Dreaming, Vol. 8, No. 1, 1998

The Effects of Description, Association, or Combined
Description/Association in Exploring Dream Images

Clara E. Hill^1,2, Emilie Y. Nakayama¹, and Teresa L. Wonnell¹

During single 20-40 minute sessions, 51 volunteer clients were given instructions to either describe their dream images in rich detail, to provide associations to the dream images, or to combine these descriptive and associative activities. Volunteer clients in the association condition reported significantly more exploration/insight gains (e.g., becoming involved while working on the dream, making previously unobserved connections between the dream and waking life) than did volunteer clients in the description condition. No differences were found among conditions on clients’ ratings of session depth (e.g., valuable, powerful), judges’ ratings of the cognitive complexity of client's dialogue during the session (e.g., clear, elaborative), judges’ ratings of how insightful clients were in their written dream interpretations, and judges’ ratings of the quality of clients’ written action plans. Implications for dream interpretation are discussed.

KEY WORDS: dream interpretation; dream exploration; description of dream images; association to dream images; psychotherapy process.

Many different approaches to dream interpretation have been developed and used over the centuries. However, until recently, very little research has examined their therapeutic effectiveness. Recently, a number of studies (Cogar & Hill, 1992; Diemer, Lobell, Vivino, & Hill, 1996; Falk & Hill, 1995; Heaton, Hill, Hess, Leotta, & Hoffman, 1997; Heaton, Hill, Petersen, Rochlen, & Zack, 1998; Hill, Diemer, & Heaton, 1997; Hill, Diemer, Hess, Hillyer, & Seeman, 1993; Rochlen, Ligiero, Hill, & Heaton, 1997; Zack & Hill, 1997) have investigated the outcomes of the Hill cognitive-experiential dream interpretation model (Hill, 1996). Even though the Hill model has been tested and found effective overall, we have no empirical evidence of the effectiveness of its components. Hence, it seems appropriate to determine each component’s contributions to the desired goals of dream interpretation.

The goals of the Hill dream interpretation model are for clients to (1) explore their dream images thoroughly and become experientially involved in the process, (2) gain insight into what the dream means, and (3) use the meaning of the dream to decide what to do differently. The model integrates elements from experiential, psychodynamic, and cognitive-behavioral theories and involves three stages: Exploration, Insight, and Action. In the exploration stage, therapists encourage clients to retell the dream, provide rich description of dream images, associate to dream images, determine the triggers for the dream in waking life, and work with affect and conflict to enhance exploration. Exploration leads to the Insight Stage, in which therapists help clients understand the meaning of the dream on at least one of four levels: the phenomenological experience of the dream, waking life, past memories, or parts of self. Insight leads to the Action Stage, in which therapists help clients use their understanding of the dream’s meaning to determine what they would like to do differently (in the dream, in life, or in continued work on issues raised by the dream).

In the present study, we examined the first part of the Exploration Stage. Our rationale for starting with the beginning of the Exploration Stage is that it sets the foundation for the remainder of the process. The type and quality of the information gathered during the exploration process dictates what therapists and clients have to work with during later stages. Hill (1996) incorporated both phenomenological and psychodynamic methods into the first part of the Exploration Stage. Phenomenologists (e.g., Craig & Walsh, 1993; Delaney, 1993) invite dreamers to engage in vivid description of each image. Painting a verbal picture of the dream images allows dreamers to recall portions of the dream that they had not initially recalled and to re-experience the dream fully. In contrast, Freudian (e.g., Freud, 1900/1966) and Jungian (e.g., Johnson, 1986; Jung, 1974) therapists invite dreamers to associate to dream images, saying the first thing that comes to mind when they think about each one. From a psychodynamic perspective, associations are important because they allow dreamers to identify unconscious material. From a cognitive perspective, Hill (1996) adds that associations are important because they uncover thoughts, feelings, and memories that reside in cognitive schemas that might be implicated in dreams. To arrive at a richer, more vivid dream interpretation, it may be valuable to stay within the dream and experience more details of the dream images, as well as to explore the thoughts, feelings, and memories that are associated with the dream images.

Our first objective in this study was to assess the comparative effectiveness of describing images in rich detail, associating to dream images, and combining description and association. Because both description and association have been used with apparent clinical utility in existing approaches to dream interpretation, we hypothesized that clients would evaluate all three conditions as providing comparable depth, i.e., as equally valuable, full, and powerful.

