COGNITIVE IMPAIRMENT IN THOUGHT REFORM

�� Aronoff et al. (2000) found that the literature on cults is filled with �varied personal, political, and scientific agendas.� Research into this field is complicated by the fact that not all who study cults agree that there is a problem in need of study.� Writers who seem to support the intellectual and behavioral diversity that cults represent (e.g., Alexander, 1983; Anthony & Robbins, 1992; Coleman, 1984; Wright & Malony, 1989) refer to cults as New Reli�gious Movements or NRM�s, a neutral term without the negative connotations connected with the term cult (Aronoff, et al. 2000). They assert that they have the same First Amendment rights to freedom of expression guaranteed to any other group.� �(e.g., Alexander, 1983; Anthony & Robbins, 1992; Wright & Malony, 1989) and point out the positive effects cults have on participants (Galanter, Rabkin, Rabkin, & Deutsch, 1979).

�� The critics of cults view the cult phenomenon as essentially a human rights issue.� They consider groups that use techniques they recognize as similar to thought reform (Lifton, 1997) are violating the basic human rights of their members. They assert that thought reform processes appear to be related to lasting psychopathology after individuals leave the group.

�� The critics of cults (e.g., Glass, Kirsch, Parris, 1977; Martin, 1993; Singer & Ofshe, 1990; West, 1993; West & Martin, 1994),� point out that ex-members they have interviewed often experience a wide range of psychological symptoms severe enough to impair social and occupational function, including depression, anxi�ety, dissociation, passivity, guilt, and panic attacks (Singer & Ofshe, 1990).�

�� The electronic database Psyclnfo was used to locate pertinent books and articles. The keyword search included the following terms: cultism, brainwash, brainwash�ing, mind control.�� The names of authors who frequently publish arti�cles in the field were also included in the search.

Introduction to the Literature

�� This search uncovered a large number of articles from both perspectives presented above that appear to be opinion pieces, quoting favorable sources and making assertions that stimulate further discussion but not necessarily knowledge.� More research-oriented articles are often based solely on interviews that gather what is essentially anecdotal data. With few exceptions, studies are also flawed by the use unique instruments designed only for the study with questionable validity and reliability (Aronoff et al., 2000).�

�� Access to subjects for study further complicates research on cults. �Studies reported below will suggest that current members of cults experience satisfactory levels of mental health and are well adjusted.� Aronoff et al. (2000) caution that studies of current members might consist of subjects who were hand selected by their leaders to give the best possible impression of the group, or who might hide their difficulties in order to avoid negative repercussions, either immediate, from their leaders or eternal, since reporting problems might violate the cosmology of the group.�

�� Studies with ex-members may also be biased in several ways.� The experimenter may have been a member of a cult and might be more sympathetic to ex-members who report negative experiences.� Ex-members who are undergoing treatment may experience more negative symptoms than other ex-members.� Counseling itself has been shown to have negative effects on some clients (Crown, 1983; Lambert & Bergin, 1994).�

�� Lack of relevant control or non-cult groups is an ongoing weakness of cult research.� Lewis and Bromley (1987) reported a range of percentages of ex-members who experienced clinically significant symptoms.� The low end was 27%, apparently quite high.� It must be remembered, however, that the base rate for clinically significant symptoms in the general population is a considerable 17% (National Comorbidity Study: Kessler et al. 1994.��

�� Another complicating factor in research on cults is that no reliable estimate of the total number of people involved with cultic groups exists.� Conventional polling procedures are of little use since members of cults do not see themselves as members of cults.� Estimates can only be derived from local surveys and polls.� For instance, the best estimate is that between two and five million Americans have been involved in cults. This figure was derived from surveys of members of new religious and parareligious movements in San Francisco and Montreal (Bird & Reimer, 1982), surveys of high school students in the San Francisco Bay area (Zimbardo & Hart�ley, 1984), a recent survey (1993) conducted by the ICR Survey Research Group for the American Family Foundation, and a survey of 1,396 primary care physicians members of Pennsylvania Medical Society, 2.2% of whom reported having had a family member involved with a cultic group (Lottick, 1993). Martin (1993) used two other surveys to estimate that there may be anywhere from 2,000 to 5,000 cultic groups in America, with as many as two to 20 million members. Martin�s (1993) is far higher than previous estimates, but is based on two different university surveys.� Even using the most conservative estimates, cults are worthy of study.

�� This review of the literature will examine studies of current members of cults, studies of former members and then turn to the literature that addresses the dynamics of how cults work.�

Critical Review of Relevant Literature

Clinical Impressions of Ex � members

�� Singer and Offshe (1990) identified areas they felt were common characteristics of ex members of cults.� Most ex‑cult members Singer interviewed struggled with depression, loneliness, indecisiveness, slipping into altered states, trigger experiences, floating, subtle cognitive inefficiencies, fear of the cult, and the feeling of being in a �fish bowl� constantly watched by family and friends.�� Having to repeat explanations of why they joined and why they stayed gradually became agonizing for them.� Ex-members often feel guilt over having brought difficulty into the family or over having recruited others into the group. To make matters worse, the ex-member now realizes he or she was not part of an elite, an historic or cosmic company on a mission to save the world.

�� Their work was exploratory, not empirical.�� Their impressions, drawn from thousands of interviews of ex-members, contain analyzes that distill a very wide spectrum of symptomology into concepts that are straightforward to handle, and presumably for this study, to quantify. Their work underscores that cults represent a problem to society and support the need for further research. This study is an attempt to quantify their observation of reduced cognitive efficiency in ex-members.� Direct application of their work to what is known about cults is limited by the lack of standard interview instruments and standard, normed measures.� This study will use an instrument with known psychometric properties to investigate their observations empirically.

Thought Reform or �Brainwashing�

�� Thought reform or �brainwashing� was considered by several researchers (Hassan, 1988; Singer & Ofshe, 1990; Galanti, 1993; Martin, 1993; West & Martin, 1994) to be a key factor in understanding the profound changes that members of cults experience.� Thought reform was first described by Robert J. Lifton, Edgar Schein, Margaret Singer, and Louis Jolyon West who in�terviewed dissidents from the Chinese Communist Workers Party who had emigrated to Hong Kong and former prisoners of war (Galanti, 1993; Hassan, 1988; Martin, 1993).

�� Robert Lifton (1997) described eight interpersonal dynamics from his research with former prisoners after the Korean Conflict and survivors of �thought reform� camps in China.� In the introduction to the latest edition of his book Thought reform and the psychology of totalism, expressed his agreement, from his own study of cults that his dynamics could be applied to them.� Individuals Lifton interviewed who had been subjected to these eight processes could be influenced to adopt new ways of looking at self or the world enabling them to make rapid changes in convictions, values, attitudes and behavior.�

�� Milieu Control

�� The foundation of thought reform is the establishment of a power differential between the new inductee and the person or group. This position of greater power is accomplished initially through the imposition� Milieu Control or control of the surroundings.� The individual is gradually denied contact with conflicting ideas or alternative explanations to the phenomena observed in the group or those supposed explained by the groups principles.� Milieu Control can be accomplished through physical separation of the inductee from friends, family and alternative source of information.� In concert with the other seven processes, physical control of surroundings is often unnecessary after the processes take effect.� A kind of psychological separation occurs, a loss interest or outright fear of considering competing ideas.

�� Mystical Manipulation

�� Mystical Manipulation is the ability of the group to induce states of emotional arousal and, eventually self-deprecation and fear.� Gradually, the group gains control of almost all the events or concepts that regulate mood.� The individual feels elation when exposed to an exercise supposedly unique to the group and the resulting elevated mood is framed as a logical response to rightly applying the principles of the group.� In like manner, any thoughts expressed by the inductee in opposition to the teachings of the group are deflected into personal challenges for �growth� and deeper understanding.� Opposing ideas are framed as lacking wisdom. Continued exposure to Mystical Manipulation results in what Lifton called the �psychology of the pawn.�� The inductee feels trapped in a world ruled by forces that only the group understands and that only the group has the means of controlling, the Sacred Science.

�� Sacred Science

�� The inductee is presented with a package without his or her knowledge or informed consent that represents that portion of the beliefs of the group or Sacred Science, that the inductee could be expected to accept given the positive experiences felt during Mystical Manipulation.� The result is that the individual is given the group�s interpretations of reality that seem to confirm what the inductee has already experienced emotionally.� This in the psychological equivalent of the financial fraud known as the Ponzi Scheme,� where initial investors are paid the promised generous returns out of the investments of later investors. Like the early investor, the inductee has an emotional experience that confirms at least some aspects of the Sacred Science are true. The Sacred Science always contains the usually unexpressed ethic of the ends justify the means.� The ends of promoting the group and its Sacred Science are so vital to life on Earth, that any means necessary are considered ethical for either furthering the interests of the group or stopping the efforts of those the group identifies as its enemies.�

�� Loading the Language

�� The second part of the package is the language of the Sacred Science itself.� It is presented by using loaded terms and phrases more laden with emotion than content using �bumper-sticker� slogans that are designed to sound like jargon.� Actually, they are �thought terminating clich�s.�� Lifton (1997) quotes Lionel Trilling who calls this Loading the Language �the language of non-thought.� By controlling the language the inductee is allowed to use to talk about the Sacred Science, the group gradually manages to also control how the inductee thinks about the Sacred Science.�

�� Cult of Confession

�� The Sacred Science is presented as a completed whole.� It appears that all others in the group accept it self-evident without the need for involved explanations, since all present have had experiences that seem to confirm its veracity.� Any doubts still plaguing the inductee are reframed as shortcomings of character that must be �confessed� as personal flaws, further removing the Sacred Science itself from the light of reasonable scrutiny.� The world is viewed by the group in simplistic, black and white categories and any failure to measure up perfectly with the demands of the Sacred Science must be confessed. Any material presented in this Cult of Confession can and will be used against the inductee as a Demand for Purity.

�� Demand for Purity

�� The Demand for Purity is based on the notion that absolute perfection is possible and any deviation from perfection is intolerable.� The inner world of the inductee is slowly reduced to endless rounds of guilt and shame.� The cycle of the Cult of Confession and Demand for Purity gradually wears down any sense of self-acceptance that might have been present prior to the onset of the process.� Eventually, inductees lose the ability to believe they can make sense of the events they experience, choosing the doctrines of the group as more trustworthy than their own experience in defining reality.�

�� Doctrine Over Person

�� Doctrine Over Person is the acquired ability of the inductee to reframe the events of life only in the context of the teachings of the group, the Sacred Science. Those experiences that support the Sacred Science are accepted, those that do not are rejected.� Eventually the inductee rewrites their personal history to force it into compliance with the Sacred Science. When the group is faced with circumstances that force it to go against its own Sacred Science, it constructs an often elaborate explanation defining the circumstance as an artifact of the collapsing world system that it, of course, predicted.� The apparent hypocrisy of the group is redefined as evidence that the Sacred Science is more true than physical reality. When the inductee has reached the point in the process where personal experience is denied and doctrine accepted as reality, all but the boldest machinations of the group are explained away by self-blame or further rejection of the world outside the group.

