• Journal of Global Scholars of Marketing Science
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• v.17 no.2
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• pp.1-29
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• 2007

The flow theory becomes one of the most important frameworks in the internet research arena. Hoffman and Novak proposed a hierarchical flow model showing the antecedents and outcomes of flow and the relationship among these variables in the hyper-media computer circumstances (Hoffman and Novak 1996). This model was further tested after their initial research (Novak, Hoffman, and Yung 2000). At their paper, Hoffman and Novak explained that the balance of challenge and skill leads to flow which means the positive optimal state of mind (Hoffman and Novak 1996). An imbalance between challenge and skill, leads to negative states of mind like anxiety, boredom, apathy (Csikszentmihalyi and Csikszentmihalyi 1988). Almost all research on the flow 4-channel model have been focusingon flow, the positive state of mind (Ellis, Voelkl, and Morris 1994 Mathwick and Rigdon 2004). However, it also needs to examine the formation of the negative states of minds and their outcomes. Flow researchers explain play or playfulness as antecedents or the early state of flow. However, play has been regarded as a distinct concept from flow in the flow literatures (Hoffman and Novak 1996; Novak, Hoffman, and Yung 2000). Mathwick and Rigdon discovered the influences of challenge and skill on play; they also observed the influence of play on web-loyalty and brand loyalty (Mathwick and Rigdon 2004). Unfortunately, they did not go so far as to test the influences of play on state of mind. This study focuses on the relationships between state of mind in the flow 4-channel model and play. Early research has attempted to hypothetically explain state of mind in flow theory, but has not been tested except flow until now. Also the importance of play has been emphasized in the flow theory, but has not been tested in the flow 4-channel model context. This researcher attempts to analyze the relationships among state of mind, skill of play, challenge, state of mind and web loyalty. For this objective, I developed a measure for state of mind and defined the concept of play as a trait. Then, the influences of challenge and skill on the state of mind and play under on-line shopping conditions were tested. Also the influences of play on state of mind were tested and those of flow and play on web loyalty were highlighted. 294 undergraduate students participated in this research survey. They were asked to respond about their perceptions of challenge, skill, state of mind, play, and web-loyalty to on-line shopping mall. Respondents were restricted to students who bought products on-line in a month. In case of buying products at two or more on-line shopping malls, they asked to respond about the shopping mall where they bought the most important one. Construct validity, discriminant validity, and convergent validity were used to check the measurement validations. Also, Cronbach's alpha was used to check scale reliability. A series of exploratory factor analyses was conducted. This researcher conducted confirmatory factor analyses to assess the validity of measurements. All items loaded significantly on their respective constructs. Also, all reliabilities were greater than.70. Chi-square difference tests and goodness of fit tests supported discriminant and convergent validity. The results of clustering and ANOVA showed that high challenge and high skill leaded to flow, low challenge and high skill leaded to boredom, and low challenge and low skill leaded to apathy. But, it was different from my expectation that high challenge and low skill didnot lead to anxiety but leaded to apathy. The results also showed that high challenge and high skill, and high challenge and low skill leaded to the highest play. Low challenge leaded to low play. 4 Structural Equation Models were built by flow, anxiety, boredom, apathy for analyzing not only the impact of play on state of mind and web-loyalty, but also that of state of mind on web-loyalty. According the analyses results of these models, play impacted flow and web-loyalty positively, but impacted anxiety, boredom, and apathy negatively. Results also showed that flow impacted web-loyalty positively, but anxiety, boredom, and apathy impacted web-loyalty negatively. The interpretations and implications of the test results of the hypotheses are as follows. First, respondents belonging to different clusters based on challenge and skill level experienced different states of mind such as flow, anxiety, boredom, apathy. The low challenge and low skill group felt the highest anxiety and apathy. It could be interpreted that this group feeling high anxiety or fear, then avoided attempts to shop on-line. Second, it was found that higher challenge leads to higher levels of play. Test results show that the play level of the high challenge and low skill group (anxiety group) was higher than that of the high challenge and high skill group (flow group). However, this was not significant. Third, play positively impacted flow and negatively impacted boredom. The negative impacts on anxiety and apathy were not significant. This means that the combination of challenge and skill creates different results. Forth, play and flow positively impacted web-loyalty, but anxiety, boredom, apathy had negative impacts. The effect of play on web-loyalty was stronger in case of anxiety, boredom, apathy group than fl ow group. These results show that challenge and skill influences state of mind and play. Results also demonstrate how play and flow influence web-loyalty. It implies that state of mind and play should be the core marketing variables in internet marketing. The flow theory has been focusing on flow and on the positive outcomes of flow experiences. But, this research shows that lots of consumers experience the negative state of mind rather than flow state in the internet shopping circumstance. Results show that the negative state of mind leads to low or negative web-loyalty. Play can have an important role with the web-loyalty when consumers have the negative state of mind. Results of structural equation model analyses show that play influences web-loyalty positively, even though consumers may be in the negative state of mind. This research found the impacts of challenge and skill on state of mind in the flow 4-channel model, not only flow but also anxiety, boredom, apathy. Also, it highlighted the role of play in the flow 4-channel model context and impacts on web-loyalty. However, tests show a few different results from hypothetical expectations such as the highest anxiety level of apathy group and insignificant impacts of play on anxiety and apathy. Further research needs to replicate this research and/or to compare 3-channel model with 4-channel model.

