle-like instruments
in front of you. You tighten up your muscles as the shrill whine
of a high speed drill echoes into the room from across the hall.
Sweat drips from your armpits as your dentist comes in, washes,
picks up a pointed, hooked tool and moves it toward your mouth.
Your heart races and you breathe deeply when the cold metal point
scrapes against your teeth, as the dentist searches for soft spots
along the gumlines and on the teeth.
DENTAL INJECTION FEAR
You are leaning back in a dental chair, head back, about to
have a cavity filled. All of your muscles feel tight as you squeeze
the armrest of the chair. The dentist stands right in front of you
holding a syringe with a long, shiny needle, and brings it toward
your mouth. Your heart pounds as the sharp needle is slowly
injected in to your upper jaw. Your eyes look about the room
during the injection, and you see the dentist's helper preparing
the drill. You gasp and then breathe rapidly. Sweat seems to pour
from your body as the needle is taken out. The drilling will soon
begin.

Ill
BLACKBOARD FEAR
Your teacher has just called on you to put a homework problem
on the blackboard, and then to explain your answer. You have the
answer, but you never had to explain it in front of so many
people before. As you walk to the front of the room, you breathe
rapidly, and glance around at your classmates, who are waiting
for you to begin. The teacher impatiently taps her fingers on her
desk. Your palms feel sweaty as you pick up a piece of chalk and
begin to write. All of your muscles feel tense. You can feel your
heart racing as you begin to explain your work.
PRINCIPAL FEAR
Your class has just had a test, and the teacher thinks that
you cheated, even though you didn't. Your heart pounds as she
calls you to the front of the room, in a loud voice says "I don't
know what your parents will think", and sends you to the
principal's office. You look around at your classmates, and then
down at the floor, as you walk towards the door. You feel tense
all over, and your palms are sweaty as you walk down the long
hall to the office. When you get to the principal's office, you take
several deep breathes before knocking on the big wooden door. The
principal says "Come in".

APPENDIX B
CHILDREN'S FEAR SURVEY SCHEDULE (DENTAL SUBSCALE)
Name Age Sex
Directions to the Parent:
Please read the directions to the Survey's Fear Thermometer
aloud to your child. Have him or her look at it with you, and
make sure that he/she understands what each number stands for.
Then, ask how afraid he/she is of elevators. Have him/her respond
by pointing to the number on the thermometer that best represents
how he/she feels. Then, beginning with statement one on the
Children' s Fear Survey Schedule (below), find out how afraid
he/she is of each of the 15 items. Mark an "X" in the appropriate
column next to the item that correponds to the child's response.
Allow your child to complete this form independently if he/she is
able to do so. Thank you for your cooperation.
Child was:Cooperative yes no Anxious about questions yes no
Answered questions yes no Understood questions yes no
Not A A fair Pretty Very
afraid little amount much afraid
at all afraid afraid afraid
1 2 3 4 5
1. dentists
2. doctors
3. injections (shots)
4. having somebody examine
your mouth
5. having to open your
mouth
6. having a stranger
touch you
7. having somebody look
at you
8. the dentist drilling
9. the sight of the
dentist drilling
10. the noise of the
dentist drilling
11. having somebody put
instruments in your
mouth
12. choking
13. having to go to
the hospital
112

113
Not
A
A fair
Pretty
Very
afraid
little
amount
much
afraid
at all
afraid
afraid
afraid
1
2
3
4
5
14. people in white
uniforms
15. having the nurse
clean your teeth

114
FEAR SURVEY'S FEAR THERMOMETER
DIRECTIONS: I would like you to try and tell me how afraid you
are of some things. This is a "Fear Thermometer". The bottom
number, one, tells me you are not afraid at all. Number two tells
me you are a little afraid, number three that you are a fair
amount afraid, number four that you are pretty much afraid, and
number five, (the highest) tells me that you are very afraid.
Directions to experimenter:
First say: What's bigger, 4
or 5? If child answers 5
proceed with other items.
If child responds 4, reread
instructions.

115
NORMS FOR CFSS Dental Subscale*
Mean of all subjects 5-13 years old = 28.73
(range possible is 15 to 75)
Age
Sex
Mean
S.D.
+2SD
-2SD
+1SD
-1SD
6
F
31.75
10.50
52.75
10.75
42.25
21.25
M
31.00
11.00
53.00
9.00
42.00
20.00
7
F
33.00
9.50
52.00
14.00
42.50
23.50
M
29.00
9.00
47.00
11.00
38.00
18.00
8
F
29.50
5.00
39.50
19.50
34.50
24.50
M
28.50
9.30
47.10
9.90
37.80
19.20
9
F
27.50
9.50
46.50
8.50
37.0
18.00
M
26.50
7.70
41.90
11.10
34.20
18.80
10
F
26.75
11.75
50.25
3.25
38.0
5.00
M
28.50
10.75
50.00
7.00
39.25
17.75
11
F
27.66
8.80
45.26
10.06
36.46
18.86
M
27.66
9.50
46.66
8.66
37.16
18.16
12
F
23.00
5.25
33.50
12.50
28.25
17.75
M
27.00
9.50
46.00
8.00
36.50
17.50
*Based on graph from Cuthbert & Melamed, 1982
** Note that all scores except that for 8 year old females are
below the minimum score of 15.

APPENDIX C
INFORMED CONSENT TO PARTICIPATE IN RESEARCH
J. HILLIS MILLER HEALTH CENTER
UNIVERSITY OF FLORIDA
GAINESVILLE, FLORIDA 32610
You are being asked to volunteer as a participant in a research
study. This form is designed to provide you with information about
this study and to answer any of your questions.
1. TITLE OF RESEARCH STUDY
Imagery Ability in Children (Part 2)
2. PROJECT DIRECTOR
Name: Barbara G. Melamed, Ph.D. and Lauren R. Kaplan, M.S.
Telephone Number: 392-3192
3. PURPOSE OF THE RESEARCH
The purpose of this research is to study children's ability to
imagine different kinds of situations, and to look at changes in
heart rate, breathing and sweating while these scenes are being
imagined. The imagined scenes will involve 1) aspects of dental
treatment, 2) school situations, and 3) neutral, calm situations.
4.PROCEDURES FOR THIS RESEARCH
Children will be seen by a dentist in the pediatric dental clinic to
determine whether they have at least two cavities which can be
treated as part of the study. If the child does meet this
requirement, bitewing x-rays will be taken. Parents will be asked
to give a health history on the child and to complete a short
questionnaire. The child will be given a short vocabulary test.
Children accepted from the screening will then be scheduled for
two additional sessions.
In the first session, your child will be taken to the dental clinic
where a filling will be done. Following that, the child will be
taken to a quiet room, where he/she will be given several
questionnaires regarding his/her ability to imagine, and his/her
116

117
fearfulnes of different situations. Next, your child will be given a
relaxation exercise, and some training to help him/her imagine
things more clearly.
In the second session, your child will be asked to imagine various
situations. During this time, measures of heart rate, breathing and
sweating will be taken, using a monitoring device (a physiograph)
through the use of sensors taped to areas of the hands, arms, and
chest. After each scene, your child will be asked to rate his/her
feelings about the situation. After this procedure is completed,
your child will go to the dental clinic for a second filling. These
dental treatment sessions will both be videotaped.
Each session will require one to one and a half hours, plus the
time needed for dental treatment. Your child will be permitted to
take breaks, if necessary.
5.POTENTIAL RISKS OR DISCOMFORTS
There are no risks or discomforts involved in participating in this
research.
6. POTENTIAL BENEFITS TO YOU OR OTHERS
This experiment will provide information about children's ability to
vividly imagine situations. This information will be useful in
planning psychological treatments for children, including ways to
prepare children for dental treatment.
7. ALTERNATE TREATMENT OR PROCEDURES, IF APPLICABLE
Not applicable.
8. GENERAL CONDITIONS
I understand that I will /will not receive money for my
participation in this study. If I am compensated, I will receive
free dental treatment on the days of experimental sessions.
I understand that I will X /will not be charged additional
expenses for my participation in this study. If I am charged
additional expenses, these will consist of $5 for bite wing X-rays,
if necessary. Only children accepted for the study will have
X-rays taken.
I understand that I am free to withdraw my/my child's consent
and discontinue participation in this research project at any time
without this decision affecting my/my child's medical care.
In the event of my/my child sustaining a physical injury which is
proximately caused by this experiment, no professional medical
care received at the J. Hillis Miller Health Center exclusive of