�� Dispensing of Existence

�� As a sense of self is squeezed, the need to connect with the group increases.� At the same time, the group makes it clear that it alone has the wisdom and authority to decide who is qualified to exist on the superior plane the group defines and who is not.� This develops naturally from the belief that the group has the inside track on ultimate knowledge and as such, represents the only hope of humankind.� All others, by definition, do not measure up and in failing to do so, threaten the forward progress of humanity, or the purposes of God, etc.� The group freely engages in this Dispensing of Existence, making it clear that the group is the elite, having more right to exist than non-members.� Usually practiced non-literally, groups Dispense of Existence through denouncing their detractors and especially their defectors, usually by Loading the Language.��

�� These eight interpersonal dynamics describe an environment carefully controlled to produce a particular response from participants, not just obedience but total commitment to the goals of the group.

�� Thought reform and its implications formed the foundation of definitions of the word �cult� that remove doctrinal or belief schema that obscured empirical research.� Singer and Lalich (1994) distinguished cults from other groups by three factors, the origin of the group and the role of its leader, the relationship between the leader and the group�s members, and the existence of a coordinated program of persuasion.�� Langone (1993) related thought reform to cults in his definition:

..a group or movement that, to a significant degree, (a) exhibits great or excessive devotion or dedication to some person, idea, or thing, (b) uses a thought reform program to persuade, control, and socialize members (i.e., to integrate them into the group�s unique pattern of relationships, beliefs, values, and practices), (c) systematically induces states of psychological dependency in members, (d)exploits members to advance the leadership�s goals, and (e) causes psychological harm to members, their families, and the community.

�� Aronoff & Lynn (1996) pointed out that these definitions describe cults in a negative fashion, presumably introducing bias to any investigation based on them. It may not be possible to use the definitions to determine if any particular group was a cult.� A perfect definition may be elusive and that there may even be a continuum along which groups may be distributed ranging from completely non-cultic to extremely cultic.� Another consideration was the unique experiences of any two individuals in the same group might be completely different, and could also be distributed on a continuum.� Those who were deeply involved might be the only source of information on the cultic nature of the group.�

�� The Group Psychological Abuse Scale was developed on the conceptual foundation of the above definitions (Langone, Dole & Wiltrout, 1992).� In order to operationalize the definition of �cult� into a measure of individual experience for this study, the GPA was chosen as a measure of the intensity of the participant�s exposure to a cultic environment.�

�� Theoretical constructs and clinical observations are crucial to social science research, and researchers who performed empirical studies reveal their theoretical orientations in their experimental design.

Empirical Studies of Current Members

�� Robbins and Anthony, (1972) in the role of participant-observers, interviewed members of the Meher Baba cult and concluded that the group which recruited many of its members from the �hippie� counterculture, promoted abstinence from substance use, a return to the work ethic and a deeper acceptance and appreciation of others.� No standardized measures were used and other emotional factors were not studied.�

�� The ability of cults to curtail substance abuse was the focus two other studies.�� Galanter and Buckley (1978) administered a questionnaire on substance use and psychiatric symptoms they developed to 119 members of the Divine Light Mission (DLM). Members were asked to answer each item when they experienced the most symptoms or used the most drugs for four 2-month periods of time,� before joining the group, immediately before joining, immediately after joining and in the two months before the assessment.� Drug use and psychiatric symptoms decreased across all designated time periods.�� Authors did not report validity or reliability data for the measures they used.

�� Galanter, Buckley, Deutsch, Rabkin, and Rabkin (1980) used the same time reporting system in a study of 119 members of Divine Light Mission (DLM) and 37 members of the Unification Church (Moonies). In this study, substance use only was assessed.� Once again, use decreased in members of both groups.� Members of the Unification Church reported a greater decrease in their substance use.

�� These two studies failed to take into account that both groups strictly forbid substance use in their members. One could assume that members who could not curtail their use would have been expelled.� If any of Galanter et al.�s subjects had actually used substances while they were members of the group and valued their membership it would follow that they would be reluctant to report that use.

�� Galanter, et al. (1979) found that current members of the Unification Church� reported less emotional well-being than nonmembers on a 216 item questionnaire.� Members did report a decline in distress the longer they were in the group.� Ninety-one percent said that their distress declined immediately after joining the group.� The authors interpreted the results to mean the group provides long-term relief from distress.� The study did not indicate the makeup of the non-member sample.

�� Again in 1980, Galanter studied attendees of Unification Church workshops. Attendees who became members experienced the same gradual reduction in emotional distress but never reported the same level of emotional well-being as nonmembers.

�� Levine (1981) asserted that cults reduce anxiety, confusion, and stress in members and they do not adversely affect their members any more than any other intense movement.

�� Ross (1983) administered the Minnesota Multiphasic Personality Inventory (MMPI), the General Health Questionnaire, and the Eyseneck Personality Questionnaire to 42 members of a Hare Krishna Temple.� All scores were in the normal range and although problems began to appear in individuals who had been members longer than one and one half years, those who had been members longer than three years scored in the normal range.� He concluded that the popular view of the group as mentally disordered was not supported.� Other studies of this group, (Weiss & Comrey, 1987; Levine & Salter, 1976), reveal a different side.�

Weiss and Comrey administered the Comrey Personality Scales (Comrey, 1970) to 226 current members and 727 nonmembers. Members were found to assess as more compulsive and distrustful than nonmembers, even though the distrustful scale was within the normal range.� Member�s high compulsivity scores may simply reflect the structured lifestyle of the group.� Levine and Salter (1976) included Krishna devotees in their study of 106 groups considered outside the mainstream at the time.� When asked why they stayed in the group, only 20% specified spiritual, transcendental, or mystical reasons.� In-depth interviews of eleven randomly selected members indicated that most displayed psychiatric symptoms but most did not meet diagnostic criteria.� They did not indicate what the symptoms were or exactly how many presented with symptoms.�

�� Latkin (1990) administered the Private Self Consciousness Scale to 232 members of the Rajneesh commune and found that they engaged in more self-examination than the instrument�s normative population. They tended to feel less discomfort around others and had higher self esteem.� These findings are in keeping with the tenets of the group which promote self-examination, self-acceptance and personal growth.� Latkin (1990) concluded that their scores indicated members have strong opinions and would be hard to persuade, contradicting the assumption that those who join cults are gullible.� The findings only provide a �snapshot� of some aspect of being hard to persuade.� Latkin did not set out to measure susceptibility to persuasion behaviorally, only drew this conclusion from combinations of scale scores.� A sample of interested visitors, presumably members-to-be, might have made his conclusion more supportable.� The study did not include other measures that might have provided a context for the hardening of opinions.� Membership in a group known to expect allegiance without question might, in itself, account for elevations in measures of strength of opinion.

�� In another study of 67 Rajneeshpuram (Sundberg, Latkin, Littman and Hagan, 1993), devotee scores on the California Psychological Inventory suggested that Rajneeshees are socially poised, independent, exhibit flexibility in thinking and reject conforming to social standards.� No data of direct interaction between the experimenters and subjects was reported to confirm test results.�

�� Ungerleider and Wellisch (as cited in Aronoff, Lynn & Malinoski, 2000) compared 33 current and 17 ex-members of several unspecified groups using structured interviews developed for the study by the authors, a mental status exam, the Wechsler Adult Intelligence Scale, short form, the MMPI, and the Interpersonal Check List.�

�� MMPI Lie scale scores were considerably higher for current members than former members.� Elevated Lie scale scores indicate that the individual is answering questions in a socially desirable light and minimizing any problems.� On one part of the paper the authors reported that current members also had elevations on scales 6 (Paranoia) and 8 (Schizophrenia), and former members had elevations on scales 3 (Hysteria) and 4 (Psychopathic Deviate). In another section, they reversed the scores, attributing high 6 and 8 scores to former members and high 3 and 4 scores to current members.� The authors did not report actual scale scores eliminating any possibility of review of the authors� interpretations or working around the typographical error.

�� Of particular interest to this study, Spero (1984) administered the Verbal and Performance sections of the Wechsler Memory Scale, (WMS), the Bender Gestalt, the Rorschach and the Embedded Figures Test to 51 members of cults before and after six months of counseling.� After six months of counseling, WMS scores increased, the Bender scores indicated more efficient processing of visual stimuli and less blocking.� Spero (1984) interpreted the results of the Rorschach and the EFT to suggest that untreated members of cults might display perceptual and cognitive inefficiencies.� He asserted that these deficits were associated with �passivity, identity confusion, other-orientedness,...� and an �unclear sense of separate self...� .� A non-cult, control group would have added considerable credibility to the study for measures this complex.� The absence of direct measures of affect undermines his conclusions.� His study was drawn from a clinical population that would more likely to be more distressed than regular members.� Although he made use of standard instruments, he did not use consistent methods for data collection or assessment making his work more anecdotal than analytical.

Concerns with Studies of Current Members

�� Most of the studies reported so far suggest that membership in a cult can be beneficial.� Members experienced relief from drug addiction (Galanter & Buckley, 1978; Galanter, et al., 1980), connection to others with similar interests (Galanter et al., 1980), and reduction of distress (Galanter et al., 1979).� Most studies (Galanter et al. 1979; 1980; Galanter & Buckley, 1978); Levine & Salter, 1976; Spero, 1984) do not allow for comparison of cult members with well-defined norming populations since they did not make use of standardized measures with known validity and reliability (Aronoff, et al., 2000).

�� Ayella (1990) lists methodological and other difficulties encountered in researching cults. Researchers must face very real culture shock, difficult emotional responses to the group, handle conversion attempts, and the stigma between colleagues and others due to their investigating a group considered by many to be deviant. Establishing and maintaining access to the group can be frustrating, often hampering researchers� ability to obtain large enough �and random enough samples of members.� Cults have much to risk in allowing researchers to do their work without interference.� A good outcome could result in favorable publicity, elevate the group�s social standing, and enhance its ability to raise funds.� On the other hand, just the fact it is being studied by researchers known to investigate cults could negatively impact the group�s image.� Leaders of cults are often overly sensitive to public opinion and are in a position to influence access to the group, analysis of research, and perceived credibility.

�� Aronoff et al. (2000) suggested the possibility that members may not report honestly on instruments and that they might be influenced to actively under report their difficulties because of pride in the group or distrust of the researcher who is an outsider.� Researchers who do gain access to groups may be able to do so because of a bias toward the group.� Levine and Salter (1976) observed that while members reported greater feelings of emotional well-being after joining the group on questionnaires, more in-depth interviews tended to uncover considerable pathology. The doctrine of the group might indicate that there will be cosmic or social repercussions for not being positive about themselves or the group at all times (Swartling & Swartling, 1992).

�� Studies with former members of cults have relatively few of these problems, but the next section will show that ex-member studies have their own shortcomings.

