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Texas Tech University, Ghada Najjar, 2017
A QUALITATIVE EXPLORATION OF EMOTIONAL RESPONSES OF PEOPLE
WITH BIPOLAR DISORDER TO THE INTERIOR RESIDENTIAL ENVIRONMENT
by
GHADA ABDULRAHMAN NAJJAR, M.A., M.S.
A DISSERTATION
IN
INTERIOR AND ENVIRONMNETAL DESIGN
Submitted to the Graduate Faculty
of Texas Tech University, in
Partial Fulfillment of
The Requirements for
The Degree of
DOCTOR OF PHILOSOPHY
APPROVED
Debajyoti Pati, Ph.D.
Chairperson of the Committee
Erin Schambureck, MFA
Lee S. Duemer, Ph.D.
ACCEPTED
Mark Sheridan, Ph.D.
Dean of Graduate School
May, 2017
Texas Tech University, Ghada Najjar, 2017
COPY RIGHT
2017
GHADA ABDULRAHMAN NAJJAR
Texas Tech University, Ghada Najjar, 2017
ACKNOWLEDGEMENTS
The completion of this study was a dream, not only for me but for my whole
family. In the beginning, I would like to thank Allah, our creator, for all his blessings in
my life. First, He gave me the opportunity to study at Texas Tech University, and thrive
under the guidance of great professors, including my committee chair, Dr. Debajyoti Pati,
who lead me in every step of this dissertation. He had enthusiasm over the uniqueness of
this topic, and provided his experienced guidance to create this study. I appreciate his
deep knowledge and a great understanding of the design field. I am also thankful for Dr.
Erin Schambureck, who devoted her time and knowledge to me, and Dr. Lee Duemer,
who helped me improve this study.
Second, Allah provided for me the support and unconditional love of my family,
which gave me the courage to fight and complete this journey. I am grateful for my
mother, Thurayah Najjar, who sacrificed and prayed for me, my two beloved children,
Aziz Alshahrani and Ghaden Alshahrani, who were patient and encouraging, and my
husband, Ali Alsharani, who would always push me to seek higher education. Finally, I
am grateful for my uncle, Ghazi Najjar, for his financial support.
Finally, Allah gave me great friends who stood by my side in hard times. I am
thankful for Samaher Fallath for her tottering help, and Sarah Alshubaiki for her reading
and editing.
In the end, I would like to dedicate this success to the spirit of my late father,
Abdulrahman Najjar, who believed that I would be the first female doctor in the Najjar
family, and the spirit of our late beloved King Abdullah Alsaud who created scholarship
programs to develop the Saudi nation. We will always be grateful.
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TABLE OF CONTENTS
ACKNOWLEDGEMENTS
ii
ABSTRACT
xi
LIST OF TABLES
xiii
LIST OF FIGURES
xv
CHAPTER
I.
II.
INTRODUCTION
1
Purpose of the Study
3
Research Questions
3
Conceptual Framework
4
Personal Differences
6
Definitions of Terms
7
Significance of the Study
9
REVIEW OF LITERATURE
11
Part I: An Overview of Bipolar Disorder
11
Types of Bipolar Disorder
11
Symptoms of Bipolar Disorder
12
Depression Symptoms
12
Manic symptoms
13
Part II: Emotional and Physiological Responses to
Environmental Stimuli
Artificial Lighting
iii
14
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Emotional response
14
Physiological response
16
Daylight
17
Emotional response
17
Physiological response
19
Colors
21
Emotional response
22
Physiological response
23
Materials
24
Emotional response
25
Physiological response
25
Seasons and Climate
26
Emotional response
26
Physiological response
27
Noise
27
Emotional response and
Physiological response
Aromatherapy
27
28
Emotional response and
Physiological response
Part III: Design Preferences
Colors preferences
iv
28
30
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III.
Interior preference
34
Natural environment preference
37
Lighting preference
38
METHODOLOGY
43
Specific Aim
43
Research Question
43
Research Design
43
Subjects
44
Inclusion Criteria
44
Exclusion Criteria
45
Sampling and Subject Recruitment
46
Research Setting
47
Variables
47
Outcome Variables
47
Influencing Variables
47
Confounding Factors
48
Intervention
50
Instrument
57
The Question List
57
Data Collection
60
Data Collection Main Steps
61
Data Analysis
62
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Steps for Analyzing the Data
IV.