• Korean Journal of Psychosomatic Medicine
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• v.5 no.2
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• pp.158-167
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• 1997

Objectives: This study was aimed to investigate the emotional state and personality characteristics of alopecia aerata patient and to determine whether these characteristics are similar with those of neurotic patient. Methods : 20 alopecia aerata patients, 20 neurotic patients, and 20 normal healthy controls were studied. Beck Depression Inventory(BDI), State and Trait Anxiety Inventory(STAI) and Korean standardized edition of Catell's 16 Personality factors Questionnaire(16PF) were used for assessment. Results: 1) Total score of BDI was higher in neurosis group than alopecia aerata group and normal control group(p<0.05). Inspire of statistical non-significance, total score of in alopecia aerata group was higher than normal control group. 2) Total scores of state anxiety and trait anxiety in alopecia aerata and neurosis group were significantly higher than normal control group(p<0.001). 3) In first-stratum source traits of 16PF, normal control group was significantly higher than alopecia aerata group and neurosis group in B-factor(intelligence) and C-factor(ego-strength)(p<0.05). Alopecia aerata group and neurosis group were significantly higher than normal control group in O-factor(guilt-proneness) and $Q_4-factor(tension,\;anxiety)$(p<0.001). 4) In second-stratum source traits of 16PF, alopecia aerata group and neurosis group were significantly higher than normal control group in ANX-factor(anxiety)(p<0.05). Conclusions : These results suggest that emotional state and personality characterstics of patients with alopecia aerata are a distinguishable different to compare with normal control, and are very similar with those of neurotic patients. The authors propose that psychiatric management in patient with alopecia aerata will be more benificial.

• Anxiety and mood
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• v.14 no.2
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• pp.63-70
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• 2018

It has been suggested that aberrant self-referential processing (SRP) is one of the important components of the explanatory models of social anxiety disorder (SAD). The default mode network (DMN), which reflects intrinsic brain functions, is known to play a critical role in SRP. Recently, resting state functional magnetic resonance imaging (fMRI) research on the functional connectivity in the brain network has gained greater attention as a tool to elucidate the neurobiological basis of various psychiatric disorders. We reviewed resting state fMRI studies that investigated the resting state functional connectivity (RSFC) of the DMN in SAD. Despite of the heterogeneity of the analytic methods and occasional negative findings, most studies consistently reported abnormalities of RSFC within the DMN, suggesting that the DMN may be significant neural correlates of aberrant SRP in SAD. Also, changes in RSFC of the DMN are associated with clinical improvements of therapeutic interventions. Moreover, emerging findings provide the basis for potential use of RSFC as a complementary method in diagnosis of SAD. Ongoing and future research to investigate RSFC of the DMN could broaden our understanding regarding the neurobiological basis of SAD, and contribute to the development of novel treatments for SAD.