Studies with Former Members

�� Clinical impressions of clinicians who have treated former cult members have influenced empirical studies.� Aronoff et al. (2000) reviewed the literature and found the most common symptom reported by clinicians was dissociation. Dissociation for the ex-cultist is called �floating� in the literature (Goldberg & Goldberg, 1982; West & Martin, 1994; West & Singer, 1980), the experience of profound ambivalence toward the group after leaving, along with feelings of being in the milieu of the group, even years after leaving. Cognitive deficiencies, particularly difficulty making decisions and simplistic, black and white thinking were often reported (Goldberg & Goldberg; Singer & Ofshe, 1990).� Depression� (West & Singer; Wright & Malony, 1989) and anxiety (Singer & Ofshe) were also commonly reported. Florid psychotic symptoms are less fre�quently noted (Singer & Ofshe), though clinicians unfamiliar with cults sometimes mistake reports of bizarre conditions in groups as delusional thinking.� These observations were made by mental health professionals on individuals who sought their help for emotional issues.� Although these investigators were reporting their impres�sions and not doing on empirical research per se, their insights have influenced a new generation of researchers who began using author-developed surveys and finally standardized psychometric instruments and diagnostic interviews. Not many have been done and all have their flaws, but all indicate that cult involvement comes with mental health risks.

�� Surveys developed by the authors were used to determine participants� impressions of their emotional state (Conway & Siegelman, 1982; Lewis & Bromley, 1987).� Conway and Siegelman found that seven symptoms (altered states, nightmares, inability to break mental rhythms of chanting, amnesia, suicidal/self harm tendencies, hallucinations and violent acting out) increased with time of involvement in the group.� Lewis and Bromley examined the same seven symptoms as Conway and Siegelman and found no correlation between length of membership and symptom intensity and frequency.

�� Swartling and Swartling (1992) asked 43 ex-members of Livits Ord or Word of Life, a group in Sweden about symptoms they experienced after but not before joining the group.� Ninety-three percent, reported anxiety and guilt, (91%) reported difficulty handling their emotions, (88%) felt empty, (96%) said they had nightmares or other disturbances of sleep, (75%) had difficulty concentrating, (63%) reported suicidal thoughts, and (90%) felt a loss of identity.� Before joining the group, (16%) had consulted a psychiatrist but (63%) did so after leaving.� They conclude that former members report that involvement in a cult increased their symptoms.

�� Aronoff, et al. (2000) reported that Wright and Malony (1989) and Galanter (1983) found quite different tendencies in ex-members they studied.� Wright and Malony found ex-members� symptoms fade quickly with time and Galanter found that ex-members do not report greater psychopathology than nonmembers but that those who had been more or less forcibly removed from their groups reported more negative feelings toward the group.� His conclusion suggests the intervention itself was responsible for increased reports of negative symptoms, not the group involvement itself.

�� These studies have most of the same problems as those with current members, nonstandard instruments, some lack control groups, and some appear to study inadequate sample sizes.� They were significant in that they served to cement researcher opinion into two camps.� One side believed that groups systematically harmed their members. The other side believed that groups are generally benign, but counter cult interventionists create problems for ex-members and bias them against their former group (Aronoff et al. 2000).

�� In 1992, Martin, Langone, Dole and Wiltrout applied standard assessment instruments to the study of ex-members.� He and his colleagues administered the Millon Clinical Multiaxial Inventory (MCMI; Millon, 1983), Beck Depression Inventory (BDI), Hopkins Symptom Checklist (HSCL; Derogatis, et al., 1974), and the Staff Burnout Scale (SBS-HP) to inpatients all of whom had sought out treatment at Wellspring Retreat and Resource Center, a facility that combined a bed-and -breakfast residential setting with a two-week program of individual counseling and workshops.� All participants had sought treatment on their own or at the urging of significant others.� None were mandated into treatment by a court or other public authority.�

�� These measures were administered di�rectly after the intake interview, a semi structured set of two questionnaires developed by the author. The first questionnaire gathered demographic information, including specific questions on the par�ticipants� experience in the group.� The second questionnaire was based on general mental status interviews in common use at community mental health agencies and hospitals, assessing current and past symptoms and physical health. The Millon inventory was chosen in the belief that the distress felt by former members was somewhat ego syntonic, resembling personality disorders, the primary focus of the instrument.�

�� A score of 75 on any MCMI scale is regarded as clini�cally significant. One hundred six of the 111 participants (95%) scored above 75 on at least one MCMI scale. The scales with the highest means were: Anxiety (76), Dys�thymia (72), and Dependent (Submissive) (72). Forty-two participants also completed the HSCL.�� The mean score was 102, with scores over 100 indicating a need for psychiatric care. Forty-six completed the SBS-HP which specifies that a score above 70 indicates burnout and acute stress.� The mean was 72.� Scores of 10 or more on the BDI are considered to be outside the normal range and scores above 17 are indicative of clinically significant depression (Langevin & Stancer, as cited in Martin, et al. 1992).� Once again, the mean was elevated, 14, not high enough to indicate a depressive disorder but outside the normal range.

�� Since it was impossible to gather times one data, elevated scores, especially on the MCMI could have been due to conditions in the participant�s experience that existed prior to joining the group.� To address this, the 111 participants were sent another MCMI six months after treatment.� Fifty-nine and one-half percent returned the materials.� Participant scores decreased on the �Histrionic, Narcissistic, and Anti�social Scales increased, and scores on the Schizoid, Avoidant, Dependent, Negativistic Aggression, Schizotypal, Borderline, Anxiety, Somatoform, Hypomania, Dysthymia, Alcohol Abuse, Psychotic Thinking, and Psychotic Depression scales.� The greatest decline from pre- to six months post-treatment was on the Dependent (Submissive), Anxiety, and Dysthymia subscales.� Before treatment, on these three scales 58.2, 52.2, and 47.8% had scores greater than 75 on the MCMI, respec�tively. After six months, only 28.4, 26.9, and 25.4% of participants had scores greater than 75 on the Dependent (Submissive), Anxiety, and Dysthymia subscales of the MCMI, respectively.

�� These results indicate those ex-members of cults who seek treatment at Wellspring after leaving the cult exhibit clinically significant symptoms.� Six months after a two-week treatment program they report significant improvement.� This is significant particularly in that the MCMI is designed to assess personality disorders, conditions that, by definition, change little over time.� Indeed, the Millon inventories have been shown to be fairly stable over time (Hyer, Woods, Gruno & Boudewyns, 1989). Martin et al. (1992) concluded that the six month scores indicate that the admission scores did not indicate long-standing personality traits, but that the environment of the cult tends to �produce and/or exacerbate dependent-compulsive types.�

�� Martin, Aronoff, Zelikovsky, Malinoski, and Lynn (1996) conducted a fol�low-up to the earlier Wellspring study. They assessed 110 different Wellspring clients.� They found that participants� highest means were on the Dependent (Submissive) (71.54), Self-Defeating (73.65), and Avoidant (74.97) subscales of the MCMI. Eighty-seven percent (87%) had elevations (>75) on at least one scale.�� The mean HSCL score was 112.78, well over 100, the level where psychiatric care is indicated.� The mean score on the BDI was 19.77, where scores of 17 or more suggest a depressive dis�order. These results were essentially identical to the initial study.

�� Aronoff et al. (2000) note that the MCMI was constructed using a comparison group of psychiatric patients, not a non-clinical group, and its use in this case could be questioned.� They also note, however, that the other two measures support the same conclusion.

�� This review suggests that former members of cults report significant symptoms and current members do not. Aronoff et al. (2000) proposed several alternatives to explain this apparent difference.� First, it was only after leaving the cult that former members fully realize the effects of their involvement. (Conway & Siegelman, 1982; Conway, Siegelman, Carmichael, & Coggins, 1986; Galanter, 1983; Martin et al., 1992; Swart�ling & Swartling, 1992).�� Second, those who leave a system to which they had completely committed will experience distress when facing the loss of faith and when attempting to adjust to life without the group.� (Galanter, 1983).

�� A stressful family background was associated with involvement in a cult (Ash, 1985; Deutsch & Miller, 1983; Nicholi, 1974; West & Singer, 1980).� The cult serves as a replacement family and when members leave the feel stress upon return to the family of origin. Maron (1988), on the other hand, found that family background was not a likely factor in cult involvement.

�� Individuals still in a cult may underreport symptoms� (Ayella, 1990; Swartling & Swartling, 1992). Individuals who have left a cult my exaggerate or fake symptoms. Self report measures used in studies do not have subtle items and validity indices raising questions about the veracity of ex-member reports (AyeIla, 1990).

�� The last explanation, that ex-members are faking, was found by Aronoff et al. (2000) to be addressed in the literature three different ways.� Conway et al. (1986), Singer & Ofshe, (1990) and Spero, (1984) stated that ex-members were often angry at the group and its leaders.� They might be motivated to fake or exaggerate their reports of symptoms in order to exact revenge on the group.

�� Bromley, Shupe, & Ventimiglia, (1983), Coleman, (1984) Galanter, (1983) Lewis & Bromley, (1987), and Solomon, (1983) alleged that contact with organizations that support ex-members of cults and their families subtly pressure them to report higher levels of pathology.

�� The generally negative view that the public has of cults (Anthony & Robbins, 1992; Barker, 1995; Lewis & Bromley, 1987; Robbins & An�thony, 1980; Saliba, 1999; Shupe, Bromley, & Oliver, 1983) might persuade ex-members to go along with society�s views, finding it in their best interest to make their experiences seem as bad as the public perceives them to be.�

�� Aronoff and Lynn (1996) addressed these issues by assessing not only ex-members (n=45) of cults but also 58 college students who presumably would be aware of the public�s negative view of cults.� The college students were given the same battery of instruments as the ex-members and told to simulate how they thought cult members would answer the items.� In addition the investigators included a control group of 56 college students who were told only to answer the items honestly.� In general, simulators reported more extreme scores than actual former members indicating it is unlikely that ex-members are faking their answers.� In addition, ex-members scored higher on the battery than non-simulators, the control population. �

Concerns With Studies With Former Members

�� Studies of ex-members of cults indicate that they experience significant emotional symptoms.� The general use of nonstandard measures, lack of control groups and possible experimenter bias suggests caution in interpreting these results.� Some of the experimenters were themselves former members of cults and might have been more supportive of those who reported negative experiences (Aronoff et al. 2000).�

�� Another concern with studies of ex-members is that most participants have presented themselves for treatment some time after leaving the group.� Random or even representative sampling was never achieved. Ex-members in treatment could hardly be considered a representative sample and studies using them would tend to have exaggerated results.

Trauma and Cults

�� The literature on psychological trauma adds much to a perspective on cult dynamics. Trauma� is usually thought of as an assault on the emotional and cognitive resources of the human organism by an overwhelming stressor. Examples include experiences and behaviors as a result of situations in which the individual perceived his or her life was in eminent danger such as war, automobile accidents, and natural disasters. (DSM-IV 1994). Others (Herman 1992b, van der Kolk 1995, Lourie 1996), extend the study of trauma to situations where the individual s conception of a predictable world is shattered. Here is where the study of cults and psychological trauma meet in the literature.

�� Van der Kolk (1995) maintains that human reaction to psychological trauma is the result of specific biological changes that occur in the brain in response to overwhelming stress. Using Vietnam-era veterans as subjects, he and others discovered a link between the reenactment of trauma in recall of memory and the release of endorphins, explaining a phenomenon of emotional numbing reported by survivors from across a large spectrum of trauma. From there, a study of the entire CNS response to overwhelming stress began. Studies were extended to survivors of other forms of trauma.

