|UFDC Home||| Help|
This item is only available as the following downloads:
PHOTOGRAPHY AND SELF AWARENESS: THE ACT OF BEING PHOTOGRAPHED BY ELIZABETH BOSSOM A Thesis Submitted to the Division of Social Sciences New College of Florida In partial fulfillment of the requirements for the degree Bachelors of Arts in Psychology Under the sponsorship of Steven Graham Sarasota, Florida May 2010
!"#$#%&'(")*'+,*-./0 1 23'&.+.44 55 Acknowledgments I would like to thank Dr. Steven Graham for sponsoring this project. His guidance over the past few years has opened up areas of research I may have o therwise been unable to explore. I would also like to thank Dr. Michelle Barton for advising and supporting me throughout the majority of my time as an undergraduate. Lastly, I would like to thank Dr. Heidi Harley for her participation on my committee. The se professors, more than any others, have exponentially expanded my knowledge of psychology and aided me in achieving all that I have in my academic career. I would also like to give recognition to all the New College students who participated in this stu dy. Without them, this thesis surely would not have been possible. I would also like to thank my loyal assistant, Margaret DeCordre, for all the time and effort she spent helping me code data and set up my lab. Finally, I would like to thank my family and friends for their unending encouragement. My parents have supported me even when I lacked direction, and my friends have helped me relocate that direction time and time again. I owe my success to these people, for without them, I would not be where I am t oday.
!"#$#%&'(")*'+,*-./0 1 23'&.+.44 555 TABLE OF CONTENTS Page ACKNOWLEDGEMENTS............................................................................................... ii TABLE OF CONTENTS....................................................................................... ........... iii ABSTRACT....................................................................................................................... v INTRODUCTION.................................................................................................. ............ 1 Phototherapy....................................................................................................................... 3 Self Awareness............................................................................................. ...................... 6 Trait Self Awareness.............................................................................................. 7 State Self Awareness............................................................................................ .11 Overview of Current Research......................................................................................... 15 METHOD......................................................................................................................... 16 Participants....................................................................................................................... 16 Design................................................................................................................... ............ 16 Measures........................................................................................................................... 17 Social Anxiety Measures................................................................................. ..... 17 Self Awareness Measures..................................................................................... 17 Procedure.......................................................................................................................... 18 RESULTS......................................................................................................................... 20 Primary Analysis Based on Hypotheses........................................................................... 20 Change i n Awareness Over Time..................................................................................... 21 Gender Differences in Awareness.................................................................................... 21 Intercorrelations between S tudy Variables Assessing Awarenesss.................................. 22
!"#$#%&'(")*'+,*-./0 1 23'&.+.44 56 DISCUSSION................................................................................................................... 23 Review of Primary Results............................. .................................................................. 23 Limitations of Current Study............................................................................................ 24 Directions for Future Research................................ ......................................................... 26 Table 1: Self Focused Sentence Completion Task Responses......................................... 28 Table 2: Time Two Self Awareness Scores....................................................... ............... 29 Table 3: Public Self Awareness Scores by Social Anxiety Group................................... 30 Table 4: Gender Differences in Scores on Self Awareness Subscales............................. 31 Figure 1: Details of Experimental Set u p......................................................................... 32 Figure 2: Self Awareness Scores Across Time................................................................ 33 References......................................................... ................................................................ 34 Appendices........................................................................................................................ 43 Appendix A: Social Interaction Anxiety Scale Items... ........................................ 43 Appendix B: Social Phobia Scale Items............................................................... 44 Appendix C: Situational Self Awareness Scale Items.......................................... 45 Appendix D: Self Focus Sentence Completion Task Stems................................. 46 Appendix E: Informed Consent Form................................................................... 47
!"#$#%&'(")*'+,*-./0 1 23'&.+.44 6 PHOTOGRAPHY AND SELF AWARENESS: THE ACT OF BEING PHOTOGRAPHED Elizabeth Bossom New College of Florida, 2010 ABSTRACT This study was designed to test whether the act of being photographed causes an increase in self awareness. Prior research has established that mirrors can be used to induce private self awareness, whereas video cameras manipulate public self awareness and that trait levels of self awareness moderate these effects. As such, it was hypothesized that participants would display an increase in public self awareness when photographed, but that this effe ct would be moderated by social anxiety scores such that those high in social anxiety would not show as much of an increase due to a ceiling effect. Mirror, video camera, and control conditions were included to test these hypotheses. Eighty nine undergra duate students ( 37 males, 52 females) participated in this experiment. Levels of self awareness were measured both before and after the manipulation via the Situational Self Awareness Scale (SSAS; Mattick & Clark, 1998). The results did not support the h ypotheses; there were no significant differences in self awareness as a function of condition. The discussion centers on potential explanations, as well as the possible directions for future research. Dr. Steven Graham Division of Social Sciences
Photography and Self Awareness 1 Photography and Self Awareness: The Act of Being Photographed Since photography was first developed in the early nineteenth century, its widespread usage has been steadily increasing. Following the more modern advancement to digital photography, came ra s have become household items. In fact, most adults in the Western world now carry a camera on them at all times embedded in their cellular phone (Martin, 2009) Nonetheless, the true extent of the use of photography in this day and age is startling. It has been estimated that as many as 2700 pictures are taken each second around the world, leading to about 80 billion photographs taken a year (Lyman & Varian, 2000 ) numbers that are since likely to have increased Yet research on the topic is mostly limi ted to the aesthetics of photography (Axelsson, 2007a, 2007b; Kaplan, Kaplan, & Wendt, 1972; Marshall & Thornhill, 1995; Tinio & Leder, 2009), the social impact of photography (Burgess, Enzle, & Morry, 2000; Colson, 1979; Durrant et al., 2009 Sontag, 1977) and the different uses of phototherapy (Cosden & Reynolds, 1982; Dennet, 2009; Diamond, 1956; Dyches, 2004; Glover Graf & Miller, 2006; Milford, Fryrear, & Swank, 1983; Nelson Gee, 1975; Nuez 2009; Phillips, 1986; Stewart, 1979; Zwick, 1978 ). Unfortun ately, very little is known about the true psychological impact of being photographed. The abundance of research concerning phototherapy is often irrelevant, generally focusing on those taking the pictures as opposed to those who are the actual subjects o f the photos. A subset of this genre is of interest, though, as it involves photographing participants or having them photograph themselves as a means of helping them gain a more accurate self concept. The fact that viewing one's own picture or engaging in self portraiture can help one become more aware carries some heavy
Photography and Self Awareness 2 implications perhaps the simple act of being photographed causes a rise in self awareness. This possibility seems even more probable when prior research on self awareness is taken into account. Specifically, experimental manipulation of self awareness has become a common occurrence, with mirrors and video cameras being the most widely accepted stimuli used to induce self focus (Carver & Scheier, 1978; Davis & Brock, 1975; Geller & Shave r, 1976). Given the inherent similarities between still photography and video recording, one need not overly stretch one's imagination to infer that the psychological effects of still photography may mirror that of its more active counterpart. However, u pon delving deeper into the wealth of self awareness literature, it becomes apparent that increased self focus is not necessarily a positive thing. Many who live with dispositionally heightened levels of trait self awareness are subject to social anxiety and/or social phobia (Clark & Wells, 1995; Fenigstein, Scheier, & Buss, 1975; George & Stopa, 2003). Even worse, excessive self focus, or "self absorption," has been linked to such conditions as general anxiety, depression, and schizophrenia (Ingram, 1990 ). Furthermore, in a sample of 138 patients diagnosed with panic disorder, depression, or anxiety, it was found that severity of psychopathology increased as tendency to self focus rose (Woodruff Borden, Brothers, & Lister, 2001). Though these findings m ay seem inapplicable to research concerning experimental induction of self awareness, a plethora of studies have shown that temporary manipulations of self focus can cause many of the same negative effects exhibited by those with chronically heightened tra it self awareness (Buss & Scheier, 1976; Duval, Wicklund, & Fine, 1972; Fejfar & Hoyle, 2000; Ickes, Wicklund, & Ferris, 1973). While this would hardly have any bearing on real life
Photography and Self Awareness 3 situations if it were only mirrors and video cameras which raised self aw areness, the invasion of photography into daily life brings this problem to the forefront of many social situations. Thus, the following questions become imperative: Does the act of being photographed raise self awareness? If so, are the effects similar to past manipulations of self awareness? Are these effects moderated by dispositional tendencies to engage in self focus? If these questions are answered, a whole new realm of research concerning the psychological effects of photography can be explored. Phototherapy Photography was first recognized as a psychiatric aid in 1856, when Hugh W. Diamond published a paper, "On the Application of Photography to Study the Mentally Ill." This paper focused on how photography could be used to record the physica l state of patients and present them with more accurate and realistic views of themselves. Phototherapy, often defined as "the use of photography or photographic materials, under the guidance of a trained therapist, to reduce or relieve painful psychologi cal symptoms and to facilitate psychological growth and therapeutic change," (Stewart, 1979, p. 42) has since become a fairly widespread phenomenon. The extensive research done on the topic in recent years has revealed its usage to be prolific, aiding peo ple of all ages across a variety of domains. Since Diamond's (1856) early discovery, researchers have expanded on the usage of phototherapy as a tool in helping patients develop more realistic views of themselves and their surroundings. Over the years, phototherapy has proven beneficial for those with schizophrenia (Colson, 1979; Cosden & Reynolds, 1982; Phillips, 1986), behavioral problems (Milford, Fryrear, & Swank, 1983), developmental disabilities (Dyches et al.,
