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Page 2

Content Analysis
of Verbal Behavior
Significance in Clinical Medicine
and Psychiatry

Editors: L. A Gottschalk F. Lolas L. L. Viney

Berlin Heidelberg New York Tokyo

Page 136

136 Allen H. Lebovits and Jimmie C. Holland

spoken per unit time is corrected so that intersubject and intrasubject comparisons can
be made. Patients who speak less than 300 words are unscorable. Reliability increases
with volume of words in the 5-min sampie. A formal scale of weighted content catego-
ries is specified for each scale.

The most reliable and widely used scales are Anxiety, Hostility, and Depression.
The Anxiety Scale yields a total anxiety score, which measures total manifest anxiety
resultant from six Anxiety Subscales:
1. Death Anxiety - references to death, threat of death, or anxiety about death.
2. Mutilation (Castration) Anxiety - references to injury, tissue or physical damage, or

anxiety about injury or threat of such.
3. Separation Anxiety - references to desertion, abandonment, ostracism, loss of sup-

port, falling, loss of love or love object, or threat of such.
4. Guilt Anxiety - references to adverse criticism, abuse, condemnation, moral disap-

proval, guilt, or threat of such.
5. Shame Anxiety - references to ridicule, inadequacy, shame, embarrassment, humilia-

tion, overexposure of deficiencies or private details, or threat of such.
6. Diffuse or Nonspecific Anxiety - references to anxiety or fear without distinguish-

ing type or source of anxiety.
There are three Hostility Scales:
1. Hostility Outward (which can be classified as overt or covert) focuses on destructive,

injurious, or critical thoughts or actions directed at others.
2. Hostility Inward (which correlates strongly with depression [16]) measures immedi-

ate thoughts, actions, or feelings that are self-critical or self-destructive.
3. Ambivalent Hostility assesses destructive, injurious, or critical thoughts or actions of

others (including situations) toward the person.
Other scales commonly scored include Hope, Cognitive-Intellectual Impairment, and
Social Alienation-Personal Disorganization.

10.3.3 Scoring and Administration Issues

As with other projective tests, the procedures and instructions of the G-G must be ad-
hered to strictly to achieve comparability with the norms of the scales and the findings
of other investigators. This sensitivity to variability in procedure and instructions can be
a serious drawback. The personality and sex of the interviewer have been shown to in-
fluence the content of the elicited speech [17]. Men, for example, may not verbalize
hostility as readily with a female interviewer as with a male interviewer. Also, some in-
terviewers may elicit greater emotional content in the verbal sampie through such
subtle means as nonvocal cues [17]. In addition to limiting comparability to other find-
ings and normative data, this methodological problem mayaiso be inherent in studies
that employ more than one interviewer. Evaluation and control of interviewer differ-
ences should be an important part of any study using the G-G. In addition to interview-
er variability, another important source of variability includes differences in instruc-
tions, which can elicit different verbal contents. The short administration time required
(usually not more than 10 min) is an important consideration because medically ill pat-
ients are sometimes reluctant to agree to an extensive psychological assessment. The
G-G Scale is easily administered. The evaluation requirements are a tape recorder and

Page 137

Seal es with Medieally III Patients 137

the reading of standardized instructions. The presenee of a skilled evaluator is not nec-
essary. The G-G test situation attempts to minimize the interviewer as a variable and
maximize the internal psychological state of the subject. The instrument itself does not
make any physical demands, such as writing, which can be a problem for physically ill
patients. It requires only that the patient speak intelligible English and be willing to
speak into a tape recorder.

Though administration of the G-G is relatively simple, scoring of the scales is not.
Scoring of the G-G is much more complex and expensive than scoring standard self-re-
port measures. Use of the G-G requires extensive training and practice for a scorer to
reliably score the verbal content speech sampies according to the scale developers' in-
tent. If more than one scorer is used in a study, then extensive interrater reliability
procedures must be used to ensure reliable agreement among the raters. Interscorer reli-
ability must be .85 or higher to provide satisfactory reliability. Alternately, a scoring ser-
vice is available through the scale's authors that, although costly, provides a greater as-
surance of reliable scoring.

The authors of the scale have achieved high interrater and test-retest reliability lev-
els and have conducted many validation studies. The G-G has been used to study psy-
chophysiological processes, such as the relationship of psychological state to phases of
the menstrual cyde [18, 19], pharmacological studies [20-22], and psychotherapeutic
processes and outcome [23]. For a more thorough description of the instrument and the
many reliability and validity studies, see the reports of Gottschalk [24-27], Gottschalk
and Gleser [17], and Gottschalk et al. [28].

10.3.4 Use with Medical Patients

The foeus of this report is a review of studies that have used the G-G in evaluating
medically ill patients: three studies of mood in cancer patients, three studies with coro-
nary patients, and four studies evaluating patients with other medical diseases.

10.3.4. 1 Use with Cancer Patients

Sholiton et al. [29] undertook a study to examine the possible etiological role of anxiety
in adrenocortical hyperfunction in some patients with bronchogenic carcinoma. The
G-G was one of three psychological measures administered to a group of 14 male pat-
ients with inoperable bronchogenic carcinoma and to a group of 14 male patients with
chronic, moderately stabilized, nonneoplastic disease (such as heart disease or ulcer).
There was no difference in levels of anxiety and hostility as measured by all of the in-
struments, induding the G-G, between the two groups of patients. The G-G did reveal
the only significant finding of the study: hostility outward and inward were positively
correlated with overall plasma steroid levels in both groups. Anxiety failed to correlate.

