J.ophthalmol.(Ukraine).2022;5:71-80.
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http://doi.org/10.31288/oftalmolzh202257180 Received: 17.10.2022; Accepted: 31.10.2022; Published on-line: 15.11.2022 Psychological testing of individuals in stressful situations: test-taking attitudes and perception of visual stimuli B. V. Biron 1, I. A. Bulakh 1, O. O. Volkova 1, D. F. Olkhovskyi 1, V. S. Rodin 2 1 Odessa I.I. Mechnikov National University; Odesa (Ukraine) 2 University of Nova Gorica; (Slovenia) TO CITE THIS ARTICLE: Biron BV, Bulakh IA, Volkova OO, Olkhovskyi DF, Rodin VS. Role of polymorphisms of folate-cycle enzymes in diabetic retinopathy progression in patients with type 2 diabetic mellitus. J.ophthalmol.(Ukraine).2022;5: 71-80. http://doi.org/10.31288/oftalmolzh202257180 Background: Professional activities of individuals under stressful conditions affect their psychic processes and capability to work. The social-cognitive distortions developing under these conditions require a comprehensive assessment involving, particularly, quantitative assessment. The relevant psychometric instruments for detecting these distortions should be carefully psychometrically adapted. Purpose: To analyze psychometrically the scales for assessing the test-taking attitudes in individuals under stressful situations, and to determine associations between response distortions and perceptual distortions. Material and Methods: The study sample consisted of 286 eye care workers from the Filatov Institute of Eye Diseases and Tissue Therapy. The study was conducted with the use of the Minnesota Multiphasic Personality Inventory by Hathaway and McKinley and Wartegg Drawing Completion Test. Results: We found that in stressful situations, social-cognitive distortions are accompanied by visual perceptual distortions. Particularly, we found that the desire of the responder to appear in a socially better light than he or she actually is, is associated with the tendency of faulty ignorance of large visual stimuli, which may be considered as co-manifestations of selective visual perception and response distortions. In addition, distortions in stressful situations were associated with both conscious and unconscious levels of psyche. We believe the modified L scale may be used in practice for assessing perceptual distortions and stress-related disorders like psychosomatic disorders and post-traumatic stress disorders. Keywords: validity scales, psychometric analysis, stress, stressful situations, ophthalmologists, social and cognitive attitudes, visual perception
Introduction This paper continues the series of publications initiated by the Ukrainian researchers Danyliuk, Vlasova and Rodina [1-4] on developing psychodiagnostic instruments for assessing the behavior of individuals from various sections of the population in stressful situations and situations of danger and life-threatening situations, as well as making these instruments psychometrically adapted to social and cultural realities of the Ukrainian environment to provide these individuals relevant psychological care. The methods previously proposed may be used as reliable auxiliary tools for assessing and improving the adaptive capacity of eye care workers as well as patients with eye disorders [4]. Researchers believe that psychologists’ attention should be paid not only to the development of stress-induced psychosomatic disorders in medical professionals, but also to the potential consequences of these disorders for the quality of care provided to patients [5]. In the opinion of Semeniuk [6], the development of adequate psychological instruments for assessing and preventing professional stress in medical professionals will allow to maintain their work efficiency, stay long in their profession, and preserve their psychic health. The intensity of Ukrainian medical professionals’ activities has increased with the onset of full-scale military actions. It has been found previously [1] that the most common stress reactions among Ukrainian eye care workers were cognitive stress reactions, namely, cognitive appraisal of and coping with stressful events. In addition, the most common physiological reaction was exhaustion, and the most common emotional reactions were fear, anxiety, and worry. Furthermore, the most common behavioral reaction in ophthalmologists was irritation [1]. That is, the above stress reactions become activated in life-threatening situations, are associated with numerous social and cognitive distortions, and psychologists’ attention should be paid not only to the reactions reflecting the psychosomatic disorders developed in medical professionals, but also to the potential consequences of these reactions for the quality of care provided to patients [6]. Questionnaire-based studies (or