Our second hypothesis was that, because of their immersion in the dream and their elaboration of related thoughts, feelings, or memories, clients in the combined description/association condition would perceive greater gains in exploration and insight than would clients in either the description or association conditions.

Our third objective was to examine the process that occurred during sessions within each of the three conditions. In a previous study (Diemer et al., 1996), we found that clients who expressed themselves with greater cognitive complexity (i.e., with greater clarity, depth, elaborativeness, personal focus, and conclusion-orientation) during dream interpretation sessions had improved session outcomes. So, in the present study, we examined which of the three conditions would most effectively encourage clients to talk about their dream images in this cognitively complex manner. Because association seems to require clients to say more about thoughts and make connections with memories, whereas description seems to encourage clients to become more involved in the experience of the dream, we hypothesized that the association condition would lead to greater cognitive complexity in clients’ dialogue than would the description condition or the combined description/association condition.

In addition, we considered two hypotheses about effects of these initial exploratory activities on clients’ independently attained insights and action plans. In this study, therapists did not actively pursue insight or action; nevertheless, we wondered whether clients would independently gain insight and develop action plans based on their experience during sessions concerned with exploration only. Rogers (1942, 1957) suggested that therapists do not need to interpret because the facilitative conditions provided during exploration are all that clients require to unblock their potential and achieve their own insights. Hence, our fourth hypothesis was that the combined condition would lead to greater insight into the dream that was discussed by the client during the exploration session. Moreover, some theorists (e.g., Gendlin, 1986; Mahrer, 1990) have suggested that there is a natural force leading to action after full experiencing of a dream. Thus, our fifth hypothesis was that the combined condition would lead to better plans for what to do differently in one's life.

In testing the effects of description, association, and combined description/association, we required therapists to use only these specific interventions, rather than allowing them to continue with a full interpretation of the dream or with development of an action plan. We reasoned that what happens in later stages of dream interpretation might influence the perceived effects of initial description and association. Because we wanted the purest possible test of these two exploratory techniques, we asked therapists to stop after clients had explored their dream images.

Volunteer Clients. Fifty-one undergraduates (24 females, 27 males; 38 European Americans, 9 African Americans, 1 Asian American, 1 Hispanic American, and 2 not identified) in psychology classes, averaging 19.53 (SD = 1.59) in age, served as volunteer clients. All had dreams that they were willing to discuss in the experimental session and received course credit for their participation.

Therapists. Sixteen graduate students (12 female, 4 male; 11 European Americans, 1 African American, 4 Asian Americans) in counseling and clinical psychology doctoral programs, averaging 29.38 (SD = 6.62) years of age, served as therapists. The average amount of therapy experience was 3.19 (SD = 2.84) years. Eight of the therapists had participated in previous studies using the Hill dream interpretation model. Using 5-point scales (5 = high) to rate their theoretical orientation, therapists rated themselves as 3.87 (SD = 0.72) on humanistic/experiential, 3.19 (SD = 0.75) on cognitive/behavioral, and 2.75 (SD = 1.06) on psychoanalytic orientations. The second and third authors (both graduate students) served as therapists. Therapists were randomly assigned to one of the three conditions.

Session Evaluation Questionnaire – Depth Subscale. This instrument (Stiles & Snow, 1984) is a widely used, adjective-anchored, self-report measure involving 5 items (valuable-worthless, full-empty, special-ordinary, powerful-weak, and deep-shallow). High scores indicate high levels of perceived session depth. Stiles and Snow (1984) reported high validity and internal consistency (Cronbach’s alpha = .87). As evidence of concurrent validity, Stiles, Reynolds, Hardy, Rees, Barkham, and Shapiro, (1994) reported that the Depth scale was positively related to the Understanding, Problem-Solving, and Relationship scales of the Session Impact Scale.

Gains from Dream Interpretation – Exploration/Insight Subscale. A subscale developed by Heaton et al. (1998) was used to assess the specific exploration and insight gains that clients reported after dream interpretation sessions. A Gains from Dream Interpretation Scale (GDI) was developed from client responses to open-ended questions about what they gained from dream interpretation sessions. The subscale measuring Exploration/Insight gains (GDI-E) consists of 7 items rated on 9-point Likert scales (9 = high). Examples include, "I was able to explore my dream thoroughly during the session," "I felt like I was very involved in working with this dream during this session," "I was able to make connections between images in my dream and images in my waking life that I had not previously considered." The internal consistency (Cronbach’s alpha) of the GDI-E was .83 in the Heaton et al. study and .88 in the present study. As evidence of concurrent validity, Zack and Hill (1997) found that the GDI-E correlated positively with the Depth scale of the Session Evaluation Questionnaire, and with Action Gains and Experiential Gains (two other subscales of the GDI).

