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The study aimed to establish affective ratings of therapeutic cards known as COPE cards by having participants rate their affective states in response to viewing each card according to the Self-Assessment Manikin rating system.

The purpose of the study was to establish affective ratings of the COPE cards, which are 88 therapeutic associative cards that have been used in clinical and community settings but for which the affective states they evoke were previously unknown.

Participants were exposed to each card for 6 seconds and then asked to rate their affective state according to the Self-Assessment Manikin (SAM) rating system, which measures arousal, valence, and dominance.

The Arts in Psychotherapy 45 (2015) 36–46

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The Arts in Psychotherapy

Affective dimensions of COPE cards: Preliminary evidence of the


affective ratings of valence, arousal and dominance of associative
cards for psychotherapeutic purposes
Ran Cohen, M.A. student a,∗ , Dmitry Leykin, PhD student b,c , Yael Aviv, B.A d ,
Anat Kukis, M.A student d , Mooli Lahad, PhD a,e
a
The Community Stress Prevention Centre (CSPC), P.O. Box 797, Kiryat-Shmona 11016, Israel
b
Department of Emergency Medicine, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev,
P.O. Box 653, Beer-Sheva 84105, Israel
c
PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel
d
Department of Psychology, Tel-Hai College, Galile-Elyon 12208, Israel
e
Department of Dramatherapy, Tel-Hai College, Galile-Elyon 12208, Israel

a r t i c l e i n f o a b s t r a c t

Article history: COPE cards are 88 therapeutic associative cards (7 cm × 10 cm) with evocative art works, which were
Available online 24 April 2015 utilized in the last two decades both in clinical and community settings. Although some evidence exists
regarding the impact of cards integration in psychotherapy and experimental settings, it is unknown
Keywords: whether the therapeutic cards can induce distinct affective states in the observer. The aim of the study was
COPE cards to establish affective ratings of the COPE cards. Participants of the study (N = 100) were undergraduates
Self-assessment manikin
(71% females) who were exposed to each of the cards for 6 s, and were asked to rate their affective state
Affective dimensions
according to the Self-Assessment Manikin (SAM) rating system. Results indicated that the cards produced
significantly different affective states among the participants. Arousal induced by the image negatively
correlated with image’ valence (r = −0.71, p < 0.001) and dominance (r = −0.73, p < 0.001), while image’
valence and dominance were highly correlated (r = 95, p < 0.001). Furthermore, cluster analysis results
suggest potential subdivisions of the COPE cards, with practical implications for practitioners. This study is
the first to present the affective states evoked by therapeutic cards. Practical implications for therapeutic
cards integration in clinical and experimental settings are suggested and discussed.
© 2015 Elsevier Ltd. All rights reserved.

Introduction generated following exposure to images which evoke an emotional response (Lahad
et al., 2010).
Projective tests based on viewing images on cards, such as Rorschach or TAT,
have been used in psychology for decades. Although the statistical validity of such
tests has been debated projective tests are used widely incontemporary personality Emotional stimuli
assessment (Gawronski, 2009). Over the last decade growing interest and appli-
cation of these cards in therapy and education can be observed (Gagnon, 2001;
Lang and colleagues (Center for the Study of Emotion &
Hahs, 2008; Lahad, Farhi, Leykin, & Kaplansky, 2010; Lahad, Shacham, & Ayalon,
2012). Cards of association, or OH cards, are of specific interest for therapists (Abel
Attention, 1995; Lang, Bradley, & Cuthbert, 1995, 1997, 1999,
& Friedman, 2009; Ayalon, 2003, 2004, 2006a, 2006b, 2007). When the cards are 2001; Lang & Greenwald, 1981; Lang, Öhman, & Vaitl, 1988) devel-
employed as a therapeutic method or tool there is a requirement to ensure that oped the international affective picture system (IAPS), a standard
statistically supported relevance as to their specific use is available. norm setting of affect evoking images. Currently, the collection
Imagination, feelings and thoughts all help generate internal representations
is comprised of more than 700 colorful images, and each is stan-
of images to which we are exposed. Specifically, such internal representations are
dardized according to the following dimensions: arousal, valence
and dominance. This unique collection offers researchers a com-
mon norm to follow, a standard that promotes better scientific
understanding of important mental health issues, such as tempo-
∗ Corresponding author. Tel.: +972 4 6900600; fax: +972 4 6950740. rary insight regarding emotional development disorders, assessing
E-mail address: ran.m.cohen@gmail.com (R. Cohen). physiological impact of different stress situations, evaluation of

http://dx.doi.org/10.1016/j.aip.2015.04.004
0197-4556/© 2015 Elsevier Ltd. All rights reserved.
R. Cohen et al. / The Arts in Psychotherapy 45 (2015) 36–46 37

emotionally pathological conditions and determining the levels of protocol SEE FAR CBT where as part of the procedure the therapist
emotional damage occurred in brain-damaged patients. To create expose the client to positive cards in order for the client to create
a better standardization it is always important to enable repro- an Imaginal safe place. So far this is done intuitively. Finally, this
ducibility and expand earlier studies of emotional evoking images study has significant relevance to the field of art therapy, by relating
(Libkuman, Otani, Kern, Viger, & Novak, 2007). Indeed, the advan- artistic drawings to the affective subjective experience (Masterson
tage of the IAPS lies in subsequent repetitions (Bradley & Lang, et al., 2008).
2007).
The three affective dimensions of the IAPS are based upon Method
a dimensional theory of semantic meaning (Osgood, Suci, &
Tannenbaum, 1957). Factor analysis has revealed that most of the Participants
variance in semantic assessment was explained by a single factor,
hedonistic valence. This factor ranges from unpleasant (sad, frus- One hundred participants, 29 men and 71 women (N = 100),
trated, desperate etc.) to pleasant (happy, satisfied, hopeful etc.). ranging between 15 and 44 years of age (M = 27.0, SD = 4.67). 43%
The second factor, which also explained some of the variance was of the participants were first year psychology students at Tel-Hai
termed arousal. It reflects the active component of emotional expe- academic college in Upper Galilee, Israel, while the rest of the sam-
rience, ranging from low levels (calm, relaxed, drowsy etc.) to high ple included volunteers who were recruited using social media and
levels (excited, stimulated, highly alert etc.). The third and last fac- personal mailing lists. All participants were Hebrew fluent speak-
tor, still explaining some of the variance but not considerably, was ers, 94% were Israeli Jews, 85% were secular, 80% were born in
termed dominance; and it refers to subjective feelings of mastery, Israel, 78% were not married and 62% had a below average fam-
competence, power or skill (Russell, Ward, & Pratt, 1981), as well as ily income level. The student participants received course credit
to the levels of control the subject has over situation, ranging from for their attendance, while others enrolled a lottery for a 250 NIS
low levels to high levels. gift card for their participation.

