Perceptual & Motor Skills: Perception 2013, 116, 3, 761-772. © Perceptual & Motor Skills 2013

THE MANCHESTER COLOUR WHEEL: ENHANCING ITS UTILITY1 HELEN R. CARRUTHERS AND PETER J. WHORWELL Department of Translational Medicine University of Manchester, Manchester, UK Summary.—The Manchester Colour Wheel was developed to investigate the role of colour in the perception of illness in gastroenterology. During validation it was found that positive, neutral, or negative connotations of the shade of a colour were more important than the colour itself. However, when asked to relate mood to a colour, the response rate was greater in individuals with mood disorders than healthy controls. This study assessed whether response rate could be made more uniform by changing the wording of the question. Mood/colour choice was compared, using two slightly different questions, in 105 and 203 healthy volunteers, resulting in response rates of 39% and 95% respectively, with the latter not associated with increased false positive responses. These results show that adjustment of the wording of a mood-related question may allow equal response rates irrespective of the mood status of participants.

The authors have recently developed and validated an instrument called the Manchester Colour Wheel (“the wheel”) that has enabled study of colour in relation to mood. The wheel was based on the three primary and three secondary colours as well as brown and pink and the achromatic colours of black, white, and grey. Four shades of each colour, except black and white, were chosen to give a person a reasonable range of choices without overwhelming them with options (Fig. 1) (Carruthers, Morris, Tarrier, & Whorwell, 2010b). The wheel is a robust and extremely reproducible way of assessing mood in people with affective disorders but, unlike other mood questionnaires, can also detect positive mood states. One drawback was that when healthy volunteers without evidence of any mood disorder, using a validated anxiety and depression questionnaire, were asked to attribute a colour to their mood from the wheel, only 39% of them were able to do so spontaneously as opposed to 70% of anxious and 79% of depressed individuals, identified using the same questionnaire. The remainder did not specify a colour associated with their mood. Clearly, if a colour questionnaire is going to be of practical value in clinical or research settings, the majority of respondents should be able to answer the question they are being asked. It was therefore the purpose of this study to establish whether changes to the question’s wording could support responses and whether responses are reliable. Address correspondence to Prof. P. J. Whorwell, Academic Department of Medicine, Education and Research Centre, Wythenshawe Hospital, Manchester M23 9LT, UK or e-mail ([email protected] or [email protected]). 1

DOI 10.2466/24.27.PMS.116.3.761-772

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FIG. 1. The ‘Manchester Colour Wheel’ (Carruthers, et al., 2010b)

Colour transcends the boundaries of language and intellect and can be easily used to describe human feelings and emotions. For instance, in Western culture, green is associated with jealously and red has connotations of love. There have been many peer-reviewed studies examining the relationship between colour and emotion and some have suggested that children begin making colour-mood associations at a very early age (Lawler & Lawler, 1965; Bourgeois-Bailetti & Cerbus, 1977; Zentner, 2001; Burkitt, Barrett, & Davis, 2003), which are probably “learned rather than inborn” (Murray & Deabler, 1957) and appear to evolve with age (Boyatzis & Varghese, 1994; Terwogt & Hoeksma, 1995). The literature suggests that yellow is associated with happiness and cheerfulness, in contrast to the grey shades and black which have negative connotations (Wexner, 1954; Schaie, 1961; Nolan, Dai, & Stanley, 1995; Carruthers, et al., 2010b). Furthermore, it has been suggested that depressed people might have impaired colour sensitivity (Barrick, Taylor, & Correa, 2002a, 2002b), view life monochromatically (De Leo, Rocco, Dello Buono, & Dalla Barba, 1989), and it appears that brown and black are commonly chosen when depressed individuals are asked to ascribe a colour to their current mood (Nolan, et al., 1995).