�� van der Kolk observed that interpersonal trauma is more insidious and more damaging that trauma from accidents and disasters. Trauma sustained in childhood is more difficult to recover from as an adult than trauma suffered as an adult. Trauma inflicted by a supposed caring relative or friend is more difficult to recover from than fires or floods (Lourie 1996). When the source of the trauma is evident and the blame is obviously on the perpetrator the victim is often better able to reconstruct a safe conception of the world and integrate the experience than the victim who is unsure of what happened. They usually conclude they have only themselves to blame.

This discussion will focus on interpersonal trauma, given that at least some emotional responses are common to all forms of trauma. (van der Kolk 1995). Lourie (1996) describes the phenomenon of cumulative trauma where no single event can be called overwhelming but taken together, the effects experienced and described by the victim are pretty much the same. Her construct agrees roughly with Herman�s (1992a) description of chronic trauma. If membership in a cult is a form of trauma (Herman 1992a; Singer & Ofshe, 1990), cognitive impairment might be a risk factor.

Summary and Conclusions

Strengths and Weaknesses of the Literature

�� A great deal of anecdotal and informed opinion material has been published over the last 30 years.� Empirical studies provide conflicting impressions of the effects of a cultic environment which should not be surprising given the weaknesses explored in this review.

�� Instruments used were usually of questionable validity and reliability (Aronoff et al., 2000).� Difficulties of access to subjects for study makes time zero data almost impossible to gather.� Possible response bias of current members in favor of their groups and of ex-members against their former group warns that caution is warranted in interpreting results.� Experimenter bias could be a factor, especially in ex-member studies are carried out by investigators who are themselves, ex-members. The results of studies of research participants who have presented themselves for treatment may not be easily applicable to all ex-members of cults. In only one study was a relevant control group utilized complicating interpretation of the results.

�� While results differed on whether members of groups are emotionally healthy, clearly some ex-members exhibit significant pathology that cannot be accounted for by pre-existing factors.� No studies were found that conclude that membership in a cult has long term, positive effects on those who leave.�

The Proposed Research

�� This study could not possibly overcome all these obstacles.� Data was gathered from ex-members who sought treatment, limiting the applicability to the larger population of ex-members.� Some of the weaknesses of other studies were addressed in gathering data. Data will be utilized in a way that addresses the problem of response bias in the recollections of ex-members.

�� One of the largest problems, that of definition (Aronoff et al., 2000) will be solved by using already collected GPA scores as a measure of exposure to a cultic system.�� This study addresses their recommendation to operationalize the definition of a cult.� This study uses individual GPA scores as a measure of cultic milieu/thought reform intensity, eliminating the need to identify and label specific groups as cults.� Several of the instruments used by Wellspring were standard measures with known psychometric properties.� Only those instruments will be used in this study. No control group will be used since the norming populations of the instruments are known.

�� This study will use Wellspring client scores on the GPA and the NIS to determine what effect, if any, exposure to a cultic environment has on cognitive impairment. It will use test-retest scores on the GPA to attempt to control for response bias.� Two measures of emotional state, the BDI and the HSCL (dissociation screen only) will be used to control for emotional contribution to elevations if any, in NIS scores.

How the Literature Supports the Need for This Study

�� It has already been observed that relatively few empirical studies have been conducted on current or former members of cults. Clearly, far more are needed.� Studies reviewed for this study focused on emotional symptoms, i.e., depression (West & Singer, 1980; Wright and Malony, 1989), anxiety� (Singer & Ofshe, 1990), and dissociation (Goldberg & Goldberg, 1982; West & Martin, 1994; West & Singer, 1980), but few (Goldberg & Goldberg; Spero 1984) investigated cognitive issues.� Goldberg and Goldberg did not present their work as empirical research, only as clinical impressions from their extensive work with of ex-members. Spero (1984) did not have a known measure of cultic environment intensity to factor into his results with cognitive measures, nor did he have a self report measure of cognitive impairment that could be given to large numbers of participants.

Chapter III

Methodology

The Sample

�� The sample for this study originally included 132 ex-members of groups or relationships identified by a group evaluation instrument to be former members of groups that were high demand, and very likely to be using the thought reform techniques defined in the first chapter.�

�� The age of these individuals was between 16 and 65 with a mean of 33.14 years (SD= 11.2). Forty-three were male and 88 were female. Eighty-six had been members of groups that used the Bible in some way as a basis for belief or practice. Twenty-six were ex-members of groups that embraced a predominately Eastern worldview.� Thirteen had been in abusive relationships or families that fit the admission criteria. Their scores were analyzed for differences from those of ex-members of groups.� Four had been in either abusive adolescent substance centers, or extremist political or business related groups. Two did not answer the item.

�� The average number of years of formal education was 14.69, that is, over two years of college.� One hundred twenty-two were Caucasian and five were African American four were either Asian American or other and one did not answer the item.� The income level most often recorded was zero.� No consistent reason for this was available.� The mean annual income for those reporting an income was $46,218 (n = 90). Socioeconomic status for the client�s families of origin was not available, due to their age (33.14).� The religious backgrounds indicated by those in the sample included 30 (Protestant� fundamental), 35 (Protestant liberal), 27 (Roman Catholic), 6 (Jewish), 0 (Islamic), 2 (Eastern), 2 (reared in group), 7 (other), and 3 (none).� These demographic data are subject to change as the study progresses.

�� All were entering treatment at Wellspring Retreat and Resource Center for what they felt were after effects of their experience in the group or relationship.� All entered treatment voluntarily and signed a statement to that effect before testing.� No clients were referred by courts or other agencies. The fee for residential treatment at Wellspring is $5000 for the two week program. At the time, Wellspring attempted to negotiate with some client�s insurance carriers for treatment but very few who had insurance were covered for residential treatment. The administrative staff estimated that about one half of all clients at the time of data collection paid for their treatment with their own or their families� resources and the other half were treated using funds raised from donors.

�� Clients of Wellspring are screened over the telephone and thorough examination of counseling records of referring professionals to include only those individuals who have experienced some form of perceived psychological trauma perpetrated by another person. Survivors of general combat situations, accidents, or natural disasters, would not be considered appropriate for admission, even though they had experienced trauma.

�� Cases involving a single abusive episode followed by some form of resolution are not considered appropriate for admission.� All clients who are admitted report having experienced repeated emotional injury and being led to believe that it was their own fault or for their own good.

�� Clients arrived at Wellspring each Sunday evening and received the test battery on Monday morning. They completed the battery over the first few days after arrival.� Batteries not completed by the end of the third day of treatment were not included in this study. Participants were included in the final count for the sample if all measures were completed.� The sample was gradually accumulated at the rate of one or two each week from November 1996 to September of 2000.

All individuals were offered three options. They could complete the battery and sign a consent form to include their data in this study.� Second, they could complete the tests for their own benefit and to provide information to their clinicians but not for use in this study, or, third,� they could elect not to take the battery at all.

�� All were informed that only their clinician would have access to their profile for treatment purposes and, at their request, would be glad to go over the profile with them.� They were told the study would not make use of their names and that only their answers and non- identifiable demographic data would be used by researchers other than their clinician.

�� Policy at Wellspring requires that client test profiles and completed batteries be kept with the individual�s medical record in a locked cabinet.� All computer scoring files containing names are kept under password control. Only aggregate results are reported in this study and any reference to specific individuals will be by an arbitrarily assigned test battery number.

The size of the sample was determined by the number of cases available at the time of this writing. The literature surveyed indicated that the effects of cultic involvement, while taken as a whole, are sometimes debilitating for the ex-member, any single, discrete effect is likely to be subtle (Martin, et al. 1992). Therefore, the effect, if any, of exposure to a cultic system on cognitive impairment is likely to be small.� Of course, a small amount of cognitive impairment could present serious problems in higher-order decision making. In order to minimize the likelihood of making a Type II error, that is to maximize the possibility of finding a difference if there is one, considerable statistical power must be available in the analysis (Stevens 1996).�

�� Due to the controversial nature of this research, Type I error, saying that involvement with a cult is correlated to cognitive impairment, when it is, in fact, not related, must be avoided.� This study used an� " level of < .05. The program R2 by Steiger & Fouladi was employed and it indicated that with five variables, "� < .05, an assumed D² =.1, a sample of 132 should yield a power of .86018, sufficient for determining correlation.

Data Collection

�� This study examined a small part of a battery of tests that is given to individuals entering treatment at Wellspring.� Those instruments relevant to this study were:

1)�� A consent form to be signed by the individual indicating his or her participation in the study found in Appendix B.

2)�� A demographic questionnaire found in Appendix C.

3)�� A battery of tests assembled by the Ohio University Department of Psychology in cooperation with the director of Wellspring Retreat and this researcher.� It consisted of ten instruments and is included� in Appendix D. Three were used in this study:

�� a.�� Hopkins Symptom Checklist dissociation screen

�� b.�� Beck Depression Inventory

�� c.�� Group Psychological Abuse Scale

4)�� In addition to the Ohio Battery, the Neuropsychological Impairment Scale was also administered.

�� It generally took participants an average of about 2.5 hours to complete all the items on the full battery.�

�� In addition, all individuals were given, among other instruments, the following at discharge, ten days to two weeks after competing the intake battery:

�� 1)�� Hopkins Symptom Checklist dissociation screen

�� 2)�� Beck Depression Inventory

�� 3)�� Group Psychological Abuse Scale with one additional item: �How do you think your perceptions of concern about your group have changed since beginning treatment?�� The same five factor scale was used with the headings �much less, less, about the same, more and much more.�

�� Scores on the Group Psychological Abuse scale and the Neuropsychological Impairment Scale were used to explore the relationship between intensity of group dynamics and cognitive disruption in ex-members.�

�� The Ohio University Institutional Review Board granted exemption for using data collected in the past under its auspices and is included in Appendix A. Administration of the Neuropsychological Impairment Scale was not included in the original IRB proposal.� It is an extension of a program of research that predated the Ohio University study.� Wellspring adhered to Codes of Ethics and Standards of Practice, American Counseling Association (1995) guidelines G. 1. through G. 3. And Ethical Principles of Psychologists and Code of Conduct, American Psychological Association, 6.06 through 6.19 with regard to the administration of this instrument.�

�� Permission to use the Group Psychological Abuse Scale was granted by the authors and a sample appears in Appendix D.� Copies of the Neuropsychological Impairment Scale were purchased from the publisher, Western Psychological Resources.� Due to copyright restrictions, it does not appear in the Appendices.�

Operational Definition of the Variables

�� The principle self report measures that were the focus of this study included the Group Psychological Abuse scale, noted above as the operative definition of exposure to a thought reform system and a measure of its intensity.� For this study, it is used to measure the degree of exposure to cultic environment or �Thought Reform Intensity.�� The Neurological Impairment Scale, also noted above is this study�s operational definition of cognitive impairment.� It is used in this study to measure the degree of cognitive impairment the ex-member experiences. Depression as a variable for this study is defined as elevated scores on the Beck Depression Inventory.� Dissociation is defined by elevations in scores of a 14-item addendum to the Hopkins Symptom Checklist.�

Instrumentation

Group Psychological Abuse Scale (GPA; Chambers. Langone, Dole & Grice, 1994 Appendix D). The GPA is a 28-item scale that seeks to examine four factors associated with abusive group environments: compliance, exploitation, mind control, and anxious dependency.� It was developed as an attempt to differentiate between groups that use practices or combinations of belief and practice that seem to be associated with deceptive persuasion techniques and those groups that do not. In the GPA, participants are asked to respond to each item in a sense of how characteristic it would be of their group.� The items are scored on a 5-point scale ranging from Not at All Characteristic (1) to Very Characteristic (5).� Total scores range from 28 to 140.� The GPA�s four subscales: Compliance, Exploitation, Mind Control, and Anxious Dependency are totaled to arrive at a Summary scale.� This scale was utilized in this study.