118
hospital expenses will be provided be without charge. This
exclusion of hospital expenses does not apply to patients at the
Veteran's Administration Medical Center (VAMC) who sustain
physical injury during participation in VAMC-approved studies. It
is understood that no form of compensation exists other than those
described above.
I also understand that the University of Florida and the Veteran's
Administration Medical Center will protect the confidentiality of my
records to the extent provided by Law. The Study Sponsor, Food
and Drug Administration or either Institutional Review Board may
ask to review my records, however, the records will remain
confidential as only a number and initial will be used.
9. SIGNATURES
I have fully explained to
the nature and purpose of the above-described procedure and the
benfits and risks that are involv
d in its performance. I have
answered and will answer all questions to the best of my ability.
I may be contacted at telephone number 392-3192.
Signature of Person Obtaining Consent Date
I have been fully informed of the above-described procedure with
its possible benefits and risks and I have received a copy of this
description. I have given permission of my/my child's participation
in this study.
Signature of Patient of Subject or Date
Relative or Parent or Guardian (specify)
Signature of Child (7 to 17 yrs. of age) Date
Signature of Witness
Date

APPENDIX D
SUBJECT DATA FORM
Subject ID
Name
Date of Birth
Sex Grade
Phone:
Number of Children in Family
Father's Occupation
Father's highest grade level_
Estimated Family Income:
Under $3,000
$3,000-$6,000
$6,000-$8,000
PREVIOUS DENTAL EXPER'
ENCE
Dental examination
Yes
No
#_
Dental injection
Yes
No
#_
Dental drilling
Yes
No
#_
Other (explain)
Age at first dental
visit
Dental Record #_
Screening Date
Date of Session 1
Date of Session 2
Address:
Mother' s Occupation:
Mother's highest grade level
$8,000-10,000
$10,000-$15,000
$15,000- above
Dental
X-rays
Yes
No
#
Dental
Extraction
Yes
No
#
Local
anesthesia
Yes
No
#
General anesthesia Yes
No
#
Why was the child seen?
How would you describe your child in
an examination was given?
not afraid at all
12 3
very cooperative
12 3
How would you describe your child in
an injection was given?
not afraid at all
12 3
very cooperative
12 3
prior dental sessions where
very afraid
4 5
very disruptive
4 5
prior dental sessions where
very afraid
4 5
very disruptive
4 5
119

APPENDIX E
CHILDREN'S FEAR SURVEY SCHEDULE
Name
Child was
Age Sex
Cooperative
yes
no
Session
Anxious about questions
yes
no
Answered questions
yes
no
Understood questions
yes
no
Items
Not A
afraid little
at all afraid
A fair Pretty-
amount much
afraid afraid
Very
afraid
1 2 3 4 5
1. dentists
2. dogs
3. being laughed at
4. doctors
5. dark
6. lightning
7. thunder
8. strangers
9. loud noises
10. getting caught
out in the rain
11. being late
for school
12. having to go up to
blackboard in
front of class
13. injections (shots)
14. losing at a game
15. being called on
in class
16. having somebody
examine your mouth
17. having to open
your mouth
18. being away from
your mother
19. having a stranger
touch you
120

121
Items
Not A
afraid little
at all afraid
A fair Pretty-
amount much
afraid afraid
Very
afraid
1 2 3 4 5
20. having somebody
look at you
21. having the nurse
clean your teeth
22. the dentist drilling
23. the sight of the
dentist drilling
24. the noise of a
dentist's drill
25. having somebody
put instruments
in your mouth
26. crying in front of
other children
27. parents yelling
at you
28. hearing other
children cry
29. being in a crowd
30. doing something new
31. getting burned
by a fire
32. parents fighting
33. getting a haircut
34. spiders
35. choking
36. the sight of blood
37. not being able
to breathe
38. rats
39. having to go to
the hospital

122
Items
Not A
afraid little
at all afraid
A fair Pretty
amount much
afraid afraid
Very
afraid
1 2 3 4 5
40. ghosts
41.having to eat the
food I don't like
42. getting lost
43. hearing my parents
argue
44. making mistakes
45. people in white
uniforms
46. getting a poor
grade
47. being alone
48. answering questions
49. taking a test
50. getting punished

APPENDIX F
DENTIST RATING FORM
Subject Number Name
Session # Date
Dentist
How cooperative was this child during dental treatment?
not at very
all cooperative
cooperative
12 34 56 78 9 10
How fearful was this child during dental treatment?
not at
all
fearful
12 34 56 78 9 10
very
fearful
Subject Number Name
Session # Date
Dentist
How cooperative was this child during dental treatment?
not at
all
cooperative
very
cooperative
12 34 56 78 9 10
How fearful was this child during dental treatment?
not at
all
fearful
very
fearful
12 34 56 78 9 10
123

APPENDIX G
BEHAVIOR PROFILE RATING SCALE (With Annotations)
Functional Definitions:
(weighting of each behavior is in parentheses)
Inappropriate mouth closing (1) — whenever dentist asks child to
open mouth (wider) at least once (even if child had opened mouth
without being asked)
Refuse to open mouth (3) — dentist either has to force patient's
mouth open by hand or instrument, child is willfully
uncooperative, child refuses verbally or in action
Eyes closed (2) — any perceptible eye closing longer than a
blink, including closing eyes to clear them - count as closed if
eyes open in slit with no eye movement or blink
Attempts to dislodge instrument (5) — any jerky head movement
and/or jerky hand movement towards face and head (if dentist's
hand or instrument at mouth)
Patient dislodges instrument (5) — any time instrment is dislodged
from patient's mouth due to child's movement and/or dentist trying
to avoid hurting child (if "Attempts to dislodge" is scored, check
to see whether this should be scored)
Cries at injection (1)
Crying (3) — grunt, painful sound either with or without tears
Rigid posture (3) — tension or stiffening of legs and arms and
body including stretching
White knuckles (2) — makes a fist, holds tightly to arms of chair,
holds on to arms of dentist and/or dental assistant
Fid getting (2) — any nervous, repetitive hands or feet movement
Kicking (4) — noticeable leg movement other than natural change
of position or fidgetting - including bringing legs up, etc. (For
bringing legs up: score only during movement, not if child stays
that way)
124

125
Flinging arms (5) — movement or arms more than once in attempts
to push dentist or dental assistant away
Restraints used (4) — when dental assistant puts her hands across
dental chair to prevent disruption, or when dental assistant holds
child's hand. If routinely used, use N; if patient fought or
exhibited fearful response, use Ac.
Verbal complaints (2) — must be verbal and must be intelligible
such as "I want my mother", "When can I go home" or "I have to
go to the bathroom"
Verbal message to terminate (3) — direct statement requesting
termination of procedure such as "Dont't do it", "don't do it to
me"
Choking (1) — coughing and/or gagging noise (ANY cough, even if
child has a cold)
Wont' sit back (2) — sitting up in chair without dentist's
permission
Rolls over (4) — turning of head and body more than 30 degrees
Stand up (4) — standing or kneeling on dental chair without
permission
Refuse chair (5) — needs coaxing and/or has to be forced on
chair, has to be forced to dental position, initially
Leaves chair (5) — completely out of chair
Faints (5) — unconscious, not sleeping, dentist has to confirm

126
Behavior Profile Rating Scale
Na me Dentist
Rater
Please indicate injection, placement of rubber dam, drilling and
end of treatment by using I, R, D, and circle last session.
Child's behavior
1
2
3
4
5
6
7
8
9
10
11
12
13
Inappropriate mouth
closing
Refuse to open mouth
Eyes closed
Attempts to dislodge
instrument
Patient dislodges
instrument
Cries at injection
Crying
Rigid posture
White knuckles
Fid getting
Kicking
Flinging arms
Restraints used
Verbal complaints
Verbal message
to terminate
Choking
Won't sit back
Rolls over
Stands up
Refuse chair
Leaves chair
Faints
Copyright by the American Dental Association. Reprinted by
permission.