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A particular finding in a previous study (Carruthers, et al., 2010b) was that different shades of the same colour had completely different connotations when people were asked to relate their mood to a colour. Black and grey as well as the darker shades of certain colours such as blue, purple and brown were rated as negative. In contrast, brighter colours such as yellow and orange as well as the paler shades of other colours such as green and purple were viewed as positive. It was concluded that for research purposes it might be more useful, when relating mood to colour, to consider this in terms of the positivity or negativity of a colour, rather than associating the colour itself with mood. Not only was reproducibility extremely high when the colour associated with mood was recorded in this way, but it also allowed division of the colours into eight permutations. This ranged from a very restricted palette of those colours most highly rated as positive or negative, to more balanced permutations containing an equal number of positive, neutral, and negative colours. Colour, and particularly the shade of that colour, has the potential for use in questionnaires designed to measure either mood or how individuals feel about other situations. However, the response rate to the question must be high and it was the aim of this study to establish whether a different way of asking the question might encourage a much higher response rate compared to that obtained spontaneously in our previous study (Carruthers, et al., 2010b). Method STUDY 1 Following advertisement by global e-mail to all employees at the University Hospital of South Manchester, those expressing an interest in the study were given an information sheet explaining the nature of the study and those consenting to participate were interviewed by one researcher (HRC) on a one-to-one basis. Healthy volunteers (N = 255; ages 16–72, M age 38.4 yr.; 175 women, 80 men) were asked to choose a colour from the wheel in response to the following questions: 1. “Which one single colour do you associate with your mood?” and 2. “If you are unable to choose one colour it would be very helpful if you could briefly explain why?” All participants were then asked to complete the Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983) so that those with clinical elevations of scores for anxiety and depression could be excluded. The scale consisted of 14 statements, seven related to anxiety and seven to depression. Each of the statements has four possible answers which are scored between 0–3, for example, “I feel tense or wound up” with labels 3: Most of the time, 2: A lot of the time, 1: From time to time, occasionally, and 0: Not at all, giving a maximum possible score of 21 for either anxi-

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ety or depression. The higher the score, the more severe the anxiety and depression, with a score of 10 or higher, suggestive of clinically elevated anxiety or depression (Zigmond & Snaith, 1983). Those patients scoring 10 or higher were excluded from the study, as were those with colour blindness or any serious illness such as diabetes or heart disease. STUDY 2 For the purposes of comparison, data from our previous study were used. This study was undertaken a few months previously and used an identical method of recruitment to that described above. This resulted in 123 healthy volunteers (ages 22–70, M age = 42.2 yr.; 105 women, 18 men) who were asked to choose a colour from the wheel in response to the following question: “With regard to your day-to-day mood over the last few months– do you associate it with a particular colour? If so, which colour?” All participants also completed the Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983), with the same exclusion criteria applying as in the current study. We have previously described in detail how colours can be divided into positive, neutral, and negative shades (Carruthers, et al., 2010b). Briefly, this is based on recording the percentage of people describing a particular colour on the wheel as positive or negative and then developing permutations based on these percentages (Fig. 2). We have recommended that permutations resulting in approximately equal numbers of positive, neutral, and negative shades, such as Permutation 1 or Permutation 4, are the most suitable for routine use and for the purposes of this study Permutation 1 was used. The percentage of people responding to the following two questions were compared, as well as the distribution of their colour choice. (1) “Which one single colour do you associate with your mood?” (Study 1 and 2) and (2) “With regard to your day-to-day mood over the last few months– do you associate it with a particular colour?” (Study 2). Statistical Analysis Each colour on the wheel was allocated a number (Fig. 1). Percentages were calculated according to the number of respondents choosing a specific colour. The statistical software SPSS Version 19 (SPSS, Inc., Chicago, IL) was used for analysing the data. The Pearson chi-squared test was used to assess the differences between the two study groups and the colour associated with mood (positive, neutral, or negative). Analysis of variance (ANOVA) was used to compare the mean values of anxiety and depression with the colour associated with mood (positive, neutral, or negative) and multiple comparisons were carried out using the Scheffé post hoc test (Scheffé, 1959) on the same data.