�� The GPA is a narrowly focused instrument, designed solely for members and ex-members of groups suspected of using thought reform techniques and there is little information available on its reliability and validity.� Internal consistency ranged from .70 on the Mind Control scale to .81 on the Compliance and Summary scales.� To determine the criterion validity of the GPA, The authors compared the scores of former members of groups suspected of being cultic to the arithmetic midpoint of each of the subscales and the Summary scale.� Former members of cultic groups scored higher than the midpoint on all scales and significantly higher than the midpoint on the Summary scale.� Langone. (1999) found that former members of the Boston Church of Christ, a group alleged by its ex-members to have cult-like tendencies, scored higher on the GPA Summary scale than former Catholics or former members of the InterVarsity Christian Fellowship, a much smaller group considered to be an intense but innocuous campus ministry.� The instrument seems to have concurrent criterion validity, that is, it is capable of fulling its purpose for this study, to provide a means of differentiation between the experiences of ex-members of cults from those of ex-members of other groups.

�� Neuropsychological Impairment Scale (NIS; O�Donnell, et al., 1994a). The NIS is a self-report measure of neuropsychological symptoms.� Its authors represent it as a screening instrument to aid in the identification, treatment and identifying progress in rehabilitation after brain injury, disease or stroke .

�� The NIS contains 95 items.� Five measure test taking attitudes, ten measure affective disturbance and 80 describe symptoms.� It provides three summary measures, the Global Measure of Impairment (GMI), the Total Items Circled (TIC), and the Symptom Intensity Measure (SIM).� Four Validity Checks are provided: Defensiveness (DEF), Affective Disturbance (AFF), Response Inconsistency (INC), and a Subjective Distortion Index (SDI). The SDI is only calculated when the client�s WAIS-R Digit Span and Digit Symbol scaled scores are available.� It is a comparison between the level of impairment that is expected based on these measures of performance and the level of symptoms reported on the NIS and will not be used for this study .

�� Seven areas of impairment are measured on subscales: Critical Items (CRIT), Cognitive Efficiency (COG), Attention (ATT), Memory (MEM), Frustration Tolerance (FRO), Learning-Verbal (L-V), and Academic Skills (ACD).�

�� Split-Half reliability of the first 40 and the last 40 neuropsychological items when corrected for attenuation was .93.� Internal consistency Cronbach�s alpha coefficients for a non-clinical norming sample were .79 and .86 for the neuropsychiatric patient sample. Test-retest reliability, using four groups of 25 college students was found to range from .64 on the DEF scale to .98 for GMI scores (O�Donnell, et al., 1994a).� It is the GMI scale that is the primary interest in this study.

�� Construct validity was determined by scale intercorrelations and factor analysis.� The highest correlations were between COG and GMI.� For this reason, this study defines cognitive impairment as GMI scale scores. The percentage of variance in GMI scores explained by factor analysis for patients was 41.6% and 33.4% for the non-clinical sample, indicating the GMI scale can discriminate between clinical and non-clinical populations.� The largest share of the variance was found to be related to items from the COG, ATT, MEM, L-V and ACD scales (O�Donnell, et al., 1994a).

�� Criterion validity for the NIS was explored using the Halstead-Reitan, the Trail Making Test B, the Performance IQ and the Trail Making Test A, the Wechsler Memory Scale�s General Memory Index and the WAIS-R Full Scale IQ.� Once again, the GMI was the most highly correlated with the performance tests (O�Donnell, et al., 1994a).�

�� These qualities of the NIS, and particularly of the GMI subscale led to its selection to test the hypothesis that exposure to a thought reform system is related to impairment in cognitive ability significant enough to appear as a separate factor in addition to depression, anxiety, and dissociation measured on the Ohio battery.� The NIS also attempts to determine if there is an emotional contribution (AFF) to low or high scores.�

�� The NIS has been used in the literature in similar ways to this study.� Losasso, (1999) used the NIS to evaluate the effects in women of exposure to solvents in their workplace as nail technicians.� Like this study, Losasso�s experimental design did not include pre-exposure administration of the instrument.� She did not test the women before commencing work.� She compared scores of workers with a control group and found significant differences in cognitive efficiency, memory and learning deficits.

�� Avants, et al. (1997) administered the NIS to 120 cocaine-dependent, methadone-maintained patients, about half of whom were HIV positive.� Those who were HIV seropositive reported significantly more impairment than HIV-seronegative patients even when controlling for demographic and substance use variables.

�� Errico, Nixon, Parsons, and Tassey (1997) found the NIS was more related to emotional distress in 73 male alcoholics undergoing treatment, than actual cognitive impairment.� The authors of the NIS, O�Donnell, DeSoto, Desoto, and Reynolds, (1994b) previously found that abstinent alcoholics reported mild cognitive impairment that eventually reached the normal range as recovery continued.� While they reported correlation with affective factors, they felt they were measuring cognitive impairment in recently detoxified alcoholics that faded with continued abstinence.� Braggio, Pishkin, Parsons, & Fishkin (1991). found NIS scores of essential alcoholics were significantly higher than those of reactive alcoholics.��

�� Due to the confounding nature of affect in determining cognitive impairment shown in the literature, the following instruments will be used to control for emotional state in addition to the NIS�s internal Affective Disturbance Scale (AFF).

�� Hopkins Symptom Checklist Dissociation Screen (HSCL; Briere and Runtz, 1990). Briere and Runtz developed this 14-item checklist to augment the Hopkins (Derogatis, et al., 1974).� Respondents were to choose a number from one (not at all) to four (extremely) indicating the intensity of their experience.� They found that this instrument had internal consistency (a=.85 and .90).� The mean was 20.95 (SD=5.80). This score was used as a �norm� for this study.� Scores more than one standard deviation above the mean were considered �above average.�� The authors found that scores correlated with childhood histories of both sexual abuse (r= .14, D < .007) and physical abuse (r = .23, D < .001). They found further that scores were congruent with the dissociation scale of the standard HSCL.� In this study, the 14-item screen, not the original full checklist is referred to as HSCL.

�� Beck Depression Inventory (BDI). The BDI was recently reviewed by Richter, Werner, Heerlein, Kraus, and Sauer (1998). They found using meta‑analyses of studies on its psychometric properties, that its shortcomings were its high item difficulty, its lack of representative norms, calling into question the objectivity of its interpretation, factorial validity problems, instability of scores over short time intervals (over the course of one day), and poor ability to discriminate against anxiety. Its advantages were its high internal consistency, high content validity, and especially for the purposes of this study, its validity in differentiating between depressed and non-depressed subjects, and its sensitivity to change. The average length of time between administrations in this study was ten days, well out of range of its reported instability problems. In spite of its many limitations, it remains useful in distinguishing level of depression.� That strength made it useful for this study.

Research Hypotheses

This study intended to determine the correlation, if any, between the intensity of the thought reform environment to which the ex-member is exposed, measured by the GPA, and the degree of subsequent cognitive impairment experienced by the ex-member, indicated by the NIS.� The research hypothesis is:

Research hypothesis: There is significant correlation between intensity of thought reform environment as measured by the GPA and cognitive impairment as measured by the NIS.�

�� Two additional factors need to be considered for the results to be meaningful.� First, it is necessary to establish some rationale for accepting the veracity of ex-member recollections (GPA scores) since so much has been written accusing them of being �disgruntled� and �disillusioned� and therefore apt to confabulate about group conditions (Wright & Malony 1989). Second, since affect has had a confounding effect on studies using the NIS in the literature, (Errico, et al. 1997) the contribution of affect relative to GPA scores on variation of NIS scores should be taken into account.

�� To address the first factor, it was assumed that individuals in treatment at Wellspring, hearing about thought reform processes and influence techniques and after living in an environment where support was available for nearly any story about the individual�s former group, would influence ex-members to judge their former group more severely than they had at intake.� In order to test the stability of the GPA in quantifying ex-members� recollection of conditions in their groups, the modified GPA described above was administered at discharge.

Two weeks of being in an environment completely supportive of their essentially negative view of the group and learning about negative processes that they are encouraged to apply to their group should substantially increase ex-member�s scores on the GPA.�

�� To investigate this hypothesis, paired sample t-tests were performed using pre- and post-treatment GPA scores.� If this research hypothesis was supported, it would be less likely that ex-member�s initial scores would actually represent what they experienced in the group. On the other hand, if the null hypothesis was supported, i.e. there is no difference between before and after treatment scores, the ex-members� scores are more likely to reflect actual experiences in the group.

�� To address the second factor, the approximate emotional state of the participants was determined at intake.� Depression and dissociation, symptoms often observed in ex-cultists (Goldberg & Goldberg, 1982; West & Martin, 1994; West & Singer, 1980), might also influence NIS scores.��

The emotional state of the ex-member will have an effect on NIS scores.� The level of depression (BDI scores) and/or dissociation (HSCL scores) will be the primary contributors to a measure of cognitive impairment (NIS scores.)

�� To investigate these hypotheses, multiple regression will be performed to determine the relative contribution of each variable, GPA, BDI, and HSCL scores, to the variance in NIS scores.� If this second research hypothesis is not supported, meaning that GPA scores are a major contributor to variance in NIS scores, any correlations discovered in the first part of the study will have more meaning.

Design of the Study

�� This study used the BDI, HSCL, GPA and NIS scores at intake and GPA scores at both intake and discharge.� After each individual completed all the instruments and the demographic survey, the batteries were scored by this investigator on a Corel Quattro Pro 7 spreadsheet designed by this investigator.� Scores were loaded into the statistical software program Statistical Package for Social Sciences (SPSS; 9.0, Norusis, 1998) to take advantage of its superior graphic and analysis procedures.

�� Means for the GPA and the NIS will be determined and compared to the cut-off scores of 84 and 60, respectively.� Pearson correlations will be calculated to explore the relationship between the two variables.�

H_A1: Both GPA and NIS scores will be elevated.� Further, Pearson correlations will indicate, with significance at the < .05 level, a zero-order correlation between GPA and NIS scales.

H_O1: GPA and NIS scores will not be higher in ex-members than in the norming� sample used by the test�s authors.� There will not be a correlation between NIS and GPA scores.��

�� Paired sample t-tests will be used to examine the effect, if any, on GPA scores before and after treatment.

�� H_A2: GPA scores will change, two-tailed, with significance at <.05 indicating that treatment has an effect on GPA scores.�

�� H_O2:: Treatment at Wellspring will have no effect on GPA scores.