APPENDIX H
QUESTIONNAIRE UPON MENTAL IMAGERY - CHILDREN
Think of someone in your family or a friend whom you see a lot,
thinking carefully of the picture that rises before your mind1 s
eye. Tell me how clear and real your image is by pointing to the
keys.
( ) l.The exact contour of face, head, shoulders and body
( ) 2. Characteristic poses of head, attitudes of body, etc.
( ) 3. The precise carriage, length of step, etc. in walking
( ) 4. The different colors worn in some familiar costume
Think of seeing the following, thinking carefully of the picture
which comes before your mind's eye, and tell me how clear and
real your image is by pointing to the keys.
( ) 5. The sun as it is sinking below the horizon
Think of each of the following sounds, thinking carefully of the
image which comes to your mind's ear, and tell me how clear and
real your image is by pointing to the keys.
( ) 6. The whistle of a locomotive
( ) 7. The honk of an automobile
( ) 8. The mewing of a cat
( ) 9. The sound of escaping steam
( ) 10. The clapping of hands in applause
Think of "feeling" or touching each of the following, thinking
carefully of the image which comes to your mind's touch, and tell
me how clear and real your image is by pointing to the keys.
( ) 11. Sand
( ) 12. Linen
( ) 13. Fur
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( ) 14. The prick of a pin
( ) 15. The warmth of a tepid bath
Think of performing each of the following acts, considering
carefully the image which comes to your mind's arms, legs, lips,
etc. and tell me how clear and real your image is by pointing to
the keys.
( ) 16. Running upstairs
( ) 17. Springing across a gutter
( ) 18. Drawing a circle on paper
( ) 19. Reaching up to a high shelf
( ) 20. Kicking something out of your way
Think of tasting each of the following, thinking carefully of the
image which comes to your mind's mouth, and tell me how clear
and real your image is by pointing to the keys.
( ) 21. Salt
( ) 22. Granulated (white) sugar
( ) 23. Oranges
( ) 24. Jelly
( ) 25. Your favorite soup
Think of smelling each of the following, thinking carefully of the
image which comes to your mind's nose, and tell me how clear and
real your image is by pointing to the keys.
( ) 26. An ill-ventilated room
( ) 27. Cooking cabbage
( ) 28. Roast beef
( ) 29. Fresh paint
( ) 30. New leather

129
Think of each of the following sensations of feelings, thinking
carefully of the image which comes before your mind, and tell me
how clear and real your image is by pointing to the keys.
( ) 31. Fatigue
( ) 32. Hunger
( ) 33. A sore throat
( ) 34. Drowsiness
( ) 35. Feeling full after a large meal

¿
APPENDIX I
MEASURE OF ELEMENTARY COMMUNICATION APPREHENSION (MECA)
© ©<2
©
very happy
I like it
a lot
happy no feeling unhappy
I like it I don't I don't
care like it
very unhappy
I really
don't like it
1. How do you feel about calling another student on the
phone?
2. How do you feel when you know you have to give a report
in class?
3. How do you feel about asking a clerk, or someone in a
store, to help you?
4. How do you feel when your teacher calls on you to
answer a question?
5. How do you feel about talking to adults?
6. How do you feel about talking a lot when you are on a
bus?
7. How do you feel when you are picked to be a leader of a
group?
8. How do you feel about talking a lot in class?
9. How do you feel about inviting your classmates to come to
a party?
10. How do you feel about talking to other people?
11. How do you feel about trying to meet someone new?
12. How do you feel after you get up to talk in front of the
class?
13. How do you feel when you know you have to give a
speech?
14. How would you feel about giving a speech on television?
15. How do you feel about talking when you are in a small
group?
16. How do you feel when you have to talk in a group?
17. How do you feel about talking to other students during
recess?
18. How do you feel about talking to all of the people who
sit close to you?
19. When someone comes to visit your class, how do you feel
about asking them questions?
20. How do you feel when you talk in front of a large group
of people?
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APPENDIX J
RELAXATION TRAINING
Today we are going to begin with some special kind of
exercises called 'relaxation exercises'. These exercises help you
learn how to loosen your muscles as much as you can and 'do
nothing with them'.
In order for you to get the best feelings from these exercises
there are some rules you must follow. First, you must do exactly
what I say, even If it seems kind of silly. Second, you must try
hard to do what I say right when I say it. Third, you must pay
attention to your body. During the exercises, pay attention to how
you muscles feel when they are tight, and when they are loose and
relaxed.
Are you ready to begin? Okay. First, get as comfortable as you
can in your chair. Sir back and just let your arms and legs hang
loose. That's fine. Now close your eyes and don't open them until
I say to. Remember to follow my instructions very carefully, try
hard, and pay attention to your body. Here we go.
1. (Left hand and arm) Pretend you have a whole lemon in
your left hand. Now squeeze it hard. Try to squeeze all the juice
out. Feel the tightness in your hand and arm as you squeeze.
(Pause) Now drop the lemon. Notice how your muscles feel when
they are relaxed. Keep letting your hand relax. (Pause) Take
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another lemon and squeeze it. Try to squeeze this one harder than
you did the first one. That's right. Real hard. (Pause) Now drop
your lemon and relax. See how much better your hand and arm
feel when they are relaxed. Keep letting them relax.
2. (Right hand and arm - same as left hand and arm, but
begin with-) Okay, now pretend you have a whole lemon in your
right hand. Now squeeze it hard...
3. (Legs and feet) Now pretend that you are standing barefoot
in a big, fat mud puddle. Squish your toes down deep into the
mud. Try to get your feet down to the bottom of the mud puddle.
You'll probably need your legs to help you push. Push down,
spread your toes apart, and feel the mud squish up between your
toes. (Pause). Now step out of the mud puddle. Relax your feet.
Let your toes go loose and feel how nice that is. It feels good to
be relaxed. (Pause). Back in to the mud puddle. Squish your toes
down. Let your leg muscles help push your feet down. Push your
feet. Hard. Try to squeeze that mud puddle dry. (Pause). Okay.
Come back out now. Relax your feet, relax your legs, relax your
toes. It feels so good to be relaxed. No tenseness anywhere. You
feel kind of warm and tingly.
4. (Abdominal muscles). Here comes a baby elephant. But he's
not watching where he's going. He doesn't see you lying there in
the grass and he's about to step on your stomach. Don't move.
You don't have time to get out of the way. Just get ready for him.
Make your stomach very hard. Tighten up your stomach muscles

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real tight. Hold it. (Pause), it looks like he is going the other
way. You can relax now. Let your stomach go soft. Let it be as
relaxed as you can. That feels so much better. (Pause). Oops,
he's coming this way again. Get ready. Tighten up your stomach.
Real hard. If he steps on you when your stomach is hard, it
won't hurt. Make your stomach into a rock. (Pause). Okay, he's
moving away again. You can relax now. Kind of settle down, get
comfortable and relax. Notice the difference between a tight
stomach and a relaxed one. That's how we want it to feel - nice
and loose and relaxed.
This time imagine that you want to squeeze through a narrow
fence and the boards have splinters them. You'll have to make
yourself very skinny if you're going to make it through. Suck
your stomach in. Try to squeeze it up against your backbone. Try
to be as skinny as you can. You've got to get through. (Pause).
Now relax. You don't have to be skinny now. Just relax and feel
your stomach being warm and loose. (Pause). Okay, let's try to
get through that fence now. Squeeze up your stomach, make it
touch your backbone. Get it real small and tight. Get as skinny
as you can. Hold tight. (Pause). You can relax now. Settle back
and let your stomach come back out where it belongs. You can feel
really good now. You've done fine. (Pause).
5. (Face and nose). Here comes a fly. He has landed on your
nose. Try to get him off without using your hands. That's right,
wrinkle up your nose. Make as many wrinkles in your nose as you