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FIG. 2. Classification of colours from the Manchester Colour Wheel into positive, neutral and negative shades (Carruthers, et al., 2010b).

Ethical approval was sought and obtained from NRES North West, GM South Research Ethics Committee and all subjects gave written consent before participating. Results STUDY 1 Some individuals (n = 47, 18.4%) had anxiety scores of 10 or above and 5 (2.0%) individuals had a depression score of 10 or above (all 5 depressed participants also had a high anxiety score) and were therefore excluded from the study, leaving 203 healthy volunteers (ages 18–72 years, M age = 38.6 yr.; 140 women, 63 men) for the analysis. Most of the healthy volunteers (n = 192, 94.6%) responded to the question, “Which one single colour do you associate with your mood?”, with the other 11 (5.4%) individuals unable to give an answer, citing reasons such as they didn’t associate colour with mood or their mood varied too frequently to choose just one colour. Fig. 3 shows the distribution of colour choice in the 192 individuals ascribing their mood to a colour when their colour choices were grouped together according to their positive, neu-

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FIG. 3. Distribution of colours associated with mood in participants from Study 1

tral, and negative attributions, as defined by Permutation 1 in Fig. 2. As can be seen, the majority of participants (73.4%) chose a positive shade to describe their mood, while only 2.1% of individuals chose a negative shade. The most commonly chosen positive colours were ‘Yellow 14’ (16.1% of respondents) and ‘Orange 32’ (7.8%). The data were also analysed to test whether there were any associations between the anxiety and depression scores, even though they were all within the normal range, and colour choice groupings (positive, neutral, or negative). The results are given in Table 1, where it can be seen that there was a statistically significant association between the depression scores (F2,189 = 4.01, p = .02, partial ␩2 = 0.04), even though they are within the normal range and colour choice, showing that people with higher scores for depression were more likely to choose a negative colour, whereas those with lower depression scores preferred positive colours. Post hoc tests indicated that there was a statistically significant differTABLE 1 ASSOCIATION BETWEEN THE HOSPITAL ANXIETY AND DEPRESSION SCALE DEPRESSION SCORE AND THE COLOUR ASSOCIATED WITH MOOD IN STUDY 1 Colour Choice (N = 192)

M

SD

Positive (n = 141)

1.70

Neutral (n = 47)

2.49

Negative (n = 4)

2.75

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95% Confidence Interval Lower Limit

Upper Limit

1.63

1.42

1.97

2.13

1.87

3.11

2.22

–0.78

6.28

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MANCHESTER COLOUR WHEEL TABLE 2 ASSOCIATION BETWEEN THE HOSPITAL ANXIETY AND DEPRESSION SCALE ANXIETY SCORE AND THE COLOUR ASSOCIATED WITH MOOD IN STUDY 1 Colour Choice (N = 192)

M

SD

Positive (n = 141)

5.09

Neutral (n = 47)

5.26

Negative (n = 4)

7.50

95% Confidence Interval Lower Limit

Upper Limit

2.38

4.70

5.49

2.77

4.44

6.07

2.38

3.71

11.29

ence between the positive and neutral groups (p = .03). Table 2 shows the results for anxiety scores (within the normal range), although the relationship between an increased anxiety score and negative colour choice was not statistically significant (F2,189 = 1.87, p = .16, partial ␩2 = 0.02). Of the 11 (5.4%) individuals who did not choose a colour with respect to their mood, the mean anxiety score was 6.27 and the mean depression score was 2.82. STUDY 2 Some individuals (n = 16, 13.0%) had an anxiety score of 10 or above and 2 (1.6%) had a depression score of 10 or above and were therefore excluded from the study, leaving 105 healthy volunteers (ages 22–70 years, M age = 42.8 yr.; 90 women, 15 men) available for the analysis. A portion of the healthy volunteers (n = 41, 39.0%) responded to the question, “With regard to your day-to-day mood over the last few months– do you associate it with a particular colour?”, with the remaining 64 (61.0%) individuals not giving an answer. Fig. 4 shows the distribution of colour choice in the 41 individuals ascribing their mood to a colour, when their colour choices were grouped together according to their positive, neutral, and negative attributions as defined by Permutation 1 in Fig. 2. As can be seen, 58.5% of participants chose a positive shade to describe their mood and 17.1% of individuals chose a negative shade. The most commonly chosen positive colours were ‘Yellow 14’ (19.5% of respondents) and ‘Orange 32’ (7.3%). As described for Study 1, the results were also assessed to see whether there were any associations between the anxiety and depression scores (Tables 3 and 4), despite the fact that they were all within the normal range and colour choice groupings (positive, neutral, or negative). The results were similar to Study 1 and it can be seen in Table 3 that there was a statistically significant association between the depression scores (F2,38 = 4.39; p = .02; partial ␩2 = 0.19), even though they are within the normal range and colour choice, showing that respondents with higher scores for depression were more likely to choose a negative colour, whereas those

