Deane H. Shapiro

Controlling ourselves, controlling our world: Psychology's role in understanding positive and negative consequences of seeking and gaining control.

This article begins by examining psychologys contributions to understanding the positive consequences of control for individual mental and physical health. Person-environment control mismatches and the negative personal, interpersonal, and societal consequences of seeking and having control are then discussed. As corrections to mismatches and negative consequences, three methods of analyses are provided. First, definitional and conceptual precision is offered, including a more careful matching of control-related interventions to multidimensional, individual-specific control profiles. Second, therapeutic assessment and interventions are placed within a biopsychosocial model of control. Finally, philosophy of science and paradigmatic issues underlying control theories are highlighted, particularly as they affect psychologys role in examining values toward which control efforts should be directed. These topics are important for peoples personal and collective well-being.

Sense of Control and Adjustment to Breast Cancer: The Importance of Balancing Control Coping Styles

The relationship of modes of control and desire for control to psychosocial adjustment in women with breast cancer was examined. Fifty-eight women with stage I or stage II breast cancer were surveyed shortly after their diagnosis and again 4 and 8 months later. The authors hypothesized that a control profile in which individuals use a positive yielding (i.e., accepting) mode of control in conjunction with an assertive mode results in better adjustment than relying exclusively or primarily on an assertive mode. Results lend preliminary support to this hypothesis. At 8-month follow-up, those women who had a high desire for control and were low in positive yielding control showed the poorest adjustment, whereas those high in desire and the positive yielding mode showed the best psychosocial adjustment. The findings suggest that balanced use of active and yielding control efforts may lead to optimal psychosocial adjustment and quality of life in the face of life-threatening illnesses.

Coping with loss of control in the practice of medicine.

Although the quest for active control and mastery can be seen as a central thread that ties together important aspects of human experience, we are frequently confronted with the reality that much of what is encountered in life lies outside our active instrumental control. Control must involve finding healthy and life-affirming ways to exercise personal mastery, and identifying constructive ways to respond to the lack of control that pervades the human condition. In this article we explore a number of professional areas in which physicians may experience significant feelings of loss or lack of personal control-difficult encounters with patients, dealing with patient nonadherence, end-of-life care, confronting the uncertainty and ambiguity that are frequently a part of illness, as well as institutional and systemic factors that can result in loss of various forms of autonomy and control over decision-making. We then consider maladaptive ways in which physicians sometimes attempt to address such losses of control and suggest that personal stress and burnout and difficulty developing effective therapeutic relationships with patients may be the consequence, in part, of these efforts. Finally, we discuss an empirically derived, multidimensional theoretical model for better understanding control dynamics, and identifying more optimal strategies physicians can employ in their efforts to gain and regain a sense of control in caring for patients.

A PSYCHOLOGICAL "SENSE-OF-CONTROL" PROFILE OF PATIENTS WITH ANOREXIA NERVOSA AND BULIMIA NERVOSA '

To investigate control and self-control issues for patients with eating disorders, 10 individuals diagnosed with anorexia nervosa or bulimia nervosa were compared to two sex-matched groups of 9 and 50 adults on the Shapiro Control Inventory. Analysis of variance and subsequent planned comparisons showed significant differences indicative of pathology between the eating-disordered group and one or both comparison groups on the general domain sense of control scale and the positive sense of control scale. Three of the four mode scales and the domain-specific sense of control scale were also in the expected direction. Several clinically relevant individual items also supported this trend. The discussion notes the clinical importance of refining how control is measured for eating-disordered populations.

Sounding board. The psychology of responsibility: some second thoughts on holistic medicine.

The New England Journal of Medicine Downloaded from nejm.org at UC SHARED JOURNAL COLLECTION on December 16, 2014. For personal use only. No other uses without permission. From the NEJM Archive. Copyright

The application of computerized content analysis of speech to the diagnostic process in a psychiatric outpatient clinic

Twenty-five new psychiatric outpatient were clinically evaluated and were routinely administered a brief psychological screening battery which included measures of symptoms, personality, and cognitive function. Included in this assessment procedure were the Gottschalk-Gleser Content Analysis Scales on which scores were derived from five-minute speech samples by means of an artificial intelligence-based computer program. Intercorrelations of these content analysis measures with scores obtained from the MMPI-2, SCL90, and other measures confirmed previously published construct validation findings. The use of this computerized content analysis procedure for initial, rapid diagnostic neuropsychiatric appraisal is supported by this research.