Cognitive Complexity of Client Speech. Procedures developed by McCarthy, Shaw, and Schmeck (1986) were used to assess how deeply and elaboratively clients talked during their dream exploration sessions. Trained judges independently rated five-minute segments of exploration dialogue on the following 6-point Likert scales (1 = high, 6 = low): (a) deep vs. shallow ("deep" means being concerned with underlying meanings and abstract conceptualizations); (b) elaborative vs. nonelaborative ("elaborative" means being involved with abstract ideas); (c) personal vs. impersonal ("personal" means using self-referential pronouns, discussing self more than others, and referring to personal topics); (d) clear vs. vague ("clear" means having well-defined ideas), and (e) conclusion-oriented vs. description-oriented ("conclusion-orientation" involves hypotheses or interpretations drawn from remembered facts). The judges for this task were four undergraduate students majoring in psychology (2 females, 2 males; all European Americans ranging in age from 20 to 25, M = 22.50, SD = 2.38) who were unaware of the purposes or design of the study. Previous studies found high interrater reliability (Cronbach’s alpha) for the averages of these ratings (McCarthy et al., 1986 = .85; Diemer et al., 1996 = .88). Interrater reliability (Cronbach’s alpha) for the composite measure among the four raters for the present study was .80. The average of these composite scores across judges was used as an index of cognitive complexity in the present study.

Insight. Procedures developed by Falk and Hill (1993) provided a measure of insight into a specific dream. After their exploration sessions, clients were asked to write their dream interpretation in response to the following question: "What do you think this dream means to you? How would this interpretation help you to explain or understand recent events in your life?" Trained judges independently rated insightfulness of the interpretation using a 9-point Likert scale (1 = no insight, 5 = moderate insight, 9 = high insight) based on Hill et al.’s (1992) definition for insight:

The judges for this task were two undergraduate students (1 male, 1 female, both European Americans and age 22), two female graduate students (one 32-year old European American, one 25-year old Asian American), and one female 48-year old European American professor (the latter three were the authors of the study). Interrater reliability (Cronbach’s alpha) in previous studies has been high (Falk & Hill, 1993 = .93; Diemer et al., 1996 = .91). For the present study, interrater reliability (Cronbach’s alpha) among the five judges was .97, and the average of the judges’ ratings was used as an index of insight.

Action. This rating was developed for the present study to evaluate the quality of an action plan that a client formulated in response to what was learned about a specific dream. After clients had written their interpretation of the dream, they were asked to write an action plan in response to the following question, "Based on this dream interpretation session, what changes would you make in your current life; and how would you go about making these changes?" To rate the quality of the action plan, trained judges (the three authors of this report) used a 9-point Likert scale (1 = low, 5 = moderate, 9 = high). Quality of the action was defined as the composite of judges’ ratings of whether the plan was clear, operational, feasible, and related to the dream. The interrater reliability (Cronbach’s alpha) among the three judges was .95, and the average of the judges’ ratings was used as an index of action plan quality.

Seventeen therapists were recruited to participate in the study. All had received prior training, which involved reading and discussing the Hill (1996) book and then practicing by doing both group and individual dream interpretation. For the present study, therapists were randomly assigned to one of the three conditions and received one additional hour of training in that condition. This training involved discussing the rationale for the condition, practicing in a group, and then practicing in dyads. All therapists were judged by the first author as competent to carry out the designated procedures. To confirm their belief in the condition in which they were trained, therapists rated, on a 5-point Likert scale (5 = believe strongly), their response to the question, "How much do you believe that the condition you have been trained in will facilitate exploration of dream images?"

Fifty-five volunteer clients were recruited from undergraduate classes by posting an announcement for a study of "Dream Images" on a sign-up board. To participate, volunteer clients were informed that they had to bring with them a written dream that they were willing to discuss, and they were told that they would be audio and videotaped. No restriction was placed on what dream the client chose to present because we have found from past experience that clients prefer to discuss dreams of their choice. Volunteer clients were randomly assigned to one of the three conditions and to one of the therapists, based on time availability. Each therapist was paired with two to four volunteer clients (M = 3.19, SD = 0.66).

