275

Br. 1. med. Psycho/. (1976). 49, 2l5-279 Printed in Great Britain

Self-concepts in anxiety states BY ALYSON BOND A N D MALCOLM LADER* Psychiatricpatients have a less favourable self-concept than normal controls. For example, using the semantic differential, Marks (1%5) demonstrated that obsessives rated themselves less good and less strong and that psychopaths felt they were less good and less safe, when compared with normal controls. Similarly, a group of neurotics had a poor self-image which improved with therapy (Luria, 1959). It might be expected therefore that patients sufferingfrom severe anxiety would also have a less favourable self-concept and view themselves as worse than others in general. Guidano, Liotti & Pancheri (1971) reported that a group of neurotic out-patients had a more negative self-concept than a group of normals who had never undergone any psychiatric treatment; also the neurotic group were less self-accepting as there was greater discordance between real self and ideal self ratings. It is not known, however, how patients with severe anxiety imagine themselves to be without their symptoms and whether this symptomless state is an ideal or something they see as possible following treatment. If it is seen as possible then the patients should have favourable attitudes towards the medical field and treatment generally. The semantic differential (Osgood, Suci & Tannenbaum, 1957) was therefore used to study a group of patients suffering from severe anxiety on three personal concepts, one concept involving other people and three treatment concepts. The results were compared with the ratings of normal matched controls. METHOD

Patients The 30 out-patients in the study were selected if free-floating anxiety was their primary complaint. Agoraphobics were included only if they also complained of free-floating anxiety. Patients with schizophreniaor with a primary depressive illness were excluded. The group was composed of 16 men and 14 women with an age range of 18-53 years. All antidepressives and major tranquillizers were stopped for at least 2 weeks before testing: anxiety-allaying drugs such as the benzodiazepines were discontinued 48-72 hours before the experiment.

Normal controls Thirty normal controls were matched with the patients for age, sex and social class. The age range was 18-54 years. They were not selected for calmness and some admitted to anxiety symptoms.

Ratings The semanticdifferential (Osgood, 1952) was used to measure both perception of self and others and attitudes towards 'treatment'. It was chosen because it is quick and easy for the experimenter to administer and for the subject to understand and it is flexible, having no fixed form. Sixteen scales which seemed relevant to the concepts were chosen (Fig. 1). Some scales related to certain concepts were non-infonnative but they were included to make the data complete. The left and right ends were systematically counterbalanced. The concepts chosen were: MYSELFAS I AM; MYSELFWITHOUTNERVOUSSYMPTOMS(only for the patients); MYSELF AS I WOULD LIKE TO BE; THE MAN IN THE STREET; MY DOCTOR; HOSPITAL CARE and MEDICINE. The order of the concepts was randomized. The forms were administered to the patients and controls with a printed set of instructions (Osgood er al. 1957). They were scored by awarding 1 point to the positive end and 7 points to the other end. The individual scales were analysed and these data presented. * Department of Psychiatry, Institute of Psychiatry, De Crespigny Park, London SES 8AF. 10-2

I

I

I

I

I

I

1

I

I

I

I

I

I

I

I I

T

I

I

I

0

T

I

I

ilo

I

i

I

I

0

I

I

F

aim uvaw

x3av-I

*MI a N v ~ N O BNOSA-IV

9LZ

I

I

I

I

I

1

I

I

I

1

I

I

I

I

1

1 1 0 - 1 - 2

-E -P

-s

LLZ

278

A L Y S O N B O N D A N D M. L A D E R

Myself without nervous symptoms vs. Myself as I would like to be The patients’ ideal self is significantly happier, more successful, wiser, more important, more beautiful, more pleasant, harder, stronger, calmer and more relaxed than their self without symptoms (Fig. 2). Myself without nervous symptoms vs. The man in the street Without nervous symptoms the patients view themselves as kinder, happier, better, healthier, more pleasant, more masculine, harder and more active than the average man (Fig. 2). DISCUSSION

The patients had a much less favourable self-conceptthan the controls. They also saw themselves as worse than the man in the street and they evaluated this unknown man, their doctor and medicine as being more relaxed than the controls rated them. It is possible that they see other things and other people as more relaxed because they feel that they themselves are very tense. In fact, they evaluated the other concepts generally higher than the controls. They had more favourable attitudes towards their doctor, hospital care and medicine which seems to indicate a more positive attitude towards the medical field and more faith in treatment. This faith in treatment may be because they see treatment as curing their symptoms and thus improving their self-image. They rated themselves without nervous symptoms much higher than their present selves. Without symptoms, their self-image was much more like that of the normal controls and more favourable than an unknown man. It is interesting, however, that they do not rate themselves without symptoms as significantly more relaxed than the man in the street although their ideal is to be much more relaxed. Perhaps, they recognize that some tension‘is a personality characteristic which treatment cannot alter. This self without nervous symptoms does not seem to be an ideal as there are still many significant differencesbetween this and their rating of their ideal self. The patients and controls rated their ideal self very similarly which may reflect socially desirable values. However, as other authors have pointed out (Deitz, 1%9; Guidano et al. 1971), there is much more discordance between the patients’ actual self and their ideal self and this could be interpreted as low self-acceptance. The patients therefore had a much lower opinion of themselves at present but they hope that treatment can alter this. The patients in the study were chosen if they complainedof free-floating anxiety and the logical trap is to assume that the differences between thenl and normals are due to anxiety. It is possible, however, that they are due to neurosis or stress in general, remembering that the controls were not selected for calmness. SUMMARY

Thirty patients suffering from severe anxiety and 30 normal controls, matched with them for age, sex and social class, filled in semantic differential forms on the concepts: MYSELF AS I AM; MYSELF AS I WOULD LIKE TO BE; THE MAN I N THE STREET: MY DOCTOR; HOSPITAL CARE and MEDICINE. The patients tilled in an additional one: MYSELF WITHOUT NERVOUS SYMPTOMS. It was found that although the patients had a less favourable concept at present, they had a more favourable image of themselves without symptoms and their ideal self was similar to that of the controls. The difference between the patients’ self-concept and ideal self-concept could mean they were less self-accepting. The patients had more favourable attitudes towards ‘treatment’.

Self-concepts in anxiety states

279

REFERENCES

DEITZ,G. E. (1%9). A comparison of delinquents with nondelinquents on self-concept, selfacceptance and parental identification. J. genet. Psychol. 115,285-295. , & PANCHERI, P.(1971). GUIDANO.V. F..L ~ o r nG. Analisi al Werenziale semantic0 del concetto del dell’accettazione del ‘Se’ e delle figure dei genitori, nei neurotici e nei soggetti n o d . Arch. Psicol. Neurol. Psichiat. 32, 298-31 1. LURIA,Z. (1959). Asemantic analysisof anormal and a neurotic therapygroup. J. abnorm. SOC. Psychiat.

‘a’,

58.216-220.

I. M. (1965). Patterns of Meaning in Psychiatric Patients. Maudsley Monographs. London:

MARKS,

Oxford University Press. OsoooD, C. E. (1952). The nature and measurement of meaning. Psychol. Bull. 49. 197-237. Osooo~,C., SUCI,G . & TANNENBAUM, P. (1957). m e Measurement of Meaning. Urbana. Ill.: Uni-

versity of Illinois Press. SIEGEL,S. (1956). Nonparametric Statistics for the Behavioural Sciences. New York. London: McGraw-Hill.