Photography and Self Awareness 4 2004; Nelson Gee, 1975; Tarulli, 1997 ), alcohol and/or drug dependency (Glover Graf & Miller, 2006; Graf, 2002; Virshup, 1985), and even cancer and other illnesses (Amaya, 2004; Dennet, 2009; Hanna & Jacobs, 1993; Zwick, 1978 ). In a representative study by Cosden and Reynolds (1982), the res earchers' use of phototherapy in a residential treatment facility for emotionally disturbed adolescents is outlined, and two case studies are examined. In this example, patients are taught to take pictures, develop the negatives, and display the finished product for others to view. It is argued that each of these steps can aid the patient in a unique way. Taking the picture can help the individual focus on one distinct object at a time, learn to control impulsiveness and capture only pictures worth takin g, and even foster social interaction when the subject of the photograph is another person. Learning to develop the picture teaches patients that there are consequences to each action, as one wrong move can ruin the photo. Finally, displaying the finishe d product can boost a patient's self esteem, especially when praise is given for exceptional work. Ensuing research has shown that those who were taught to use photography in a therapeutic setting have displayed increased self esteem ( Colson, 1979; Cosden & Reynolds, 1982; Milford, Fryrear, & Swank, 1983; Zwick, 1978 ), enriched language skills (Dyches et al., 2004; Nelson Gee, 1975), more comfort in social interactions ( Cosden & Reynolds, 1982; Phillips, 1986; Zwick, 1978), and an overall improvement in co mmunication (Glover Graf & Miller, 2006; Phillips, 1986). Regrettably, the majority of this work revolves around teaching the participants to use a camera to take pictures of their external environment. A much smaller body of work examines the psychologi cal effects of self portraiture (Fryrear, Nuell, & Ridly, 1974; Hunsberger, 1984; Nuez, 2009; Stewart, 1979). Of course, self portraiture involves
Photography and Self Awareness 5 intense self focus by its very definition, so its association with increased self concept is unsurprising. Scant attention is paid to the simple process of being photographed. Deborah Zwick (1978) performed a study that used both self and other photography as a means of raising self awareness in elderly patients who either lived in a retirement manor or were c onfined to a medically facilitated nursing home. Each participant was given a Polaroid camera and asked to complete a series of exercises designed to focus attention either inwardly toward the self or outwardly toward the environment. Exercises intended to focus attention externally included documenting things in either the immediate or extended environment and documenting one's daily habits. Exercises meant to focus attention inwardly included photographing mirror images of themselves, having others pho tograph them during social interactions, and documenting others' facial and body movements in response to the participants own interactions with them. As seen in the results, participants who lived in the nursing home (as opposed to the retirement manor) had problems adopting new perspectives one woman only photographed herself with her roommate, even in the mirror image exercise; many of the participants only photographed things from eye level, refusing to change their vantage point. This implies discomf ort with both interacting with the environment and engaging in self scrutiny. Those in the retirement manor, on the other hand, displayed increased awareness of both themselves and their environments they changed their perspective by standing on furniture or lying on the ground to get better pictures of objects, they made faces at themselves during the mirror task, and they expressed delight at seeing that others could differentiate their expressions as well in the photographs they took of them.
Photography and Self Awareness 6 Of course this experiment is not without its flaws. Primarily, participants were not only asked to photograph themselves, but were subsequently asked to view these photos, rendering these two variables inseparable when considering the results. Furthermore, only half of the participants (those living in the retirement manor) displayed increased awareness due to these photographic exercises, while those confined to a nursing home remained stable, even stagnant, despite equal treatment. Finally, though it was concl uded that these photographic exercises increased awareness of both the self and the environment, this was only measured qualitatively through the creativity of the pictures that were taken. A quantitative measure of awareness would be much more accurate a nd attuned to nuances. Despite these flaws, the implications of this study are remarkable. It suggests that being photographed may lead to an increase in self awareness, though it also raises the question of possible mediating variables which may render certain groups (like those in the nursing home) impervious to experimental manipulations of self awareness. Clearly, a closer look at self awareness theory is required. Self Awareness In his seminal work on self and identity, Mead (1934) points out that this thing we call "self" is precisely what differentiates humans from animals. The uniqueness of the self lies in its reflexivity, or rather, its ability to be both a subject and an object to itself (Mead, p. 137). It has been suggested that even anima ls have the capability of being the subjects of experience they can act and live within the moment, feel both pain and pleasure as they occur, and simply exist within the world as individual beings this is called "consciousness." Yet self consciousness," or the ability to view oneself from the
Photography and Self Awareness 7 outside as one would be viewed by others (Mead, p. 163), is a trait generally relegated to humans alone. Duval & Wicklund (1972) further elaborate that being the subject of experience, with attention turned outward toward the external world, is the natural state of all beings they call this "subjective self awareness." They argue that one only becomes self conscious when outside stimuli directs attention back toward the self. The most common, and probably original way that this occurs is through one's interaction with another person. When the self becomes an object of another's evaluation and scrutiny, it turns its attention inward, becoming an object to itself. Focus is then given to internal states, feelings, a nd attitudes this is called "objective self awareness." Though Duval & Wicklund (1972) theorized that one remains in the subjective state until external stimuli directs attention inwards, it has since been determined that objective self awareness can and does occur spontaneously. Furthermore, subjective and objective self awareness are not mutually exclusive, but rather, they exist along a continuum measuring the degree to which one's attention is directed toward the internal or external world. Govern & Marsch (2001) developed the Situational Self Awareness Scale to measure self awareness at any given time. Specifically, the SSAS measures the degree to which one is aware of internal thoughts (private self awareness), the self as a social object (public s elf awareness), and the external world (awareness of surroundings). SSAS scores are highly variable as they depend on moment to moment situational and internal factors. This should not be confused with trait self awareness, which refers to the one's over all propensity to attend to self focused thoughts. Trait self awareness. Trait self awareness refers to a person's tendency to direct their attention inwardly toward themselves. Those with higher levels of trait self
Photography and Self Awareness 8 awareness spend more of their time in the objectively self aware state. In order to better research the effects of dispositional self awareness levels, Fenigstein, Scheier, & Buss (1975) created a scale to measure the trait. Though they name the trait "self consciousness," they are still re ferring to one's proclivity to focus attention inwardly or outwardly. Thus, the Self Consciousness Scale (SCS) measures one's habitual awareness of their innermost thoughts and feelings (private self awareness), awareness of oneself as a social object (pu blic self awareness), and level of comfort when placed in a social setting (social anxiety). Fenigstein et al. (1975) found that those high in social anxiety almost always display elevated levels of both private and public self awareness, yet one can have either or both of these latter traits without being socially anxious. George & Stopa (2008) further verified that public self awareness was strongly associated with social anxiety, while private self awareness showed a weaker correlation. Additional res earch aims at explaining this connection. Duval & Wicklund (1972) account for the negative consequences of self focus via their Objective Theory of Self Awareness. They argue that when people view themselves from an external perspective they begin to eva luate themselves based on their internal "personal standard of correctness" (p. 123). This self evaluation invariably leads one to notice an "attitude behavior discrepancy," (p. 122) as one's actions rarely align with one's ideal image of him or herself. As Festinger (1957) explains with his theory of cognitive dissonance, when two contradictory ideas are held simultaneously, one experiences a cognitive discomfort if the discrepancy is not minimized. Thus, a kind of anxiety arises when behavior does not match attitudes.
Photography and Self Awareness 9 Those subject to intense self evaluation are lead to focus more on this discrepancy than the average person. Logically, then, it would seem that everyone with high levels of trait self awareness would subsequently exhibit heightened anxi ety. This is not the case, though. Clark and Wells (1995) created the Cognitive Model of Social Phobia in an attempt to explain why this discrepancy causes social anxiety in some but not in others. They propose that socially anxious individuals employ tw o distinct cognitive processes which work to maintain their social fears. The first is indeed the intense self focus shared by all with increased self awareness, but this is coupled with unrealistically high "standards of correctness" in those with social anxiety. Thus, the attitude behavior discrepancy is heightened, causing these individuals to attend almost exclusively to negative self aspects. In fact, researchers have shown that socially anxious individuals attend to themselves to the exclusion of o ther input, recalling fewer details from social interactions and ignoring positive or neutral feedback from their environment (Hope, Heimberg, & Klein, 1990). The second cognitive process involved in maintaining social anxiety is the predisposition to vie w the self as a social object. Multiple studies have shown that socially anxious individuals are more likely to remember events, especially bad ones, from the perspective of an outside observer ( Hackmann, Clark, & McManus, 2000 ; Hackmann, Surawy & Clark, 1998 ; Stopa & Bryant, 2004). Viewing the event from this "observer perspective" adds credibility to the individual's warped self concept by implying that others see the individual in the same skewed way. Researchers have found that socially anxious indiv iduals do have a distorted image of how they appear to others (Abbot & Rapee, 2004; Clark & Arkowitz, 1975).