Materials and apparatus


Therapeutic associative cards
Demographic questionnaire
Therapeutic associative cards represent the emotional scope of Demographics data collected included: birth year, gender, level
humans (Lang et al., 1999). They are visual, immediate and acces- of education, marital status, country of birth, religious views, eco-
sible and are not considered a threat. The goal of these cards is to nomic status and political views.
recreate a story by means of a person’s imagination. The associa-
tive response to the cards might reveal inner worlds and possibly COPE therapeutic associative cards
allow the remembering of childhood memories, hidden experi- A package of 88 associative COPE cards (OH Publishing, 2012).
ences and stimulate blocked emotions (Ayalon, 2006a, 2006b). These are paintbrush scanned images and their purpose is to reveal
They are also considered to expand on the world of imagery and hidden and deep emotions within subjects, that in turn, will allow
metaphors and enhance verbal ability, allowing for better inter and them to share and process traumatic experiences. For experi-
intra-personal communication of thoughts and feelings (Ayalon, mentation purposes, the cards were scanned in series of 9 at a
2007). time using Microsoft Office 2010 using JPEG file type. Scanning
COPE cards, produced by the OH card Publishing, were illus- pixel resolution was 752 × 1036, 120 dpi. For the current study,
trated by the Russian artist Marina Lukyanova, and published in the cards were separated and set at 640 × 465 pixel resolution,
English by Steve Weir, are associative cards designed to stim- 96 dpi.
ulate the imagination (Ayalon, 2003; OH Publishing, 2012). The
process by which they were produced included a focused group Self-Assessment Manikin (SAM)
of therapists engaged in stress crisis and trauma treatment with In order to measure the three dimensions of affect – arousal,
background in art therapies. These cards reflect, in a symbolic and valence and dominance, we used the Self-Assessment Manikin
metaphoric way, traumatic events and emotional responses. They (SAM) (Lang, 1980). The SAM is a non-verbal pictorial assessment
are used as a helping tool for dealing with crisis, processing trau- tool designed to measure a person’s affective reaction to stimuli.
matic experiences and achieving a renewed sense of control and The SAM depicts each of the above mentioned dimensions by
meaningful insights. With the right use it is possible to identify means of a changing graphic character arranged along a continuous
coping strategies and develop new ones (Ayalon, 2003). Each card nine-point scale. Three 9-point scales are introduced: (1) valence
or a combination of cards can bring to mind events and specific scale: happy face character (high valence) vs. unhappy face char-
reactions (Ayalon, 2006a, 2006b). Thus, it allows managing and acter (low valence), (2) arousal scale: a small dot in the center
processing the experiences. of the body of the graphic character (low arousal/relaxed) to an
In this current study, we suggest that COPE cards, evoke emo- explosion (high arousal/excited) and (3) dominance scale: a large
tions on 3 different dimensions: arousal, valence and dominance. figure of the graphic character (dominant) vs. little figure of the
We wish to standardize norms for these cards, using similar graphic character (controlled). Each extreme of the scale is explic-
methodology previously used for IAPS affective normative rating itly explained and participants are requested to mark one answer
standardization. Creating a standardized database will allow the- along the 9-point range (see procedure). Previous data suggests
rapists and researchers alike to make use of this tool for different that the valence and arousal scales explain most of the variance,
purposes, places, time and conditions. We expect that the var- 27% and 23%, respectively. In comparison, the dominance scale
ied representations and emotional responses evoked by the COPE generally explained less of the variance (Bradley & Lang, 2007). Pre-
cards, will allow practice in various universal situations, similar to vious studies suggest high test-retest reliability (Lang, Greenwald,
the IAPS. In addition, we seek to outline natural groups or clusters Bradley, & Hamm, 1993; Ito, Cacioppo, & Lang, 1998). There is a
in the therapeutic cards, as suggested by Anderberg (1973) in the significant amount of psychometric data for the SAM. The valence
procedures of Cluster analysis. Presentation of emerging clusters and arousal dimensions were found to correlate with physiological
within the data will enable to better characterize the cards and reaction associated with emotional experience (Chanel, Kronegg,
adapt them for specific group processes such as in the treatment Grandjean, & Pun, 2006; Horlings, Datcu, & Rothkrantz, 2008).
38 R. Cohen et al. / The Arts in Psychotherapy 45 (2015) 36–46

The SAM has also been used to assess emotional reactivity during We tested Pearson correlations between the means of the card
exposure-based therapy (Sloan & Marx, 2006). And internal con- ratings for each of the three different emotional dimensions. Neg-
sistency reliability was found to be similar for younger and older ative significant correlations were found between arousal and
adults, 0.63 and 0.82 for valence, respectively (Backs, da Silva, & valence, r(88) = −0.71, p < 0.001, and between arousal and domi-
Han, 2005). Arousal scores were 0.98 for both groups. nance, r(88) = −0.73, p < 0.001; and a positive significant correlation
was found between dominance and valence r(88) = 0.95, p < 0.001.
Procedure
Cluster analysis
The entire research procedure was conducted online using
Qualtrics research suite (www.qualtrics.com). Some of partici- The first analysis aimed to select the optimal model accord-
pants have received a link via email to answer the questionnaire ing to Bayesian information criterion (BIC). The Gaussian finite
online, or were invited to complete the same questionnaire in the mixture model fitted by Expectation-Maximization (EM) was an
lab. Furthermore, the link was distributed in a snowball sampling EEV (ellipsoidal, equal volume and shape) model with two com-
manner via social media websites, such as Facebook, to enhance ponents, one contains 45 cards and the second cluster contains
survey attendance. The first screen of the electronic question- 43 cards (see Figs. 2 and 3 for model-based clustering plots), log
naire included basic demographic information and brief personality likelihood = −179.70, BIC = −431.03.
survey (not described in the present study). The second screen According to the plots, we can notice the two clusters them-
introduced the affective rating procedure and included throughout selves across the different combinations of the affective dimensions
explanation of the SAM rating system. Lang et al. (1999) instruc- (valence vs. dominance, valence vs. arousal, arousal vs. dominance).
tions for the affective ratings were modified and translated from The agglomerative hierarchical clustering (described in Fig. 4)
English to Hebrew (for full procedure instructions, see Lang et al., clearly shows two main clusters in the data, although it also shows
1999). Next, participants were trained on the process using random that more clustering solutions are available (i.e. 3 cluster and 5 clus-
artistic image obtained from the Internet and verified the com- ter solution). A summary of cards according to their cluster and
prehension of the task. Following brief introduction, participants affective dimensions appears in Table 1.
rated dimensions of arousal, valence and dominance for each of The optimal number of clusters estimated by optimum average
the 88 COPE cards. The 88 cards were divided into four equal series, silhouette width is 2 and the average silhouette width (i.e. silhou-
while a one minute break was given between each series to prevent ette coefficient) was found to be 0.54, which indicates a reasonable
exhaustion. During the task itself, each card was displayed for 6 s structure of the data.
and followed by the affective rating using SAM. The total duration
of the procedure was about 40 min in total for all participants.
Further analysis