134
can. Scrunch your nose up real hard. (Pause). Good. You've
chased him away. Now you can relax your nose. (Pause). Oops,
here he comes back again. Right back in the middle of your nose.
Wrinkle up your nose again. Shoo him off. Wrinkle it up hard.
Hold it just as tight as you can. (Pause). Okay, he flew away.
You can relax your face. Notice that when you scrunch up your
nose that your cheeks and your mouth and your forehead and your
eyes all help you, and they get tight too. So when you relax your
nose, your whole face relaxes too and that feels good. Oh-oh. this
time that old fly has come back, but this time he's on your
forehead. Make lots of wrinkles. Try to catch him between all
those wrinkles. Hold it tight now. (Pause). Okay, you can let go.
He's gone for good. Now you can just relax. Let your face go
smooth, no wrinkles anywhere. Your face feels nice and smooth and
relaxed.
6. (Shoulder and Neck). Now pretend you are a turtle. You're
sitting out on a rock by a nice, peaceful pond, just relaxing in
the warm sun. It feels nice and warm and safe here. Oh-oh! you
sense danger. Pull your head into your shell. Try to pull your
shoulders up to your ears and push your head down into your
shoulders. Hold in tight. (Pause). The danger is past now. You
can come out again, relax, and feel the warm sunshine. (Pause).
Watch out now! More danger. Hurry, pull your head back in and
hold it tight. You have to be closed in tight to protect yourself.
Okay, you can relax now. Bring your head out and let your

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shoulders relax. Notice how much better it feels to be relaxed than
to be all tight. (Pause). One more time, now. Danger! Pull your
head in. Push your shoulders way up to your ears and hold tight.
Don't let even a tiny piece of your head show outside your shell.
Hold it. Feel the tenseness in your neck and shoulders. (Pause).
Okay. You can come out now. It's safe again. Relax and feel
comfortable in your safety. There's no more danger. Nothing to
worry about. Nothing to be afraid of. You feel good.
Copyright AACD. Reprinted with permission. No further
reproduction authorized without written permission of AACD.

APPENDIX K
STIMULUS IMAGERY TRAINING
The next thing that we are going to do is to teach you how to
imagine very clearly. When you see a movie, does it ever seem
real? Well, imagining is something like that.
We're going to ask you to imagine some common scenes.
Remem her, this is like seeing movies, but your're going to try to
bring it under your own control. It will help if you try to remain
very relaxed, like you just learned.
Try to relax yourself; all of your muscles. As you are sitting
there, deeply relaxed, we would like you to try to imagine some
scenes. Try to imagine these situations as clearly and vividly as
you can. Try to picture the scenes. For example, the first scene is
about flying a kite. I want you to see the picture with as much
detail as possible, just like it was real, and in front of you. Try
to get the most realistic picture of the scene that you can.
Now I am going to play a tape of the first scene. Listen
carefully, and create the image in your mind. Try bo get a real
detailed picture of what everything would look like. When the tape
finishes, keep imagining until I tell you to stop. Now we're
ready. Take a deep breath, relax, and close your eyes.
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137
(PLAY TAPE OF SCENE. HAVE CHILD CONTINUE TO IMAGINE THE
SCENE FOR 20 SECONDS AFTER SCENE ENDS)
(It is a clear, bright sunny day and you are outside flying
your red kite. The dark red of the kite shows clearly against the
cloudless blue sky. The meadow is filled with colorful flowers. A
strong breeze is blowing, and your red kite quickly rises upward,
and almost seems to dance in the wind. With each step you take,
the long white tail flows behind the soaring kite, waving back
and forth in the wind. Other children are flying kites too, and
the colors of all of the kites together make a pretty picture in the
sky.)
Now, stop imagining the scene and think about relaxing your
msucles (10 seconds). Now open your eyes.
(ASK THE FOLLOWING QUESTIONS, PRAISE STIMULUS
PROPOSITIONS)
1. How well were you able to imagine the scene?
2. What did you imagine?
3. Did you see the colors of the flowers?
4. Could you see the kite dancing in the wind?
5. Could you feel the wind blowing?
6. Could you see the colors of all the kites together?
Remember, it is very important to include in the picture all of
the details that you can, and to try to see everything, just like
it were real, and in front of you. Try to see a realistic picture
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138
All right, now that we've reviewed the idea of seeing the
image clearly, lets try the same scene again. Close your eyes,
take a deep breath, and relax (20 seconds). Don't worry if the
scene was not clear before. At first, some people are better than
others, but with practice, everyone can see the picture clearly.
Lets try the same scene again.
(REPEAT SCENE, AND THEN REPEAT QUESTIONS)
Close your eyes and take a few seconds to get relaxed again.
We'll do another scene. Relax your hands, relax your arms. Then,
relax your legs, and your feet. Relax your stomach, then, relax
your face. Finally, relax your shoulders and your neck.
Remember, you are trying to learn to imagine the scene clearly
and realistically. Just like before, try to picture all of the
details. For example, include colors, sizes and shapes in your
picture. Let's do another one. This scene is about riding a
bicycle.
(PLAY TAPE OF SCENE. ALLOW CHILD TO CONTINUE IMAGINING
FOR 20 SECONDS AFTER TAPE ENDS)
(On a clear Saturday morning you are riding your shiny red
bicycle on a quiet street. Some birds fly lazily around in the blue
sky. To your left is a field of tall green corn, and to your right
are several tall, wooden farm buildings. Ahead of you is a steep
hill. You notice some children playing tag along the side of the
road. They wave to you as you pass. Some chickens scatter when

139
you pass a large red barn. Your hear a rooster crow loudly. You
near the top and the long black road seems to stretch forever.)
Stop imagining the scene and think hard about relaxing all of
your muscles (10 seconds). Now, open your eyes.
(ASK THE FOLLOWING QUESTIONS. PRAISE STIMULUS
PROPOSITIONS)
1. How well were you able to imagine the scene?
2. What did you imagine?
3. Could you see the shiny red bicycle?
4. Did you see the farm buildings?
5. Could you hear the rooster crowing?
6. Did you see the long, black road?
Remember, it is important to make the picture of the scene as
real as possible. This means imagining all those little details.
Let's practice that last scene again. Sit back, take a deep
breath, and relax. Close your eyes. Relax your hands, relax your
arms. Then, relax your legs, and your feet. Relax your stomach,
then, relax your face. Finally, relax your shoulders and your
neck.
(REPEAT SCENE, AND THEN REPEAT QUESTIONS)

APPENDIX L
RESPONSE IMAGERY TRAINING
The next thing that we are going to do is to teach you to
imagine very clearly. When you see a movie, does it ever seem
like you're really a part of it? Well, imagining is something like
that.
We're going to ask you to imagine some common scenes. This is
like daydreaming, but you're going to try to bring it more under
your own control. It will help you if you try to remain very
relaxed, like you just learned.
Try to relax yourself, all of your muscles. As you are sitting
there, deeply relaxed, we would like you to try to imagine some
scenes. Try to imagine these scenes as clearly as you can and
involve yourself fully in the image, as if you were there. For
example, the first scene I will ask you to imagine will be about
flying a kite. I want you to try to move your eyes as you watch
your kite in the sky. The idea of a clear image is that you get
the feeling of a real experience.
Now I am going to present a scene, and as I read it, make the
picture in your mind, doing just what you would in the real
situation. When I finish the description, keep imagining the scene
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141
until I tell you to stop and relax. Now we're ready. Close your
eyes, take a deep breath, and relax.
(PLAY RECORDING OF SCENE. HAVE CHILD CONTINUE TO IMAGINE
FOR 20 SECONDS AFTER SCENE ENDS)
(It is a bright, sunny day and you are outside flying your
kite. As the sun shines in your eyes, you close them tightly,
squeezing the muscles in your forehead around your eyes. The
meadow is filled with colorful flowers. You breathe deeply and
your heart races as you run with your kite. A strong breeze is
blowing, and your red kite goes higher and higher. The long
white tail flows back and forth in the wind. You can feel the
sweat dripping down your face as your eyes follow the blowing
tail of your soaring kite.)
Stop imagining the scene and try to relax all of your muscles
(10 seconds). Now open your eyes.
(ASK THE FOLLOWING QUESTIONS, PRAISE RESPONSE
PROPOSITIONS)
1. How well were you able to imagine that scene?
2. What did you imagine?
3. Did your eyes follow the blowing tail of your kite?
4. Did you tense the muscles around your forehead to block out
the sun?
5. Did your heart race in your image?
6. Did you feel sweat dripping down your face?
7. Did you breathe deeply in your image?