�� Using a hierarchical approach, the variables BDI, HSCL, as a group, will be regressed on to NIS scores.� The GPA will then be entered into the regression, to examine the relative contribution of each variable to the variance in NIS scores.

Ha_3:�GPA scores will best explain or account for the most unique variance in NIS scores.

�� Ho₃: BDI, HSCL will have a confounding effect on NIS scores.

Summary

�� In chapter III, the process of data gathering and the instruments used in this study was discussed. The sample consisted of 132 clients of Wellspring Retreat and Resource Center.� All had been screened before being admitted to treatment to insure their experiences and symptoms were appropriate for the Center�s program emphasis.� Of all respondents, 123 completed all the instruments in first part of this study.

�� Data for this study was drawn from their scores on the Neurological Impairment Scale, the Group Psychological Abuse scale, with the Beck Depression Inventory and the Hopkins Symptom Checklist dissociation screen used to control for emotional state.� Scores on the GPA and NIS were evaluated for any correlation.�

�� The GPA was given before and after treatment.� Independent t-tests were used to examine the influence of treatment on participants� recollections of conditions in the group.

�� Multiple regression was used to examine contributing factors (BDI, HSCL, GPA) to variation in NIS scores.�

Chapter IV

Results

Descriptive Analyses

�� As presented in chapter III, the sample for this study included 132 ex-members of groups or relationships identified through a screening interview to be ex-members of cults, that is, groups that were very likely to have used the thought reform techniques defined in the first chapter.� Participants participated voluntarily in the study. They were given the option to allow the scores on their intake and discharge tests to be included in the study or to be used only in their treatment. They could also elect not to take the instruments at all.

�� Demographic material was obtained for all participants on age, gender, ethnicity, educational level, annual income of family of origin, religious upbringing, and nature of group.� Raw scores were recorded from each item and means, standard deviations, and frequency counts were computed. All analyses were performed using Norusis� Statistical Package for Social Sciences (SPSS, Release 9.0.0, 1998). The sample used for the analysis of means and correlations, as well as affective contribution to elevated NIS scores, included only those participants who completed all items (n = 123).� The sample used for analysis of pre- and post-treatment GPA scores used the same criteria (n = 117).� These values are indicated in Tables 1 and 1a below.� Note that the NIS subscale designation GMI is used in tables and graphs.

�� Missing cases (132 - 9 = 123) were due to participant failure to respond to items.� No participant failed to respond to all items.�

�� The mean age of participants in the this smaller sample than that presented in chapter III, was 33.00 years (SD = 11.31) ranging between 16 and 65. Males numbered 39 and females, 84. Ethnicity of participants was as follows: 113 were Caucasian (91.9%), 5� (4.1%) were African American, 4, (3.2%) reported either Asian American or �other� and 1 (.8%) did not answer the item.� Mean years of formal education was 14.68 (SD = 2.65).

�� The income levels varied from 0, reported by 29 participants to $150,000, reported by 2 participants. The item was left blank by nine participants.� No consistent reason for this was available.� The mean annual income for those 85 participants reporting an income greater than zero was $44,290.� This analysis uncovered a problem with the wording of the item.� The questionnaire was prepared with the expectation of a younger demographic that would have reported their parent�s income.� For older participants, the item was not clear whether the response should indicate the participants� income or that of their family of origin. Figure 1 indicates that annual incomes were skewed toward the lower end.� The graph includes those 29 participants who reported an income of zero and it indicates that about 40 respondents reported incomes below $20,000.� Religious backgrounds of participants included 27 who endorsed Protestant� fundamental (22%), 32 Protestant liberal (26%), 26 Roman Catholic (21%), 4 Jewish (3%), 2 Eastern (2%), 25 other (20%), 2 reared in group (2%)� and 5 none (4%). Figure 2 provides a visual representation of these data.

Figure 1. Income of Participants

Figure 2. Religious Background

�� The demographic survey item �Group Type� permitted the following responses:� (a) those groups that used the Bible in some way as a basis for belief or practice (83), (b) those that embraced a predominately Eastern worldview (23), (c) those participants who had been in abusive relationships or families that fit the admission criteria (13), �other,� i.e. adolescent substance centers, or extremist political or business related groups (4) and (d) One participant did not answer the item.

Means and Correlations

�� The mean of ex-member scores on the NIS was 61.2 (SD=11.63).� According to the manual for the NIS (O�Donnell, et al, 1994a), this score indicates a level of cognitive impairment above the normal range. Scores of 70 or more indicate significant impairment, and 75 participants (61%) scored over 70.� Figure 3 is a histogram of NIS GMI subscale scores that indicates the distribution was skewed by� the very large number of scores in the vicinity of 70.� Internal consistency was extremely high ("=.99).

�� Mean score on the GPA was 102.4 (SD = 18.49).� The authors of the instrument (Chambers, et al, 1994) propose that scores above 84 are likely to be indicative of a thought reform system. This study found that 11 participants scored below 84 (10%) and 112 participants (90%) scored 85 or over.� The line on Figure 4, a histogram of GPA scores, indicates a normal distribution. Internal consistency was moderately high ("=.78)

�� Ns of both measures were 127.

Figure 3. Histogram of scores on the NIS-GMI subscale

Figure 4. Histogram of Group Psychological Abuse scores

�� A Pearson correlation of .24 (p=.007) was found between NIS and GPA scores (Table 6).� The null hypothesis is, therefore, rejected in favor of the research hypothesis: there was a positive correlation between intensity of thought reform environment as measured by the GPA and cognitive impairment as measured by the NIS. Bartlett�s test of sphericity was significant (p=.001)

Pre- and Post Treatment GPA Scores

�� In an attempt to establish the veracity of the recollections of ex-members vis-�-vis conditions in their respective groups, paired-sample t-tests were used to measure reports of conditions in their groups before and after treatment. Mean of GPA scores at intake was 103.26 (SD = 18.32) and at the conclusion of treatment it was 106.43 (SD = 16.45), (n = 106).� A correlation, .798, was found between intake and discharge GPA (p<.000) scores.�

�� Paired samples t-test results, t = -2.92, p = .004, d = -0.18, supported the research hypothesis that treatment did have an effect on ex-member recollections of conditions in their groups.� The paired samples t-test was prepared using only those participants who answered the measure both at intake and discharge (n = 106).� This difference appeared to be due to oversight by staff. No participants refused to answer discharge materials when presented to them.

Affective Contribution

�� Mean and standard deviation of the NIS�s internal AFF scale, the BDI and the HSCL were 62.85, 29.33, and 19.58 (SDs = 12.60, 9.77, and 11.56 respectively).Zero-order correlations between the predictors and the NIS are reported in Table 2 to provide a basis for evaluating the results of the regression process reported in Table 3 (Model 1 R² = .574. Model 2 R2 = .660).

��

Table 1

Zero-Order Partial Correlation Coefficients

�� HSCL�� BDI�� GPA�� NIS

HSCL�� 1.0000�� .6620�� .2620�� .7576

�� P= .�� P= .000�� P= .003�� P= .000

BDI�� .6620�� 1.0000�� .2959�� .7209

�� P= .000�� P= . �� P= .001�� P= .000

GPA�� .2620�� .2959�� 1.0000�� .2431

�� P= .003�� P= .001�� P= .�� P= .007

NIS�� .7576�� .7209�� .2431�� 1.0000

�� P= .000�� P= .000�� P= .007�� P= .

________________________________________________________________________

(Coefficient / (D.F.) / 2-tailed Significance)

Table 2

Coefficients of Measures of Affect and a Measure of Thought Reform

		Unstandardized Coefficients	�� Standardized �� Coefficients
�Model�� B�� Std. Error�� Beta�� t�� Sig.�
1	(Constant)	35.861	2.014	�	17.810	.000
�	HSCL	.602	.086	.499	7.024	.000
�	BDI	.392	.071	.391	5.496	.000
2	(Constant)	36.064	3.778	�	9.545	.000
�	HSCL	.602	.086	.500	6.971	.000
�	BDI	.393	.073	.391	5.405	.000
�	GPA	-2.269E-03	.036	-.004	-.064	.949

a� Dependent Variable: NIS

��

�� GPA did not contribute to variation in NIS when controlling for HSCL and BDI. Observed power was a concern in the discussion of sample size in chapter III.� The sample used above was somewhat smaller, 122, due to missing cases. However, this sample size enabled this study to find a significant multiple correlation or R.�

Post Hoc Analysis

�� The research hypothesis for this study was that Group Psychological Abuse (GPA) scores would be the primary predictor of Neuropsychological Impairment Scores (NIS) among possible confounding variables such as measures of affect.� Instead this analysis indicated that GPA was not related to NIS among measures of affect.�

�� Several participants in this investigation (13) had been in relationships that fit the admission criteria for treatment.� Table 4 presents the means of this group and those of the remainder of the sample (110).� No differences between this group and the other participants was detected when comparing HSCL, BDI, and NIS.� GPA scores were lower in this group, and that difference was found to be statistically significant (p = .03).� Four participants in this group scored below 84 on the GPA.

�� During the course of this investigation, it appeared that other important associations might exist between NIS and GPA.� To this end, a clustered boxplot (See Figure 5 in Appendix F) was prepared using the GPA cutoff score of 84, differentiating between those participants who had been exposed to a thought reform environment and those who were not so exposed, as the discriminant variable .
Table 3�

Comparison of Mean Scores of Participants in Abusive Relationships

Group Type�� HSCL�� BDI�� GPA�� NIS��

Abusive Relationships� �� 29.75�� 18.75�� 92.25�� 60.92��

Groups�� 29.33�� 19.58�� 102.7�� 61.20

t�� .131�� -.174�� -2.172�� -.179

Sig. (two-tailed)�� .896�� .863�� .032�� .859

�� Standardized, or z, scores, were used to compare variances since scales for the variables differ.� The two groups were very different in size (n = 12 vs. n = 111) since the population was screened to increase the likelihood that those treated at Wellspring would

be from thought reform systems.

�� NIS scores differed by nearly one standard deviation between those 12 participants who did not score above 84 on the GPA, i.e. did not indicate they had experienced a thought reform system, and those who scored 85 and above.

Summary

�� Means and correlation between participant�s level of reported cognitive impairment and level of exposure to thought reform were presented.� A measure of thought reform correlated with a measure of cognitive impairment.� Paired sample t-test results were presented indicating treatment may have been a factor in changes in participant report of their individual cult experience.

�� Statistically significant zero-order correlations were indicated between all variables in the study.� The relative contribution of depression and dissociation, as well as thought reform exposure, to variation in cognitive impairment scores was analyzed using linear regression. Measures of affect were shown to have a more unique contribution to variation in a measure of cognitive impairment than a measure of exposure to thought reform. The results of further power analysis necessitated by the decrease in sample size found while analyzing missing cases were presented. Sufficient power for some analyses was determined, but power may not have been sufficient for the multiple regression performed in this study, due to the relatively small amount of variation in GPA scores.

�� Further investigation prompted by the proposed research was reported, including preliminary discriminant analysis using cut scores developed by the authors of the instruments, to investigate whether the differences between group means might be remarkable. A boxplot of z-scores indicated that significant differences existed between a group of participants exposed to levels of thought reform above the cutpoint and a group exposed to levels below the cutpoint.