Results To check for gender differences of emotional mean ratings for


the COPE cards, a within subjects repeated-measures ANOVA test
Statistical analysis was done. Also, we checked for an interaction effect between the
mean ratings of COPE cards and gender using between subjects
To test for the affective reactions evoked by COPE cards, means one-way ANOVA test (Appendix C).
and standard deviations were calculated for each of the emotional For the dimension of arousal, a significant effect was found for
dimensions per card. The values of the emotional dimensions were the type of card, F(87,8439) = 11.33, p < 0.01, 2 = 0.11, and no sig-
compared against the center value 5, which indicates intermedi- nificant effects were found for the interaction between the type of
ate levels of the affective dimension and presumably a neutral card and gender F(87,8439) = 0.899, p > 0.05, 2 = 0.01 or for gender
state. One sample t-tests were performed to examine the effect F(1,97) = 1.485, p > 0.05, 2 = 0.02.
cards had over the three different dimensions. Cluster analysis of For the dimension of valence, a significant effect was found for
the data was performed using R project statistical computing soft- the type of card F(87,8526) = 52.24, p < 0.001, 2 = 0.35, an interac-
ware (Bunn & Korpela, 2012; Gentleman, Ihaka, & Bates, 1997) and tion effect was found between card and gender F(87,8439) = 1.83,
the following packages for cluster analyses: (1) MCLUST (Fraley p < 0.001, 2 = 0.02 and a significant effect was not found for gender
& Raftery, 2000) for the selection of the optimal model accord- F(1,98) = 1.332, p > 0.05, 2 = 0.01.
ing to Bayesian information criterion (BIC), a common criterion for For the dimension of dominance, significant effects were found
model selection among a finite set of models. MCLUST presented for the type of card F(87,8352) = 19.38, p < 0.001, 2 = 0.17 and for
Gaussian finite mixture model fitted by Expectation-Maximization the interaction between type of card and gender F(87,8439) = 1.86,
(EM) algorithm. (2) Cluster Package (Maechler, Struyf, & Maechler, p < 0.001, 2 = 0.02. A significant effect was not found for gender
2008) for agglomerative hierarchical clustering of the observations; F(1,96) = 0.11, p > 0.05, 2 = 0.001.
(3) ggdendro (de Vries & Ripley, 2014) package for extraction of No significant differences were found between men and
dendrograms. Dendrogams, or cluster trees, are the result of hierar- women’s strength of correlations for arousal and valence (z = 0, n.s.)
chical clustering procedures (Langfelder, Zhang, & Horvath, 2008). or arousal and dominance (z = 0.25, n.s.), but a significant differ-
Branches of the dendrogram represent the desired clusters and ence in correlation strength was found for dimensions of valence
cluster members. b. Finally, fpc package (Hennig, 2014) was used and dominance between the genders (z = −3.42, p < 0.001), although
for the estimation of the optimal number of clusters using silhou- both correlation coefficients were very high. For men, a significant
ettes, a graphical aid to the interpretation and validation of cluster positive correlation between dominance and valence r(88) = 0.89,
analysis (Rousseeuw, 1987). According to Kaufman and Rousseeuw p < 0.001, while for women this correlation was almost perfect,
(2009), Silhouette Coefficients fall into four categories: ≤0.26 (no r(88) = 0.96, p < 0.001.
substantial structure has been found), 0.26–0.50 (the structure is Correlations for the differences between genders and average
weak and could be artificial), 0.51–0.70 (a reasonable structure has card showed that amongst men, there is a significant negative
been found) and 0.71–1.00 (a strong structure has been found). correlation between valence and arousal r(88) = −0.70, p < 0.001,
The findings are presented in Appendix C. The cards did not a significant negative correlation between arousal and domi-
evoke a uniform response each time. nance r(88) = −0.68, p < 0.001 and a significant positive correlation
R. Cohen et al. / The Arts in Psychotherapy 45 (2015) 36–46 39

Table 1
Summary of cards according to their cluster and affective dimensions.

Cards in cluster Cluster description Arousal Valence Dominance

38, 76, 57, 85, 17, 45, 6, 44 Celebration, happiness and love, depicted by humans Medium High High
and physical objects
49, 77, 67, 35, 66, 33, 42, 74, 62, 64 Landscape is described, including skies, sunsets, if Low High High
people are present they are surrounded by nature
43, 88, 70, 24, 51, 12, 61, 81, 14, 5, 29, 32, 79, 83 Ambivalent scenes of humans and animals Medium Medium Medium
48, 53, 80, 9, 15, 40 States of helplessness, sorrow, grief and immense High Low Low
danger
7, 2, 59, 84, 1, 60, 65, 54, 72, 78, 58, 19, 56 Combination of people and natural scenes that Low Medium Medium
produce ambivalent feelings toward the picture (or
character/s if relevant)
46, 82, 71, 3, 50, 52, 86, 31, 28, 55, 68 Ambiguous descriptions of humans, body parts and Medium Mid-Low Medium
natural scenes
22, 16, 21, 27, 30 Humans at natural scenes during a journey or walk Medium Mid-Low Medium
8, 73, 41, 75, 20, 69, 63, 87 Distressing and negative feelings inducing images of High Low Low
humans in negative mood or anxiety inducing images
13, 23, 37, 39, 4, 34, 26, 47, 10, 25, 36, 11, 18 Chaotic and fearful scenes of destruction and/or High Low Low
disaster.

Fig. 1. Examples of COPE cards evoking significant emotional responses. From right to left: COPE48 resulted in high arousal (t(99) = 8.54, p < 0.001), low valence (t(99) = −18.08,
p < 0.001) and low dominance (t(99) = −8.31, p < 0.001); COPE80 resulted in high arousal (t(99) = 6.56, p < 0.001), low valence (t(99) = −10.62, p < 0.001) and low dominance
(t(99) = −7.51, p < 0.001); COPE77 resulted in low arousal (t(99) = −5.12, p < 0.001), high valence (t(99) = 10.38, p < 0.001) and high dominance (t(99) = 6.93, p < 0.001); COPE45
resulted in low arousal (t(99) = −3.65, p < 0.001), high valence (t(99) = 16.34, p < 0.001) and high dominance (t(99) = 8.49, p < 0.001). Note: COPE cards numbers appear in small black
printing below each card.

between dominance and valence r(88) = 0.89, p < 0.001. For women, have been suggested before in second and third generation of Holo-
a significant negative correlation was found between arousal caust survivors (Scharf, 2007). Indeed, 94% of the participants in
and valence r(88) = −0.70, p < 0.001 and between dominance and this research were Israeli Jews. Hence, the emotional responses of
arousal r(88) = −0.70, p < 0.001, also, a significant positive correla- high arousal and low valence can represent anxiety and rejection,
tion was between dominance and valence r(88) = 0.96, p < 0.001.