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FIG. 4. Distribution of colours associated with mood in participants from Study 2

with lower depression scores had a preference for positive colours. Post hoc tests revealed that there was a statistically significant difference between the positive and negative groups (p = .02). Table 4 shows the results for anxiety scores (within the normal range), and although individuals with higher scores appeared to choose more negative colours, this was not statistically significant (F2,38 = 1.94; p = .16; partial ␩2 = 0.09). In the 64 (61.0%) participants not choosing a colour with respect to their mood, the mean anxiety score was 4.84 and the mean depression score was 1.83. TABLE 3 ASSOCIATION BETWEEN HOSPITAL ANXIETY AND DEPRESSION SCALE DEPRESSION SCORE AND COLOUR ASSOCIATED WITH MOOD IN STUDY 2 Colour choice (N = 105) Positive (n = 24)

M

SD

1.50

1.67

95% Confidence Interval Lower Limit

Upper Limit

0.80

2.20

Neutral (n = 10)

2.50

2.84

0.47

4.53

Negative (n = 7)

4.14

2.34

1.98

6.31

Study 1 vs Study 2: Colour Associated With Mood Table 5 compares the positive, neutral, and negative mood/colour choices in Study 1 and Study 2. As can be seen, a higher proportion of participants chose a positive mood colour in Study 1 than Study 2 (73.4% vs 58.5%, respectively). Similarly, participants in Study 1 were far less likely

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MANCHESTER COLOUR WHEEL TABLE 4 ASSOCIATION BETWEEN HOSPITAL ANXIETY AND DEPRESSION SCALE ANXIETY SCORE AND COLOUR ASSOCIATED WITH MOOD IN STUDY 2 Colour Choice (N = 105)

M

SD

Positive (n = 24)

4.58

Neutral (n = 10)

4.60

Negative (n = 7)

6.71

95% Confidence Interval Lower Limit

Upper Limit

2.36

3.59

5.58

3.27

2.26

6.94

2.36

4.53

8.90

TABLE 5 COMPARISON BETWEEN STUDY 1 AND STUDY 2 WITH RESPECT TO COLOUR ASSOCIATED WITH MOOD Colour Associated with Mood Colour Choice

Positive

Neutral

Negative

No.

%

No.

%

No.

Study 1 (n = 192)

141

73.4

47

24.5

4

% 2.1

Study 2 (n = 41)

24

58.5

10

24.4

7

17.1

to choose a negative colour than those in Study 2 (2.1% vs 17.1%, respectively). This difference between the two groups was statistically significant [␹2 (2) = 17.14; p < .001; ␾ = 0.27]. DISCUSSION This study has clearly shown that using a revised mood colour question results in a dramatically improved response rate from 39.0% to 94.6%, which is sufficiently high to make using the wheel a realistic and practical screening instrument for mood disorders. Furthermore, the improved response rate associated an increase in the proportion of participants choosing a positive colour from 58.5% to 73.4% and a decrease in the proportion of individuals choosing a negative colour from 17.1% to 2.1%. This latter observation is particularly important in a normal group of individuals, as was the case in this study, because if the wheel is effectively screening for depression, the proportion of normal people choosing a negative mood colour should be very low. Consequently, despite encouraging a higher proportion of people to answer the question, the results appear to be even more reliable. Many of the instruments used for assessing mood can be time consuming, intrusive, and occasionally hard to understand. The Hospital Anxiety and Depression Scale has been developed as a more simple screener for detecting disorders of mood and is now widely used for clinical and research purposes. It is easier to complete than the more traditional instruments and is relatively less time consuming, but the wheel has two poten-