142
Remember, it is important to try to move your eyes as you
watch your kite in the sky. A good image depends on making the
scene a real, actual experience. Do in the image what you would
do in the real situation.
Now that we have reviewed the idea of a clear image, or clear
picture, let's try that same scene again. Close your eyes, take a
deep breath, and try to relax yourself (20 seconds). Don't worry
if the scene was not clear before. At first, some people are better
than others, but with practice, everyone can get it. Now let's try
the same scene again.
(REPEAT SCENE, AND THEN REPEAT QUESTIONS)
Close your eyes and take a few seconds to get comfortable and
relaxed again. Relax your hands, relax your arms. Then relax
your legs, and your feet. Relax your stomach, then, relax your
face. Finally, relax your shoulders and your neck.
Remember that what you are trying to learn is to imagine
clearly, with you taking part in that image. It is like acting in
your own daydreams. That means doing what the picture requires.
The next image involves riding a bicycle. I want you to tense
your face and neck muscles as you ride up a steep hill. This will
make your image better.
Now I am going to present a scene. Try to make the picture in
your mind, doing what you would do if it was real. When I
finish, keep imagining the scene until I tell you to stop. Here is
the scene.

143
(PLAY SCENE. ALLOW CHILD TO CONTINUE IMAGINING FOR 20
SECONDS AFTER SCENE ENDS)
(On a clear Saturday morning you are riding your shiny red
bicycle on a quiet street. You breathe heavily and sweat runs
down your face as you pedal along. To your left is a field of
tall, green corn, and to your right are several large, wooden farm
buildings. Ahead of you is a steep hill, and you tighten your face
and neck muscles, working to climb the hill. Your eyes look right
at some chidlren playing a game of tag. They wave to you as you
pass. Your heart pounds as you near the top.)
Stop imagining and think about relaxing all of your muscles
(10 seconds). Now open your eyes.
(ASK QUESTIONS, PRAISE RESPONSE PROPOSITIONS)
1. How well were you able to imagine that scene?
2. What did you imagine?
3. Did your eyes move as you looked around?
4. Did you tense your face and neck muscles in your image?
5. Did your heart pound in the image?
6. Did you breathe heavily?
7. Did you feel sweat running down your face?
It is important to do in the scene what you would do in the
real situation. This means things like tightening your muscles,
moving your eyes and breathing deeply. Let's practice that last
scene again. Sit back, close your eyes, and relax. Relax your
hands, relax your arms. Then relax your legs, and your feet.

144
Relax your stomach, then, relax your face. Finally, relax your
shoulders and your neck.
(REPEAT SCENE, AND THEN REPEAT QUESTIONS)

APPENDIX M
IMAGERY PROCEDURE INSTRUCTIONS
Note: Instructions are for response subjects. Phrases that vary
for the stimulus and response groups are in all capital letters.
Substitutions for stimulus subjects are in parentheses.
(ASK CHILD IF SHE/HE NEEDS TO USE THE RESTROOM, AND ASK
HIM/HER TO REMOVE ANY GUM OR CANDIES FROM HIS/HER MOUTH.
HAVE SUBJECT SIT IN CHAIR.)
Today we are going to imagine scenes very similar to the ones
you imagined last time. Do you remember? Remember, the idea is to
imagine the situation as clearly as you can, and to INVOLVE
YOURSELF FULLY IN THE IMAGE, AS IF YOU WERE THERE (SEE THE
PICTURE WITH AS MUCH DETAIL AS YOU POSSIBLY CAN, JUST LIKE IT
WAS REAL, AND IN FRONT OF YOU). When you hear each scene,
make the picture in your mind, DOING JUST WHAT YOU WOULD DO IN
THE REAL SITUATION (WITH AS MUCH DETAIL AS POSSIBLE, JUST
LIKE YOU WERE WATCHING A MOVIE). Today, I am going to measure
the way your body responds when you are imagining. I am going
to do this using the monitors thatX showed you last time. Now I'm
going to put the monitors on. I'll explain what I'm doing as we
go along.
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(ATTACH MONITORS, EXPLAIN EACH STEP AS YOU GO ALONG.)
Now, you will be asked to imagine seven different scenes. The
first scene will be for practice. Just like the other scenes, from
last time, these have been recorded on to a tape and will be
played to you on that speaker (POINT). When you imagine each
situation, try to imagine that you are actually part of each
situation, rather than just "watching yourself" in the situation.
To begin, I will lower the lights, like this (DIM LIGHTS).
Next, you will hear instructions through the speaker asking you bo
get comfortable in this chair, to close your eyes, and to
concentrate on relaxing different parts of your body. Once these
relaxation instructions are over, please keep your eyes closed and
wait for the reading of the first situation.
As the scene is read, keep your eyes closed, listen carefully
and imagine the scene as it is described. When the description
ends, keep on imagining the scene as clearly as you can, starting
from the beginning of the script. Keep on imagining until you hear
a beep. When you hear the beep, stop imagining, and relax your
muscles as much as you possibly can. Keep on relaxing until you
hear the beep again. Then, when you hear the second beep, open
your eyes and look at this screen (POINT) to make three ratings
about what you imagined. Then, we will ask you to rate how
clearly you imagined the scenes. Then, I will bell you to close
your eyes, relax, and wait for the next scene. We will tell you

147
what to do when the beep comes on, to help you remember. Do you
have any questions so far?
(ASK SUBJECT TO EXPLAIN PROCEDURE IN HIS/HER OWN WORDS,
TO CHECK FOR UNDERSTANDING).
I will ask you to tell me how you feel about each of the scenes
you imagine. I'll want you to tell me whether you felt happy or
not, excited or calm, or how important or in control you feel. I'll
want you to tell me as exactly as you can. This is not always
easy to do with words. To help you show me how you feel, we'll
use SAM (for girls: SAM is short for Samantha). SAM can be used
to show three different ways of feeling: whether you're happy or
unhappy, calm or excited, and how important you feel.
(HAPPY/SAD)
When the screen says "Please center ratings knob", like that,
you turn the knob to get a picture of SAM. These pictures show
how happy SAM is, from most to least, all the way from being
really pleased to being very unhappy (TURN KNOB TO
DEMONSTRATE). You can turn the knob to change the way SAM
feels. In this picture, SAM feels the most happy. When you feel
the same as SAM, really happy, make SAM look like this
(DEMONSTRATE). This is how SAM looks when you feel the most
unhappy (DEMONSTRATE). This is how SAM looks when you feel
completely neutral, neither happy nor unhappy (DEMONSTRATE).
You can change SAM to show exactly how you felt while you were
imagining a scene, anywhere from very happy to very unhappy.

148
Once you've changed SAM to show how happy or unhappy you felt
during imagery, you push this button to go on to the next rating.
(DOMINANCE)
SAM can show other kinds of feelings. You can use SAM to tell
me how important you feel. When SAM looks like this
(DEMONSTRATE) you feel the most important. When you feel the
biggest, like the boss, make SAM look like his. Now, this is the
way SAM looks when you feel small and cared for. (DEMONSTRATE).
When you feel the most controlled and influenced by others, make
SAM look like this. If you didn't feel either way, completely
neutral, not at all the boss, but not cared for either, you would
make SAM look like this. Remember to push this button to go on to
the next rating.
(EXCITED/CALM)
This is the third type of feeling that I'll ask you about. Here,
SAM changes from being very excited to completely calm
(DEMONSTRATE). You can show how excited you are by changing
SAM to show how you are feeling. When SAM looks like this, you
feel the most excited (DEMONSTRATE). Now, when SAM looks like
this, (DEMONSTRATE) you feel the most relaxed, calm and sleepy,
not at all aroused or excited. Of course, if you feel completely
neutral, neither excited nor calm, make SAM look like this
(DEMONSTRATE). Remember to push the button when SAM shows just
how you feel. You should remember that being excited can be