Photography and Self Awareness 10 It is unsurprising that increased trait self awareness has other unfortunate effects. Researchers have found a negative correlation between scores on each of the SCS subscales and levels of self esteem (Turner, Scheier, Carver, & Ickes, 1978). Fejfar & Hoyle (2000) conducted a meta analysis of the research concerning trait self awareness and affective response. When a total of 56 studies were anal yzed, SCS scores of private self awareness were significantly correlated with negative affect. Scheier & Carver (1977) argue that increased self awareness only leads to negative affect and lowered self esteem when it is coupled with negative feedback. Th ey found that those with higher SCS scores of private self awareness were not only more responsive to negative mood inductions, but actually responded more strongly to positive feedback as well. It would seem, then, that heightened self awareness on its o wn would only lead to negative affect and lowered self esteem in those with a predisposition to attend to negative self aspects (specifically those with social anxiety). In fact, it has been established that those with social anxiety tend to interpret amb iguous situations more negatively than their less anxious counterparts (Huppert et al., 2003). It follows that researchers have found an association between social anxiety and lower levels of self esteem (Elliot, 1984; Kocovski & Endler, 2000), negative a ffect (Kashdan & Roberts, 2004, 2006; Vittengl & Holt, 1998; ), and even negative response to positive feedback (Alden et al., 2008; Lake & Arkin, 1985). Considering the negative consequences of high trait self awareness, specifically when coupled with so cial anxiety, it is important to question whether experimental manipulations of self awareness have the same effects. Keep in mind that these
Photography and Self Awareness 11 manipulations affect state self awareness, whereas trait self awareness remains relatively constant regardless of the situation. State self awareness. In studying state self awareness, it must first be determined which stimuli produce self focus. Strangely, much of the literature on the topic is flawed in that many studies take it for granted that certain stimuli necessarily cause attention to be directed inward. Specifically, listening to an audio recording of one's own voice, viewing oneself in the mirror, and knowing that one is being video recorded supposedly force one to recognize him or herself as an object in the environment. Following this presumption, many experiments were conducted to analyze the effect of such self awareness induction before the experimental manipulations were properly validated (Buss & Scheier, 1976; Carver, 1974, 1975; Duval & Wicklu nd, 1971, 1973; Duval, Wicklund, & Fine, 1972; Ickes, Wicklund, & Ferris, 1973; Scheier, 1976; Scheier & Carver, 1977). Fortunately, this flaw in the literature was eventually noticed, and researchers set about investigating the assumption that self awaren ess could be experimentally induced. The first study to do this tested the mirror and the video camera as manipulations of self awareness (Davis & Brock, 1975). Self awareness was measured in a unique way: participants were given a paragraph written in a foreign language with which they were unfamiliar and were told to attempt to highlight all of the first person pronouns, labeling them "I," "me," "my," etc. those with increased self awareness should identify more first person pronouns since the "self" is more salient to them. In the first experiment, participants placed in front of a video camera identified significantly more first person pronouns (correctly or incorrectly) than those in the control. The second experiment used
Photography and Self Awareness 12 a mirror to induce self aw areness, but did not include a control group, as validation of the experimental manipulation was not the primary objective, but rather a secondary priority. Carver & Scheier (1978) saw where the aforementioned study fell short, and hoped to validate the m irror as a means of heightening self awareness. Self awareness was measured via the Self Focus Sentence Completion task (SFSC; Exner, 1973). The SFSC consists of 30 sentence stems to be completed by the participant with the first thought that comes to mi nd. Responses are coded as self relevant, externally focused, or neither. Heightened self awareness should lead to an increase in self relevant responses. It was shown that those in the mirror condition displayed a much higher tendency to make self focus sentence completions than those in the control. Geller & Shaver (1976) measured self awareness in yet a different way, hoping to further validate the use of mirrors and video cameras as self awareness inductions. They used a Stroop test (Stroop, 1938, a s cited in Gellar & Shaver, 1976) with self relevant words. A Stroop test presents one word at a time in various colors, and the participant is asked to identify the color of the word. Past research has shown that it takes longer to identify a word that has been seen or heard recently, or has otherwise been freshly activate in one's mind (Scheibe, Shaver, & Carrier, 1967, as cited in Gellar & Shaver, 1976). Thus, self relevant words should take longer to identify in those whose self awareness in increase d because the "self" is at the forefront of their mind. This task was chosen because it does not require people to self report their levels of awareness, yet still indirectly measures it. Two experiments were conducted to see whether there were different Stroop test results for those who were made self aware versus controls. Those in the self aware group faced a mirror that had a video camera pointed at it. Results
Photography and Self Awareness 13 showed that the color naming latency for self relevant words was significantly higher in those in the increased self awareness condition. A final study was designed to test whether mirror presence actually caused one to view oneself from the point of view of an outside observer (Hass & Eisenstadt,1990). This was done in an ingenious way: par ticipants were asked to draw an E on their foreheads, and the analysis relied on the orientation of the letter. Some would orient the E so that it looked correct to them, while others would draw it in such a way that it would be readable by an outside obs erver. Results supported the hypothesis in that those in the mirror condition more often oriented the E to be readable by an observer, even though this meant that the mirror image of the E was actually backwards. These findings offer possibly the most ro bust support to date of the idea that mirror presence actually causes an increase in objective self awareness. Self awareness is not measured in some roundabout way; it is directly demonstrated that those placed in front of a mirror are made objectively s elf aware, as evidenced by the fact that they begin viewing themselves as an object in the environment from the perspective of an outside observer. After experimental manipulations of self awareness were sufficiently validated, researchers began questionin g whether all stimuli used to induce self focus actually manipulated the same type of self awareness. Froming, Walker, and Lopyan (1982) predicted that this was not the case. Instead, they hypothesized that mirrors induced private self awareness while aud ience presence induced public self awareness. They found that mirror presence has effects similar to trait private self awareness, whereas audience presence more closely echoes the effects of trait public self awareness. Specifically, those in the first group are less susceptible to suggestion, whereas those in
Photography and Self Awareness 14 the latter group are more likely to shift their attitudes in the direction of popular opinion. Data from other studies are consistent with these hypotheses using video cameras as the public self a wareness manipulation (Scheier & Carver, 1980; Scheier, Carver, & Gibbons, 1979). Researchers have since accepted that mirrors induce private self awareness, whereas video cameras induce public self awareness. It follows from here that experimentally ma nipulated self awareness has effects similar to dispositionally heightened trait self awareness. In their meta analysis of research concerning self awareness and affective response, Fejfar & Hoyle (2000) found that when private self awareness is manipulat ed via mirror presence, the resulting negative affect follows the same vein as that produced by heightened levels of trait private self awareness as measured by the SCS. Similarly, Scheier & Carver (1977) conducted a series of four experiments to test whe ther self focus manipulated via exposure to a mirror would have effects comparable to self focus as determined by scores on the SCS. Results implied that both trait and state self awareness lead to increased self evaluation, which, in turn, lead to greate r responsivity to affect. Other researchers have found an association between experimentally heightened self awareness and negative affect (Duval, Wicklund, & Fine, 1972), as well as lowered self esteem (Buss & Scheier, 1976; Ickes, Wicklund, & Ferris, 19 73). Furthermore, researchers found that higher levels of trait self awareness may mediate the effect of self focus manipulations. When tested, it was shown that mirror presence only heightened self awareness (as measured by self relevance of words on the SFSC) in participants scoring below the median on private self consciousness as measured by the SCS (Carver & Scheier, 1978). Participants with high levels of private
Photography and Self Awareness 15 self consciousness had roughly the same number of self relevant responses whether the m irror was there or not. This implies that those who are already inclined to attend to the self may not be as affected by self focus manipulations. A final question should ask whether this is true for those with social anxiety as well. In a study by Geor ge & Stopa (2008), participants low and high in social anxiety engaged in a social conversation in the presence of either a mirror or a video camera. Self awareness was measured by the SSAS both before and after the experimental manipulations, and post te st anxiety was measured along a 0 100 point scale. It was hypothesized that those high in social anxiety would show an increase in public self awareness in both conditions, which would correspond with a decrease in awareness of surroundings. Furthermore, it was predicted that the manipulations would cause greater anxiety in the high but not the low social anxiety group. Overview of Current Research The present study was designed to test the effectiveness of still photography in manipulating self awarene ss. Both mirrors and video cameras have been used in the past to induce self focus (Carver & Scheier, 1978; Davis & Brock, 1975; Geller & Shaver, 1976; Hass & Eisenstadt, 1980; Scheier & Carver, 1977), and thus, conditions involving each of these were inc luded as a means of ensuring that the experiment properly manipulated self awareness in ideal circumstances. Of course, a control group was also included to make sure that self awareness was not just rising as a function of being a part of the experiment, but rather, was actually being induced by the different conditions. Finally, a measure of social anxiety was incorporated, as it has been shown in the past that such anxiety involves increased self focus and leads to nearly identical rises in self