• Sleep Medicine and Psychophysiology
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• v.6 no.1
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• pp.76-84
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• 1999

Objectives: A number of studies have shown that sleep deprivation results in reduced vigilance and increased negative affects such as tension, depression and anger. However there are few studies about effects of sleep deprivation on anxiety. The purpose of this study was to investigate the effects of 40 hour sleep deprivation on state anxiety, affects, sleepiness and fatigue. The authors also intended to study the effect of trait-anxiety on these psychological variables after sleep deprivation. Methods: Twenty nine subjects(22 men, 7 women, $24.59{\pm}1.35$ years of age) participated in this study. Subjects had no past history of psychiatric disorders and physical illnesses, and had normal sleep-waking cycle without current sleep disturbances. All of the subjects completed sleep dairy for two weeks to exclude some who suffered from chronic sleep deprivation or sleep disturbances. Subjects were instructed to get a normal sleep as usual at night before the study. After awakening, subjects remained awake for 40 hours under continuous surveillance. They completed State-Trait Anxiety Inventory, Index of General Affect, Stanford Sleepiness Scale and Fatigue Questionnaire every three hours, therefore they completed the scales 14 times totally. Subjects were dictated not to take caffeine, alcohol, or any medications on the day of the study. Heavy exercises and naps were restricted too. Results: Sleep deprivation resulted in increased state anxiety, negative general affects, and increased sleepiness and fatigue(p<.001). Dividing into high trait-anxiety group and low trait-anxiety group, there was significant sleep deprivation x traitanxiety interaction effect on general affect(p<.05). But, there was no significant sleep deprivation x trait-anxiety interaction effect on state-anxiety, sleepiness and fatigue. During sleep deprivation, the highest ratings of scales on anxiety, negative affect, sleepiness and fatigue occurred between 4 : 00AM and 7 : 00AM. Conclusions: These results show that sleep deprivation results in increased anxiety, mood state disturbance and increment of sleepiness and fatigue. These findings also suggest that trait-anxiety is a factor that influences the degree of worsening in general affect caused by sleep deprivation. During sleep deprivation, the rating curves of anxiety, affect, sleepiness and fatigue show rhythmicity that may be related to circadian rhythm.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.2
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• pp.437-441
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• 2012

Objective: Health risk appraisal is often utilized to modify individual's health behavior, especially concerning disease prevention, and web-based health risk appraisal services are being provided to the general public in Korea. However, little is known about the psychological effect of the health risk appraisal even though poorly communicated information by the web-based service may result in unintended adverse health outcomes. This study was conducted to explore the psychological effect of health risk appraisal using epidemiological risk factor profile. Methods: We conducted a randomized trial comparing risk factor list type health risk appraisal and risk score type health risk appraisal. We studied 60 women aged 30 years and older who had no cancer. Anxiety level was assessed using the Spielberger State-Trait Anxiety Inventory YZ. Results: The results of multivariate analysis showed that risk status was the independent predictors of increase of state anxiety after health risk appraisal intervention when age, education, health risk appraisal type, numeracy, state anxiety, trait anxiety, and health risk appraisal type by risk status interaction was adjusted. Women who had higher risk status had an odd of having increased anxiety that was about 5 times greater than women who had lower risk status. Conclusions: Our findings indicate that communicating the risk status by individual health risk appraisal service can induce psychological sequelae, especially in women having higher risk status. Hospitals, institutes, or medical schools that are operating or planning to operate the online health risk appraisal service should take side effects such as psychological sequelae into consideration.