FINDINGS
64
66
Final Sample
66
Images of High Proportion Average Between Bipolar Subjects and
Non-Bipolar Subjects
67
High Materials, Low Contrast, and High Daylight
67
Low Materials, High Contrast, and Low Daylight
69
Neutral Materials, High Contrast, and High Daylight
71
Low Materials, Low Contrast, and Neutral Daylight
73
Low Materials, Neutral Contrast, and Low Daylight
75
Neutral Materials, Low Contrast, and Neutral Daylight
77
Neutral Materials, Neutral Contrast, and Low Daylight
79
Neutral Materials, Neutral Contrast, and High Daylight 80
Neutral Materials, High Contrast, and Low Daylight
82
High Materials, Neutral Contrast, and Low Daylight
84
Neutral Materials, High Contrast, and Neutral Daylight 86
Images of High Proportion Average Between Two Age Groups of
Bipolar Subjects
88
Neutral Materials, High Contrast, and Neutral Daylight 89
High Materials, Low Contrast, and High Daylight
90
Low Materials, High Contrast, and Low Daylight
91
High Materials, Neutral Contrast, and Neutral Daylight 93
Neutral Materials, Low Contrast, and Neutral Daylight
vi
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High Materials, High Contrast, and Low Daylight
97
Neutral Materials, Low Contrast, and High Daylight
98
Neutral Materials, High Contrast, and Low Daylight
100
High Materials, Low Contrast, and Low Daylight
101
Low Materials, High Contrast, and Low Daylight
103
Neutral Materials, Low Contrast, and High Daylight
104
High Materials, Neutral Contrast, and High Daylight
106
High Materials, Neutral Contrast, and Neutral Daylight 105
Comparison Between Images with High Proportion Average
Score between Bipolar Subjects and Non-Bipolar Subjects
108
High Materials, Low Contrast, and High Daylight VS High
Materials, Neutral Contrast, and Low Daylight
108
Low Materials Settings
109
Neutral Material Settings
110
Comparison Between Images with High Proportion Average
Score Between Two Age Groups of Bipolar Subjects (24-37) (4054)
111
Low Materials
111
Neutral Materials and Low Contrast
112
Neutral Materials and High Contrast
114
High Materials and Low Contrast
115
High Materials and Neutral Contrast
116
Liked and Preferred Images for Bipolar and Non-Bipolar
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Subjects
117
Low Materials, Low Contrast, and Neutral Daylight
117
Neutral Materials, Low Contrast, and Neutral Daylight 117
Low Materials, Neutral Contrast, and High Daylight
119
Neutral Materials, Neutral Contrast, and
Neutral Daylight
119
High Materials, High Contrast, and Low Daylight
120
High Materials, High Contrast, and Neutral Daylight
123
Low Materials, Neutral Contrast, and Low Daylight
123
Neutral Materials, High Contrast, and Low Daylight
123
Liked and Preferred Images for Two Bipolar Age Groups
124
Low Materials, Neutral Contrast, and High Daylight
125
High Materials, Low Contrast, and High Daylight
125
Neutral Materials, Neutral Contrast, and Neutral Daylight
126
High Materials, Neutral Contrast, and Neutral Daylight 128
V.