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tial additional advantages over the Hospital Anxiety and Depression Scale. Firstly, it can be completed even more rapidly and secondly, it overcomes the problem of language. However, with regard to this latter use, it has to be borne in mind that some colours have different meanings in different cultures and therefore validation on which colours are positive or negative in a particular setting where its use is intended would be necessary. Other groups of people where the use of standard questionnaires for assessing mood can be challenging include children or individuals with poor literacy, and it would seem reasonable to assume that the wheel could well have application in situations such as these. Another interesting and potentially important finding is how critical the wording of a question can be to the responses obtained, and this is likely to be relevant in a whole variety of questionnaires. In this study, we found that the way the mood colour question was worded led to a major increase in the response rate: from 39.0% to 94.6%, without any loss of reliability. Another advantage of the wheel over other mood questionnaires such as the PHQ 9 (Spitzer, Kroenke, & Williams, 1999) and the Beck Depression Inventory (Beck, Steer, & Brown, 1996) is that it has the potential to identify a positive frame of mind as well as a negative mood and it would be of interest to study its validity in relation to a questionnaire designed to assess a positive mood such as the Oxford Happiness Questionnaire (Hills & Argyle, 2002). Furthermore, this particular facility might also have application in the assessment of judging an individual’s attitude, either positive or negative, toward a range of scenarios not necessarily related to mood; for instance, asking them to relate how they feel about their well being or even a situation completely outside the healthcare arena. However, for any of these potential applications, the data also suggest that it would be prudent to find the best way of phrasing the question to ensure an optimum response. It is a common clinical observation that patients with more positive attitudes toward their treatment appear to have better outcomes, and this is now being backed up by a growing body of research evidence (Kim, Kubomoto, Chua, Amichai, & Pimentel, 2012; Michael, Garry, & Kirsch, 2012). Perhaps somewhat surprisingly, this effect can occur with medication, but it is even more important in relation to behavioural treatments, especially as these are time consuming and relatively expensive to provide. The authors have also previously shown that the colour associated with mood can be used to help predict who will do well with an intervention, such as hypnosis, e.g., patients choosing a positive colour before starting a course of hypnotherapy for irritable bowel syndrome were nine times more likely to respond to treatment than those choosing a neutral or negative colour (Carruthers, Morris, Tarrier, & Whorwell, 2010a). Consequently, now that a high response rate to the wheel questionnaire can be

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ensured, this approach might have application in predicting responders to a variety of treatments especially when they are expensive. It was interesting to note that even within the normal range, as depression scores increased, participants were significantly more likely to relate their mood to less positive colours. A similar pattern was observed for anxiety although this did not reach significance (small effect). This observation deserves further research as it suggests that the wheel might have sufficient sensitivity to detect ‘subclinical’ changes in mood. Potential issues that might need further consideration in the future are the advisability of classifying some colours as neutral, and the choice of which permutations should be used. These considerations may vary according to the purpose of a particular application, but for studies on mood it was felt that a neutral group was necessary to provide a buffer between colours being classified as normal or abnormal to avoid overidentification of an abnormality. From the point of view of permutations, it may be that the use of extremely positive or negative versions may have utility under certain circumstances. REFERENCES