surveys) are highly susceptible to response distortions caused by the protective behavioral strategies (social desirability, conformism, negativism, etc.) used by responders. The validity scales adopted from personality questionnaires are believed to be least susceptible to response distortions [7]. However, the efficacy of these scales under stressful conditions has not been investigated yet. There is a lack of data on how stress impacts psychological processes, particularly, social-and-cognitive attitudes, introduces test-taking distortions, and how these distortions are associated with visual perception. Therefore, the purpose of this paper was twofold: first, to analyze psychometrically the scales for assessing the test-taking attitudes in individuals under stressful situations, and second, to determine associations between response distortions and perceptual distortions. Material and Methods The study sample consisted of 286 eye care workers (156 nursing staff members and 130 ophthalmologists). The study was conducted with the use of the Minnesota Multiphasic Personality Inventory by Hathaway and McKinley. The Wartegg-Zeichen-Test (WZT) or Wartegg Drawing Completion Test [8] was used for the visual perception stimulus assessment. The test is composed of eight squares with a stimulus of small dimension within each square. The stimuli in the eight squares differ from each other. The test taker is asked to draw a picture in each of the squares. It is an expressive, impressive and additive projection technique with more than 150 characteristics. Although the reliability and validity of Wartegg test parameters are still under discussion, the research on the prsychometric characteristics of the methodology is underway [8-10]. The Minnesota Multiphasic Personality Inventory by Hathaway and McKinley [11] was adopted into Russian by Berezin, Miroshnikov and Rozhanets in 1976 [12] and was used for assessing the beliefs towards the testing procedure. The text was revised and the inventory was adopted into Ukrainian by Rodina [9]. The instrument is comprised of 13 scales for assessing personality traits and psychopathology of adults, particularly, 10 clinical scales and 3 validity scales (L scale (Lie), F scale (Infrequency), and K scale (Correction)). The instrument consists of statements to which participants have to respond with “agree”/“disagree” statements scored one and zero, respectively. Statistical analysis was conducted using IBM SPSS Statistics 26.0.0 and IBM SPSS Amos 26.0.0 software. The study was conducted within the framework of the Study of the Personality’s Psychological Health: a Sanocentric Approach (state register No. 0122U000260), a research by the Differential and Clinical Psychology Department, Mechnikov National University of Odesa. The procedures followed were in accordance with the ethical standards of the Helsinki Declaration. Results At the first phase of the study, the L, F, and K validity scales were psychometrically adapted. The maximum likelihood estimation was used for the exploratory factor analysis of each of the three validity scales. Kaiser–Meyer–Olkin (KMO) test was used as a measure of suitability of the data, and KMO values were acceptable (0.659 and 0.632) for the L and K scales, respectively, and unacceptable (0.465) for the F scale. Phase 1 of the factor analysis found a statistically significant Bartlett’s test of sphericity for item matrices of the L scale (χ2 = 330.442; p < 0.001), F scale (χ2 = 4277.461; p < 0.001) and К scale (χ2 = 914.045; p < 0.001). It was found that the L scale was homogeneous, whereas F scale and К scale were not homogeneous, i.e., either of the last two scales did not reflect the same construct. Cattell scree plots [13] showed that a one-factor solution was the optimal solution for the L scale, a four-factor solution was the optimal solution for tbe F scale, and a two-factor solution was the optimal solution for the K scale. That is, it is for the L scale that the hypothesis of monofactoriality with the development of a psychometrically adequate scale was verified. The L scale, composed of 15 items (statements), was designed to detect the tendency of the responder to appear in a socially better light than he or she actually is. All items of this scale were reversed before analysis. The percentage of participants responding with agreement varied from 12.6% to 87.4%, and the percentage of participants responding with disagreement varied from 16.1% to 83.9%, depending on the particular item (statement) to which they responded. An initial one-factor model included all the 15 items, explained 20.634% of the total variance and did not correspond to empirical data (Table 1, Model 1). The internal reliability of the 15-item scale was found to be sufficient (Cronbach's α = 0.700).