Low Materials, Neutral Contrast, and Low Daylight
129
Neutral Materials, High Contrast, and Low Daylight
130
DISCUSSION
131
Theoretical Implications
Relating the Theory to the Findings
Difference Between Bipolar and Non-Bipolar Subjects
Materials
132
132
134
135
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Color Contrast
135
Daylight
136
Differences Between Bipolar Age Groups
137
Color Contrast
138
Materials
139
Daylight
139
Implications for Practice
140
Design Preferences for Bipolar Disorder
140
Design Preferences for Younger Bipolar
142
Design Preference for Older Bipolar
144
Recommendation for Bipolar People for Two Age Groups
146
Limitation and Challenges of the Study
147
Measuring Reliability and Trustworthiness
147
Applicability of the Study
147
Neutrality
148
Credibility
148
Transferability
149
Dependability
150
Confirmability
150
Future Studies
150
REFERENCE
152
APPENDIX I
166
APPENDIX II
167
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APPENDIX III
168
APPENDIX IV
169
APPENDIX V
170
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ABSTRACT
Mental illnesses such as bipolar disorder have great effect on people’s wellness
and their interaction with the environment surrounding them. Bipolar disorder is a genetic
mental illness that causes mood shifts from depression to mania in a cycle. Bipolar
disorder has both physical and psychological implications. These three attributes of
design were systematically manipulated to measure subjects’ responses. Furthermore, this
study explores whether age has effects on subjects’ responses.
Due to the limited literature on designing for bipolar disorder and limited access
to people with bipolar disorder, this study adopted a qualitative, non-experimental design
and a non-probability, purposive-quota sampling strategy. Twenty-seven images of
different design settings were created in the HomeStyler online program to systematically
manipulate the amounts of daylight, wood materials, and color contrast. Ten bipolar
subjects and ten non-bipolar subjects were asked to rate 27 different images on six binary
emotional and affective responses, and provide reasons for their assessments.
Results showed that bipolar subjects from the younger group seemed to have
more responses of wide awake, unstressed, peaceful, and relaxed to the settings with a
high amount of light wood (Rovere) and open windows that allow a lot of natural light.
However, they did not like the wooden ceiling. They preferred lighter colored ceiling and
the open space concept.
On the other hand, bipolar subjects from the older group have more responses of
wide awake, unstressed, peaceful, and relaxed for settings with natural colors with darker
wood colors (Doc Pisa). The older bipolar subjects preferred softer lighting and the dark
colored ceiling which made the room pop. Both groups demanded access to an outside
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view for safety reasons. Some subjects from both groups also complemented the color of
the apples on the tables and suggested adding accent colors to the room design.
In contrast, both groups liked the room with neutral colored marble flooring and
open windows. Moreover, settings with very dark tones of wood (Maple Sambuca) were
appreciated only when there were enough daylight and good contrast with white ceiling
and wood panels.
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LIST OF TABLES
3.1
Settings Combinations of Materials (M), Color (C), and Daylight (D),
and Different Values Low (L), Neutral (N) and High (H).
50
3.2
Values of Natural Materials, Contrast, and Daylight
56
3.3
Semantic Differential Scale (Emotion)
57
3.4
Emotional Response Toward Interior Environment
58
3.5
Emotional and Affective Response to be used in the Current Study
59
3.6
Questions of the interview
61
3.7
Color Coded Settings Combination of Materials (M), Color Contrast
(C), and Daylight (D), and Different Values Low (L), Neutral (N) and
High (H)
62
3.8
Proportion Average Between Bipolar and Non-Bipolar and Their
Materials, Contrast, and Daylight Settings
64
4.1
Proportion Average Between Bipolar and Non-Bipolar and Their
Materials, Contrast, and Daylight Settings
67
4.2
Images Proportion Average Between Two Bipolar Age Groups and
The Images’ Materials, Contrast and Daylight Settings
88
4.3
The Most Liked and Preferred Images for Bipolar and Non-Bipolar
Groups
117
4.4
The Least Liked and Preferred Images for Bipolar and Non-Bipolar
Subjects
120
4.5
The Most Liked and Preferred Images for Two Bipolar Age Groups
(24-37) and (40-54).
124
4.6
The Least Like and Preferred Images for Two Bipolar Age Groups
(24-37) and (40-54).
128
5.1
Difference Between Bipolar and Non-Bipolar Subjects.
134
5.2
Differences Between Bipolar Age Groups
137
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5.3
Living Room Preferences for Bipolar People.
140
5.4
Living Room Preferences for People with Bipolar Disorder Age (2437).
142
5.5
Living Room Preferences for People with Bipolar Disorder Age (4054).