When volunteer clients arrived, they first completed a demographic questionnaire and signed a consent form that (a) informed them about the measurement procedures in which they would be involved, (b) informed them about the taping of a session in which they would be exploring dream images, and (c) indicated that they would not come to a final interpretation of their dream. They then completed some instruments (not reported in the present study) and provided a copy of their written dream (needed for later ratings of insight and action). If they had not written down the dream, clients were asked to do so at that time. If dreams were long, clients were asked to choose a portion of the dream (i.e., one scene or about a paragraph) that they could briefly discuss. This was done to ensure that dreams were about the same length and that therapists would have about the same number of images to cover.

Volunteer clients were then introduced to their individual therapists, who began sessions by asking clients to retell the designated portion of the dream in the present tense. Therapists then gave a brief rationale for the method that they would be using to work with the dream images and indicated that they would progress through the dream images sequentially. In all conditions, therapists tried to engage clients in the process by informing them that exploring images was the most important part of the dream interpretation process.

Therapists then began the procedures for the designated condition. Therapists tried to cover at least 10 dream images as thoroughly as possible. In all conditions, therapists were careful not to ask clients to look for the triggers of the dream in waking life, to interpret the dream, or to discuss action plans based on their interpretation of the dream (all later steps of the Hill model). If the clients brought up triggers, made interpretations, or discussed action plans spontaneously, therapists listened but immediately directed the discussion back to the specific task of description and/or association. Therapists timed the section of the session involving work with images (after the retelling of the dream and provision of the rationale) so that it lasted 20-40 minutes. Specific rationales and procedures in the three conditions were as follows:

Description. Therapists asked clients to provide more details about each image and to paint a verbal picture of the dream, similar to what Craig and Walsh (1993) called "explication" of dreams. Clients were asked to imagine themselves actually being in the dream and to describe it to the therapist. The rationale given to clients was that therapists were trying to facilitate a rich and accurate description of the dream that could lead to an understanding of their experience of it. Therapists were allowed to use the following probes (where X = image): "Tell me about the setting." "Tell me about the mood in the dream." "What was the time of day?" "What was the weather?" "Tell me about the surroundings." "Tell me in great detail about the event." "I want to see the details of the dream." "Describe the X." "What colors are there in X?" "What is the texture, size, shape of X?" "How were you feeling at this point in the dream?"

Associations. Therapists defined associations for clients as "any word, idea, mental picture, feeling, or memory that pops into your mind when you look at the image in the dream" (Johnson, 1986, p. 52). The rationale for this condition was explained as helping the person get back to the thoughts and feelings about the images stored in their minds so that they could see what the images meant to them. Therapists then asked clients to associate to the major images of the dream, always coming back to the original image for additional associations. They used the following probes (taken from Hill, 1996): "What is the first thing that comes to your mind when you think of X?" "What else?" "What does X remind you of?" "How is X different from other things?" "What is X?" "How do you feel now when you think of X?" "What memories do you have of X?" "What do you generally use X for?"

Combined Description and Associations. Therapists delivered the above rationales for doing both description and association and defined each technique. Therapists then focused on individual images and asked clients to describe more details and provide associations. Therapists were allowed to use the probes suggested for both the description and association conditions.

Post-Session Testing. After the session, clients completed the Depth scale and GDI-E (and other measures not reported in the present study). Clients were then asked to think about their dream and then to write an interpretation of the meaning of the dream and an action plan for what they wanted to do based on the meaning of the dream. Concurrently, therapists completed a three-item check on their adherence to the condition procedures: (a) "How much did you focus on getting the client to associate (defined as saying whatever words, ideas, mental pictures, feelings or memories come to mind) to dream images? (b) How much did you focus on getting the client to describe the different parts of their dream more thoroughly and to paint a verbal picture of their dream? and (c) How competently do you feel you performed the condition? Each question used a 5-point Likert scale ranging from not at all (1) to very much (5).