Photography and Self Awareness 16 awaren ess over controls as does experimental manipulation of self awareness (Fejfar & Hoyle, 2000; Scheier & Carver, 1977). It was hypothesized that those in the mirror condition would show an increase in private self awareness, whereas those in the video camer a and photography conditions would show an increase in public self awareness. Awareness of surroundings should remain low across conditions, as attention should be focused elsewhere. Since those with social anxiety have inherently heightened levels of se lf awareness, these individuals were expected to display less of an increase in self awareness across conditions. Method Participants Eighty nine undergraduate students ( 37 males, 52 females) attending New College of Florida participate d in this experime nt. This convenience sample was recruited via multiple messages to the student forum inviting volunteers. Nine participants left questions unanswered, and were thus eliminated from subsequent analysis, leaving 80 participants (34 males, 46 females). The ir ages ranged from 18 31 years, with a median age of 20. They were divided evenly into four experimental groups using a random number generator Design The study used a mixed design. There were two between subjects factor s (social anxiety and type of s elf focus manipulation ), and one within subjects factor ( time ). The dependent variable s were levels of self awareness and the self relevance of responses
Photography and Self Awareness 17 Measures Social anxiety measures. Two scales were employed to measure social anxiety: the Social Phobia Scale (SPS; Mattick & Clarke, 1998), and the Social Interaction Anxiety Scale (SIAS; Mattick & Clarke, 1998). The SPS consists of twenty questions developed to measure one's fear of being scrutinized during routine interactions. For each item, the respondent is asked to "indicate the degree to which you feel the statement applies to you" along a five point (1 5) Likert scale coupled with the verbal counterparts "not at all," "slightly," "moderately," "very," and "extremely." Some sample questions include "I get nervous that people are staring at me as I walk down the street," and "I get panicky that others might see me to be f aint, sick, or ill (see Appendix A for complete list of questions). The SIAS consists of twenty questions developed to mea sure one's fear of social interactions, specifically the fear that they will go poorly due to a personal deficiency Each question employs the same Likert scale used by the SPS Some items are negatively vale nced to reverse their score. Sample questions include "I have difficulty making eye contact with others," and "I find it easy to make friends my own age (see Appendix B for complete list of questions). Both of these scales are well established measures of social anxiety and have demonstrated suffici ent reliability and discriminant validity (Mattick & Clarke, 1998; Peters, 2000). Self awareness measures. The Situational Self Awareness Scale (SSAS; Govern & Marsch, 2001) consists of nine questions (three per subscale) measuring pr ivate and public sel f awareness and awareness of surroundings. A few representative items are "Right now, I am keenly aware of everything in my environment," and "Right now, I am conscious of my inner feelings (see Appendix C for complete list of questions). Items
Photography and Self Awareness 18 are rate d on a seven point Likert scale (1 = strongly disagree 7 = strongly agree ). The SSAS has previously been established as a valid, reliable means of measuring situational changes in levels of self awareness (Govern & Marsch, 2001). Bas eline levels of self awareness we re measured at the beginning o f the experiment using the SSAS and again at the end to measure the effects of the manipulations. A dditionally, the participant was asked to respond to a Self Focused Sentence Completion task (SFSC; Exner, 1973) during the course of the experiment. The SFSC contains 30 sentence completion stems, many of which begin with I, me, or my (e.g., "I think, I wish, It's fun to daydream about"). See Appendix D for complete list of sentence stems. Participants are in structed to complete each stem with the first thing that comes to their mind Responses are coded as self relevant, external, ambivalent, or other by both the primary researcher. A research assistant coded 20% of the responses with 96.25% agreement. Mor e self relevant responses imply higher levels of self awareness. Procedure Participants first enter ed the lobby of the laboratory and were asked to sign an informed consent form (see Appendix E for copy of form). Baseline levels of self awareness were th en measured with the SSAS. Next, participants were asked to fill out the social anxiety measures (SPS & SIAS), after which they we re given a Sudoku puzzle to complete as a filler task while they wait ed to be individually called into the experimental room. The experiment wa s conducted in a room containing 2 chairs facing a table In the mirror condition, a mirror was set on top of the table, leaning against the wall behind it In the video camera condition, a video camera was situated on a tri pod betwee n the
Photography and Self Awareness 19 table and the wall. In the photography condition, a camera set to take pictures every fifteen seconds during the experiment, was situated o n a tri pod between the table and the wall In the control condition, the table was simply placed against th e wall with the chairs in front of it See Figure 1 for a display of the experimental set up. When the participant entered, s/he was instructed to sit in the far chair In the video/camera condition, the experimenter then adjusted the video camera or cam era to ensure that the participant was in the shot, and then either pressed record or released the shutter to begin the series of photographs. In the mirror condition, the experimenter wiped a supposed smudge off the mirror, to make it equally salient. T he experimenter then informed the participant that s/he must verbally respond to the following section, which would be audio taped to be scored later. The participant was thus asked to speak clearly. The experimenter then began recording, and read the fo llowing instructions to the participant before beginning the Self Focused Sentence Completion task: "For this part of the experiment, I'm going to read you a list of thirty incomplete sentence stems. You should finish each sentence with the first thing th at comes to your mind. Remember, there is no right or wrong answer, so just respond however you see fit. Let's begin." When finished, the experimenter informed the participant that s/he was almost done, stopped the audio recording, and distributed the S SAS once again. The experimenter than left the room after informing the participant that s/he may take a colorful pen as means of compensation. On the way out, the participant was offered a debriefing and thanked again for volunteering.
Photography and Self Awareness 20 Results Primary Analysis Based on Hypotheses Primary analyses focused on levels of self awareness as measured by the SSAS at time two, following the experimental manipulations, as well as self relevance of responses on the SFSC. Specifically, it was hypothesized that al l conditions other than the control would respond to the SFSC with greater numbers of self relevant completions. Furthermore, it was hypothesized that private self awareness at time two would be highest in the mirror condition, while public self awareness would be highest in the camera and video camera conditions. Awareness of surroundings was expected to remain low across conditions. Only the last of these hypotheses was supported. A one way analysis of variance revealed no significant differences betw een conditions on the self relevance of responses to the SFSC, F (3, 76) = .017, p = .997. The highest possible score was 30, with self relevant responses scored as 1, ambivalent responses scored as 0.5, and external/other scored as 0. Nonetheless mean sc ores remained near the median across conditions. For mean scores on the sentence completion task, see Table 1. Another one way ANOVA showed no significant difference between the camera, video camera, mirror, and control conditions for private self awarene ss at time two, F (3, 76) = 1.105, p = .352. Similarly, a one way ANOVA revealed no significant difference between conditions for time two levels of public self awareness, F (3, 76) = .150, p = .930. Finally, a one way ANOVA revealed no significant differe nces between conditions for awareness of surroundings at time two, F (3, 76) = 1.009, p = .393. Nonetheless, it was shown that time two levels of all three types of awareness (public, private, and
Photography and Self Awareness 21 awareness of surroundings) were highest in the video camera condition. For mean self awareness scores at time two for each condition, see Table 2. It was further hypothesized that social anxiety scores as measured by the SIAS and SPS would moderate the effects of the self awareness manipulations such that those h igh in social anxiety would show less of an increase in self awareness in each condition due to heightened levels of self awareness at time one. Two groups were created (high and low social anxiety) by dividing combined SIAS and SPS scores along a median split ( Mdn = 2.2). Three 2 (social anxiety score) X 4 (experimental condition) ANOVAs were run to analyze the results. Social anxiety was found to be a significant predictor of public self awareness at time two regardless of condition, F (3, 72) = 3.078, p = .007. See Table 3 for mean public self awareness scores at time two for each group by condition. Social anxiety was not found to be a significant predictor of time two private self awareness, F (3, 72) = .668, p = .698, or awareness of surroundings, F (3, 72) = .894, p = .516. Change in Awareness Over Time Further analyses concerned changes in levels of self awareness as measured by the SSAS from baseline scores to scores at time two. Comparing the between subjects factor of condition to the within su bjects factor of time, a repeated measures ANOVA revealed a significant increase of private self awareness across conditions, F (3, 76) = 24.507, p < .001 (see Figure 2). Similarly, a repeated measures ANOVA revealed a marginally significant increase in pu blic self awareness across conditions, F (3, 76) = 5.749, p = .019. A final repeated measures ANOVA revealed no significant change in awareness of surroundings across conditions, F (3, 76) = .001, p = .970.