Chapter V

Discussion of Implications, Conclusions and Recommendations

Overview

�� This chapter summarizes the study, and the findings presented in the last chapter, that investigated a possible relationship between thought reform and cognitive impairment.� Issues raised in chapter II Review of the Literature are discussed in light of these findings.� Topics of discussion in this chapter are the reason for the study, implications of the demographics of the participants in this study, a review of the hypothesis, methodology, the results of the data analysis, the limitations of this study, possible implications of this investigation for counselors and other human services professionals, and suggestions for future research.

Reason for the Study

�� The purpose of this study was to investigate the relationship between the level of thought reform in a cult and the level of cognitive impairment in ex-members presenting for treatment at Wellspring Retreat and Resource Center.� The idea for this study was suggested by an article by Singer & Ofshe (1990) in which they observed �subtle cognitive deficiencies� in ex-members of cults. Cognitive deficiencies, particularly difficulty making decisions and simplistic, black and white thinking were reported by other observers (Goldberg & Goldberg, 1982).�

Participant Demographics

�� One hundred and thirty two clients of Wellspring Retreat and Resource Center were administered a battery of tests that included a demographic questionnaire, the Hopkins Symptom Checklist dissociation screen, the Beck Depression Inventory, the Group Psychological Abuse Scale and the Neuropsychological Impairment Scale. Of these participants, 123 completed both the GPA and the NIS. This became the sample for demographic data and all other investigations with the exception of the test-retest GPA which will be discussed later.

�� Gender data was unremarkable, females outnumbered males 85 to 39. The sample was overwhelmingly Caucasian, accounting for 113 out of 132 participants (91.9%).� This could indicate that at least for the last several years, cult participation has been a largely white phenomenon.� As discussed in chapter II, the population at Wellspring had to have access to the internet, watch news-magazine style� programs or be willing to research cult issues on their own in libraries, to know of the existence of the facility.�

�� Cultural differences may also have been a factor in reducing the non-Caucasian population. Members of some ethnic groups may be less likely than others to admit or recognize they have been in a cult. Groups that target non-white populations may function differently than cults.� The cultural milieu of ex-members of predominately non-white cults might provide more support from family, extended family or friends, for the ex-member, making treatment less of a necessity for re-entry into society.� It may also provide less support, making it less likely a non-white ex-member would know treatment was available.� It is also possible that members of other ethnic groups have more internal resources than Caucasians, making treatment less important for their recovery.

�� Mean years of formal education was 14.68 (SD = 2.65).� This population was fairly well educated, yet the income level most often recorded (n = 29) was zero. Nearly 40 more, about 70 out of 133 reported an annual income at or below $20,000 suggesting over half of the participants were under-employed.�� This finding appears to confirm the observations of some critics of cults (Martin 1993; Singer & Ofshe, 1990; West & Martin, 1994). One possibility is that the symptoms reported in the last chapter and discussed later in this chapter may have prevented participants from earning the level of income that might be assumed, given their education.� They may also have chosen to pursue less materialistic goals for life.� The mean annual income for those reporting an income was $44,290 (n = 85) but it was not clear whether this figure indicated the participants income or their family of origin, since the battery was prepared on the assumption of a younger demographic than recorded, (33.00).� About one-half of the participants in the study were treated without charge and might have been reluctant to divulge their income on the survey since they had already applied for victim assistance funds on the basis of need.� If they underreported their income in order to get free treatment, they would underreport on the survey.

�� Further research in this area should be conducted with a view to exploring any hidden vocation-related costs to society due to cult involvement. Suggestions for further study might also include determining how long after leaving a cult it takes� ex-members to regain the expected earning potential appropriate to their level of education.� Although this study was conducted using ex-members of cults rather than current members, this finding might call Levine�s (1981) conclusions, that a cult experience was generally helpful, into question.� At least some ex-members do not carry those alleged benefits into their post cult earning potential.

�� Levine and Salter (1976) found that only 20% of current members surveyed stayed in groups for spiritual, transcendental, or mystical reasons.� Perhaps the fear of an inability to adjust to life outside the group, possibly confirmed by this study�s finding of reduced earning potential after the cult was a factor.

�� Religious backgrounds of participants appear to indicate that they were an exceptionally religious sample of North Americans.� Further research using general demographic studies could confirm this assumption.� Participant�s level of practice prior to joining the group was beyond the scope of this study, but also bears further research.� Religious background information might have been provided when the participant�s family had only membership in some congregation but never actually practiced. On the other hand, this finding might suggest that individuals with religious backgrounds might be more at risk for cult involvement, or that a religious background before cult involvement might be a contributor to pre-existing symptoms.� The presence of a religious background might exacerbate whatever negative effects the group may have had on the participant in the study, making it more likely that they would seek treatment.��

�� Bible based groups supplied by far the largest number of participants, 84 (68.3%) with all other types of groups and abusive relationships accounting for only 39 (31.7%). Two participants (1.6%) did not answer the item.� This finding was consistent with Martin et al. (1992).� Wellspring has historically attracted larger numbers of ex-members of Bible based groups.�

�� The demographics of participants suggest that considerable difficulties would be encountered in generalizing the findings of this study to other populations associated with cults i.e., current members and ex-members who, for whatever reason, never sought treatment.� This study may be helpful in advancing knowledge of the needs and challenges of some ex-members of cults.

The Hypotheses of the Study: Discussion and Comment

�� The research hypothesis was: The intensity of� thought reform environments is correlated to the level of cognitive impairment in ex-members. To investigate this correlation, it was necessary to determine that both scores were elevated since if they were not, any correlation would be meaningless.� The mean of ex-member scores on the NIS was 61.2 (SD = 11.69), indicating that participants were experiencing cognitive impairment outside the range of normal cognitive function. Scores of 70 or more indicate significant impairment� (O�Donnell, et al, 1994a).� Seventy five participants (60.98%) scored over 70.� This would appear to be a very serious finding.� Any clinical sample found to contain an unknown impaired sub-group of over 60 percent of the whole sample would be extraordinary. This finding supports and, to some extent quantifies, Singer (1990) who observed what they perceived to be cognitive inefficiencies in ex-members of cults they interviewed.

�� Mean score on the GPA was 102.7 (SD = 18.42), indicating that participants were �very likely� to have been exposed to thought reform (Chambers, et al, 1994). Once again, this is not only elevated but is well above the cutoff of 84.� In fact, 112 participants (90.24%) scored above the cutoff.� Only 11 scored below 84 (9.76%).� It must be taken into account, however, that the population from which the respondents were drawn was pre-screened for appropriateness for treatment.� Screening included determining if the individual had been involved in some group or relationship that they felt contributed to their negative symptoms.� Elevated scores were expected and should not be considered remarkable.� The eleven who scored below the cutpoint may have experienced some level of psychological harm from involvement but it may not been from the experience of thought reform, but some other avenue of emotional injury.� This situation was apparently not detected in the screening process.

�� The sample used in this study included 13 ex-members of abusive relationships or families.� The GPA scores of these individuals were significantly lower than the rest of the sample.� This group of only 13 participants contributed a disproportional 4 of the 11 scores below the cutpoint of 84.� It is possible that this segment of the sample might have had other influence on the outcome of this research.

�� The mean reported in this study agrees with Langone� (1999), who found that GPA mean scores of ex-members of two International Church of Christ groups were significantly different from those of former Catholics and InterVarsity graduates, groups generally considered intense but not necessarily as cults. In this study, scores on both instruments indicate that respondents were experiencing cognitive impairment and that they were very likely to have experienced a thought reform environment.�

�� The results of this section of the study would seem to answer Aronoff & Lynn (1996) who were concerned that conceptual definitions of the term �cult� carry a negative connotation introducing bias into the investigative process.� Their call for an operational definition that would distribute groups along a continuum from completely non-cultic to extremely cultic would seem to be answered in the GPA scores of this study and Langone�s (1999).� The groups represented in this study clustered above the theoretical cutpoint of 84 since the population was self-selected from ex-members who had been involved in groups they felt had harmed them emotionally. The GPA may not have provided the desired continuum in this study due to the nature of the sample studied.��

�� A correlation was found between cognitive impairment scores (NIS) and exposure to thought reform (GPA).� The null hypothesis is, therefore, rejected in favor of the research hypothesis: There was a positive correlation between intensity of thought reform environment and cognitive impairment. However, the correlation was only .24, not unusual for studies in the social sciences, statistically significant but so weak that, at face value, should not be considered very important.�

Veracity of Ex-member Recollections

�� Paired-sample t-tests were used to evaluate participant reports of conditions in their groups before and after treatment. The sample for this investigation differed slightly from the one used in the other analyses.� One hundred six out of 133 participants completed both the pre- and post-treatment GPA.� Participants failed to complete the discharge tests for several reasons, usually due to apparently random factors such as scheduling and administrative oversight and was not due to participant refusal and self selection. Only� matched cases were used for this calculation to increase the likelihood that the difference, if any were found, would be due to treatment effect. Mean score on the GPA at intake was 103.26 (SD = 18.32) and at discharge, 106.43 (SD = 16.45), (n = 106). This was expected from ex-members who would be more inclined to report conditions in their groups more negatively after two weeks of treatment in which considerable social support was given for a negative view of cults in general and emotional support was available for negative feelings about their group in particular. What is remarkable is that the difference was not considerably higher.� Instead, pre- and post- treatment scores only increased by 3 points.� The increase was statistically significant (p< .05) but practically, the increase may not represent an important increase in ex-member �fabrication� of conditions inside their groups. Treatment may have had an effect on ex-member report of conditions in the group, but that effect would be small.

�� This finding suggests that ex-member recollections might be subject to negative bias, if their scores could be affected by treatment, supporting� Anthony & Robbins, 1992; Barker, 1995; Lewis & Bromley, 1987; Robbins & An�thony, 1980; Saliba, 1999; Shupe, et al., 1983 that ex-members respond to outside pressure to make their experiences seem worse than they were to satisfy other�s expectations.� It might confirm Bromley, Shupe, & Ventimiglia, (1983), Coleman, (1984) Galanter, (1983) Lewis & Bromley, (1987), Solomon, (1983) who alleged that organizations that support ex-members of cults and their families apply subtle pressure to get them to report higher levels of pathology.�

�� Even though scores increased, the increase would not seem to be sufficient to confirm the allegations in the literature. There may be other explanations for the slight increase in scores after treatment.� Participant bias might have been in favor of the group prior to treatment.� The information received in treatment may have served simply to clarify participant�s impressions of how the group functioned, resulting in a slightly less biased reflection of the group.

