The controlled oral word association test

The word association test

In a word association test, the individual is given a word and asked to report the first word that comes to mind. Jung was the first individual to employ systematically the use of the word association test in the clinical setting (cf. Bennet, 1983). His principal purpose was to use it to help identify the client’s problematic complexes. More specifically, by examining what words produced various types of nervous behavior (e.g., stammering and/or changes in respiration rate) in the client, as well as the associations themselves, Jung was able to assess the degree of emotionality of the word associations and uncover their attachment to problematic complexes. For example, a client with a problematic family complex might respond to the words “house,” “father,” and “vacations” with an increasing heart rate, by leaning back in the chair, and stumbling verbally over the associations produced. With the problematic complex identified, the client and analyst would start to explore the root causes of the problem by probing deeper into the specific complexes and archetypes in the unconscious.

The word association test

In a word association test, the individual is given a word and asked to report the first word that comes to mind. Jung was the first individual to employ systematically the use of the word association test in the clinical setting (cf. Bennet, 1983). His principal purpose was to use it to help identify the client’s problematic complexes. More specifically, by examining what words produced various types of nervous behavior (e.g., stammering and/or changes in respiration rate) in the client, as well as the associations themselves, Jung was able to assess the degree of emotionality of the word associations and uncover their attachment to problematic complexes. For example, a client with a problematic family complex might respond to the words ‘house,’ ‘father,’ and ‘vacations’ with an increasing heart rate, by leaning back in the chair, and stumbling verbally over the associations produced. With the problematic complex identified, the client and analyst would start to explore the root causes of the problem by probing deeper into the specific complexes and archetypes in the unconscious.

Measures of Associations Not Using Reaction Times

Tests of memory associations using word production in addiction typically have used various types of word association tests. Common tests have used free word association, in which the participant lists the first word that comes to mind in response to a cue word, phrase, or picture, or a variant termed controlled association, in which a category of some type (e.g. verb) is requested using similar instructions. Given that, tests do not directly inquire about the target concept (e.g. drug associations), these tests are indirect and may assess implicit processes. Indeed, consistent evidence across diverse paradigms from memory research shows that word association tests are capable of detecting implicit conceptual memory, and associations uncovered in these tests predict the spontaneous activation of cognitions across a wide range of experimental procedures. Probably the most compelling evidence for the implicit quality of word association tests comes from studies in amnesic participants, who show severely impaired explicit memory but no impairments on tests of implicit memory.

Addiction research began using word association methods comprehensively with the work of Szalay and colleagues. They found different associative structures in drug users versus nonusers and among participants entering versus successfully completing drug treatment. Most of the addiction research using word association conducted after this pioneering work has relied on traditional word association, using either free word association or a form of controlled association termed verb generation; verb generation asks for the first action or behavior that comes to mind in response to the cue, which may be a word, picture, or other stimuli. In the first study using this technique, Stacy and colleagues asked college students to generate the first behavior that came to mind in response to a series of alcohol-related and neutral short phrases. The alcohol-related phrases did not explicitly mention alcohol or its synonyms, but were obtained from college student norms for likely (perceived) positive outcomes of alcohol use (e.g. having fun, feeling good). Strong correlations were found between the generation of alcohol responses and alcohol consumption, even though nothing was asked about alcohol until after the associations were elicited using this indirect assessment. A number of studies have replicated this finding but have also documented the importance of associations between cues (in addition to affective associations) and alcohol as well as other substances. In a meta-analysis by Rooke and colleagues, word association tasks demonstrated the best predictive effects among all indirect tests of alcohol or other drug-related associations studied to date.

II.D Verbal Fluency

Frontal lobe impairment can also produce deficits in a person’s ability to rapidly generate words. The Controlled Oral Word Association Test (COWAT), also known as the “FAS,” is a commonly used neuropsychological measure of verbal fluency. The COWAT consists of three word conditions. The subjects’ task is to produce as many words as he can that begin with the given letter (F, A, or S) within a 1-min time period. Subjects are also instructed to exclude proper nouns, numbers, and the same word with a different suffix.

The COWAT and other measures of verbal fluency have proven to be sensitive indicators of frontal lobe dysfunction. In 1989, Jerry Janowsky, Arthur Shimamura, and Larry Squire found that patients with circumscribed left or bilateral frontal lobe lesions produced significantly fewer words than did control subjects. Other researchers found that left frontal lesions resulted in lower word production than right frontal ones. Similarly, regional cerebral blood flow findings have shown left-sided frontal activation during the performance of verbal fluency tasks.

Frontal lobe damage can also impair performance on visual or design fluency tasks. Design fluency tests were developed as visual analogs to verbal fluency measures such as the FAS. The subjects’ task is to generate as many unique designs as they can within a given time period. Although the left prefrontal region appears to be specialized in using verbal material, Christina Elfgren and Jarl Risberg reported bilateral frontal lobe activation during the performance of visual generation tasks.