144
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LIST OF FIGURES
3.1
Living Room with High Wood, Low Contrast and Low Daylight
(HMLCLD)
54
3.2
Living Room with High Wood, High Contrast and Neutral
Daylight (HMHCND)
54
3.3
Living Room with Low Wood, High Contrast, and High Daylight
(LMNCHD)
55
3.4
Living Room with Neutral Wood, High Contrast and Neutral
Daylight (NMHCND)
55
4.1
Image 19: Living Room with High Materials, Low Contrast, and
High Daylight (HMLCHD)
68
4.2
Image 11: Living Room with Low Materials, High Contrast, and
Low Daylight (LMHCLD)
70
4.3
Image 27: Living Room with Neutral Materials, High Contrast
and High Daylight (NMHCHD)
72
4.4
Image 27: Living Room with Neutral Materials, High Contrast
and High Daylight (NMHCHD)
75
4.5
Image 18: Living Room with Low Materials, Neutral Contrast,
and Low Daylight (LMNCLD).
76
4.6
Image 1: Living Room with Neutral Materials, Low Contrast, and
Neutral Daylight (NMLCND)
78
4.7
Image 25. Living Room with Neutral Materials, Neutral Contrast,
and Low Daylight (NMNCLD)
80
4.8
Image 17: Living Room with Neutral Materials, Neutral Contrast,
and High Daylight (NMNCHD)
81
4.9
Image 20: Living Room with Neutral Materials, High Contrast
and Low Daylight (NMHCLD)
83
4.10
Image 13: Living Room with High Materials, Neutral Contrast,
and Low Daylight (HMNCLD)
85
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4.11
Image 10: Living Room with Low Materials, Neutral Contrast,
and High Daylight (LMNCHD)
87
4.12
Image 7: Living Room with Neutral Materials, High Contrast and
Neutral Daylight (NMHCND)
90
4.13
Image 19: Living Room with High Materials, Low Contrast, and
High Daylight (HMLCHD)
92
4.15
Image 23: Living Room with Low Materials, High Contrast, and
Neutral Daylight (LMHCND)
94
4.16
Image 9: Living Room with High Materials, Neutral Contrast,
and Neutral Daylight (HMNCND)
94
4.17
Image 1: Living Room with Neutral Materials, Low Contrast, and
Neutral Daylight (NMLCND)
96
4.18
Image 5: Living Room with High Materials, High Contrast, and
Low Daylight (HMHCLD)
Image 16: Living room with Neutral Materials, Low Contrast,
and High Daylight (NMLCHD)
98
4.20
Image 20: Living Room with Neutral Materials, High Contrast,
and Low Daylight (NMHCLD)
102
4.21
Image 22: Living Room with High Materials, Low Contrast, and
Low Daylight (HMLCLD)
102
4.22
Image 11: Living Room with Low Materials, High Contrast, and
Low Daylight (LMHCLD)
104
4.23
Image 12: Living Room with Neutral Materials, Low Contrast,
and High Daylight (NMLCHD)
105
4.24
Image 21: Living Room with High Materials, Neutral Contrast,
and High Daylight (HMNCHD)
107
4.25
Image 6: Living Room with Low Materials, Low Contrast, and
Neutral Daylight (LMLCND)
118
4.26
Image 1: Living Room with Neutral Materials, Low Contrast, and
Neutral Daylight (NMLCND)
118
4.27
Image 10: Living Room with Low Materials, Neutral Contrast,
and High Daylight (NMLCND)
119
4.19
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4.28
Image 4: Living Room with Neutral Materials, Neutral Contrast,
and Neutral Daylight (NMNCND)
120
4.29
Image 5: Living Room with High Materials, High Contrast, and
Low Daylight (HMHCLD)
121
4.30
Image 24: Living Room with High Materials, High Contrast, and
Neutral Daylight (HMHCND)
122
4.31
Image 18: Living Room with Low Materials, Neutral Contrast,
and Low Daylight (LMNCLD)
122
4.32
Image 20: Living Room with Neutral Materials, High Contrast,
and Low Daylight (NMHCLD)
123
4.33
Image 10: Living Room with Low Materials, Neutral Contrast,
and High Daylight (LMNCHD)
126
4.34
Image 19: Living Room with High Materials, Low Contrast, and
High Daylight (HMLCHD)
127
4.35
Image 4: Living Room with Neutral Materials, Neutral Contrast,
and Neutral Daylight (NMNCND)
127
4.36
Image 9: Living Room with High Materials, Neutral Contrast,
and Neutral Daylight (HMNCND)
128
4.37
Image 18: Living Room with Low Materials, Neutral Contrast,
and Low Daylight (LMNCLD)
129
4.38
Image 20: Living Room with Neutral Materials, High Contrast,
and Low Daylight (NMHCLD)
130