Relative Contribution of Measures of Affect

�� The authors of the NIS state in the manual that affect was a factor in patient over-reporting of neuropsychological symptoms, particularly depression (O�Donnell, et al, 1994a). To control for what they called �affective disturbance�, they included a scale (AFF) with 10 items that address depression and anxiety symptoms.��

�� Participants� mean score on the AFF, was within the range indicated by the authors (> 70) that suggests affect was not a contributor to elevated NIS scores (O�Donnell, et al, 1994a).� On the other hand, participants in this study reported an above average though not clinical� levels of depression on the BDI (Richter, et al. 1998). This finding confirms West & Singer, (1980) and Wright and Malony (1989) who consistently observed depressive symptoms in ex-members.�

�� Goldberg & Goldberg, (1982), West & Martin (1994), West & Singer, (1980) and Singer & Ofshe, (1990) found that dissociation or �floating,� an experience of profound ambivalence toward the group even long after leaving, as well as occasional feelings of being back in the group was very common in ex-members.� Their observations were confirmed by the elevated mean score of 29.33 (SD = 29.33) found in this study using the HSCL (dissociation screen).� The authors of the HSCL (Briere & Runtz, 1990) considered this level to be above normal for both males and females.�

�� There could be several reasons for the discrepancy in these findings.� First, there may not be a discrepancy.� The AFF was only eight points below the cutpoint of 70.�� Measurement error, on the AFF, could account for the apparent discrepancy. Both the BDI at 28 items and the HSCL at 14 items could easily be more robust measures of their respective constructs than the AFF with only 10 items for both depression and anxiety. The HSCL dissociation screen may not be measuring the same symptom set as the AFF.� The BDI and HSCL were found to be very reliable in this study.��

�� In any case, participants were clearly experiencing significant levels of depression and dissociation.� This finding agrees with Conway & Siegelman, (1982), Lewis & Bromley, (1987) and Martin, et al. (1992).� Conway and Siegelman found altered states, nightmares, inability to break mental rhythms of chanting, amnesia, suicidal/self harm tendencies, hallucinations and violent acting out increased with time of involvement in the group.� This finding would also seem to agree with Swartling and Swartling (1992) who found extremely high percentages of those surveyed reported anxiety and guilt, difficulty handling emotions, emptiness, nightmares or other disturbances of sleep, difficulty concentrating, suicidal thoughts, and loss of a sense of identity.�

�� Elevations in BDI and HSCL scores agree with Martin et al. (1992).� He administered the Millon Clinical Multiaxial Inventory (MCMI; Millon, 1983), Beck Depression Inventory, Hopkins Symptom Checklist (HSCL; Derogatis, et al., 1974), and the Staff Burnout Scale (SBS-HP) also to inpatients at Wellspring Retreat and Resource Center. Ninety five percent of participants had elevated scores on at least one measure and means on all measures were elevated according to the instruments� published norms.� Martin, et al. (1996) had essentially identical results in a fol�low-up to the earlier Wellspring study, using a different set of participants.� This study had similar results using a third group of ex-members.

�� The results of this study might contradict Wright and Malony (1989) and Galanter (1983).� Wright and Malony (1989) found ex-members� symptoms fade quickly with time and, especially problematic in light of this study, Galanter (1983) found that ex-members do not report greater psychopathology than nonmembers.� He proposed that� those who had been more or less forcibly removed from their groups reported more negative feelings toward the group, a finding implicitly contradicted by the meager change in test- retest GPA scores reported above.� The relationship between method of exit and reported symptoms was beyond the scope of this study and would be an important avenue of further research.

�� To investigate the relative contribution of affect to cognitive impairment, affect scores and GPA were regressed on to NIS scores. The HSCL, and the BDI were more unique contributors to variation in NIS scores than GPA (p < .01 vs. p = .949).� Measures of affect accounted for the variation in reported cognitive impairment.� In the light of measures of affect, the relationship between thought reform exposure and cognitive impairment disappeared.��

�� This finding and the weak correlation reported above appear to follow Lewis and Bromley (1987) who examined the same seven symptoms as Conway and Siegelman and found no correlation between length of membership and symptom intensity and frequency.� There may be a weakness in experimental design in both Lewis and Bromley and this study in using correlations to understand a relationship which may be better studied using cutpoints.

�� The elevated cognitive impairment scores in this study might be due to the �effect of affect� on participant report of cognitive impairment symptoms.� A deficiency in the NIS instrument itself might be that it is overly sensitive to affect when it� indicates impairment is present. On the other hand, the NIS may be a more sophisticated indicator of the tendency of individuals who are depressed and dissociated to make errors in logic (Beck, et al, 1961; Briere & Runtz, 1990).� In other words, cognitive impairment scores may have been elevated precisely because participants were depressed and dissociated.�

�� Other dynamics may explain the presence of cognitive impairment and affective factors in ex-members of cults.� They might have brought this impairment into their group experience.� They may have also been depressed and dissociated before joining the group.� Those who find cults attractive may do so because they are already cognitively impaired.

Discussion of Post Hoc Findings

�� Variation in thought reform exposure as measured by the GPA may not be as important to the study of cults than its simple presence or absence.� The range of scores for the GPA in this study was rather narrow, given the maximum of 140.� All but 4 cases fell between 65 and 140. Four of the 12 scores below 84 were from survivors of cult-like abuse but not from ex-members of cults per se. These factors might account for the low correlation between the GPA and the NIS.� So many participants had high GPA scores that there was little variation making it impossible for it to be highly correlated with any other variable.

�� The cut point (84) for thought reform exposure was used in a additional investigation as a determinant for a study of two groups, one exposed to thought reform and the other was not exposed. The two resulting groups were very different in size (n = 12 vs. n = 111). This would be expected since the population at Wellspring is screened to insure that clients had experienced a thought reform systems.� Thought reform as a discriminant variable for comparison of two groups yielded an interesting contrast.� The level of reported symptoms, dissociation, depression, and cognitive impairment, increased dramatically for those who scored over the 84 cutpoint.� The boxplot presented in Appendix E indicates that cognitive impairment and affect scores differed by nearly one standard deviation between those 12 participants who did not report having experienced a thought reform system and those 111 who did so report.� This area must remain a recommendation for further study.

Limitations of the Study

�� Limitations to the application of this study are found in the inherent limitations of self report measures, the nature and source of the participants and the subject matter itself.�

�� Self report measures are convenient for the researcher in that data can be gathered without his or her physical presence. Even the venerable Beck Depression Inventory, with its considerable literature, is only a fair predictor of DSM diagnosis. The HSCL dissociation screen, the NIS and the GPA were found in this study to be generally reliable.� This study restricted the use of the NIS and the GPA to only those most general scales.

�� The pool of possible participants is limited by the complicating factors presented in chapter II.� Current members of cults cannot be relied upon to be unbiased in their report of conditions and affect.� Ex-members may have axes to grind motivating them to over-report negative aspects of their groups.� This last limitation was addressed in part by retesting participants after treatment.� The fact that participant scores increased with treatment suggests that other self-reports may be questioned.� Using participants from a treatment facility has the limitation common to the quasi-experimental design of� research, that is, research performed �after the fact.�� Adequate controls are impossible.� The lack of history of symptoms before the participant joined the group makes the contribution of the group dynamic, if any, impossible to detect.� Reasons for the lack of true, controlled experimental research in thought reform are revisited below.�

�� The population from which the participants in this study were drawn introduced limitations to the results in several ways.� The homogeneity of the participants that may have been a strength in the statistical analysis becomes a limitation for generalizing the results to non-clinical populations of ex-members, or ex-members of color.� The results of this study would not be generalizable to current members of cults.� Any application in this area would seem to be limited to a given ex-member having� better insight into his or her personal behavior while in the cult.��

�� Research on cults is particularly difficult for a variety of reasons (Ayella 1990).� Very personal matters motivate individuals to become involved in causes beyond themselves.� Approaching current members of cults with hard questions and psychological tests could reasonably be considered sacrilegious and personally offensive.

�� Direct experimental research on thought reform is fraught with ethical dilemmas.� Some sociologists assert that thought reform or brainwashing is a fictitious concept.� They point out that it has never been subjected to scientific scrutiny in controlled, laboratory conditions (Barker 1995). Thought reform has not been researched in �controlled laboratory conditions� since the early 1970's because modern research ethics do not permit it.� Thought reform researchers realized the potential for lasting harm to research participants (Zimbardo, 1981; Singer & Lalich, 1994). .

Implications for Counselors and Public Policy

�� This study established the existence of a correlation between thought reform and cognitive impairment.� As in so much of social science research, what was found in the designed investigation may not have been as important as the peripheral, almost collateral insights that were gained.� This sizable sample of ex-members cults scored quite differently on a measure of thought reform exposure than ex-members of non-cultic groups in the literature.� Exposure to two weeks of negative information about their groups and emotional support for negative emotions against their groups had an effect on their scores sustaining that the testimony of ex-members of cults concerning conditions in the group might be questionable.�

�� Ex-members in this study were depressed, dissociated and a high percentage were experiencing significant levels of cognitive impairment.� Their impairment could not be statistically correlated to the level of thought reform when measures of affect were factored into the relationship.

�� Counselors should be aware that ex-members of cults who present for treatment may do so because they may be depressed, dissociated and experience some form of cognitive impairment.� This study did not establish a connection between their symptoms and cult membership and other factors besides their involvement in a cult should be considered in their treatment.

�� Public policy with regard to cults is problematic due to the occasional overt acts of certain cults and cult-like groups. This study failed to find a unique relationship between the level of thought reform in the group and cognitive impairment in some ex-members that� might be a factor in those overt acts.�� The results of this study would imply that the acts themselves should shape public policy rather than factors present in ex-members.

Suggestions for Future Research

�� Further research is called for by this study on several fronts.� The discrepancy between expected age and actual age of ex-members should be explored further.� Comparisons with other general demographic studies might be fruitful in expanding our knowledge of the larger population of ex-members who have left their groups but who did not seek treatment.� The length of time in the group should be compared to the level of symptoms.�

�� Cognitive impairment and thought reform should be examined from a multicultural perspective.� Why are so few non-white members of cults presenting for treatment.� Are non-whites less likely to be recruited by cults?� Are there other cult-like involvements that take the place of cults in other cultural settings such as gangs or long term abusive relationships?�

�� Unusually low incomes of participants suggest that further research into how ex-members of cults rate in light of national averages earning potential per year of formal education.� How long after leaving the cult do ex-members attain national average earning potential, given their years of education?� If the time is significant, there may be a hidden vocation-related costs to individual ex-members and to society at large from cult involvement.��

�� Further investigation into the religious backgrounds of ex-members of cults would provide important insights into the precursors if any, there are to involvement in a cult.� Are ex-cultists from more religious families than the general population? Further research using general demographic studies could answer this question.� Participant�s level of practice prior to joining the group could be an important factor in cult involvement. Does religious background have any relation to the type of group joined?� Does it effect length of stay in the cult?�

�� The results of the GPA test-retest regimen should be repeated at other times on clients at Wellspring as well as other populations of ex-members to insure that the effect of treatment is not isolated to the participants of this study.

�� The measures used in this study should be given to non-cult clinical and non-clinical ex-member control groups to further investigate cutpoint groups for exposure to a thought reform environment and affect on cognitive impairment.

�� The study should be redesigned and redone using better instrumentation for measuring cognitive impairment.� More research into the connection between affect and cognitive impairment should influence design of the new study.

��

References

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American Psychiatric Association. (1994). Diagnostic and statistical, manual of mental disorders (4th ed.). Wash�ington, DC: Author.

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Consent form Used by Participants in this Study

Appendix C

Demographic Questionnaire

Appendix D

The �Ohio Battery� From Which This Study Was Taken

Appendix E

Boxplot of Post Hoc Study