Discussion

In this study we hypothesized that, COPE therapeutic associative


cards, will evoke affective responses with regard to three different
dimensions: arousal, valence and dominance. Thus, we hoped, to
create standards and norms, to enable further use in research and
therapy, similar to those achieved previously with IAPS (Libkuman
et al., 2007).
Our results suggest that 83 out of 88 cards (94.3%) provoked
a significant emotional response at least on one emotional scale
(Appendix C).
Fig. 1 provides an example concerning four cards, which evoked
significant strong emotional responses on all three emotional
dimensions. COPE card no. 48 evoked high arousal, low valence and
low dominance. The card portrays a child with his arms raised as in Fig. 2. Model-based clustering plot according to BIC values. Note: EII: spherical,
surrendering (Fig. 1). The picture might resemble a famous image equal volume; VII: spherical, unequal volume; EEI: diagonal, equal volume and
shape; VEI: diagonal, varying volume, equal shape; EVI: diagonal, equal volume,
from the holocaust, of a Jewish child with his hands raised facing
varying shape; VVI: diagonal, varying volume and shape; EEE: ellipsoidal, equal vol-
a Nazi officer. This image might be stronger amongst Israeli citi- ume, shape, and orientation; EEV: ellipsoidal, equal volume and equal shape; VEV:
zens, specifically the Jewish population. Long term effects of trauma ellipsoidal, equal shape; VVV: ellipsoidal, varying volume, shape, and orientation.
40 R. Cohen et al. / The Arts in Psychotherapy 45 (2015) 36–46

Fig. 3. Classification plot of the 2 clusters according to the three affective dimensions of arousal, valence and dominance.

respectively; and the low dominance might represent a feeling of that tend to rate unpleasant events as arousing. This is consis-
helplessness. COPE card no. 80, portraying a boat in a stormy sea, tent with the nature of the measurement of arousal (low vs. high
evoked similar responses. Once again the image ratings might rep- arousal) compared to the nature of valence measurement.
resent feelings of anxiety, helplessness and instability. For the present dataset we used up to date methods for clus-
COPE cards 77 and 45, show a different pattern. COPE card no. ter analysis to explore sub-groups in our data. One major question
77 portrays a man sitting in front of soaring mountains (Fig. 1), this that remains a great topic for research is the optimal number of
may express expectations and aspirations that fill a man with calm- clusters one should find in the data (Mirkin, 2011). Although vari-
ness and quietness (low arousal) and with happiness and optimism ous methods exist to solve this question, sometimes the decision is
(high valence), that in turn would facilitate a feeling of control (high subjective and depends on the author’s opinion. For practical rea-
dominance). Similarly, COPE card no. 45 portrays a pleasant situa- sons researchers would like to partition the data into 3 or 5 groups,
tion (Fig. 1) of a couple and a pastoral background, which may cause depends on the specific needs. For instance, a practitioner would
expressions of harmony, equality and intimacy. like to subset five types of cards based on a specific affective fea-
Our findings are supported by Osgood et al. (1957). Their ture, like dominance, so later it will be applicable to conduct an
research of semantic meaning, involving the emotional dimension, activity that should sequentially impact dominance levels. Other
indicated that emotional degree develops as a result of changes practitioners might choose an alternative strategy and would pre-
in basic dimensions of arousal and pleasantness. Our findings also fer to sub-divide the data into two broad categories (low arousal
align with Ayalon’s (2007) argument, associative cards stimulate vs. high arousal, or low dominance vs. high dominance). The subdi-
the imagination as they symbolize previous traumatic events. vision may also rely on the content of the cards. In the dendrogram
In line with our other findings, strong significant correlations presented in this work (Fig. 4), if pruned at three-level clusters,
were found between the three emotional dimensions. The strong by observing the leaves (at the bottom – center of the image)
negative correlation between valence and arousal might stem from we can see a cluster which contains cards 48, 53, 80, 9 and 5
either a feeling of anxiety (high arousal, low valence) or a feeling (see Appendices A & C for description of the cards and affective
of calmness and pleasure (low arousal, high valence). This expla- descriptive statistics). These cards are all highly arousing, strongly
nations also agrees with the strong negative correlation found and negatively valenced and relatively low in dominance (i.e. pro-
between arousal and dominance and to the strong positive cor- duce low levels of sense of control). These cards include images
relation between dominance and valence. Osgood et al. (1957) of individuals in submissive and not in control states. If the den-
also found similar correlations between valence and dominance. drogram is pruned at five-level clusters, we can inspect an eight
Bradley and Lang (2007) provide an explanation for these findings; cards cluster which contains the cards: 38, 76, 57, 85, 17, 45, 6 and
they show that the level of dominance displays low variance for 44. Except card 44 (which depicts colorful balloons) all other cards
the SAM scale ratings, compared with dimensions of arousal and show humans (or human and animals) and arms holding a red tra-
valence. Although, for images of a more symbolic and less social ditional heart shape. As these cards are positively valenced they can
nature better variance was measured. We saw that the situations be used as a calming and relaxing stimuli during psychotherapeu-
derived from the COPE cards deal with symbolic emotional rep- tic session. For instance, the PTSD treatment protocol SEE FAR CBT
resentations, as expected from therapeutic associative cards (Lang (Lahad et al., 2010), utilizes the use of “safe place” concept, a men-
et al., 1999). Hence, this provides an explanation for the strong cor- tal and physiological state characterized by feelings of control and
relation found between the dimensions of dominance and valence relaxation. Although the establishment of a “safe place” using ther-
in the current study. apeutic cards involves the individual selection of cards (so even
A negative linear correlation between arousal and valence, sim- not so pleasant cards can serve as safe place stimuli), the thera-
ilar to the one found in the current study, is referred to by Bradley pist can direct the client in choosing specific cards based on tested
and Lang (2007) as negative bias; and its characteristic of people estimation of the affective experience these cards can induce.
R. Cohen et al. / The Arts in Psychotherapy 45 (2015) 36–46 41

6
4
2
0
38
76
57
85
17
45
6
44
49
77
67
35
66
33
42
74
62
64
43
88
70
24
51
12
61
81
14
5
29
32
79
83
48
53
80
9
15
40
7
2
59
84
1
60
65
54
72
78
58
19
56
46
82
71
3
50
52
86
31
28
55
68
22
16
21
27
30
8
73
41
75
20
69
63
87
13
23
37
39
4
34
26
47
10
25
36
11
18
Fig. 4. Hierarchical clustering of COPE cards.