BARRICK, C. B., TAYLOR, D., & CORREA, E. I. (2002a) Color sensitivity and mood disorders: biology or metaphor? Journal of Affective Disorders, 68, 67-71. BARRICK, C. B., TAYLOR, D. E., & CORREA, E. I. (2002b) Psychometric assessment and clinical application of the Correa-Barrick Depression Rating Scale. Clinical Nursing Research, 11, 363-381. BECK, A. T., STEER, R. A., & BROWN, G. K. (1996) BDI–II, Beck Depression Inventory: manual. (2nd ed.) Boston: Harcourt Brace. BOURGEOIS-BAILETTI, A. M., & CERBUS, G. (1977) Color associations to mood stories in first grade boys. Perceptual & Motor Skills, 45, 1051-1056. BOYATZIS, C. J., & VARGHESE, R. (1994) Children’s emotional associations with colors. The Journal of Genetic Psychology, 155, 77-85. BURKITT, E., BARRETT, M., & DAVIS, A. (2003) Children’s colour choices for completing drawings of affectively characterised topics. Journal of Child Psychology and Psychiatry and Allied Disciplines, 44, 445-455. CARRUTHERS, H. R., MORRIS, J., TARRIER, N., & WHORWELL, P. J. (2010a) Mood color choice helps to predict response to hypnotherapy in patients with irritable bowel syndrome. BMC Complementary and Alternative Medicine, 10, 75. CARRUTHERS, H. R., MORRIS, J., TARRIER, N., & WHORWELL, P. J. (2010b) The Manchester Color Wheel: development of a novel way of identifying color choice and its validation in healthy, anxious and depressed individuals. BMC Medical Research Methodology, 10, 12. DE LEO, D., ROCCO, P. L., DELLO BUONO, M. R., & DALLA BARBA, G. F. (1989) Grey mood: grey colours. Lancet, 2, 573-574. HILLS, P., & ARGYLE, M. (2002) The Oxford Happiness Questionnaire: a compact scale for the measurement of psychological well-being. Personality and Individual Differences, 33, 1073-1082.

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KIM, S. E., KUBOMOTO, S., CHUA, K., AMICHAI, M. M., & PIMENTEL, M. (2012) “Pre-cebo”: an unrecognized issue in the interpretation of adequate relief during irritable bowel syndrome drug trials. Journal of Clinical Gastroenterology, 46(8), 486-490. LAWLER, C. O., & LAWLER, E. E., III. (1965) Color-mood associations in young children. The Journal of Genetic Psychology, 107, 29-32. MICHAEL, R. B., GARRY, M., & KIRSCH, I. (2012) Suggestion, cognition and behavior. Current Directions in Psychological Science, 21, 151-156. MURRAY, D., & DEABLER, H. (1957) Colors and mood-tones. Journal of Applied Psychology, 41, 279-283. NOLAN, R. F., DAI, Y., & STANLEY, P. D. (1995) An investigation of the relationship between color choice and depression measured by the Beck Depression Inventory. Perceptual & Motor Skills, 81, 1195-1200. SCHAIE, K. W. (1961) Scaling the association between colors and mood-tones. American Journal of Psychology, 74, 266-273. SCHEFFÉ, H. (1959) The analysis of variance. New York: John Wiley and Sons. SPITZER, R. L., KROENKE, K., & WILLIAMS, J. B. (1999) Validation and utility of a self-report version of PRIME–MD: the PHQ Primary Care Study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. Journal of the American Medical Association, 282, 1737-1744. TERWOGT, M. M., & HOEKSMA, J. B. (1995) Colors and emotions: preferences and combinations. Journal of General Psychology, 122, 5-17. WEXNER, L. B. (1954) The degree to which colors (hues) are associated with mood-tones. Journal of Applied Psychology, 38, 432-435. ZENTNER, M. R. (2001) Preferences for colours and colour-emotion combinations in early childhood. Developmental Science, 4, 389-398. ZIGMOND, A. S., & SNAITH, R. P. (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavia, 67, 361-370. Accepted April 5, 2013.

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The Manchester Colour Wheel: enhancing its utility.

The Manchester Colour Wheel was developed to investigate the role of colour in the perception of illness in gastroenterology. During validation it was...
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