Photography and Self Awareness 22 Gender Differences in Awareness There was a main effect of gender on time one levels of self awareness across the experimental conditions. Specifically, an independent samples t test revealed that men scored significantly higher than women on awareness of surroundings at time one, t (78) = .549, p = .016 Women scored higher than men on public self awareness at time one, however this difference was marginally significant, t (78) = .5107, p = .063. These effect disappeared at time two, though, such that both genders scored roughly the same on both awaren ess of surroundings, t (78) = .232, p = .364, and public self awareness, t (78) = .454, p = .164. For mean scores on the different types of self awareness by gender over time, see Table 4. Intercorrelations Between Study Variables Assessing Awareness Pe arson's correlation coefficients were computed to analyze the correlations between the different variables. As should be expected, scores on the Social Interaction Anxiety Scale were highly correlated with scores on the Social Phobia Scale, ( r = .725, p < .001). Social anxiety was negatively correlated with awareness of surroundings at time one ( r = .342, p = .002). Social anxiety was also positively correlated with public self awareness at time two ( r = .374, p = .001.), as was social phobia ( r = .424, p < .001). Time one levels of public self awareness were positively correlated with scores on the Self Focus Sentence Completion task ( r = .259, p = .020), meaning that higher levels of public self awareness were associated with greater numbers of self r elevant sentence completions. Time one levels of private self awareness were positively correlated with time one levels of both public self awareness ( r = .242, p = .030) and awareness of
Photography and Self Awareness 23 surroundings ( r = .292, p = .009), as well as time two levels of pri vate self awareness ( r = .582, p < .001) and awareness of surroundings ( r = .231, p = .039). Similarly, time one levels of public self awareness were correlated with time two levels of public self awareness ( r = .535, p < .001) and awareness of surroundin gs ( r = .232, p = .039). Finally, time two levels of awareness of surroundings were positively correlated with time one awareness of surroundings ( r = .594, p < .001), as well as time two levels of private self awareness ( r = .342, p = .002). Discussion Review of Primary Results The purpose of this paper was to study the effect of photography on self awareness. Specifically, it was hypothesized that participants would display an increase in public self awareness from baseline levels after being subject to a photography condition. The main hypothesis was not supported, though. Time two levels of public self awareness were not significantly higher in the photography condition over other conditions. Luckily, this experiment included a manipulation check Past research has validated both mirrors and video cameras as experimental inductions of self awareness (Carver & Scheier, 1978; Davis & Brock, 1975; Geller & Shaver, 1976; Hass & Eisenstadt, 1980; Scheier & Carver, 1977). As such, it was expected that participants in the mirror condition would show an increase in time two levels of private self awareness, while those in the video camera condition would show an increase in public self awareness. Neither of these manipulations was effective, though, as results showed no difference between conditions on time two awareness of any type. Further analyses revealed a main effect of time on both private and public self awareness, meaning that
Photography and Self Awareness 24 participants showed an increase in these variables regardless of con dition. This implies that the experiment itself was causing a rise in self awareness, rendering the manipulations ineffective. Results revealed some surprising gender differences in time one levels of self awareness. Specifically, it was found that me n were more aware of their surroundings, while women had higher public self awareness. These findings are only startling in light of the fact that past research has found no gender differences in self awareness. As such, the differences seen here are mos t likely due to peculiarities in this particular sample, and are likely not generalizable to the population as a whole. The fact that these gender differences disappeared by time two says something about the experiment itself. Participants should have sh own relatively stable increases in self awareness levels by condition, preserving their original differences. The disappearance of these differences implies that the experiment was a bit overwhelming, causing instability in participants' reactions to it. The final hypothesis concerned the effects of social anxiety on the manipulations of self awareness. Those with increased social anxiety were expected to have higher baseline levels of public self awareness, and lower levels of awareness of surroundings Though the experimental conditions should still cause subsequent increases in self awareness, these effects were expected to be less dramatic as heightened baseline self awareness may lead to a ceiling effect at time two. Interestingly, results found s ocial anxiety to be a predictor of time two public self awareness, though it was unrelated to time one measures of the same variable. As hypothesized, a negative correlation was found between social anxiety and awareness of surroundings at time two.
Photography and Self Awareness 25 Lim itations of the Current Study When considering the results of this study, the limitations and flaws should be kept in mind. Perhaps most importantly, the social nature of the experiment may have skewed the results. The fact that participants verbally com pleted the SFSC in the presence of the experimenter most likely caused the rise in self awareness regardless of experimental condition. Past research has shown that audience presence can cause a rise in self awareness that parallels the effects of being vi deo recorded (Carver & Scheier, 1978; Froming, Walker, & Lopyan, 1982). Eye contact was avoided throughout the SFSC, as previous research has found that audience presence only affects self awareness when frequent eye contact is maintained (Scheier, Fenigs tein, & Buss, 1974). Still, it is possible that the participants continued to feel scrutinized by the experimenter, and thus began to self evaluate across conditions. The SFSC was completed verbally as a means of experimentally replicating a social situa tion, so as to better analyze the effects of social anxiety on self awareness induction. Perhaps future research should focus on validating photography as an experimental manipulation of self awareness before considering how this is affected by participan ts' social anxiety. The social nature of the experiment may also have added to the correlation between social anxiety and time two levels of public self awareness. Perhaps participants' social anxiety was inactive at the onset of the experiment but the so cial interaction of the SFSC caused participants to activate the cognitive processes that maintain social anxiety (Clark & Wells, 1995). Once participants began to intensely focus their attention on themselves and view themselves as social objects from an observers' perspective, they experienced a dramatic increase in public self awareness.
Photography and Self Awareness 26 The subsequent decrease in awareness of surroundings was to be expected, as attention to the self would detract from attention to the environment, especially since tho se with social anxiety have been shown to attend to themselves to the exclusion of other input ( Hope, Heimberg, & Klein, 1990). Keeping these limitations in mind, the present study has not disconfirmed the possibility that photography may cause a rise in public self awareness. In the future, this study should be replicated with the participants' completing the SFSC on paper so as to eliminate the social aspect. Perhaps individual levels of trait self awareness should then be measured with the SCS instead of the social anxiety scales to determine whether they affect self awareness induction. Direction for Future Research The aim of this study was to determine whether or not having one's picture taken induced public self awareness, and to see if this effec t was mediated by social anxiety. Though results showed no increase in public self awareness in the photography condition, this was likely due more to experimental flaws than to the actual ineffectiveness of photography in inducing self awareness. As suc h, future research should be conducted to ascertain the true psychological effects of photography. If it is eventually shown that having one's picture taken leads to a rise in self awareness, knowledge of the intricacies of today's photo culture will expo nentially increase. One possibility for future research would be an exploration of the phenomenon of "camera shyness." If photography increases self awareness, an explanation for this behavior is immediately recognizable. Past research has shown that pe ople generally wish to avoid self focus, particularly when they are engaged in discrepant behavior
Photography and Self Awareness 27 (Greenberg & Musham, 1981) or have low self esteem (Brockner & Wallnauc, 1981), as it brings about negative affect (Duval, Wicklund, & Fine, 1972; Fejfar & H oyle, 2000). It would thus be unsurprising if individuals with social anxiety or low self esteem would shy away from cameras. Similarly, it would be interesting to see if normally camera tolerant individuals would avoid photo opportunities when they were engaged in atypical, "discrepant" behaviors. Furthermore, it would be interesting to see if social anxiety could be reduced via personal exposure to photography. Specifically, those with social anxiety could engage in a kind of phototherapy involving se lf portraiture in an attempt to become gain a more accurate self concept and become more comfortable with heightened self awareness. Perhaps this would help these individuals become more comfortable in social situations, particularly when photography was involved. This paper questioned whether photography caused an increase in public self awareness. Though results were inconclusive, future research should further explore this possibility. Discovering the effect of photography on self awareness is only th e beginning of a long line of research that could be conducted on the psychological impact of photography. Hopefully, future research will explore exactly how picture taking has come to influence our social interactions, our self concepts, and our overall experiences. Considering the infiltration of photography into today's culture, it is a phenomenon which should not be left unexplored.
Photography and Self Awareness 28 Table 1 Self Focus Sentence Completion Task Responses Condition M (SE) 95% CI Mirror 16.01 (.87) [14. 29, 17.74] Video Camera 16.25 (.83) [14.60, 17.90] Camera 16.00 (.84) [14.32, 17.68] Control 16.35 (.83) [14.70, 18.00] Note CI = Confidence Interval
Photography and Self Awareness 29 Table 2 Time Two Self Awareness Scores Mirror Video Camera Camera Control Va riable M (SD) M (SD) M (SD) M (SD) F (3, 76) p 95% CI Public SA 4.25 (1.51) 4.42 (1.27) 4.13 (1.72) 4 .17 (1.31) .150 .93 [3.92, 4.56] Private SA 4.77 (1.16) 5.43 (1.20) 5.07 (1.21) 4.9 8 (1.16) 1.105 .352 [4.80, 5.33] Surroundings 4.47 (.96) 5.05 (1.06) 4.70 (1.29) 4.58 (1.15) 1.0 09 .393 [4.45, 4.95] Note CI = Confidence Interval
Photography and Self Awareness 30 Table 3 Time Two Public Self Awareness Scores for High and Low Social Anx iety Groups Low Anxiety High Anxiety Condition M (SE) 95% CI M (SE) 95% CI Mirror 4.18 (.37) [3.45, 4.91] 4.38 (.50) [3.39. 5.38] Video Camera 3.83 (.42) [3.00, 4.67] 5.00 (.42) [4.17, 5.83] Camera 3.08 (.47) [2.15, 4.02] 4.83 (.38) [4.07, 5.60] C ontrol 3.30 (.42) [2.47, 4.13] 5.03 (.42) [4.20, 5.87] Note. CI = Confidence Interval
Photography and Self Awareness 31 Table 4 Gender Differences in Scores on Self Awareness Subscales Male Female ( n = 34) ( n = 46) Variable M ( SD) M (SD) t (78) p 95% CI Time 1 Public Self Awareness 3.60 ( 1.10) 4.11 (1.26) .511 .063 [ 1.05, .03] Pr ivate Self Awareness 4.38 (1.46) 4.46 (1.16) .074 .801 [ .66, .51] Awareness of Surroundings 5.02 ( 1.04) 4.47 (.94) .549 .016 [.10, .99] Time 2 Public Self Awareness 3.98 (1.52) 4.43 (1.36) .454 164 [ 1.10, .19] Private Self Awareness 5.12 ( 1.26) 5.02 (1.13) .096 .723 [ .44, .63] Awareness of Surrounding 4.83 ( 1.24) 4.60 (1.03) .232 .364 [ .27, .74] Note CI = Confidence Interval
Photography and Self Awareness 32 (a) (b) (c) (d) Figure 1. Details of experimental set up for control condition (a), mirror condition (b), video camera condition (c), and camera condition (d).