In further analysis, we sought to measure gender differences The current study has theoretical and practical implications.
in card’s ratings; based on the assumption that women tend to First, this study’s innovative attitude toward COPE cards allows for
report higher stress levels than men (Kimhi, Eshel, Zysberg, & a reliable and valid application for researchers and therapists alike.
Hantman, 2009). This tendency led us to the hypothesis that sig- Second, it expands on the IAPS collection. Furthermore, it forms a
nificant differences will be found in the emotional dimensions basis for future research, to set more accurate standards and norms;
ratings between the genders. However, we did not find a signif- these may deepen our scientific understanding of issues related to
icant effect. Thus, perhaps there is no significant difference. We mental health (Bradley & Lang, 2007).
did find a significant effect for the type of card in relation to the
emotional dimensions. Therefore, one might conclude that cer- Limitations
tain cards are able to elicit significantly stronger scores of valence,
arousal and/or dominance as opposed to others. For the dimensions The current study has a few notable limitations. First, many
of valence and dominance a significant interaction effect was found of participants answered the survey via a link that appeared on
between card type and gender. That is, certain types of cards tend social media sites, this limited supervision of careless answers by
to heighten the sense of pleasantness and control among each gen- participants. However, we tried to minimize careless responses by
der separately, while other cards do not have similar effects for any utilizing dynamic and interactive environment that clearly directs
gender. the participants and also provides short pause interval for rest.
COPE card no. 45, which had a strong effect on all three dimen- Second, many of the participants claimed that they were not able
sions of emotion amongst the participants; also showed higher to keep their concentration during the entire survey (average
feelings of control and pleasantness for women as opposed to time spent was 40 min), which in turn might also cause careless
men. However, no significant difference was found for arousal answers. Third, there was a significant difference in group size
in this case. The situation in the card (as seen in Fig. 1) might between the genders, 29 & 71, for men and women, respectively.
remind a romantic situation; causing more feelings of warmth This might have been cause for uneven distributions and bias.
and pleasure in women than in men, which might lead to higher Forth, the study involved mainly Jewish students, which limits it
feelings of empowerment and efficacy for women (Chodorow, generalizability.
1974; Unger, 2001). As mentioned, a strong positive correlation Future research should include: implementing physiological
was found between the dimensions of valence and dominance for measures in order to enhance validity of subjective affective
all of the participants and within each gender. Bradley & Lang’s responses, segmentation and time intervals to prevent careless
(2007) argument which states that for pleasant images there will answers, and adding qualitative measures to validate subjective
be a significantly stronger positive correlation for arousal and reactions. Future research should further explore the suggested
valence ratings for men than women, might explain why a sig- interaction between gender and card content. A previous study has
nificant effect was not found of both gender and the interaction shown that, in a series of experiments, more automatic in-group
between gender and card type on the arousal dimension. The cur- bias for women compared to men (Rudman & Goodwin, 2004),
rent study showed that images of pleasant situations, which in thus, gender might play a role in participant’s subjective emotional
turn enhance the feeling of control (for example, COPE card no. response to certain cards. A more thorough examination of the
45), did not significantly enhance the level of arousal amongst images in question, specifically, of gender might provide a better
women. explanation for the above mentioned interaction.
42 R. Cohen et al. / The Arts in Psychotherapy 45 (2015) 36–46

Appendix A. Description of individual COPE cards

ID Description ID Description

1 Broken window, mountain landscape 45 Two men sitting on a white couch


2 Several houses, on tall and sharp and in 46 People in white attached by strings
the background dark clouds
3 A woman waving a handkerchief in the 47 Two children curled over black background
air
4 Chair with large shade behind it 48 Boy standing with submissive hands
5 White background, a man resting his 49 Several people in a circle extending their
hands on another set of hands on a hands
table
6 A man with a girl 50 A woman, above her a small face with a
large face on top of it
7 Two tress without leaves 51 Butterfly and broken egg
8 A naked woman sitting and her 52 Woman carrying a girl on her back
shadow behind her
9 A boy behind a barbed wire fence 53 Large fire and firemen
10 Figure holding a stick casts a shadow in 54 Circle of people and a man in the middle
an alley with a chair
11 Smoke, fire, construct and tree 55 A statue of a woman and a broken statue
next to her.
12 A naked man thinking 56 A man with a little boat on the beach
13 A horse with its mouth open 57 Four children with mouths open raising
their arms
14 Half woman and half shadow on a wall 58 A man and girl sitting on fence in front of a
house
15 Boy sitting and leaning over a lying 59 Two women carrying buckets of water
poodle
16 Boy riding a donkey with baskets 60 A boy without a leg on a bicycle on the
beach
17 Girl hugging a dog 61 A man holding a notebook in his hand and
a pencil in his mouth
18 Curled naked man hugging a 62 Open door, outside sunshine, clouds and
man\woman grass
19 Woman holding a box, a boy and 63 Tied ropes
houses in the background
20 Woman with her two children 64 A tree and in the background the sun sets
in the sea
21 People carrying bricks 65 Tree bark and roots
22 Two men back to back 66 Rainbow reflected on the water
23 A bear bites a red cloth 67 Three man in white, two of them are
jumping
24 A man in front of a horse and the sun 68 A woman looking out the window and
there is an eye on the glass
25 A man strangling woman and her hand 69 A body in a chair with a crow above him
on his arm
26 A man sitting on a chair looking down, 70 Man with legs spread apart in front of
and a structure with broken ceiling mountains
27 A man holding something behind his 71 Sand clock
back, flowing another man
28 Man behind a chair 72 A boy with blue paint on his hands
29 Naked man hugging his feet 73 Man with mouth open and hands
outstretched, and a woman behind him
30 Big smoke 74 Woman swimming in the sea
31 Curled woman playing the harp 75 Kids dancing in circle and girl in the middle
32 Man, woman and child sailing a canoe 76 Three men in suits jumping
33 Fruit-basket on the grass 77 A man sitting with his back to the picture,
and a mountain landscape
34 Several people and one has his hand 78 A man entering a broken egg shell
over his head
35 Houses, below a river with pair of 79 Stones arranged in circle
people sailing
36 Foot and stick on the ground 80 Boat in a stormy sera
37 A woman puts her hand on her head 81 Napkin with dinnerware
and holding a child, and a woman
behind her supporting her
38 Two women holding hands in dance 82 A green maze
39 A Man takes a mask out of a cage 83 Two hands playing chess
40 A man leaning downwards with one 84 Two hand holding a rope
hand on his face
41 Girl with a gas mask 85 two pairs of hands holding a heart
42 Woman playing violin and children 86 A hand with an eye stamped on it
behind her
43 A man with a hat standing on someone 87 A hand holds stone-like shape of curled
else’s belly legs/person
44 Colorful balloons 88 A hand reaching another, and clouds in the
background
R. Cohen et al. / The Arts in Psychotherapy 45 (2015) 36–46 43

Appendix B. Descriptive statistics (N = 100) of COPE cards emotional dimension ratings