The absolute fit indices were moderate, but the relative fit indices were inadequate. In addition, absolute values of factor loadings of some items fell below a threshold of 0.300, which was unacceptable [14]. Therefore, these items (Nos. 65, 120, 180, 270, 300, and 360) were not indicators of a latent variable and had to be eliminated from the scale. We also used correlations between residual variances to fit the model to empirical data, and modification through permitting correlations between residual variances of contently related items Nos. 50 and 240, 50 and 163, 65 and 90, 65 and 163, 163 and 240 was performed and resulted in the modified model. The fit of the modified model (Table 1, Model 2) was significantly better than the original model, and the values of fitness indices were within the acceptable range. Figure 1 shows the path diagram for the modified model. The internal reliability of the 9-item scale was found to be high (Cronbach's α = 0.714). The list of items of the modified L scale is provided in the Appendix.
Based on the fact that the study sample can be used as a scale standardization sample, and the norms calculated for the sample are representative for the individuals of relevant age and social status, we introduced the relevant test norms. Descriptive statistics for raw scores of the modified L scale were as follows: M = 3.713; Mdn = 4.000; SD = 2.269; IQR = 4.000; S = 0.020; K = -1.190. With all items of the scale reversed before analysis, raw scores of the modified L scale were translated to the standardized t-scores (Table 2).
T-scores ranging from 34 to 42 (low scores) are indicative of individuals who (a) do not experience much tension, feel relaxed and at ease, (b) show-off their “honesty”, exaggerated frankness and even disclose some faults they see in themselves, (c) want to show themselves eloquent, relaxed, sociable, ingenuous and self-confident; and (d) may be somewhat sarcastic and cynical. T-scores ranging from 47 to 60 (normal range) are indicative of individuals who (a) maintain a balance between openness and the desire to create favorable first impression, (b) are self-aware and self-reliant; and (c) adequately tend to show themselves socially desirable and socially conforming. T-scores ranging from 64 to 69 (high scores) are indicative of individuals who may have somewhat reduced adaptability and somewhat reduced self-awareness. A short-term abrupt increase in t-score to 64-69 which disappears on retest may be indicative of a situation requiring expressive denial of socially unwelcome traits (e.g., a situation when the participant believes he was unjustifiably accused). A t-score of 73 was indicative of individuals who (a) have intentional social desirability distortion, (b) may have inadequate self-concepts, (c) deny having behavioral weaknesses that are inherent in any human being, (d) display high normative behavior which significantly narrows the spectrum of adaptivity; (e) have approach problems in inflexible ways (have deficient flexibility) which places them at a substantially increased risk of personal distress even in slight changes in the environment. At the second phase of the study, we employed Pearson correlation (r) and point-biserial correlation (rpb) to examine associations between the modified L scale and Wartegg test characteristics. No large effects (r = 0.30) that are potentially powerful in both the short and long run were found [15]. Three medial effects (r = 0.20) that are of some explanatory and practical use even in the short run were found. The modified L scale had a positive correlation with the characteristic of the Qualitative Profile (the parameter of inadequate perception of qualities of Stimulus 7) (r = 0.234; p < 0.001). In addition, it had negative correlations with (a) the characteristic of the Characterological Profile (point 2.5) which describes the type of visual perception of a stimulus as large, round, loose, wide, diffuse and asymmetric (r = -0.202; p = 0.001), and (b) the characteristic of the Structure of Boxes (the parameter of a single perseveration of stimulus 2) (rpb = -0.199; p = 0.001). The results obtained indicate that the modified L scale demonstrated sufficient criterion validity. The analysis of the psychological content of the relationships between distortions in the perception of verbal stimuli and distortions in the perception of visual stimuli is given below. Discussion Therefore, we established the construct validity of the modified L scale. Others have reported that the psychometric quality of MMPI validity scales was not sufficient [16] and these scales (particularly, the L scale) were further modified to achieve psychometric adequacy [17]. Application of confirmatory factor analysis to the psychometrically modified scale L allows using the scale proposed by us as a high-validity instrument. Moreover, in the current study, the modified scale L exhibited the internal criterion validity, which was indicated by the effects detected in our examination of associations between the modified L scale and