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CHAPTER I
INTRODUCTION
The environment consists of several physical elements that work together to create our
surroundings (Kopec, 2006). Psychological and physiological conditions can affect how people
perceive the environment around them (Kopec, 2006). In essence, the environment can influence
and be influenced by humans. Psychology can either be the influencer or the outcome in this
relationship (Kopec, 2006). Different aspects of the environment such as artificial lighting,
daylight, colors and temperature, can have impacts on our mood. Environmental conditions can
also influence the circadian rhythm, which is the cycle of sleep (Stephenson et al. 2012). As a
result, cognition and performance can also be affected. Further, the environment can effect
human physiological changes such as oxygen consumption, body weight, and energy (Graw et al.
1999). Psychological condition plays a mediating role between environmental conditions and the
way it is perceived by humans. People with psychological issues such as depression, seasonal
depression, and bipolar disorder perceive elements of the environment slightly different
(Silverstone et al. 1995). For example, people with seasonal depression can be affected by
weather changes, and the amount of light they are exposed to, whereas people with bipolar
disorder can be sensitive to light. In some studies, bipolar patients reported annoyance to bright
light, especially during springtime (Silverstone et al. 1995).
The current study focuses on the emotional and affective responses of people with bipolar
disorder to the interior environment. Bipolar disorder is a mental illness that has biological and
psychological aspects (Alloy et al. 2005). Bipolar disorder is a condition that causes alternating
episodes of bipolar depression and bipolar mania. In other words, it is extreme happiness and
extreme depression in cycles (Craddock and Jones, 1999). According to Hedaya (2011), the
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United States has the highest lifetime rate of bipolar disorder at 4.4%, and India the lowest, with
0.1%. Patients with bipolar disorder in the manic phase can make poor decisions such as buying
expensive items. Manic patients could also jeopardize their relationships, marriages, and
friendships. There are three different types of mania. Euphoric mania, which make people appear
happier and very excited about anything (Belmaker, 2004). Patients in these episodes can have a
substantial influence on other people because of high positive energy and self-confidence.
However, they may attempt risky actions (Belmaker, 2004). Dysphoric mania, is a combination
between mania and depression. In these episodes, the patient changes mood at a much faster rate
(Belmaker, 2004). They don’t sleep well, feel uncomfortable, and agitated. Unmediated long
episodes of mania can cause serious psychological problems such as believing in things that are
not real, seeing or hearing voices. These symptoms can appear as a response to a great loss in the
family, like a death of a loved one (Belmaker, 2004). Some patients get manic episodes early on
in their youth and depression episodes after that. The last type is bipolar depression, in which
patients get more episodes of depression than manic episodes (Belmaker, 2004).
Mental illnesses or disorders cause people to be more sensitive to environmental stimuli
such as light, color, views, temperature, aroma, and noise. These environmental stimuli can have
healing and therapeutic benefits for people (Mazuch and Stephen, 2005). The role of an interior
designer is to create an environment that takes into consideration different stimuli and use that to
serve the occupants in the best way (Kopec, 2006). Humanistic architecture considers mental
well-being as a person’s awareness to his/her environment, which means how a person receives
information about the environment through his/her senses and responds to it (Mazuch & Stephen,
2005).