Arousal Valence Dominance Cluster Solution

M SD M SD M SD

COPE01 4.78 2.08 5.13 1.91 5.48 2.09 d4 , h3 , j2


COPE02 4.35 1.98 4.96 1.77 5.00 1.91 d4 , h3 , j2
COPE03 4.82 2.00 5.11 1.80 4.94 2.18 d4 , h3 , j2
COPE04 5.84 1.92 3.57 1.44 3.92 2.00 e5 , h3 , j2
COPE05 4.57 2.09 5.80 1.74 5.53 1.89 b2 , f1 , i1
COPE06 4.80 2.40 7.46 1.59 6.74 2.02 a1 , f1 , i1
COPE07 4.06 2.01 5.06 1.76 5.31 2.05 d4 , h3 , j2
COPE08 5.59 2.06 4.36 1.88 4.31 2.29 e5 , h3 , j2
COPE09 5.66 2.14 2.91 1.69 3.75 2.09 c3 , g2 , j2
COPE10 5.31 2.01 3.46 1.67 4.05 2.00 e5 , h3 , j2
COPE11 5.60 2.07 3.75 1.77 4.22 1.96 e5 , h3 , j2
COPE12 4.21 2.03 5.45 1.58 6.00 1.85 b2 , f1 , i1
COPE13 5.70 1.98 3.93 1.85 4.50 1.94 e5 , h3 , j2
COPE14 4.35 1.98 5.82 1.68 5.44 1.84 b2 , f1 , i1
COPE15 6.18 2.11 2.83 1.83 3.68 2.16 c3 , g2 , j2
COPE16 4.77 1.90 3.88 1.73 4.28 1.94 e5 , h3 , j2
COPE17 4.92 2.54 7.78 1.45 7.02 1.84 a1 , f1 , i1
COPE18 5.43 2.25 3.76 1.72 4.14 1.89 e5 , h3 , j2
COPE19 4.33 2.08 5.40 1.68 5.26 1.77 d4 , h3 , j2
COPE20 5.25 1.79 3.93 1.58 4.64 1.89 e5 , h3 , j2
COPE21 4.91 2.03 3.78 1.61 4.23 2.17 e5 , h3 , j2
COPE22 4.23 1.98 4.05 1.27 4.90 1.55 e5 , h3 , j2
COPE23 6.03 1.79 3.75 1.62 4.40 2.21 e5 , h3 , j2
COPE24 4.88 1.93 6.37 1.66 5.88 1.88 b2 , f1 , i1
COPE25 5.45 2.24 3.64 1.51 3.99 1.87 e5 , h3 , j2
COPE26 5.51 2.08 3.40 1.61 3.85 1.80 e5 , h3 , j2
COPE27 4.93 2.00 4.14 1.66 4.38 1.83 e5 , h3 , j2
COPE28 4.93 2.05 4.63 1.65 4.80 1.76 d4 , h3 , j2
COPE29 4.54 1.94 5.77 1.80 5.60 1.98 b2 , f1 , i1
COPE30 5.15 2.05 3.94 1.68 4.28 1.97 e5 , h3 , j2
COPE31 4.41 1.99 4.60 1.86 4.68 1.91 d4 , h3 , j2
COPE32 4.10 2.04 5.99 1.60 5.68 1.70 b2 , f1 , i1
COPE33 4.15 2.19 6.74 1.87 6.38 1.99 b2 , f1 , i1
COPE34 5.85 1.94 3.55 1.73 4.05 1.98 e5 , h3 , j2
COPE35 4.26 2.18 6.65 1.59 5.88 1.97 b2 , f1 , i1
COPE36 5.58 1.85 3.55 1.57 4.28 1.81 e5 , h3 , j2
COPE37 5.78 1.83 3.28 1.79 4.16 2.08 e5 , h3 , j2
COPE38 4.63 2.32 6.95 1.92 6.59 1.90 a1 , f1 , i1
COPE39 5.81 2.10 3.41 1.52 4.40 2.03 e5 , h3 , j2
COPE40 5.99 1.97 2.99 1.57 3.90 2.06 c3 , g2 , j2
COPE41 5.84 2.06 4.21 2.06 4.65 2.32 e5 , h3 , j2
COPE42 4.29 2.27 6.98 1.97 6.37 2.12 b2 , f1 , i1
COPE43 4.48 2.01 5.97 1.88 5.99 1.97 b2 , f1 , i1
COPE44 4.70 2.42 7.54 1.62 6.33 2.17 a1 , f1 , i1
COPE45 4.17 2.27 7.39 1.46 6.61 1.90 a1 , f1 , i1
COPE46 4.82 2.17 5.44 2.11 4.60 2.29 d4 , h3 , j2
COPE47 5.63 1.99 3.61 1.78 3.76 2.16 e5 , h3 , j2
COPE48 6.69 1.98 2.37 1.45 3.12 2.26 c3 , g2 , j2
COPE49 3.76 2.24 6.55 1.54 5.91 2.04 b2 , f1 , i1
COPE50 4.86 1.98 5.15 1.48 5.06 1.67 d4 , h3 , j2
COPE51 4.69 2.21 6.37 1.87 5.94 1.92 b2 , f1 , i1
COPE52 5.17 1.96 4.76 1.91 5.08 2.10 d4 , h3 , j2
COPE53 6.07 1.95 3.22 1.47 3.60 1.83 c3 , g2 , j2
COPE54 4.46 1.96 5.38 1.27 5.66 1.62 d4 , h3 , j2
COPE55 4.67 1.84 4.53 1.43 4.66 1.63 d4 , h3 , j2
COPE56 4.33 2.01 5.33 1.79 5.08 1.88 d4 , h3 , j2
COPE57 5.21 2.18 6.76 1.86 6.29 1.96 a1 , f1 , i1
COPE58 4.32 2.14 5.65 1.92 5.18 1.97 d4 , h3 , j2
COPE59 4.38 1.88 4.77 1.59 5.17 1.94 d4 , h3 , j2
COPE60 4.74 1.97 4.92 1.70 5.36 1.95 d4 , h3 , j2
COPE61 3.90 2.00 5.65 1.51 5.98 1.81 b2 , f1 , i1
COPE62 4.59 2.35 6.93 1.68 6.23 2.19 b2 , f1 , i1
COPE63 5.14 2.05 4.30 1.67 4.59 1.97 e5 , h3 , j2
COPE64 4.30 2.21 7.11 1.78 6.12 2.09 b2 , f1 , i1
COPE65 4.82 2.13 5.51 1.78 5.73 2.07 d4 , h3 , j2
COPE66 4.27 2.17 6.46 1.65 5.78 1.92 b2 , f1 , i1
COPE67 4.36 2.17 6.44 1.83 6.16 2.09 b2 , f1 , i1
COPE68 4.64 1.89 4.47 1.36 4.92 1.73 d4 , h3 , j2
COPE69 5.16 1.83 4.33 1.65 4.90 1.90 e5 , h3 , j2
COPE70 4.73 1.98 6.18 1.57 6.19 2.03 b2 , f1 , i1
COPE71 4.66 2.14 4.97 1.62 4.78 2.37 d4 , h3 , j2
COPE72 4.40 1.98 5.42 1.68 5.54 1.63 d4 , h3 , j2
COPE73 5.59 1.91 4.24 1.79 4.62 1.82 e5 , h3 , j2
COPE74 4.16 2.24 7.00 1.66 6.37 2.05 b2 , f1 , i1
44 R. Cohen et al. / The Arts in Psychotherapy 45 (2015) 36–46

Appendix B (Continued)
Arousal Valence Dominance Cluster Solution

M SD M SD M SD

COPE75 5.75 1.95 4.30 2.25 4.66 2.35 e5 , h3 , j2


COPE76 4.81 2.07 7.00 1.59 6.55 1.77 a1 , f1 , i1
COPE77 3.84 2.26 6.77 1.70 6.48 2.13 b2 , f1 , i1
COPE78 4.79 1.98 5.52 1.76 5.25 2.14 d4 , h3 , j2
COPE79 4.03 1.91 5.66 1.33 5.53 1.72 b2 , f1 , i1
COPE80 6.26 1.92 3.29 1.61 3.44 2.08 c3 , g2 , j2
COPE81 4.06 1.94 5.81 1.44 5.91 1.65 b2 , f1 , i1
COPE82 4.67 1.88 5.44 1.50 4.78 2.16 d4 , h3 , j2
COPE83 4.04 2.14 5.69 1.38 5.63 1.95 b2 , f1 , i1
COPE84 4.43 1.83 4.77 1.19 5.69 1.78 d4 , h3 , j2
COPE85 5.09 2.49 7.12 1.79 6.60 2.17 a1 , f1 , i1
COPE86 4.91 2.02 4.73 1.43 5.31 1.89 d4 , h3 , j2
COPE87 5.39 1.89 4.46 1.51 4.66 2.06 e5 , h3 , j2
COPE88 4.73 2.03 5.79 1.83 5.93 1.98 b2 , f1 , i1
Note: a1 , b2 , c3 , d4 , e5 – represent five factor solution and each letter and uppercase digit represents a cluster membership. f1 , g2 , h3 – represent three factor solution with
the uppercase digit indicates cluster membership. i1 , j2 – represent two factor solution.