• Journal of Korean Academy of Nursing
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• v.27 no.4
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• pp.912-922
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• 1997

The purpose of this study was to examine the effect of supportive nursing on stress reaction of breast cancer patients undergoing chemotherapy. The nonequivalent control group pre-test/post-test design was used for this experimental study. The subjects were 32 patients who were receiving chemotherapy after mastectomies at K hospital in Taegu from June, 1994 to June 1995. Among 32 subjects, 16 were placed in the experimental group and 16 in the control group. The experimental and control groups were tested for general characteristics, trait anxiety, health locus of control, family support, state anxiety, hopelessness, physical stress, and anxiety behavior. Collected data was analized by means of a chisquare test and a t-test for the comparative analysis of the general characteristics and homogeneity of subjects. ANOVA, and MANOVA were used for testing the hypothesis. Reliability of the tools were analyzed using the Pearson Correlation coefficient. The results of this study were as follows : 1. The hypothesis : The stress reaction of the experimental group which took supportive nursing was lower than the stress reaction of the control group : this was supported statistically. The main variable influenced in stress reaction was hopelessness. Supportive nursing for breast cancer patients, who are receiving chemotherapy, was especially effective in the reduction of hopelessness compared to state anxiety, physical stress, and anxiety behavior. 2. An analysis of the difference on stress reaction, according to the frequency of supportive nursing between the control and experimental group, showed the level of hopelessness of the experimental group was lower than the control group after four supportive meeting sessions. But there was no statistical difference in state anxiety, physical stress, and anxiety behavior. In conclusion, this study supported utilization of supportive care as well as demonstrating the effectiveness of the System-Developmental Stress Model developed by Chrisman and Riehl-Sisca.

• Research in Community and Public Health Nursing
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• v.12 no.2
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• pp.375-389
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• 2001

The purpose of this study was to evaluate the effect of Self-foot Reflex Massage (SRM) programme on the physical condition and anxiety level of hypertension workers. The research was designed in the pre and post-test. Sample test was done in five workers with essential hypertension. They were divided in two groups:- Group A and Group B. The Self-foot Reflex Massage (SRM) was applied three times a week for Group A and five times a week for Group B. The SRM was given in 40 minutes each time for 4 weeks from the 1st of January to the 30th of April in 2001. In order to evaluate the effect on SRM. blood pressure, total cholesterol, triglyceride, HDL cholesterol and LDL cholesterol were measured as physical parameters and state trait anxiety inventory was used twice each time between before and after the exercise. The collected data was analysed by Mann-Whitney test with SPSS program. The results were as follows: 1. Average age for the subjects were 39.8 (ranged from thirty-two to fifty-three) and average period of hypertension history was 42 months (ranged from twenty to eighty-four). 2. There was no significant difference between two examined groups in blood pressure. But, there was a significant difference in SRM of pre and post-test for two groups. 3. There was no significant difference in blood cholesterol between two groups and between pre and post-test. 4. State trait anxiety showed significant difference between pre and post-test except the results between two groups. This result suggests that SRM is effective on the decrease of systolic and diastolic pressure and the relief of state trait anxiety except for the blood cholesterol. Therefore, blood cholesterol is needed further evaluation in large subjects and longer period. Further research is regarded as necessary to evaluate and to compare the precise effects of SRM on the foot reflex massage (FRM) in anxiety.

• Sleep Medicine and Psychophysiology
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• v.2 no.1
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• pp.82-90
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• 1995

Objectives : Insomnia is significantly influenced by the pre-sleep arousal, self efficacy, sleep hygiene, depression and anxiety. The authors tried to explore how these factors are related with the clinical features of sleep. Methods : Fifty three patients diagnosed as insomnia by DSM-IV criteria were studied. They filled up the pre-sleep arousal scale(PSAS), sleep efficacy scale(SES), sleep hygiene awareness and practice scale, BDI, and state and trait anxiety scales. Results: 1) The mean values of sleep-related variables were as follows : Sleep latency,136.89 minutes ; frequences of awakening during a night, 2.28 ; minutes to get back to sleep, 42.70 ; total sleep time, 180.19 minutes ; duration of illness, 72.00 months. 2) The mean scores of scales were as follows : PSAS(cognitive), 22.40 ; PSAS(somatic), 17.32 ; SES, 20.16 ; sleep hygiene knowledge, 25.96 ; caffein knowledge, 59.78 ; sleep hygiene practice, 42.12 ; BDI. 18.2 ; state anxiety, 41.24 ; trait anxiety ; 44.50. 3) In the subjects with superimposed depression, the mean frequency of awakening during a night and the mean pre-sleep arousal scale score were higher than in those without depression. 4) Frequency of awakening were correlated positively with a PSAS(a tight tense feeling in your muscle) and sleep hygiene awareness. PSAS(cognitive) were correlated positively with a PSAS(somatic). BDI correlated positively with a PSAS item(a jittery, nervous feeling in your body)and a SES item (not allow a poor night's sleep to interfere with daily activities). Anxiety scales were correlated positively with sleep hygiene practice scale sleep, and PSAS were correlated negatively with SES. Conclusions : The mean scores of PSAS, SES, sleep hygiene awareness and practice scale, BDI, state and trait anxiety scales of insomniacs were correlated either positively or negatively in insomnia patients. These factors seem to contribute to the development and maintainence of insomnia.