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While a body of literature exists that have examined the impact of the physical
environment on people in general, very few scholarly investigations have focused on people with
bipolar disorder (elaborated in the literature review section). In the United States, 2.6 % of the
adult population have been clinically diagnosed as suffering from chronic bipolar disorder
(Kessler, Chiu, Demler, and Walters, 2005). In addition, there are numerous people who suffer
from the problem without being clinically diagnosed as bipolar. As mentioned earlier, bipolar
disorder not only affects the patient, but also affects loved ones, and could have a serious impact
on one’s domestic life, work, and productivity. Considering the existing gap in the literature on
the subject matter, this dissertation examines whether there are differences in emotional
responses to environmental stimuli between people with and without bipolar disorder, with the
long-term aim of developing design guidelines that may help psychological states of the affected
people through appropriate environmental interventions.
Purpose of the Study
The purpose of the study is to examine emotional responses of people with bipolar
disorder to different environmental states. Specifically, the study aims to identify interior
environmental conditions (daylight, color contrast, and wood material) that may enhance the
psychological state of people with bipolar disorder.
Research Questions
The study addressed the following questions:
(1) How do people with bipolar disorder emotionally respond to differences in interior
daylighting, color contrast, and wood materials?
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(2) Are there any differences between how people with and without bipolar disorder respond
to these changes?
(3) Does age of people with bipolar disorder influence their responses?
Conceptual Framework
A review of the literature (elaborated in Chapter 2) found that many elements in the
environment can affect people with bipolar disorder such as artificial light, natural light, sound,
temperature, colors, and so on. The best theories that explain the impact of environmental
stimulations are the integration theory and the stimulation theory. The current study will be
situated within these two theoretical frameworks.
The integration (integral) theories state that elements in the environment work in
harmony to facilitate a particular behavior (Gifford 2001). These elements are: (1) common
characteristics of an environment such as artificial light or daylight, furniture, and the overall
atmosphere of the place (2) stimuli that trigger our behaviors such as light, noise, colors, and
finishes (3) a situation that bring disappointment or pleasure, this can relate to a person’s
memories and experience (4) environment that facilitate or restrict our behavior (5) features in
the environment that guild us what we can do and where we go (Kopec, 2006). In the residential
environment, many factors influence people such as natural light, artificial light, materials, and
colors, which are all considered the variables that trigger our senses. Different values of each of
these factors can cause different reactions on peoples’ moods and emotions. Therefore, these
changes affect peoples’ behaviors and interactions with the environment surrounding them. For
example, the amount of daylight coming from a window can have possible positive effects, but it
can also create a disturbing glare. This can affect a worker’s performance and productivity, so
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they may leave their office more often. Moreover, when a person is interacting with his /her
environment, he or she impacts the environment through making choices of either littering or
recycling (Treisman, and Gelade, 1980). This leads us to the conclusion that the relation between
the environment and the human goes both ways in influencing each other (Gifford, 2001).
The stimulation theory also explains the relationship between the environment and
humans. Stimulation theory states that the environment is full of sensory information that we
need to process (Wohlwill, 1966). Our mind is always working to process information that we
get from our five senses such as smell, touch, taste, sight or hearing. This information is
processed through our mind and the cognitive processes, which comprehends and reacts to these
information (Kopec, 2006). Our senses can be overstimulated (hyper-stimulated) when the
stimulation is more than what we can handle at a point in time (Kopec, 2006). The human mind
has limits in processing information. On the other hand, we also can be under-stimulated (hypostimulated) if the stimulation is not enough to keep us attentive (Kopec, 2006). For example, a
room with a light that is too bright can cause glare and irritation, which makes people
uncomfortable. This can impact their emotions, interaction with their environment, and
productivity. However, the nature and magnitude of reaction to environmental stimuli vary from
person to person. People with mental illnesses such as bipolar disorder may perceive their
environment differently than other people (Silverstone et al. 1995). Designers need to know
which stimulation they want to work with in order to get people to pay attention to something
(attention selection) (Kopec, 2006). That means if we want to enhance peoples’ alertness, for
example, we should improve a specific environment condition, such as lighting (Küller et al.
2006). Moreover, we receive stimulation from the environment as a whole, and not individual
stimulus in isolation (Chein, 1954).
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Personal Differences
Mental illnesses, such as bipolar disorder, make people perceive the surrounding
environment differently than other people. Age and gender can also affect people affective and
emotional responses. Therefore, we implicitly hypothesize that age, gender, and bipolar disorder
can affect people’s interior preferences.