Appendix C. Results of one-sample t-test of COPE cards, for the three emotional dimensions and the obtained effect size

Arousal Valence Dominance

M SD t(99) d M SD t(99) d M SD t(99) d

COPE01 4.78 2.08 −1.06 0.11 5.13 1.91 0.68 0.07 5.48 2.09 2.30 0.23
COPE02 4.35 1.98 −3.28** 0.33 4.96 1.78 −0.23 0.02 5 1.91 0.00 0.00
COPE03 4.82 2.00 −0.90 0.09 5.11 1.80 0.61 0.06 4.94 2.18 −0.27 0.03
COPE04 5.84 1.92 4.37*** 0.44 3.57 1.44 −9.90*** 0.99 3.92 2.00 −5.39*** 0.54
COPE05 4.57 2.10 −2.05** 0.20 5.8 1.74 4.59*** 0.46 5.53 1.89 2.79** 0.28
COPE06 4.8 2.40 −0.83 0.08 7.46 1.59 15.51*** 1.55 6.74 2.02 8.62*** 0.86
COPE07 4.06 2.01 −4.68*** 0.47 5.06 1.76 0.34 0.03 5.31 2.05 1.51 0.15
COPE08 5.59 2.06 2.87** 0.29 4.36 1.88 −3.40** 0.34 4.31 2.29 −3.01** 0.30
COPE09 5.66 2.14 3.08** 0.31 2.91 1.69 −12.38*** 1.24 3.75 2.09 −5.99*** 0.60
COPE10 5.31 2.01 1.54 0.15 3.46 1.67 −9.21*** 0.92 4.05 2.00 −4.76*** 0.48
COPE11 5.6 2.07 2.90** 0.29 3.75 1.77 −7.08*** 0.71 4.22 1.96 −3.99*** 0.40
COPE12 4.21 2.03 −3.89*** 0.39 5.45 1.58 2.85** 0.28 6 1.85 5.39*** 0.54
COPE13 5.7 1.98 3.53** 0.35 3.93 1.86 −5.77*** 0.58 4.5 1.94 −2.58* 0.26
COPE14 4.35 1.98 −3.28** 0.33 5.82 1.68 4.86*** 0.49 5.44 1.84 2.39* 0.24
COPE15 6.18 2.11 5.59*** 0.56 2.83 1.83 −11.88*** 1.19 3.68 2.16 −6.13*** 0.61
COPE16 4.77 1.90 −1.21 0.12 3.88 1.73 −6.47*** 0.65 4.28 1.94 −3.71*** 0.37
COPE17 4.92 2.54 −0.32 0.03 7.78 1.45 19.21*** 1.92 7.02 1.84 10.96*** 1.10
COPE18 5.43 2.25 1.91 0.19 3.76 1.72 −7.19*** 0.72 4.14 1.89 −4.55*** 0.46
COPE19 4.33 2.08 −3.22*** 0.32 5.4 1.68 2.38* 0.24 5.26 1.77 1.47 0.15
COPE20 5.25 1.79 1.39 0.14 3.93 1.58 −6.75*** 0.68 4.64 1.89 −1.90 0.19
COPE21 4.91 2.03 −0.44 0.04 3.78 1.61 −7.60*** 0.76 4.23 2.17 −3.55** 0.35
COPE22 4.23 1.98 −3.88*** 0.39 4.05 1.27 −7.46*** 0.75 4.9 1.55 −0.64 0.06
COPE23 6.03 1.80 5.74*** 0.57 3.75 1.62 −7.73*** 0.77 4.4 2.21 −2.72** 0.27
COPE24 4.88 1.93 −0.62 0.06 6.37 1.66 8.24*** 0.83 5.88 1.88 4.68*** 0.47
COPE25 5.45 2.24 2.01* 0.20 3.64 1.51 −9.02*** 0.90 3.99 1.87 −5.41*** 0.54
COPE26 5.51 2.08 2.46* 0.25 3.4 1.61 −9.91*** 0.99 3.85 1.80 −6.39*** 0.64
COPE27 4.93 2.00 −0.35 0.04 4.14 1.66 −5.19*** 0.52 4.38 1.83 −3.39** 0.34
COPE28 4.51 2.05 −2.39* 0.24 4.63 1.65 −2.24* 0.22 4.8 1.76 −1.13 0.11
COPE29 4.54 1.94 −2.37* 0.24 5.77 1.80 4.28*** 0.43 5.6 1.98 3.00** 0.30
COPE30 5.15 2.05 0.73 0.07 3.94 1.68 −6.31*** 0.63 4.28 1.97 −3.66*** 0.37
COPE31 4.41 1.99 −2.97** 0.30 4.6 1.86 −2.15* 0.22 4.68 1.91 −1.67 0.17
COPE32 4.1 2.04 −4.41*** 0.44 5.99 1.61 6.16*** 0.61 5.68 1.70 4.00*** 0.40
COPE33 4.15 2.19 −3.87*** 0.39 6.74 1.87 9.31*** 0.93 6.38 1.99 6.93*** 0.69
COPE34 5.85 1.94 4.38*** 0.44 3.55 1.73 −8.38*** 0.84 4.05 1.98 −4.81*** 0.48
COPE35 4.26 2.18 −3.40** 0.34 6.65 1.59 10.40*** 1.04 5.88 1.97 4.46*** 0.45
COPE36 5.58 1.85 3.14** 0.31 3.55 1.57 −9.22*** 0.92 4.28 1.81 −3.98*** 0.40
COPE37 5.78 1.83 4.25*** 0.43 3.28 1.79 −9.59*** 0.96 4.16 2.08 −4.03*** 0.40
COPE38 4.63 2.32 −1.59*** 0.16 6.95 1.93 10.13*** 1.01 6.59 1.90 8.38*** 0.84
COPE39 5.81 2.10 3.85*** 0.39 3.41 1.53 −10.43*** 1.04 4.4 2.03 −2.96** 0.30
COPE40 5.99 1.97 5.02*** 0.50 2.99 1.57 −12.83*** 1.28 3.9 2.06 −5.35*** 0.53
COPE41 5.84 2.06 4.07*** 0.41 4.21 2.06 −3.83*** 0.38 4.65 2.32 −1.51 0.15
COPE42 4.29 2.27 −3.13** 0.31 6.98 1.97 10.05*** 1.01 6.37 2.12 6.45*** 0.65
COPE43 4.48 2.01 −2.59* 0.26 5.97 1.88 5.16*** 0.52 5.99 1.97 5.02*** 0.50
COPE44 4.7 2.42 −1.24 0.12 7.54 1.62 15.70*** 1.57 6.33 2.17 6.12*** 0.61
COPE45 4.17 2.27 −3.65*** 0.37 7.39 1.46 16.34*** 1.64 6.61 1.90 8.49*** 0.85
COPE46 4.82 2.17 −0.83 0.08 5.44 2.11 2.08* 0.21 4.6 2.29 −1.75 0.17
COPE47 5.63 1.99 3.17** 0.32 3.61 1.78 −7.81*** 0.78 3.76 2.16 −5.74*** 0.57
COPE48 6.69 1.98 8.54*** 0.85 2.37 1.45 −18.09*** 1.81 3.12 2.26 −8.31*** 0.83
COPE49 3.76 2.24 −5.54*** 0.55 6.55 1.54 10.06**** 1.01 5.91 2.04 4.45*** 0.45
COPE50 4.86 1.98 −0.71 0.07 5.15 1.48 1.01 0.10 5.06 1.68 0.36 0.04
COPE51 4.69 2.21 −1.40 0.14 6.37 1.87 7.33*** 0.73 5.94 1.92 4.89*** 0.49
R. Cohen et al. / The Arts in Psychotherapy 45 (2015) 36–46 45