Photography and Self Awarenes s 33 Figure 2. Mean levels of self awareness as measured by the Situational Self Awareness Scale across conditions over time. # $ % & ( Mean Scores on SSAS ) *+,-!./! *+,-!*01 !!!!!!23+456! !7-89 : ;053-/-<<= !!!!!!!2>?8+@ 7-89 : ;053-/-<<== !!!!;053-/-<< 19!7>331>/A+/B< %C"(( %C"(% %C)%) &CDE) %C%)$ $C(#& %C)%) Types of Self Awareness *Change w as significant, F(3, 76) = 24.507, p = .000 **Change was significant, F(3, 76) = 5.749, p = .019
Photography and Self Awareness 34 References Abbott, M. J., & Rapee, R. M. (2004). Post event rumination and negative self appraisal in social phobia before and after treatment. Journal of Abnormal Psychology, 113 (1), 136 144. doi: 10.1037/0021 843X.113.1.136 Alden, L. E., Taylor, C. T., M ellings, T. M. J. B., & Laposa, J. M. (2008). Social anxiety and the interpretation of positive social events. Journal of Anxiety Disorders, 22 (4), 577 590. doi: 10.1016/j.janxdis.2007.05.007 Amaya, H. (2004). Photography as technology of the self: Matusch ka's art and breast cancer. International Journal of Qualitative Studies in Education, 17 (4), 557 573. doi:10.1080/09518390410001709599 Axelsson, O. (2007 a ). Individual differences in preferences to photographs. Psychology of Aesthetics, Creativity, and th e Arts, 1 (2), 61 72. doi: 10.1037/1931 3818.104.22.168 Axelsson, O. (2007 b ). Towards a psychology of photography: Dimensions underlying the aesthetic appeal of photographs. Perceptual and Motor Skills, 105 (2) 411 434. doi: 10.2466/PMS.105.6.411 434 Brockner, J ., & Wallnau, L. B. (1981). Self esteem, anxiety, and the avoidance of self focused attention. Journal of Research in Personality, 15 277 291. doi:10.1016/0092 6566(81)90026 X Burgess, M., Enzle, M. E., & Morry, M. (2000). The social psycholog ical power o f photography: C an the image freezing machine make something out of nothing? European Journal of Social Psychology, 30 (5) 613 630. doi: 10.1002/1099 0992(200009/10)30:5<613::AID EJSP11>3.0.CO;2 S Buss, D. M., & Scheier, M. F. (1976). Self consciousness, se lf awareness, and self
Photography and Self Awareness 35 attribution. Journal of Research in Personality, 10 (4), 463 468. doi: 10.1016/0092 6566(76)90060 X Carver, C. S. (1974). Facilitation of physical aggression through objective self awareness. Journal of Experimental Social Psychology, 10 (4), 365 370. doi: 10.1016/0022 1031(74)90032 8 Carver, C. S. (1975). Physical aggression as a function of objective self awareness and attitudes toward punishment. Journal of Experimental Social Psychology, 11 (6), 510 519. doi: 10.1016/0022 1031(75)90002 5 Carver, C. S., & Scheier, M. F. (1978). Self focusing effects of dispositional self consciousness, mirror presence, and audience presence. Journal of Personality and Social Psychology, 36 (3) 324 332. doi: 10.1037/0022 3522.214.171.1244 Clark, J. V., & Arkowi tz, H. (1975). Social anxiety and self evaluation of interpersonal performance. Psychological Reports, 36 (1), 211 221. Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In M. Liebowitz, D. A. Hope, F. Schneier, & R. G. Heimberg (Eds). Social phobia: Diagnoses, assessment, and treatment. New York: Guilford Press. Colson, D. B. (1979). Photography as an extension of the ego. International Review of Psycho Analysis, 6 (3) 273 282. Cosden, C., & Reynolds, D. (1982). Photography as therapy. The Arts in Psychotherapy, 9 (1) 19 23. doi: 10.1016/0197 4556(82)90023 5 Davis, D. & Brock, T. C. (1975). Use of first person pronouns as a function of increased objective self awareness and performance feedback. Journal of Experimental Social Psychology, 11 (4) 381 388. doi: 10.1016/0022 1031(75)90017 7
Photography and Self Awareness 36 Dennett, T. (2009 ). Jo Spence's camera therapy: P ersonal therapeutic photography as a response to adversity. European Journal of Psychotherapy & Counselling, 11 7 19. doi: 10.1080/13642530902723041 Diamond, H. W. (1856). On the application of photography to the physiognomic and mental phenomena of insanity. Proceedings of the Royal Society of London, 8 117. Retreived from http://www.jstor.org/stable/111302 Durrant, A., Frohlich, D., Sellen, A., & Lyons, E. (2009). Home curation versus teenage photography: Photo displays in the family home. International Journal of Human Computer Studies, 67 (12) 1005 1023. doi: 10.1016/j.ijhcs.2009.09.005 Duval, A., & Wicklund, R. A. (1971). Opinion change and performance fac ilitation as a result of objective self awareness. Journal of Experimental Social Psychology, 7 319 342. doi: 10.1016/0022 1031(71)90032 1 Duval, A., & Wicklund, R. A. (1972). A theory of objective self awareness. New York, New York: Academic Press. Du val A., & Wicklund, R. A. (1973). Effects of objective self awareness on attribution of causality. Journal of Experimental Social Psychology, 9 17 31. doi: 10.1016/0022 1031(73)90059 0 Duval, A., Wicklund, R. A., & Fine, R. L. (1972) Avoidance of objective s elf awareness. In A. Duval and R. A. Wicklund, A theory of objective self awareness New York, New York: Academic Press. Dyches, T. T., Cichella, E., Olsen, S. F., & Mandleco, B. (2004). Snapshots of life: Perspectives of school ages individuals with deve lopment disabilities. Research & Practice for Persons with Severe Disabilities, 29 (3) 172 182.