Many studies discuss the topic of gender and environmental relationships. Males are the
stronger sex because they have more muscle mass. In the old days, males were hunters and they
formed closer relationships with each other as hunter groups (Kopec, 2006). On the other hand,
women are more nurturing because they give birth to children and take care of them. People of
both genders acquire a certain role in society (Buckingham-Hatfield, 2005). Women are the
primary caretakers of the private sphere of the household, whereas men dominate the public
sphere (Buckingham-Hatfield, 2005). This means that men spend more time outside the home
working or doing other activities such as mowing and gardening while women spend more time
taking care of children, cooking and cleaning. Women are more associated with their gender
space in the home such us kitchen, laundry, and bedroom, where they spend most of their day
(Kopec, 2006). Specifically to this study, both genders have different preferences to the living
room environment. For example, males would prefer more muscular finishes and more neutral
colors, while women prefer feminine designs (Kopec, 2006). Moreover, age is another issue that
concerns interior and environmental design researchers. Emotional responses to the environment
can vary considerably by age (Ulrich, 1983).
The relationship between humans and their environment is mediated by culture (Ingold,
1992). Different cultures see the physical environment in very different ways (Altman and
Chemers, 1984). Homes are designed differently around the world. For example, some houses in
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parts of India are oriented towards sacred directions (Altman & Chemers, 1984). The physical
environment and culture blend as a unity, each affecting the other (Altman & Chemers, 1984).
The environment has many effects on human health conditions. Pollution can cause many
diseases, such as how global climate changes can cause infectious diseases (Frumkin, 2001). On
the other hand, the natural environment has health enhancing powers (Frumkin, 2001).
Since people with bipolar disorder have not been the subject matter of earlier studies, we
are using findings from studies on the general population as a basis to assume what
environmental characteristics could possibly make a difference on emotional response in the case
of people with bipolar disorder. Natural landscapes such as parks, cemeteries, golf courses and
lawns invite people to go outside more (Frumkin, 2001).
Definitions of Terms
Choma. Attribute of color used to indicate the degree of departure of the color from a
neutral color of the same lightness. C*, (in the CIE 1976 L*, a*, b* or L*, u*, v* system) the
quantity C*ab = (a*2 + b*2)1/2 or C*uv = (u*2 + v*2)1/2 (ASTM International, 2013).
Colors. The color is a result of spectra of optical radiation generated by light sources,
modified by objects, and processed by the human eye (DiLaura, Houser, Mistrick, and Steffy,
2010). Color, is the most emotional and personal element of all design elements. Everyone has
different preferences to color but usually people respond similarly to some color combinations
(Nielson & Taylor, 2011).
Color Contrast. color contrast is the difference between two colors (Feisner and Reed,
2013).
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Depression. It is a drop of self-esteem with or without a feeling of guilt. Depression
involves a significant lowering of mood, and feelings of hopelessness and helplessness (Parker
and Hickie, 2007).
Gender. It is the social construction organized around biological sex. People, as they
grow older, they acquire gender identity (Buckingham-Hatfield, S, 2005).
Hue. The attribute of color perception by means of which a color is judged to be red,
orange, yellow, green, blue, purple, or intermediate between adjacent pairs of these, considered
in a closed ring (ASTM International, 2013).
Illuminance. Luminous flux incident per unit of area (ASTM International, 2013).
Light. Light is a component of the built environment that produce our visual perception
and provides for our visual performance (DiLaura, Houser, Mistrick, & Steffy, 2010). Light in
interior design can have two sources: natural light and artificial lighting. Light can have an
influence on how we see things, and it can make the place seem larger (Nielson & Taylor, 2011).
Light reflectance value. (LRV)—the luminance factor Y, of a sample expressed as a
percent. Thus, a Y value of 70 would equate to an LRV of 70%. The LRV indicates the portion
of light cast on a sample that is not absorbed (ASTM International, 2014).
Luminance. Luminous flux in a beam, emanating from a surface, or falling on a surface,
in a given direction, per unit of projected area of the surface as viewed from that direction, per
unit solid angle (ASTM International, 2013).