AGING AND SENSE OF CONTROL

Three groups representing different phases of the developmental lifecycle—12 senior citizens, 67 young adults, and 14 healthy middle-aged normal adults—were assessed using a multidimensional control inventory. Senior citizens had a healthy over-all sense of control comparable to those of the other two groups and a significantly lower (healthier) negative sense of control. They also were significantly more likely to endorse acceptance as a way of addressing areas of concern and to complement self as a source of control with a sense of control coming from others (including God, belief in a higher power).

Self-Control and Relationship Toward a Model of Interpersonal Health

Objections to pathology-based theories of human nature have led to efforts to develop views of positive personal health. In this article we posit the need for interpersonal intimacy as one context for health and suggest that there is a similar need for positive concepts of relationships. In an effort to address this need, a control model of psychological health is applied to relationships at different developmental stages, culminating in a vision of exceptional relationship health. A case example is also included, illustrating the clinical usefulness of conceptualizing relationship along the dimensions of assertive and yielding forms of control.

Psychological Control and Morbidity/Mortality in Breast Cancer Patients: A 20-Year Follow-Up Study

The purpose of this paper was to examine the longitudinal effects of psychological sense of control and control-related coping strategies on breast cancer outcomes. Utilizing the California Cancer Registry, follow-up data on cancer recurrence and all-cause mortality were obtained for 54 of 58 women originally diagnosed with breast cancer in 1992 to 1994. Relationships between cancer outcomes and psychological control and mood at 4 and 8 months post-diagnosis were examined. Results of the study showed that a greater sense of control at 8 months was associated with less cancer recurrence, while higher desire for control at both 4 and 8 months was associated with greater likelihood of recurrence. Utilization of an accepting mode of control appeared to mitigate the negative effects of desire for control on recurrence. No significant relationships were observed between mood and mortality or recurrence. These findings suggest the potential value of examining psychological control and control-related coping on cancer outcomes in future epidemiological and clinical studies.

Self-control: refinement of a construct.

Previous efforts, on a theoretical/model building level, refined the construct “self-control” into four quadrants: (1) positive assertive (active control), (2) positive yielding (letting-go control), (3) negative assertive (over-control), and (4) negative yielding (too little control). To test the discreteness of the four quadrants, 706 individuals, the majority in health and healing professions, from nine cities across the United States, responded to prompt words designed to assess each quadrant. A factor analysis provided partial concurrent validation, and the results revealed information about the semantic structure of self-control, as well as personal characteristics associated with self-control. Further, mean tabulations showed not only cultural bias (i.e., high self-control was associated almost exclusively with Quadrant 1, but also sex role bias (i.e., low self-control for a man was most often associated with Quadrant 3, negative assertiveness, and for a woman was most often associated with Quadrant 4 negative yielding). Clinical implications of these findings in terms of developing a self-control assessment inventory for matching self-control strategy to an individual with a particular clinical problem are discussed, and guidelines and suggestions for further research are offered.Previous efforts, on a theoretical/model building level, refined the construct “self-control” into four quadrants: (1) positive assertive (active control), (2) positive yielding (letting-go control), (3) negative assertive (over-control), and (4) negative yielding (too little control). To test the discreteness of the four quadrants, 706 individuals, the majority in health and healing professions, from nine cities across the United States, responded to prompt words designed to assess each quadrant. A factor analysis provided partial concurrent validation, and the results revealed information about the semantic structure of self-control, as well as personal characteristics associated with self-control. Further, mean tabulations showed not only cultural bias (i.e., high self-control was associated almost exclusively with Quadrant 1, but also sex role bias (i.e., low self-control for a man was most often associated with Quadrant 3, negative assertiveness, and for a woman was most often associated with Quadrant 4 negative yielding). Clinical implications of these findings in terms of developing a self-control assessment inventory for matching self-control strategy to an individual with a particular clinical problem are discussed, and guidelines and suggestions for further research are offered.