• Women's Health Nursing
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• v.26 no.2
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• pp.180-190
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• 2020

Purpose: The purpose of this study was to identify the effects of a supportive program on uncertainty, anxiety, and maternal-fetal attachment in high-risk pregnant women. Methods: The participants were 59 high-risk pregnant women admitted to the maternal-fetal intensive care unit. The control group (n=30) received usual treatment and antenatal care, while the experimental group (n=29) received an additional supportive program. Uncertainty, anxiety, and maternal-fetal attachment were measured in both groups prior to the intervention and at 3 days and 10 days after the intervention (or at discharge). Data were analyzed with the t-test, chi-square test, repeated-measures analysis of covariance, and the Greenhouse-Geisser correction in SPSS version 23.0. Results: A supportive program including information provision, nutritional care, emotional care, and exercise care was developed from the literature. All variables except women's length of stay were found to be homogeneous the between experimental and control groups in the pre-test. Length of stay was calculated as a covariate for testing hypotheses. There was a significant difference in state anxiety over time between the two groups, while there were no differences in uncertainty or maternal-fetal attachment. Conclusion: This supportive program was identified as an effective nursing intervention on state anxiety in high-risk pregnant women during their stay in the maternal-fetal intensive care unit. It is suggested that nurses could apply this program to alleviate high-risk pregnant women's state anxiety, and that this program could be modified to be more effective on uncertainty and maternal-fetal attachment in high-risk pregnant women.

• Safety and Health at Work
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• v.14 no.3
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• pp.303-308
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• 2023

Background: Occupational workers at altitudes are more prone to falls, leading to catastrophic outcomes. Acrophobia, height-related anxiety, and affected executive functions lead to postural instabilities, causing falls. This study investigated the effects of repeated virtual height exposure and training on cognitive processing and height-related anxiety. Methods: Twenty-eight healthy volunteers (age 20.48 ± 1.26 years; mass 69.52 ± 13.78 kg) were recruited and tested in seven virtual environments (VE) [ground (G), 2-story altitude (A1), 2-story edge (E1), 4-story altitude (A2), 4-story edge (E2), 6-story altitude (A3), and 6-story edge (E3)] over three days. At each VE, participants identified occupational hazards present in the VE and completed an Attitude Towards Heights Questionnaire (ATHQ) and a modified State-Trait Anxiety Inventory Questionnaire (mSTAIQ). The number of hazards identified and the ATHQ and mSTAIQ scores were analyzed using a 7 (VE; G, A1, A2, A3, E1, E2, E3) x 3 (DAY; DAY 1, DAY 2, DAY 3) factorial repeated measures analysis of variance. Results: The participants identified the lowest number of hazards at A3 and E3 VEs and on DAY 1 compared to other VEs and DAYs. ATHQ scores were lowest at G, A1, and E1 VEs. Conclusion: Cognitive processing is negatively affected by virtual altitudes, while it improves with short-term training. The features of virtual reality, such as higher involvement, engagement, and reliability, make it a better training tool to be considered in ergonomic settings. The findings of this study will provide insights into cognitive dual-tasking at altitude and its challenges, which will aid in minimizing occupational falls.