Mood/Affect

The associative view of creativity has been used as a bridge in linking affect with creativity. Eysenck suggested that word association tests provided the best means of determining creativity because they located the point in a continuum between normality and psychosis which could be identified by a point in a continuum between common and bizarre associations to words. On the affective side, he labeled this point ‘psychoticism’ and on the creative side he labeled this point ‘originality.’ Much of the research verifying and expanding on Eysenck’s work has been done with word association tests. In addition, word association tests have been used in studying the relationship between schizophrenia and mood.

The RAT, and other similar instruments, on the other hand, have been used, particularly recently, to link creativity to everyday moods rather than to psychopathology. Positive affect has been shown to increase RAT scores and individuals’ ability to judge the extent to which varying levels of related word triads adapted from the RAT are in fact related. In some cases, judgments of coherence, under positive mood conditions, may be overcorrect, that is judgments of coherence were given even when triads were weakly related. Both spread of activation and broadened attention have been suggested as the mediator between positive affect and enhanced capability of making connections between remote associates. Varying mood has also been implicated in remote associates performance. In one study by E. M. Fodor, individuals who showed a bipolar inclination, though were not at a clinical level, performed significantly higher on the RAT in an enhanced mood than all other participants, including other individuals with bipolar inclinations who did not have their mood manipulated.

Other Measures

A wide variety of other association measures exist to further the understanding of associations in creativity. The Kent–Rosanoff Word Association Test (KRWAT) is another word association measure. The measure has shown significant correlations with other creativity ratings for engineering honor students and research scientists. Participants respond to each stimulus word with the first word that comes to mind. This measure was the first to have objective scoring and norms presented in frequency tables; however, the test was criticized for not incorporating individual differences in responses due to factors such as socioeconomic status, age, or education level.

One important development is that tasks such as the RAT are now seen involving some convergent thinking, where information is brought together to form a single solution. Insight tasks would also fit this category. In contrast, associations and creativity are increasingly measured using divergent thinking tests. A divergent thinking test is another measure of creativity which can also be used to explore remote associations and ideational patterns. Divergent thinking is a more open-ended task than the RAT in that subjects are asked to generate as many responses as they can think of to a given stimuli. For example, a subject might be asked to “name all the uses you can think of for a button.” Aside from the sheer number of ideas presented by a person (fluency), the individual answers might also be scored in terms of their originality. Current measures used in this area include J. P. Guilford’s Alternate Uses Task, Michael Wallach and Nathan Kogan’s adaptation of the Alternate Uses Test for children, and the Torrance Tests of Creative Thinking (TTCT).

Fuld Object Memory Evaluation

The Fuld Object Memory Evaluation (FOME) is a neuropsychological test that was originally developed to assess episodic memory function in an elderly population (Fuld, 1981). The FOME is unique from most other instruments used as dementia screens due to its multi-modal process of encoding: tactile; auditory; and visual. The tested person is initially instructed to place their hand into a bag that contains ten common objects (e.g., key, mug, playing card) and asked to name the object using only their sense of touch. The tested person then removes the object from the bag, visually confirms the selection, and verbally names the object with mistakes being corrected by the test administrator. This process is repeated one by one until all ten objects have been identified and removed from the bag. The objects are then removed from sight, and a verbal fluency distracter task is initiated for approximately 60 seconds. Next, the tested person is given 60 seconds to name as many objects as they can remember that were initially contained in the bag. This is followed by a selective reminding procedure and the process is repeated four more times for a total of five trials. A total of 50 points is possible on the FOME (one point for each correctly recalled item during each trial) with scores of 30 or lower deemed indicative of cognitive impairment.

Operating characteristics of the FOME are relatively unaffected by education or ethnicity and have demonstrated excellent utility in detecting dementia (Chung, 2009; La Rue, 1989; Loewenstein, Duara, Arguelles, & Arguelles, 1995; Marcopulos, Gripshover, Broshek, McLain, & Brashear, 1999; Mast, Fitzgerald, Steinberg, MacNeill, & Lichtenberg, 2001; Wall, Deshpande, MacNeill & Lichtenberg, 1998;). The FOME has demonstrated excellent utility in detecting mild dementia (sensitivity and specificity >0.95) in both English and Spanish speaking elders (Loewenstein et al., 1995) and has also demonstrated high sensitivity (0.98) in detecting dementia among older African Americans using the retrieval cutscore of 30 (Mast et al., 2001). The slope of learning over five trials has been associated with daily functioning (IADLs) (Mast & Allaire, 2006). The FOME places fewer demands on processing speed than other list learning measures such as the California Verbal Learning Test (CVLT) or the Hopkins Verbal Learning Test (HVLT). Because the learning and encoding of words occurs at a slower pace on the FOME, it may be a purer measure of memory function than other measures which may partially confound memory and processing speed, which is the ability most affected by normal aging (Salthouse, 1993, 1994).