149
either a positive or good feeling, for example, as if you just ran
around the block, or a negative or bad feeling, for example,
feeling very jumpy.
There is one more rating I'll ask you to make. I want you to
tell me how clearly you imagined the scene. If your image was
perfectly clear and real, like this picture of the keys (SHOW
PICTURES OF KEYS IN VARYING DEGREES OF FOCUS) you would move
the arrow to this end of the scale, where it says "Just like a real
situation". If the image was very unclear, or not present at all,
like this picture (SHOW KEYS) you would move the arrow to the
opposite end, like this. It says "Not at all vivid". If your image
was more like one of tbe.se pictures, you could move the arrow to
any point on the line to show how clear and real your image was.
Now I'd like you to make a sample set of ratings. Remember to
turn the knob to start. (WAIT FOR SUBJECT TO TURN THE KNOB TO
BEGIN.) Please turn the knob all the way to the right and then
all the way to the left to see the different ratings you can choose.
What feelings is SAM showing in these pictures? (HAPPY/SAD; WAIT
FOR SUBJECT'S RESPONSE, CLARIFY AS NECESSARY.) Now, show me
how SAM would look when something pretty good happens, like
eating a dessert. (WAIT FOR RESPONSE, IF APPROPRIATE , SAY
"THAT'S FINE. IF RESPONSE IS INCORRECT, EXPLAIN CONCEPT
AGAIN, AND ASK FOP ANOTHER RATING). How would SAM look of you
fell and scraped your knee? Push the button to go on to the next
rating.

150
Now, turn the knob to look at all of the possible ratings. What
feelings is SAM showing here? (DOMINANCE; WAIT FOR RESPONSE,
CLARIFY AS NECESSARY). Now, show me some of your feelings. How
did you feel the first day in school? (VERIFY RESPONSE, AS
ABOVE.) What does it feel like when you win a game? Push the
button to go on to the next rating.
Again, turn the knob to look at all of the possible ratings.
What feelings is SAM showing here? (EXCITED/CALM; WAIT FOR
RESPONSE, CLARIFY AS NECESSARY.) Now, show me how you would
feel if you were going to see a really good movie? (VERIFY
RESPONSE.) What about if someone called you a bad name? (VERIFY
RESPONSE.) Go ahead and push the button.
Now, turn the knob so that you can see all of the ratings.
What does this racing show? (IMAGE CLARITY; WAIT FOR RESPONSE,
CLARIFY AS NECESSARY). Where would the arrow be if your image
was perfectly clear and real? (VERIFY RESPONSE.) What if you had
no image at all? (VERIFY RESPONSE.) What if your image was
somewhat clear but a little bit fuzzy? (VERIFY RESPONSE).
Remember to always push the button after you make your
rating. Also, the ratings will not come on the screen in the same
order each time, but you will know which rating to make by how
SAM looks. Do you have any questions?
Let's review everything. First you will hear some relaxation
instructions, then you will hear the first scene over the speaker.
Imagine the scene as it is being read, imagining that you are

151
actually a part of the scene. When the reading stops, keep on
imagining the scene, starting over from the beginning of the
description. When you hear a beep, stop imagining, and relax.
When you hear the next beep, open your eyes, and make ratings
using SAM. Then I will ask you to tell me how clear your image
was. I might also ask you some questions about what you
imagined. Then I will tell you to close your eyes and wait for the
next scene. I will tell you when the last scene has been finished.
If you have any questions while we are doing this, ask them,
but try to ask only during the times you are making your ratings.
Also, please try to sit very still in the chair, don't move your
arms, because this will affect our recordings. If you need to, you
can move around when you make your ratings. Any questions? We
will start in a few minutes. Please relax while waiting for
instructions over the speaker.
BRIEF INSTRUCTIONS BEFORE RELAXATION:
Can you hear me (Name of subject)? (WAIT FOR RESPONSE.)
That's fine. Just a few reminders. Listen to each scene with your
eyes closed. Once the scene has been read, keep on imagining as
clearly as you can, starting from the beginning of the description.
When you hear a beep, stop imagining the scene, and just relax.
Keep your eyes closed. When you hear the next beep, open you
eyes to make the ratings. Once you finish the ratings, close your
eyes, relax, and wait for the next scene. The relaxation exercise

152
will begin shortly. Please call out if it is too loud or too soft.
Until then, just sit quietly and relax.
WHEN IMAGERY PROCEDURE IS OVER, REMOVE MONITORS. TALK
WITH CHILD ABOUT EASIEST/HARDEST SCENES TO IMAGINE,
MOST/LEAST FAVORITE SCENE. INQUIRE ABOUT ANY UNUSUAL SAM
RESPONSE OR OTHER UNUSUAL INCIDENTS DURING THE PROCEDURE.

APPENDIX N
PILOT STUDY OF SCENE CONTENTS
The purpose of this pilot study was to assess the properties of
the scenes to be used in the main study. The primary goal was to
determine whether the a priori designations of the scenes as
fearful and neutral was accurate, based on children's ratings of
the scene contents. The scenes were also evaluated for the degree
of similarity to the children's past experiences, and for the
children's expectations that such situations could occur in the
future.
Method
Twenty-two students at the P.K. Yonge Elementary School in
Gainesville, Florda served as subjects in this study. There were
seven first graders, eight third graders, and seven fifth graders.
Subjects in these grades were selected because their ages were
distributed across the age range to be used in the main study.
The students in each grade were tested together. After instruction
in the use of the answer booklet children were asked to close their
eyes and to imagine each scene as it was played on a tape
recorder. After each scene was completed, they answered the
following questions:
153

154
1. How much is this scene like something that has happened to you
in the past?
2. How much is this scene like something that could happen to you
in the future?
3. How afraid are you of this situation?
4. How happy or unhappy does this situation make you feel?
5. How excited or calm does this situation make you feel?
6. How important or in control does this situation make you feel?
The questions regarding similarity to past and future experiences,
as well as the question regarding fearfulness of the situation were
answered with a three point Likert scale. Three boxes of graded
size were presented, and each child marked the box corresponding
bo his/her answer (small box = not at all, medium box = a little,
large box = very much). The questions regarding the pleasure,
arousal and dominance dimensions were answered by marking one
of five pictures of SAM (Self Assessment Mannekin; Lang, 1980)
presented for each dimension).
Seven scenes (See Appendix B) were presented to the children.
These included 1 practice neutral scene (bus stop), two neutral
scenes (lawn chair and living room), two dental fear scenes
(dental examination and dental injection), and two school fear
scenes (blackboard and principal). The practice scene was not
included in the analyses. A different scene order was used for
each group.

155
Results
Analysis of Variance was used to evaluate differences between
scenes for each of the dimensions under consideration. Differences
between means were computed by the LSD test.
Pleasure
Ratings on the pleasure dimension showed that fear scenes were
rated as more unpleasant than neutral scenes (main effect of
Scene: F(5,95)=14.65, p<.0001). All four fear scenes were rated as
significantly more unpleasant than the lawn chair scene (all LSD
pC.Ol) while the dental exam (LSD p<.05), dental injection (LSD
pC.Ol) and principal (LSD p<.01) scenes were rated as
significantly more unpleasant than the living room scene. The
principal scene was rated as significantly more unpleasant than
all other scenes including the other fear scenes. The ranking of
scenes from most unpleasant to pleasant is as follows: principal,
dental injection, dental exam, blackboard, living room and lawn
chair.
Arousal
Scene content also influenced arousal ratings (main effect of
Scene: F( 5,95) =5.93, pC.0001) although these ratings were not
completely consistent with expectation. While the dental injection
received the highest arousal ratings, the lawn chair scene received
the second highest ratings on the arousal dimension. The ratings
for the dental injection scene were significantly higher than those
for the dental exam (LSD p<.05), principal (LSD p<.05) and living

156
room scene (LSD pC.Ol). The ranking of scenes from most to least
arousing is as follows: dental injection, lawn chair, blackboard,
dental exam, principal and living room.
Dominance
Analysis of Variance on the dominance ratings yielded an
interesting result. The blackboard scene received the highest
dominance ratings, and was rated significantly higher in
dominance than the dental exam (LSD p<.05), dental injection (LSD
p<.05) and principal (LSD p<.01) scenes). The ratings for the
blackboard scene did not differ from those for the neutral scenes.
The principal scene was rated significantly lower in dominance
than were all other scenes (all LSD pC.Ol except for that between
principal and dental injection where LSD p<.05). The dominance
ratings for the dental fear scenes did not differ from those for the
neutral scenes. The ranking of scenes from lowest to highest
dominance ratings is as follows: principal, dental injection, dental
exam, living room, lawn chair and blackboard.
Fear
The principal and dental injection scenes were rated as
significantly more fearful than all other scenes (all LSD pC.Ol).
These two scenes did not differ significantly from one another. The
ranking of scenes from most to least fearful is: principal, dental
injection, blackboard, dental exam, living room and lawn chair.