Appendix C (Continued)
Arousal Valence Dominance

M SD t(99) d M SD t(99) d M SD t(99) d

COPE52 5.17 1.96 0.87 0.09 4.76 1.91 −1.25 0.13 5.08 2.10 0.38 0.04
COPE53 6.07 1.95 5.49*** 0.55 3.22 1.47 −12.13*** 1.21 3.6 1.83 −7.67*** 0.77
COPE54 4.46 1.96 −2.76** 0.28 5.38 1.27 2.99** 0.30 5.66 1.62 4.06*** 0.41
COPE55 4.67 1.84 −1.80 0.18 4.53 1.43 −3.28** 0.33 4.66 1.63 −2.09* 0.21
COPE56 4.33 2.01 −3.34** 0.33 5.33 1.79 1.84 0.18 5.08 1.88 0.43 0.04
COPE57 5.21 2.18 0.96 0.10 6.76 1.87 9.43*** 0.94 6.29 1.96 6.59*** 0.66
COPE58 4.32 2.14 −3.18** 0.32 5.65 1.92 3.38** 0.34 5.18 1.97 0.92 0.09
COPE59 4.38 1.88 −3.29** 0.33 4.77 1.59 −1.45 0.14 5.17 1.94 0.87 0.09
COPE60 4.74 1.97 −1.32 0.13 4.92 1.70 −0.47 0.05 5.36 1.95 1.84 0.18
COPE61 3.9 2.00 −5.51*** 0.55 4.65 1.51 4.31*** 0.23 5.98 1.82 5.40*** 0.54
COPE62 4.59 2.35 −1.74 0.17 6.93 1.68 11.50*** 1.15 6.23 2.19 5.61*** 0.56
COPE63 5.14 2.05 0.68 0.07 4.3 1.67 −4.20*** 0.42 4.59 1.97 −2.08* 0.21
COPE64 4.3 2.21 −3.16** 0.32 7.11 1.78 11.85*** 1.19 6.12 2.09 5.35*** 0.54
COPE65 4.82 2.13 −0.85 0.08 5.51 1.78 2.86** 0.29 5.73 2.07 3.52** 0.35
COPE66 4.27 2.17 −3.37** 0.34 6.46 1.65 8.82*** 0.88 5.78 1.92 4.07*** 0.41
COPE67 4.36 2.17 −2.95** 0.29 6.44 1.83 7.85*** 0.79 6.16 2.09 5.54*** 0.56
COPE68 4.64 1.89 −1.90 0.19 4.47 1.36 −3.90*** 0.39 4.92 1.73 −0.46 0.05
COPE69 5.16 1.83 0.87 0.09 4.33 1.65 −4.06*** 0.41 4.9 1.90 −0.53 0.05
COPE70 4.73 1.98 −1.36 0.14 6.18 1.57 7.53*** 0.75 6.19 2.03 5.85*** 0.59
COPE71 4.66 2.14 −1.59 0.16 4.97 1.62 −0.19 0.02 4.78 2.37 −0.93 0.09
COPE72 4.4 1.99 −3.02** 0.30 5.42 1.68 2.49* 0.25 5.54 1.63 3.31** 0.33
COPE73 5.59 1.91 3.08** 0.31 4.24 1.79 −4.24*** 0.42 4.62 1.82 −2.09* 0.21
COPE74 4.16 2.24 −3.75*** 0.38 7 1.66 12.02*** 1.20 6.37 2.05 6.68*** 0.67
COPE75 5.75 1.95 3.84*** 0.38 4.3 2.25 −3.11** 0.31 4.66 2.35 −1.45 0.14
COPE76 4.81 2.07 −0.92 0.09 7 1.59 12.58*** 1.26 6.55 1.77 8.74*** 0.88
COPE77 3.84 2.26 −5.12*** 0.51 6.77 1.71 10.38*** 1.04 6.48 2.13 6.93*** 0.69
COPE78 4.79 1.98 −1.06 0.11 5.52 1.76 2.96** 0.30 5.25 2.14 1.17 0.12
COPE79 4.03 1.92 −5.07*** 0.51 5.66 1.34 4.94*** 0.49 5.53 1.72 3.08** 0.31
COPE80 6.26 1.92 6.56*** 0.66 3.29 1.61 −10.62*** 1.06 3.44 2.08 −7.51*** 0.75
COPE81 4.06 1.94 −4.84*** 0.48 5.81 1.44 5.62*** 0.56 5.91 1.65 5.50*** 0.55
COPE82 4.64 1.88 −1.76 0.19 5.44 1.50 2.93** 0.29 4.78 2.16 −1.02 0.10
COPE83 4.04 2.14 −4.48*** 0.45 5.69 1.38 5.01*** 0.50 5.63 1.95 3.22** 0.32
COPE84 4.43 1.83 −3.11** 0.31 4.77 1.19 −1.94 0.19 5.69 1.79 3.86*** 0.39
COPE85 5.09 2.49 0.36 0.04 7.12 1.79 11.85*** 1.18 6.6 2.17 7.37*** 0.74
COPE86 4.91 2.02 −0.45 0.04 4.73 1.43 −1.89 0.19 5.31 1.90 1.64 0.16
COPE87 5.39 1.89 2.06* 0.21 4.46 1.51 −3.58** 0.36 4.66 2.06 −1.65 0.17
COPE88 4.73 2.03 −1.33 0.13 5.79 1.83 4.31*** 0.43 5.93 1.98 4.69*** 0.47
*p < 0.05 **p < 0.01 ***p < 0.001. The values of the emotional dimensions were compared aga1inst the center value 5. Estimates of effect size (Cohen’s d) for the difference
between the mean value of 5 to the attained affective means of each cards obtained by using a formula suggested by Kotrlik and Williams (2003), and interpreted after Cohen
(1988) as d > 0.20 = small effect size, d > 0.50 = medium effect size and d > 0.80 = large effect size.

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