Photography and Self Awareness 37 Elliot, G. C. (1984). Dimensions of the self concept: A source of further distinctions in the nature of self consciousness. Journal of Youth and Adolescents, 13 (4), 285 307. doi:10.1007/BF02094866 Exner, J. E. (1973). The s elf focus sentence completion: A study of egocentricity. Journal of Personality Assessment, 37 (5) 437 455. Fejfar, M. C., & Hoyle, R. H. (2000). Effect of private self awareness on negative af fect and self referent attribution: A quantitative review. Personality and Social Psychology Review, 4 (2) 132 142. doi: 10.1207/S15327957PSPR0402 Fenigstein, A., Scheier, M. F., & Buss, A. H. (1975). Public and private self consciousness: Assessment and th eory. Journal of Consulting and Clinical Psychology, 43 (4), 522 527. doi: 10.1037/h0076760 Froming, W. J., Walker, G. R., & Lopyan, K. J. (1982). Public and private self awareness: When personal attitudes conflict with societal expectations. Journal of Expe rimental Social Psychology, 18 476 487. doi:10.1016/0022 1031(82)90067 1 Fryrear, J. L., Nuell, L. R., & Ridley, S. D. (1974). Photographic self concept enhancement of male juvenile delinquents. Journal of Consulting and Clinical Psychology, 42 (6), 915. do i: 10.1037/h0037574 Geller, V. & Shaver, P. (1976). Cognitive consequences of self awareness. Journal of Experimental Social Psychology, 12 (1) 99 108. doi: 10.1016/0022 1031(76)90089 5 George, L., & Stopa L. (2008). Private and public self awareness in soc ial anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 39 (1) 57 72. doi: 10.1016/j.jbtep.2006.09.004
Photography and Self Awareness 38 Glover Graf, N. M., & Miller, E. (2006). The use of phototherapy in group treatment for persons who are chemically dependent. Rehabilitation Counseling Bulletin, 49 166 181. doi: 10.1177/00343552060490030401 Govern, J. M., & Marsch, L. A. (2001). Development and validation of the situational self awareness scale. Consciousness and Cognition; An International Journal, 10 366 378. doi: 10.1006/c cog.2001.0506 Graf, N. M. (2002). Photography as a therapeutic tool for substance abuse clients who have a history of sexual abuse. Counseling and Psychotherapy Research, 2 201 207. doi: 10.1080/14733140212331384835 Greenberg, J., & Musham, C. (1981). Avoi ding and seeking self focused attention. Journal of Research in Personality, 15 191 200. doi: 10.1016/0092 6566(81)90018 0 Hanna, K. M., & Jacobs, P. (1993). The use of photography to explore the meaning of health among adolescents with cancer. Issues in C omprehensive Pediatric Nursing, 16 155 164. doi: 10.3109/0146086930907827 Hass, R. G., & Eisenstadt, D. (1990). The effects of self focused attention on perspective taking and anxiety. Anxiety Research, 2 (3), 165 176. Hope, D. A., Heimberg, R. G., & Klein J. F. (1990). Social anxiety and the recall of interpersonal information. Journal of Cognitive Psychotherapy, 4 (2), 185 195. Hunsberger, P. (1984). Uses of instant print photography in psychotherapy. Professional Psychology: Research and Practice, 15 (6) 884 890. doi: 10.1037/0735 7028.15.6.884 Huppert, J. D., Foa, E. B., Furr, J. M., Filip, J. C., & Mathews, A. (2003). Interpretation
Photography and Self Awareness 39 bias in social anxiety: A dimensional perspective. Cognitive Therapy and Research, 27 (5), 569 577. doi: 10.1023/A:102635910 5456 Ickes, W. J., Wicklund, R. A., & Ferris, C. B. (1973). Objective self awareness and self esteem. Journal of Experimental Social Psychology, 9 202 219. doi: 10.1016/0022 1031(73)90010 3 Ingram, R. E. (1990). Self focused attention in clinical disorders : Review and a conceptual model. Psychological Bulletin, 107 (2), 156 176. doi:10.1037/0033 2909.107.2.156 Kaplan, S., Kaplan, R., & Wendt, J. S. (1972). Rated preference and complexity for natural and urban visual material. Perception & Psychophysics, 12(4 ) 354 356. Kashdan, T. B., & Roberts, J. E. (2004). Social anxiety's impact on affect, curiosirt, and social self efficacy during a high self focus threat situation. Cognitive Therapy and Research, 28 (1), 119 141. doi: 10.1023/B:COTR.0000016934.20981.68 Ka shdan, T. B., & Roberts, J. E. (2006). Affective outcomes in superficial and intimate interactions: Roles of social anxiety and curiosity. Journal of Research in Personality, 40 (2), 140 167. doi:10.1016/j.jrp.2004.10.005 Kocovski, N. L., & Endler, N. S. (2 000). Social anxiety, self regulation, and fear of negative evaluation. European Journal of Personality, 14 (4), 347 358. doi: 10.1002/1099 0984(200007/08)14:4<347::AID PER381>3.0.CO;2 7 Lake, E. A., & Arkin, R. M. (1985). Reactions to objective and subjecti ve interpersonal evaluations: The influence of social anxiety. Journal of Social and Clinical Psychology, 3 (2), 143 160.
Photography and Self Awareness 40 Lyman, P., & Varian, H. R. (2000). Film. In How much information? Retreived from http://www2.sims.berkeley.edu/research/projects/how mu ch info/film.html Marshall, P. H., & Thornhill, A. G. (1995). When a photograph is judged artistic: The influence of novelty and affect. Visual Arts Research, 21 (1), 71 75. Martin, R. (2009). Inhabiting the image: Photography, therapy, and re enactment ph ototherapy. European Journal of Psychotherapy and Counselling, 11 35 49. doi: 10.1080/13642530902723074 Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measurese of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36 455 470. doi: 10.1016/S0005 7967(97)10031 6 Mead, G. H. (1934). Mind, self & society: From the standpoint of a social behaviorist. Ed. Charles W. Morris. Chicago, IL: University of Chicago Press. Milford, S. A., Fryrear, J. K., & Swank, P. S. (1983). Phototherapy with disadvantaged boys. The Arts in Psychotherapy, 10 (4) 221 228. doi: 10.1016/0197 4556(83)90022 9 Neslon Gee, E. (1975). Learning to be: A look into the use of therapy with Polaroid photography as a means of recreating the development of perception and the ego. Art Psychotherapy, 2 (2) 159 164. doi: 10.1016/0090 9092(75)90017 4 Nuez, C. (2009). The self portrait, a powerful tool for self therapy. European Journal of Psychotherapy & Counseling, 11 (1) 51 61. doi: 10.1080/ 13642530902723157 Peters, L. (2000). Discriminant validity of the social phobia and anxiety inventory (SPAI), the social phobia scale (SPS), and the social interaction anxiety scale (SIAS). Behaviour Research and Therapy, 38 (9), 943 950. doi: 10.1016/S0005
Photography and Self Awareness 41 7967(99)00131 X Phillips, D. (1986). Photography's use as a metaphor of self with stabilized schizophrenic patients. The Arts in Psychotherapy, 13 (1) 9 16. doi: 10.1016/0197 4556(86)90004 3 Scheier, M. F. (1976). Self awareness, self consciousness, and ang ry aggression. Journal of Personality, 44 (4), 627 644. doi: 10.1111/j.1467 6494.1976.tb00142.x Scheier, M. F., & Carver, C. S. (1977). Self focused attention and the experience of emotion: attraction, repulsion, elation, and depression. Journal of Personali ty and Social Psychology, 35 (9), 625 636. doi: 10.1037/0022 35126.96.36.1995 Scheier, M. F., Carver, C. S., & Gibbons, F. X. (1979). Self directed attention, awareness of bodily states, and suggestibility. Journal of Personality and Social Psychology, 37 (9), 1 576 1588. doi: 10.1037/0022 35188.8.131.526 Scheier, M. F., Fenigstein, A., & Buss, A. H. (1974). Self awareness and physical aggression. Journal of Experimental Social Psychology, 10 (3), 264 273. doi: 10.1016/0022 1031(74)90072 9 Sontag, S. (1977). On photog raphy. New York, New York: Farrar, Straus, and Giroux. Stewart, D. (1979). Photo therapy: Theory & Practice. Art Psychotherapy, 6 (1) 41 46. doi: 10.1016/0090 9092(79)90019 X Stopa, L., & Bryant, T. (2004). Memory perspective and self concept in social anxi ety: An exploratory study. Memory, 12 (4), 489 495. Doi: 10.1080/09658210444000098 Tarulli, N. J. (1997). Using photography to enhance language and learning: A picture can encourage a thousand words. Language, Speech, and Hearing Services in Schools,
Photography and Self Awareness 42 29 (1) 54 57. Tinio, P. P. L., & Leder, H. (2009). Natural scenes are indeed preferred, but image quality might have the last word. Psychology of Aesthetics, Creativity, and the Arts, 3 (1), 5 2 56. doi: 10.1037/a0014835 Turner, R. G., Scheier, M. F., Carver, C. S. & Ickes, W. (1978) Correlates of self consciousness. Journal of Personality Assessment, 42 (3), 285 289. doi: 10.1207/s15327752jpa4203 Virshup, E. (1985). Group art therapy in a methadone clinic lobby. Journal of Substance Abuse Treatment, 2 (3), 153 158. d oi: 10.1016/0740 5472(85)90045 5 Vittengl, J. R., & Holt, C. S. (1998). Positive and negative affect n social interactions as a function of partner familiarity, quality of communication, and social anxiety. Journal of Social and Clinical Psychology, 17 (2), 196 208. Woodruff Borden, J., Brothers, A. J., & Lister, S. C. (2001). Self focused attention: Commonalities across psychopathologies and predictors. Behavioural and Cognitive Psychotherapy, 29 (2), 169 178. doi: 10.1017/S1352465801002041 Zwick, D. S. (1978 ). Photography as a tool toward increased awareness of the aging self. Art Psychotheraphy, 5 (3) 135 141. doi: 10.1016/0090 9092(78)90003 0
Photography and Self Awareness 43 Appendix A Social Interaction Anxiety Scale Items 1. I get nervous if I have to speak with someone in authori ty (teacher, boss, etc.). 2. I have difficulty making eye contact with others. 3. I become tense if I have to talk about myself or my feelings. 4. I find it difficult to mix comfortably with the people I work with. 5. I find it easy to make friend s my own age. 6. I tense up if I meet an acquaintance in the street. 7. When mixing socially, I am uncomfortable. 8. I feel tense if I am alone with just one other person. 9. I am at ease meeting people at parties, etc. 10. I have difficul ty talking with other people. 11. I find it easy to think of things to talk about. 12. I worry about expressing myself in case I appear awkward. 13. I find it difficult to disagree with another's point of view. 14. I have difficulty talking to attract ive persons of the opposite sex 15. I find myself worrying that I won't know what to say in social situations. 16. I am nervous mixing with people I don't know well. 17. I feel I'll say something embarrassing when talking. 18. When mixing in a group, I find myself worrying I will be ignored. 19. I am tense mixing in a group. 20. I am unsure whether to greet someone I know only slightly. *These items are reverse scored
Photography and Self Awareness 44 Appendix B Social Phobia Scale Items 1. I become anxious if I h ave to write in front of other people. 2. I become self conscious when using public toilets. 3. I can suddenly become aware of my own voice and of others listening to me. 4. I get nervous that people are staring at me as I walk down the street. 5. I fe ar I may blush when I am with others. 6. I feel self conscious if I have to enter a room where others are already seated. 7. I worry about shaking or trembling when I'm watched by other people. 8. I would get tense if I had to sit facing other peo ple on a bus or a train. 9. I get panicky that others might see me to be faint, sick, or ill. 10. I would find it difficult to drink something if in a group of people. 11. It would make me feel self conscious to eat in front of a stranger at a restauran t. 12. I am worried people will think my behavior odd. 13. I would get tense if I had to carry a tray across a crowded cafeteria. 14. I worry I'll lose control of myself in front of other people. 15. I worry I might do something to attract the attenti on of others. 16. When in an elevator, I am tense if people look at me. 17. I can feel conspicuous standing in a queue. 18. I get tense when I speak in front of other people. 19. I worry my head will shake or nod in front of other people. 20. I feel awkward and tense if I know people are watching me.