157
Similarity to Past Experiences
The dental exam scene was rated as most similar to past
experiences of the children, while the principal scene was rated as
the least similar (main effect of Scene: F(5,95)=2.79, p<.02). The
dental exam scene was rated as significantly more similar to past
experience than the living room (LSD p<.05) and principal (LSD
p<.01) scenes. The principal scene received similarity ratings that
differed significantly from those for the dental exam (LSD pC.Ol),
lawn chair (LSD pC.Ol) and dental injection (LSD p<.05) scenes.
The ranking of scenes from most to least similar to past experience
is: dental exam, lawn chair, dental injection, blackboard, living
room and principal.
Similarity to Possible Future Experiences
Analyses of Variance on the children's ratings of the likelihood
that each of the situations could happen to them yielded no
significant main effect of scene.
Discussion
The results of this pilot study supported the classifications of
the imagery assessment scenes as fearful and neutral. Thus, fear
scenes were rated as more unpleasant, lower in dominance and as
more fearful than were the neutral scenes. While the blackboard
scene received moderately high ratings of fear, this scene also
received very high dominance ratings. This scene may differ in
some way from the other fear scenes. Data to be obtained in the
main study can shed further light on this issue.

158
An unexpected pattern of results was obtained for the arousal
ratings. A high rating for the dental injection scene is consistent
with the expectation that this scene would be anxiety provoking.
The high rating given to the blackboard scene is appropriate to
the activation or arousal required to carry out the task. However,
it is not clear why the lawn chair scene received a high arousal
rating, or why the principal scene was rated low in arousal. It is
likely that the children do not have a clear understanding of the
arousal dimension. It is also possible that the children may have
different perceptions of the situations than do adults, resulting in
ratings that are not consistent with expectation.
The similarity ratings obtained for each scene were fairly
moderate, with approximate averages being two out of a maximum
three points. It will be important to consider the low similarity
ratings obtained for the principal scene when evaluating
physiological responsivity to the scenes. A number of factors may
be responsible for these moderate similarity ratings. First, may of
the children in the study seemed to personalize the scenes. For
example, a child might comment "I've been at a bus stop before,
but I never saw a man in a brown shirt while I was at the bus
stop". The effects seen in this study may differ from those
obtained in the main study. The one on one attention given to
each subject in the main study may increase concentration and

159
compliance with the tasks. Second, the imagery training given is
likely to have an effect on how well the subject "gets in to" each
scene and makes it real.
In summary, the results of this pilot study indicate that the
scenes selected for use in the children's imagery study have
moderate similarity to experiences that children have had or
believe that they may have in the future. The a priori
classifications of neutral and fearful that were given to each scene
were supported by the data.

APPENDIX O
TABLES OF MEANS FOR AFFECTIVE RATINGS, HEART RATE
AND SKIN CONDUCTANCE*
TABLE 3
MEANS
FOR AFFECTIVE
RATINGS — FULL
SAMPLE
SCENE NAME
PLEASURE
AROUSAL
DOMINANCE
Lawn Chair
27.25
14.54
21.08
(4.06)
(13.44)
(9.95)
Living Room
22.96
14.75
18.46
(8.87)
(12.98)
(10.21)
Dental Exam
16.88
15.71
10.54
(8.67)
(11.66)
(10.62)
Dental Injection
12.54
12.04
9.46
(10.53)
(11.04)
(10.20)
Blackboard
16.79
15.92
14.88
(7.90)
(10.89)
(10.86)
Principal
5.79
12.58
6.75
(9.74)
(12.25)
10.12
*In all tables standard deviations are listed in parentheses below
each mean.
160

161
TABLE 4
MEANS FOR AFFECTIVE RATINGS — BY GROUP
(a) Pleasure Ratings
SCENE NAME
HIGH
Stimulus
FEAR
Response
LOW F
Stimulus
EAR
Response
Lawn Chair
27.67
(2.07)
26.20
(5.22)
26.14
(5.98)
29.00
(0.00)
Living Room
27.33
(3.20)
17.60
(11.33)
19.29
(10.77)
27.33
(4.08)
Dental Exam
22.17
(8.54)
20.20
(8.04)
16.29
(6.75)
9.50
(7.50)
Dental Injection
18.33
(11.67)
13.80
(9.83)
13.00
(11.00)
5.17
(6.65)
Blackboard
17.00
(11.44)
19.60
(8.71)
18.14
(7.06)
12.67
(2.16)
Principal
11.33
(13.57)
1.80
(3.49)
8.00
(11.15)
1.00
(2.45)
(b)
Arousal
SCENE NAME
HIGH
Stimulus
FEAR
Response
LOW F
Stimulus
EAR
Response
Lawn Chair
17.50
(14.21)
9.40
(8.20)
16.71
(14.75)
17.50
(13.53)
Living Room
19.00
(14.74)
8.80
(12.52)
19.43
(9.14)
10.00
(14.74)
Dental Exam
19.50
(13.35)
19.40
(7.40)
7.86
(9.99)
18.00
(12.65)
Dental Injection
19.17
(11.48)
7.40
(9.10)
9.71
(7.65)
11.50
(14.21)
Blackboard
12.50
(11.93)
20.00
(5.52)
15.14
(13.90)
16 .83
(10.70)
Principal
13.17
(14.72)
18.40
(12.90)
12.43
(10.78)
7.33
(11.59)

162
TABLE 4 (continued)
(c) Dominance
SCENE NAME
HIGH
Stimulus
FEAR
Response
LOW F
Stimulus
EAR
Response
Lawn Chair
21.33
(12.47)
21.20
(7.26)
18.00
(11.55)
24.33
(8.48)
Living Room
21.67
(9.35)
15.20
(8.67)
15.14
(11.33)
21.83
(11.21)
Dental Exam
15.50
(14.17)
13.40
(11.67)
10.00
(9.45)
3.83
(3.19)
Dental Injection
8.83
(11.29)
16.40
(11.89)
8.00
(8.42)
6.00
(9.32)
Blackboard
12.83
(9.30)
22.80
(6.94)
16.71
(13.16)
8.17
(9.13)
Principal
12.17
(11.00)
7.40
(12.26)
7.42
(10.77)
0.00
(0.00)

163
TABLE 5
MEANS
FOR HEART RATE
— FULL
SAMPLE
SCENE NAME
READ
IMAGE
RECOVER
Lawn Chair
-.62
-1.61
-2.50
(6.15)
(5.63)
(6.66)
Living Room
1.16
.60
-.39
(7.09)
(4.74)
(5.30)
Dental Exam
-1.64
-.84
.11
(4.59)
(5.65)
(4.77)
Dental Injection
-1.55
.11
.57
(5.76)
(4.49)
(5.04)
Blackboard
-.43
1.76
-.14
(4.67)
(6.44)
(5.63)
Principal
-4.78
-2.99
-2.56
(5.31)
(4.56)
(5.51)