Manipulation Check. Two undergraduate students (1 female, 1 male; both European Americans and age 22), who were unfamiliar with the therapists or the conditions to which they had been assigned, listened to 10 minutes of each session (beginning after the dream and rationale) and indicated which of the three conditions was being presented. Judges had perfect agreement about the final designation of each tape as being association, description, or combined description/association. On the basis of this manipulation check, two sessions (by the same therapist) were dropped because the therapist was judged as encouraging description when she was supposed to be facilitating combined description/association (effectively this therapist was dropped from the study because these were the only two sessions that she did). Another session was dropped because the therapist was judged as encouraging combined description/association when she was supposed to be facilitating association. Another session was dropped from the study because the condition lasted only 15 minutes rather than the required 20-40 minutes. Hence, although 55 sessions were completed, only 51 were used in the subsequent analyses.

Therapist Belief in Condition. A one-way analysis of variance (ANOVA) indicated no differences among conditions in how much therapists believed that the condition they were trained in would facilitate the exploration of dream images (description M = 4.00, SD = 1.00, association M = 4.67, SD = .82, combined M = 4.20, SD = .45; F(2,15) = 1.04.

Therapist Adherence. An ANOVA indicated that therapists differed in how much they reported focusing on description, F(2,48) = 34.92, p < .001. Post hoc Scheffe comparisons indicated that the description (M = 4.47, SD = 0.62) and combined (M = 3.88, SD = 0.60) conditions were equivalent and that both were higher than the association condition (M = 1.94, SD = 1.34). Another ANOVA indicated that therapists differed in how much they reported focusing on association, F(2,48) = 43.82, p < .001. Post hoc Scheffe comparisons indicated that the association condition (M = 4.76, SD = 0.44) was higher than the combined condition (M = 3.76, SD = 0.83), which was higher than the description condition (M = 1.88, SD = 1.27). A third one-way ANOVA found no differences in how competently therapists felt that they had conducted their sessions (description: M = 3.82, SD = 0.53; association: M = 4.18, SD = 1.01; combined: M = 3.71, SD = 0.59), F(2,48) = 1.85. Hence, according to their self-reports, therapists adhered to the appropriate conditions and were equally competent across conditions.

Equivalence of Conditions. No differences were found among the three conditions for client age, gender, or ethnicity. Similarly, there were no differences among the three conditions for therapist age, gender, race, experience level, or confidence level for their assigned condition. Hence, random assignment appeared to have created equivalent conditions on client and therapist demographic variables.

Descriptive Statistics. Table 1 shows the means and standard deviations for all the dependent measures across conditions. Table 2 shows the correlations among measures (using an alpha of .01 to correct for the number of correlations). Interestingly, depth, exploration/insight gains, and cognitive complexity were all related. (Please recall that the direction of scoring for cognitive complexity was opposite that of the other measures). These correlations suggest that the more cognitively complex the client was in the dialogue, the more exploration/insight gains the client reported and the more depth the client thought the session had attained. In addition, insight into the dream, exploration/insight gains, and quality of the action plan were positively related, suggesting that the clients who had more insight into their dreams also were able to make better action plans and gained more exploration/insight from their sessions.

Because we had five separate hypotheses, we conducted five separate analyses of variance and used an alpha of .01 to correct for the number of analyses (.05/5).

Differences in Depth. As expected, an analysis of variance (ANOVA) with condition as the independent variable and Depth as the dependent variable was not significant, F(2,48) = 1.79.

Differences in Exploration/Insight. An ANOVA with condition as the independent variable and Exploration/Insight Gains as the dependent variable was significant, F(2,48) = 5.83, p < .01. Post hoc Scheffe tests revealed that participants in the association condition reported more gains than did participants in the description condition, whereas the combined condition fell in between and was not significantly different from either of the other two groups. We should note that average scores on Exploration/Insight Gains (M = 5.64, SD = 1.77) were more than one standard deviation below those in a previous study (Heaton et al., 1998) in which volunteer clients participated in all three stages of the model (M = 8.06, SD = 0.73).

Differences in Cognitive Complexity. An ANOVA with condition as the independent variable and the cognitive complexity ratings as the dependent variable was not significant, F(2,48) = 0.50. Average cognitive complexity ratings (M = 3.51, SD = 0.57) were within a standard deviation of those reported by Diemer et al. (1996) for dream interpretation sessions during brief therapy (M = 3.32, SD = 0.67).