the parameters of the Wartegg test. The effects may be interpreted as follows. Stimulus 7, the dotted half-circle, is characterized by unfocusedness and sparseness. This stimulus activates the deepest and finest feelings and early emotional experience [8]. Responses to this stimulus reflect human emotional traits such as sensitivity, impressionability, sensibility, and emotional lability. Inadequate perception of this stimulus indicates poor understanding of the nuances of the situation and loss or rationalization of sensuality. That is, it indicates reduced feedback with the environment at the level of visual perception, which is in agreement with the social-and-cognitive distortions in the responses to the modified scale L. It was found that the desire of the responder to appear in a socially better light than he or she actually is, is associated with the tendency of faulty ignorance of large visual stimuli, which may be considered as co-manifestations of selective visual perception and response distortions. Stimulus 2 characterizes the relationships of the individual with society, the pattern of social communication. In the opinion of Wartegg, this indicates the personality traits a person wants to show others and the emotional disposition of this person in his/her social contacts (excitability, vivacity/ indifference, insularity; emotional warmth. coldness) [8]. There is a feedback between a single perseveration of stimulus 2 (this parameter enables assessing the presence of a single inadequate response to the stimulus) and the modified scale L. Correspondingly, the test taker tending to appear in a socially better light than he or she actually is, by demonstrating conformance with social norms at the unconscious level, exhibits active desire to make contacts. These effects present new and important aspects of the performed study, because they demonstrate associations between visual perceptual distortions and social cognitive distortions of the individual. Therefore, the modified L scale of the MMPI was shown to have high construct and criterion validity. It was found that distortions in stressful situations are associated with both conscious and unconscious levels of psyche. Rodina [9] inverted Maslow's pyramidal hierarchy of needs [18] to develop a classification of stressful situations. She postulated that, the lower the individual’s stress-related needs, the larger their effect on the personality, and the more substantial changes they cause. The most acute stresses threatening the very existence of the individuals are on the top, whereas the least acute stresses preventing self-actualization and the development of personal capabilities are at the basis of the proposed “inverted pyramid”. According to Maslow’s theory, physiological needs are the most basic of human needs and are followed by safety, love and belonging, and esteem (approval, gratitude, recognition and competence) needs. At the top of the needs hierarchy is self-actualization. Consequently, the lower the level of individual’s needs related to stressful situations, the stronger their impact on, and the more substantial changes they induce in, the personality. Therefore, we will obtain the inverted pyramid of stresses, with the most serious stresses (those threatening the individual’s existence) being at the top. We hypothesize on the corresponding eye care workers’ responses to stressful situations, with associations between the individual’s visual perceptual distortions and social-and-cognitive distortions. This study was limited by a sample composed only of eye care workers. Further research of these phenomena with the involvement of other professions (military service, military medical care, etc.) working under extraordinary and challenging conditions is warranted to elucidate the mechanisms of stress impact on the efficacy of performance of these professions. The use of the standardized L scale will allow comparing the findings of further studies with the results of the current study. We believe these scales will be widely used in practice for assessing visual perceptual distortions and social cognitive perceptual distortions, particularly in stress-related disorders like psychosomatic disorders and post-traumatic stress disorders.
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Disclosures Received 17.10.2022 Accepted 31.10.2022 Corresponding Author: B. V. Biron, Email: biron@i.ua Author Contribution: Development/conceptualization: Biron B.V.; Data collection/research: Bulak I.A., Volkova O.O., Olhovskyi D.F., Rodin V.S.; Data analysis/interpretation: Biron B.V., Rodin V.S.; Manuscript preparation/writing/reviewing: Biron B.V., Bulak I.A., Volkova O.O., Olkhovskyi D.F. Sources of Support: There are no external sources of funding. Declaration of Conflict of Interest: All authors have no actual or potential conflict of interest (financial, personal, professional, or other interests) that could affect the subject or material described and discussed in this manuscript.
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