Photography and Self Awareness 45 Appendix C Situational Self Awareness Scale Items ***1. Right now, I am keenly aware of everything in my environment 2. Right now, I am conscious of my inner feelings. ** 3. Right now, I a m concerned about the way I present myself. ** 4. Right now, I am self conscious about the way I look. *** 5. Right now, I am conscious of what is going on around me. 6. Right now, I am reflective about my life. ** 7. Right now, I am concerned about what other people think of me. 8. Right now, I am aware of my innermost thoughts. *** 9. Right now, I am conscious of all objects around me. *Private Self Awareness subscale items **Public Self Awareness subscale items ***Awareness of Surroundings subscale items
Photography and Self Awareness 46 Appendix D Self Focus Sentence Completion Task Stems 1. I think 2. I was happiest when 3. It's fun to daydream about 4. My father 5. If only I could 6. It's hardest for me 7. I wish 8. As a child I 9. I am 10. I'm at my best 11. Others 12. When I look in the mirror 13. If only I would 14. At least I'm not 15. My sex life 16. It upsets me when 17. The things I like best about myself 18. Friends 19. I would like most to be photographed 20. I guess I'm 21. My m other 22. I wonder 23. The worst thing about me 24. I always wanted 25. I try hardest to please 26. Someday I 27. My appearance 28. My parents 29. If I had my way 30. I like
Photography and Self Awareness 47 Appendix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escription B&5!.,$!)*C)/$3!/&!2.,/)6)2./$!)*! .$+"2".+:8$23;-7 !&* !/#$!$%%$6/0!&%!.(.,$*$00!&* !0&6).'! )*/$,.6/)&*08! B&5!()''!1$!.07$3!/&! 6&-2'$/$!.!%$(!05,C$40;!.0!($''!.0!&,.''4!,$02&*3!/&!.!0$/!&%! 2,&-2/08!"#$!0$6&*3!2.,/!&%!/#$!0/534!()''!1$!/.2$3!C).!.*!.53)& D ,$6&, 3)*+!3$C)6$;!.0!($''!.0! E2#&/&+,.2#$3F!C).!.!C)3$& D 6.-$,.G8!<''!,$6&,3)*+0!()''!1$!2,&-2/'4!$,.0$3!&*6$!/#$4!#.C$!1$$*! /,.*06,)1$3!14!/#$!,$0$.,6#$,!.*3!2.),$3!()/#!4&5,!(,)//$*!05,C$408!H&!)3$*/)%4)*+!)*%&,-./)&*! ()''!1$!)*6'53$3!./!/#)0!2&)*/8 B&5,!.*0($ ,0!()''!1$!6&-2'$/$'4!.*&*4-&50!.*3!()''!*$C$,!1$! 3)06'&0$3!/&!.*4&*$!$A6$2/!/#$!,$0$.,6#$,!.*3!.!,$0$.,6#!.00)0/.*/8! B&5,!2.,/)6)2./)&*!()''!/.7$!.22,&A)-./$'4!IJ D KL!-)*5/$08! Benefits of Being a Part of this Research Study @4!/.7)*+!2.,/!)*!/#)0!,$0$.,6 #!0/534;!4&5!-.4!)*6,$.0$!4&5,!&C$,.''!7*&('$3+$!&%!.(.,$*$00!.*3! 0&6).'!0)/5./)&*08!B&5!()''!.'0&!1$!6&*/,)15/)*+!/&!/#$!3$C$'&2)*+!,$0$.,6#!)*!/#)0!%)$'3!&%! 2046#&'&+48 Risks of Being a Part of this Research Study "#$,$!.,$!*&!,)070!)*C&'C$3!()/#!.!1$)*+ !.!2.,/!&%!/#)0!0/5348 Payment for Participation B&5!()''!*&/!1$!2.)3!%&,!2.,/)6)2./)&*!)*!/#)0!0/534;!/#&5+#!4&5!()''!1$!&%%$,$3!.!6&'&,%5'!2$*!14! -$.*0!&%!6&-2$*0./)&*8! Confidentiality of Your Records B&5,!2,)C.64! )0!)-2&,/.*/8!!M&($C$,;!/ #$!,$05'/0!&%! /#)0!0/534!-.4!1$!251')0#$38 B &5,!)*3)C)35.'! 2,)C.64!()''!1$!-.)*/.)*$3!)*!.''!251')0#$3!.*3!(,)//$*!3./.!,$05'/)*+!%,&-!/#$!0/5348 N*'4!
Photography and Self Awareness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olunteering to Be Part of this Research Study :%!4&5!#.C$!,$.3!/#)0!%&,-!.*3!#.C$!3$6)3$3!/&!2.,/)6)2./$!)*!/#)0!2,&S$6/;!2'$.0$!5*3$, 0/.*3! 4&5,!2.,/)6)2./)&*!)0!C&'5*/.,4!.*3!4&5!#.C$!/#$!,)+#/!/&!()/#3,.(!4&5,!6&*0$*/!&,!3)06&*/)*5$! 2.,/)6)2./)&*!./!.*4!/)-$!()/#&5/!2$*.'/4! &,!'&00!&%!1$*$%)/0!/&!(#)6#!4&5!.,$!&/#$,()0$!$*/)/'$3 8! B&5!#.C$!/#$!,)+#/!/&!,$%50$!/&!.*0($,!2.,/)65'.,!T5$0/) &*08 Questions and Contacts If you have any questions about this research study, contact Elizabeth Bossom at (813) 841 4981, or Elizabeth.email@example.com. If you have questions about your rights as a person who is taking part in a research study, you may contact the Human Protections Administrator of New College of Florida at (941) 487 4649 or by email at firstname.lastname@example.org. Consent to Take Part in This Research Study I give consent to be audio recorded during this study: Please initial your response: _____ _Yes ______No I give consent to be video recorded during this study: Please initial your response: ______Yes ______No
Photography and Self Awareness 49 @4!0)+*)*+!/#)0!%&,-!:!.+,$$!/#./U I have fully read or have had read and explained to me this informed consent form describing this research project. I have had the opportunity to question one of the persons in charge of this research and have received satisfactory answers. I understand that I am being asked to participate in research. I understand the risks and benefits, and I freely give my consent to participate in the research project outlined in this form, under the conditions indicated in it. I have been given a copy of this informed consent form, which is mine to keep. VVVVVVVVVVVVVVVVVVVVVVVVV VVVVVVVVVVVVVVVVVVVVVVVVV D DDDDDDDDDDDDDDDDDDD =)+*./5,$!&%!9.,/)6)2.*/ 9,)*/$3!H.-$!&%!9.,/)6)2.*/ O./$ Principal Investigator Statement :!#.C$!6.,$%5''4!$A2'.)*$3!/&!/#$!051S$6/!/#$!*./5,$!&%!/#$!.1&C$!,$0$.,6#!0/5348!!:!#$,$14!6$,/)%4! /#./!/&!/#$!1$0/!&%!-4!7*&('$3+$!/#$!051S$6/! 0)+*)*+!/#)0!6&*0$*/!%&,-!5*3$,0/.*30!/#$!*./5,$;! 3$-.*30;!,)070;!.*3!1$*$%)/0!)*C&'C$3!)*!2.,/)6)2./)*+!)*!/#)0!0/5348 VVVVVVVVVVVVVVVVVVVVVVVV!!!!!!!!!!!!!!!!!!!! VVVVVVVVVVVVVVVVVVVVVVVVV DDDDDDDDDDDDDDDDDDDDD =)+* ./5,$!&%!9,)*6)2.'!:*C$0/)+./&,!!!!!!!! !!!! 9,)*/$3!H.-$!&%!:*C$0/)+./&, O./$ In Case of Illness or Injury If you get sick or injured while par ticipating in this study, call Elizabeth Bossom at (813) 841 4981 If you have an emergency, go to the closest emergency room or clinic for treatment. Principal Investigator Statement (telephonic consent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