164
TABLE 6
MEANS FOR HEART RATE — BY GROUP
SCENE NAME
H I G H F
EAR
LOW F
EAR
Lawn Chair
Stimulus
Response
Stimulus
Response
Read
1.60
-1.02
1.40
-4.86
(6.11)
(3.86)
(6.88)
(5.37)
Image
-.37
-.79
-.42
-4.94
(3.07)
(8.40)
(6.21)
(3.99)
Recover
-1.76
-5.17
1.57
-5.77
(5.12)
(7.64)
(7.52)
(4.39)
Living Room
Read
.34
-3.31
1.57
5.23
(4.38)
(3.14)
(4.24)
(11.90)
Image
-1.46
.28
.24
3.37
(5.14)
(3.35)
(2.78)
(6.23)
Recover
-1.89
-2.79
2.39
-.12
(4.35)
(6.73)
(6.06)
(3.25)
Dental Exam
Read
-4.20
-1.77
-1.12
.42
(4.15)
(4.23)
(4.14)
(5.62)
Image
-.83
-.86
.31
-2.19
(8.84)
(5.15)
(5.13)
(3.48)
Recover
-2.08
.75
2.87
-1.47
(6.03)
(5.37)
(4.13)
(2.21)
Dental Injection
Read
-2.50
-5.25
.16
.48
(4.92)
(7.71)
(4.58)
(5.64)
Image
.60
-1.96
.45
.96
(4.57)
(5.58)
(4.00)
(4.69)
Recover
.67
-1.60
1.61
1.09
(3.79)
(5.15)
(6.18)
(5.38)
Blackboard
Read
.82
-3.37
-.51
.86
(4.78)
(2.51)
(3.87)
(6.48)
Image
2.48
-1.92
1.91
3.94
(5.61)
(6.70)
(8.50)
(4.10)
Recover
-2.25
-.69
2.52
.67
(6.40)
(6.67)
(5.61)
(3.94)
Principal
Read
-4.02
-6.25
-5.52
-3.46
(3.31)
(5.07)
(6.61)
(6.33)
Image
-2.40
-4.40
-4.59
-.53
(3.94)
(2.36)
(5.73)
(4.93)
Recover
-2.44
-3.23
-3.28
-1.30
(5.15)
(5.84)
(6.14)
(6.11)

165
TABLE 7
MEANS FOR SKIN CONDUCTANCE — FULL SAMPLE
SCENE NAME
READ
IMAGE
RECOVER
Lawn Chair
-.39
-.41
-.33
(.71)
(1.34)
(1.44)
Living Room
-.32
-.40
-.26
(.44)
(.56)
(1.00)
Dental Exam
-.07
-.25
-.27
(.95)
(1.02)
(1.19)
Dental Injection
-.20
-.44
-.29
(.72)
(.68)
(.79)
Blackboard
.16
-.08
-.07
(.85)
(.81)
(1.44)
Principal
-.19
-.42
-.38
(.64)
(.97)
(1.02)

166
MEANS
SCENE NAME
Lawn Chair
Read
Image
Recover
Living Room
Read
Image
Recover
Dental Exam
Read
Image
Recover
Dental Injection
Read
Image
Recover
Blackboard
Read
Image
Recover
Principal
Read
Image
Recover
TABLE 8
SKIN CONDUCTANCE -
H I G H F
EAR
Stimulus
Response
-.20
-.22
(.88)
(.37)
-.23
.64
(.56)
(2.27)
.17
.82
(.84)
(2.26)
-.10
-.21
(.25)
(.39)
- .28
-.15
(.25)
(.64)
-.45
-.33
(.39)
(.46)
.13
-.44
(.59)
(.54)
-.04
-.67
(.64)
(.62)
.13
-.52
1.15)
(.58)
-.15
-.39
(.29)
(.31)
-.40
-.75
(.42)
(.62)
-.22
-.51
(.44)
(.83)
-.23
.62
(.51)
(1.32)
-.41
.32
(.68)
(1.30)
-.53
.84
(.96)
(.58)
-.07
-.24
(.23)
(1.29)
.03
-.97
(.51)
(1.87)
.21
-.89
(.70)
(1.50)
BY GROUP
LOW F
EAR
Stimulus
Response
-.32
-.82
(.79)
(.63)
-.65
-1.19
(1.10)
(.63)
-.73
-1.32
(1.04)
(.64)
-.44
-.49
(.41)
(.62)
-.63
-.47
(.33)
(.85)
-.01
-.31
(1.26)
(1.51)
-.32
.31
(1.21)
(1.15)
-.46
.13
(1.31)
(1.26)
-.60
-.08
(1.67)
(1.08)
-.33
.07
(.84)
(1.11)
-.36
-.31
(.27)
(1.20)
-.01
-.49
(.44)
(1.29)
.31
-.02
(.59)
(.87)
-.04
-.12
(.45)
(.83)
-.16
-.26
(.28)
(1.42)
-.17
.28
(.31)
(.58)
-.17
-.71
(.39)
(.58)
-.04
-.94
(.88)
(.64)

167
TABLE 9
CORRELATIONS BETWEEN AFFECTIVE RATINGS AND PHYSIOLOGY
SCENE Pleasure
Arousal
Dominance
Pleasure
Arousal
Dominance
Lawn Chair
Read
.15
.17
-.22
-.03
.13
.00
Image
.10
-.04
-.01
.02
-.05
.00
Recover
.42*
.30
.03
.06
-.11
-.12
Living Room
Read
.17
-.18
.18
.08
-.27
-.19
Image
.00
-.31
.35
.30
-.17
.22
Recover
-.11
.13
.17
.22
-.08
.23
Dental Exam
Read
-.04
-.29
-.35
-.10
.16
-.00
Image
-.04
-.19
-.23
-.16
.18
.00
Recover
.14
-.37
-.05
-.15
.06
.01
Dental Injection
Read .36
.04
-.19
-.21
-.04
.02
Image
.20
.25
-.05
-.04
-.23
-.11
Recover
.12
.40*
-.10
.00
-.24
-.30
Blackboard
Read
-.11
.11
-.23
.14
-.01
.07
Image
-.17
.11
.03
.11
-.07
.02
Recover
-.16
.16
.05
.04
-.10
.01
Principal
Read
.05
.19
.22
.07
-.38
-.07
Image
-.12
.05
-.04
-.07
-.34
.10
Recover
-.09
.11
.20
.09
-.41
.10
*p<.05

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BIOGRAPHICAL SKETCH
Lauren Kaplan Cohn was born on November 19, 1958, in New
York City. She grew up on Long Island. She attended John H.
Glenn High School in Elwood, New York. She earned her Bachelor of
Science degree at the State University of New York at Stony Brook
in 1981 and received University High Honors and Departmental
Honors in psychology. Ms. Cohn was elected to Phi Beta Kappa in
1980. She earned her Master of Science degree in clinical
psychology at the University of Florida in 1983. Her predoctoral
internship was completed at Beth Israel Medical Center in New
York during the 1985-86 academic year.
Ms. Cohn was married in August, 1986, and lives in Miami,
Florida, with her husband, Alan. After completion of her doctoral
studies, Ms. Cohn will work in a private practice that specializes
in the treatment of children.
175

I certify that I have read this study and that in my opinion
it conforms to acceptable standards of scholarly presentation and
is fully adequate, in scope and quality, as a dissertation for the
degree of Doctor of Philosophy.
Professor of Clinical Psychology
I certify that I have read this study and that in my opinion
it conforms to acceptable standards of scholarly presentation and
is fully adequate, in scope and quality, as a dissertation for the
degree of Doctor of Philosophy.
JL
iussell M. Baue
Associate Professor of Clinical
Psychology
I certify that I have read this study and that in my opinion
it conforms to acceptable standards of scholarly presentation and
is fully adequate, in scope and quality, as a dissertation for the
degree of Doctor of Philosophy.
B^nnett Johhson
ne Bennett Joh
iiate Professor
on
of Clinical
Psychology
I certify that I have read this study and that in my opinion
it conforms to acceptable standards of scholarly presentation and
is fully adequate, in scope and quality, as a dissertation for the
degree of Doctor of Philosophy.

I certify that I have read this study and that in my opinion
it conforms to acceptable standards of scholarly presentation and
is fully adequate, in scope and quality, as a dissertation for the
degree of Doctor of Philosophy.
White
of Nursing
This dissertation was submitted to the Graduate Faculty of the
College of Health Related Professions and to the Graduate School
and was accepted as partial fulfillment of the requirements for the
degree of Doctor of Philosophy.
May, 1987
UAnJ) (?-
Dean, College of Health Related
Professions
Dean, Graduate School

UNIVERSITY OF FLORIDA



UNIVERSITY OF FLORIDA
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