Due to the time and materials needed to administer the FOME it is usually administered as part of a brief battery rather than a stand-alone screener. The FOME is, however, a useful dementia screen and a viable alternative for screening elders with hearing and/or visual impairment (Chung & Ho, 2009). The development of a shorter, three-trial version of the FOME may increase its use as a screener. However, when combined with other measures such as the DRS-2, the FOME can be very effective in evaluating dementia (Mast, MacNeill, & Lichtenberg, 2000).

Verbal fluency

Verbal fluency tests, and in particular initial letter fluency, are widely used as tests of executive dysfunction. Initial letter fluency, also referred to as the Controlled Oral Word Association Test (COWAT), requires the generation of words from initial letters (normally F, A and S) under time constraints, normally 60 seconds per letter (Benton & Hamsher 1978). Fluency tests are reliable, quick to administer and even patients with quite severe deficits can understand the task requirements. In an area replete with failures to replicate, studies of initial letter fluency have been remarkably consistent in demonstrating impaired fluency following left or bilateral frontal lobe damage. Frith et al (1991) also reported that verbal fluency tasks activated left frontal brain regions during PET scanning.

Projective Tests of Personality

The historical development of projective tests (now referred to as performance tests) is tied to psychoanalysis and to the idea of unconscious motives. Carl Jung developed the Word Association Test (1910) to measure the Freudian concept of “mental conflict”; it was one of the first attempts to standardize a projective technique. For Jung, the time it took someone to respond to a word revealed how close that subject matter was to the person’s particular complex. Longer response times meant that the person was defending against the affect that was brought up by the word.

In 1921, Hermann Rorschach published his Inkblot Test. Interestingly, the idea of using inkblots was not unique to Rorschach, as Binet (1895) unsuccessfully attempted to use this method in his early testing of children in the French school system to measure visual imagination.¹⁷ For Rorschach, a game called Klecksographie (Blotto) was very popular in Europe at the time when he was entering school. In this game, inkblots were used to generate artistic and colorful descriptions for entertainment. Rorschach observed that psychotic patients produced very different responses to the Blotto game than did others. After extensive systematic exploration of the diagnostic potential of having patients perceive a series of standard inkblots, he published his book Psychodiagnostik, which received only a lukewarm reception. Rorschach passed away within a year of the book’s publication without ever realizing the impact his test would eventually have on personality assessment.

The second milestone in projective assessment came with the publication of the Thematic Apperception Test (TAT).¹⁸ Unlike the Rorschach, which uses ambiguous inkblots, the TAT is a series of redrawn pictures of people of varying genders and ages engaged in some sort of activity. The respondent is instructed to tell a story about the picture that has a beginning, middle, and end and describes what the characters in the picture are thinking and feeling. The TAT stimuli were selected from pictures, magazine illustrations, and paintings. Murray, a faculty member at Harvard, had been in psychoanalysis with Carl Jung and was strongly influenced by Jung’s theory. Unlike the tentative acceptance of the Rorschach during the same period, the TAT was widely accepted and used by researchers from many different theoretical orientations. The TAT has sparked a wide interest, and many other tests of apperception have been developed over the years for clinical and research purposes.

Performance-based tests of psychological functioning differ substantially from objective tests. These tests are less structured and require more effort both on the part of the patient to make sense of, and to respond to, the test stimuli, and the examiner to conduct appropriate queries into vague responses while recording each response verbatim. Even the instructions for the projective tests tend to be less specific than those of an objective test. As a result, the patient is provided with a great degree of freedom to demonstrate his or her own unique personality characteristics and psychological organizing processes. While self-report tests provide a view of the patient’s “conscious” explicit motivations (what he or she wants the examiner to know), the projective tests provide insights into the patient’s implicit motivations, his or her typical style of perceiving, organizing, and responding to ambiguous external and internal stimuli. When combined together, data from objective and performance-based tests can provide a comprehensive multidimensional description of a patient’s functioning.

Experimental Evidence for Janusian and Homospatial Processes

A tendency or capacity for the use of the Janusian process among proven and potentially creative persons, manifested by very rapid opposite responding on word association tasks, was experimentally identified. Standard Kent–Rosanoff word association tests were individually administered to 22 Nobel laureates in science (physics, chemistry, medicine or physiology) and to rated-as-creative Yale College students. Control groups consisted of matched but rated-less-creative students and high IQ psychiatric patients. Test instructions were to give the first word that came to mind in response to a standardized list of word stimuli and both speed and content of response were electronically recorded. Results signified, for the most creative subjects, formulation of simultaneous or virtually simultaneous opposite associations. The statistically significant highest number of extremely rapid opposite responses (averaging 1.1–1.2 seconds) were given by proven creative subjects, the Nobel laureate group, and the next highest by the rated-as-creative Yale students.

With highly talented award winning artists, another experiment was carried out to assess whether the results of the previous experiments could have been due to stimulus presentation effects. Results indicated that presentation of test superimposed images in controlled comparison with foreground-background (gestalt) displays of the same subject matter yielded significantly higher rated creative products.