Differences in Insight and Action. An ANOVA with condition as the independent variable and insight ratings as the dependent variable was not significant, F(2,48) = 1.22. Average ratings of insight in this study (M = 3.60, SD = 1.98) were within a standard deviation of those found by Diemer et al. (1996) (M = 4.99, SD = 1.69) following 12 sessions of therapy involving dream interpretation. An ANOVA with condition as the independent variable and action ratings as the dependent variable also was not significant, F(2,48) = 0.15.

Volunteer clients in the association condition reported more exploration/insight gains than did volunteer clients in the description condition, with the combined description/association condition falling in between. One explanation for why association led to more client-reported gains in exploration is that association enabled clients to think more broadly about their dreams, increasing the likelihood of making previously unconsidered connections between dream images and other thoughts and memories. In contrast, the description condition required that volunteer clients stay within the dream, minimizing their opportunity to connect the dream to other aspects of their lives and correspondingly minimizing the likelihood of identifying engagingly novel thoughts and memories.

An alternative possibility is that the differences observed were due to experimenter demand. Association is the kind of dream interpretive activity that is most familiar to undergraduate students and the time spent associating to dream imagery increased progressively from the description condition to the combined condition to the association condition. Thus, according to the experimenter demand explanation, the volunteer clients may have been reporting that they gained what their conventional characterization of associative interpretive activity suggests they should have gained – and in direct proportion to the extent it was "demanded" of them. Although there is no compelling reason to favor this account over one that gives greater credence to clients’ reported exploration gains, future studies should attempt to address this issue.

No differences were found among conditions in perceived session depth, cognitive complexity of client dialogue, insight into the dream, or the quality of action plans based on the dream. In effect, the differences among conditions were minimal, suggesting that description and association are comparable dream interpretative techniques, with a slight advantage to association for promoting exploration. More research is needed to determine whether description or association is more appropriate for particular clients or particular types of dreams and whether there are optimal times within sessions to use each technique.

We should stress that the results of this study might have been different if later stages of dream interpretation had been included. For example, clients might have evaluated description or association differently after going through other steps in the model. In designing the study to determine the effects of description and association, we decided that therapists should not continue with the Insight or Action Stages because events during these stages could influence the perceived effectiveness of the description and association techniques. However, not completing the dream interpretation process and terminating the session before attaining tangible results was not satisfying for either the clients or therapists. Clients rated the sessions lower in gains than has been found in another dream interpretation study (Heaton et al., in press). Furthermore, some clients expressed irritation that they were not given an interpretation of their dreams and had not gained much from the sessions. Similarly, therapists did not like doing just the first stage of the Hill model because it felt incomplete to stop short of an explanation for the dream.

These findings suggest that both description and association are potentially helpful interventions, but that therapists should particularly consider using association to facilitate exploration. A second implication is that therapists need to go beyond description or association to later steps of dream interpretation so that clients can gain more meaning from their dreams. Another implication is that therapists should not distribute stages of the dream interpretation process across sessions but rather complete all stages within one session. If only exploration is done in a session, which may occur because of the time it takes to explore all the images thoroughly, clients will not feel a sense of closure.

One limitation of the present research was the use of quite brief 20-40 minute sessions. A second limitation was the use of volunteer clients of unknown motivation. Perhaps volunteers motivated to interpret dreams or clients engaged in therapy would have different reactions to description or association than those observed here. An additional limitation is that graduate student therapists were used. In short, we cannot confidently generalize from the experimental situation presented here to a situation involving full dream interpretation with motivated clients and experienced therapists.

In future research, other components of dream interpretation models should be tested. For example, we need to know how important it is to immerse oneself in re-experiencing the dream, to identify the triggers in waking life, to work with conflicts in the dream, or to discuss possible action plans based on the dream. Eventually, we hope to develop a more effective and efficient dream interpretation model based on empirical evidence about the effectiveness of various components.

The authors wish to express their gratitude to the therapists and clients who participated, to Eric Spiegel and Allison Grolnick for assisting with the study, and to Aaron Rochlen and Jason Zack for reading drafts of the manuscript. This study was presented at the annual meeting of the Association for the Study of Dreams in Asheville, North Carolina in June, 1997.

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Note. ** p < .01. Depth is rated on a 7-point scale (7 = high); Exploration/Insight Gains is rated on a 9-point scale (9 = high); cognitive complexity is rated on a 6-point scale (1 = high; insight and action ratings are based on a 9-point scale (9 = high).

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Note. * p < .01, ** = p < .001. See the Note in Table 1 for description of measures and directionality of scoring.

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