Sixteen patients with metastatic carcinoma receiving total- or half-body irradiation
as palliative treatment were evaluated before and after treatment and at six time inter-
vals afterward with the Halstead Battery, the WAlS, the Reitan tests, and the G-G [30].
The battery of tests was given for assessment of cognitive and intellectual impairrnent
and emotonal states such as anxiety, hostility, and hope. The G-G was the only instru-

Page 272


effect on anxiety and hostility 32

and content analysis 5
mastectomy and Gottschalk-Gleser content

analysis scales 171-187
mastectomy and the Global Assessment

scale and the SCL-90 Analogue scale

Medically ill patients
use of Gottschalk-Gleser scales with

Meperidine (Demerol)

pharmacokinetics and dinical response

Mesoridazine (SerentiI)
effect on social alienation-personal disorga-

nization 34
pharmacokinetics and dinical response


and death and mutilation anxiety 49-52

Nitrous oxide
effect on cognitive impairment scores 32

Oral contraceptive (Enovid)
effect on affect during menstrual cyde 32,42

Origin scale 57-59, 105, 121
in diabetes mellitus and other chronic

diseases 160-167, 169

Pawn scale 57-59,79, 105, 120
in diabetes mellitus and other chronic

diseases 160-167, 169

and content analysis 7,34-35
and dinical response 257-267

Pharmacokinetics of some psychoactive drugs
and relationship to dinical response

Portuguese language

adaptation of Gottschalk-Gleser Hostility
scales to 6, 231

aggressiveness in psychotherapy and its rela-
tionship with the patient's change

Positive emotion scale
and content analysis 6
in physical illness 6
in diabetes mellitus and other chronic

diseases 160-167, 169

Subject Index

in patients who are physically ill - defend-
ing or coping 215-224

Prediction of psychotherapy outcome
by affective content of speech 6

Propranolol (Inderal)
antianxiety effects 32

Psychoactive drugs
and content analysis 31-35

Psychoanalytic group therapy
and content analysis scores 50, 53

Psychodynamic phenomena
and content analysis 38-39

Psychokinetic phenomena
and content analysis 37-38

Psychological states and traits 22-25
Psychophysiological variables

and affect scores 48, 52
Psychopolitics 39
Psychosomatic phenomena

and content analysis 36

and affect scores 49, 52
in research 50,53, 123-130
affective content of speech as a predictor

and Gottschalk-Gleser Hostility scales


Rating scales
versus content analysis 30

of content analysis measurement 60-63

Gottschalk Hope scale 29
Gottschalk-Gleser Cognitive Impairment

scale 29
Hamilton Anxiety rating 30
Hopkins Symptom checklist 30
Physician Questionnaire Rating 30
Gottschalk-Gleser Depression scale 30
Self-report scales versus content analysis

Sociality 57-79
Positive feelings 57, 79
Cognitive anxiety 57, 79
construction of new scales 57-59
Origin scale 57-59, 79
Pawn scale 57-59,79
self-report 133-134
observer rating 134
validity of content analysis scales 63-67

Page 273

Subject Index

self-report 133-134
observer rating 134
Overall Gorham Brief Psychiatrie Rating

scale (BPRS) 257-259
Hamilton Depression scale 117-118,

Zung Depression scale 117-118
Beck Depression scale 117-118,252
Wittenbom Rating scale 257-259

genetic liability and content analysis 6,

effect of withdrawing and readministering

phenothiazines on social alienation-
personal disorganization 33

and cognitive impairment 33-34
anxiety and hostility scores at hospital ad-

mission and discharge 49-53
and family therapeutic session 50
and pharmacokinetics of thioridazine and

mesoridazine 257-267
Self-report scale scores

correlations with Gottschalk-Gleser affect
scores 48-52

self-report inventories 133-134
Sensory overload

effect on cognitive function and social
alienation-personal disorganization

Sex of interviewer
influence on anxiety and hostility scores

Social alienation-personal disorganization

effect of withdrawing and readministering

phenothiazines to schizophrenie
patients 33

distinguishing between phenothiazine
responders and nonresponders 35

a validated scale 105, 120
as a measure of a heritable trait 197-205

in studies of drug pharmacokinetics in
schizophrenia 257-267

Sociality scale
applicable to verbal behavior 5, 57, 79
in diabetes mellitus 160-167, 169
in drug addiction 189-196
in physically ill people 219-224

Somatopsychic phenomena
and content analysis 36

Spanish language


adaptation of Gottschalk-Gleser Anxiety
and Hostility scales to 5, 60

Suicidal individuals
and hostility inward scores 49, 52

Swedish language
content analysis 60

Thioridazine (Mellaril)
effect on social alienation-personal disorga-

nization scores 34-35
pharmacokinetics and clinical response

Type A und Type B personalities

relation to anxiety and hostility scores 50,

Ulcer patients
and affective verbal behavior 207-213

Validation of Gottschalk-Gleser scales
47-53, 114-122

Verbal behavior
elicitation of 4
written verbal sampIes 32
effect of standard method of elicitation ver-

sus other methods 48, 52
eliciting an interpersonal measure of

Verbal behavior analysis

pragmatic type of 11, 20, 23

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