Major life events. A major event that changes a person's status or circumstances. It can
have an impact on health, social relationship, habits, patterns of activity and health-related
behaviors. In other words, major life events can affect the person’s pattern of daily hassles
(Kanner, Coyne, Schaefer, and Lazarus, 1981).
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Materials. The final appearance of all exposed interior surfaces; floors, walls,
ceilings, and all finish materials, such as tile, marble, plastic laminate, wood, and paint (the free
dictionary). Materials catch and either absorb or reflect light. Smooth surfaces reflect more light,
which makes colors look brighter. Grained wood and other rough textures break up the light and
make color appear darker (Nielson & Taylor, 2011).
Mood. It is an emotional state that may last anywhere from a few minutes to several
weeks. Mood effects the way people respond to stimuli (goodtherapy.org)
Peaceful. To feel happy and calm because you are satisfied with your life
(Cambridge.org).
Relaxed. Feeling happy and comfortable because nothing is worrying you
(Combridge.org).
Stimulated. An action or thing that causes someone or something to become more active
or enthusiastic or to develop or operate (Cambridge.org).
Stressed. Stress is a psychological and physiological response to a stimulus or stressors
(Kopec, 2006).
Wide-awake. Feeling not sleepy and alert (Bradley and Lang, 1994).
Significance of the Study
Mental Health America reported nearly 6 million American adults (2.6 percent of the
population) are suffering from bipolar disorder I and II (Kessler et al. 2005). Studies show the
medical expenses are about 24 billion US dollars (Begley et al. 2001). One study reported
expenses ranging from $11,720 $ to $624,785 (Begley et al. 2001). Bipolar disorder is one of the
ten most disabling illnesses, affecting the healthy functioning of individuals who have the illness
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(Kupfer, 2005). The lifetime rate of suicide attempts among bipolar subjects is 29.2%, and
unipolar disorder is 15.9% (Chen and Dilsaver, 1996). Studies have shown a significant impact
of bipolar disorder on performance, social activities, and family interactions (Calabrese et al.
2003). It affects individuals and families in numerous ways - being jailed, arrested and convicted
of crimes for men, and disruption in social and family life for women (Calabrese et al. 2003;
Hirschfeld et al. 2003). Very few studies have examined the influence of interior design on the
psychological wellbeing of people with bipolar disorder.
This study constitutes the first step towards understanding the potential effects of interior
environments on the psychological state of people with bipolar disorder in residential settings.
The current study is expected to create the foundation for a larger quantitative study leading to
design guidelines for this population.
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CHAPTER II
REVIEW OF LITERATURE
Part I: An Overview of Bipolar Disorder
Types of Bipolar Disorder. There are two types of bipolar disorder: Bipolar I has the
most severe mania and depression periods, and Bipolar II, which has less dramatic
episodes. Cyclothymia is another type of bipolar disorder which swings between high and
low moods (Soreff and McInnes, 2004). A study done by Parker et al. (2014) found no
gender differences between the two types or symptoms. Both men and women could be
diagnosed with Type I or Type II. However, the health-related quality of life (HRQOL)
reported that women with bipolar depression had a lower HRQOL than men. It also
found that depressive episodes are stronger in a lower HRQOL than manic episodes.
Moreover, women experience more physical pain than men when diagnosed with bipolar
illnesses (la Cruz, Lai, Goodrich and Kilbourne, 2013). There are three types of mania:
Euphoric mania, which makes people appear happier and very excited about anything.
Patients in these episodes can have substantial influence on other people because of high
positive energy and strong self-confidence. However, they may attempt risky actions
(Belmaker, 2004). Dysphoric mania is combination between mania and depression. In
these episodes, the patient changes mood at a much faster rate (Belmaker, 2004). They
don’t sleep well, feel uncomfortable, and agitated. Unmediated long episodes on mania
can cause serious psychological problems such as believing in things that are not real,
seeing or hearing voices (Belmaker, 2004). These symptoms can appear as a result of a
loss as a death of a family member. Some patients get manic episodes early in their youth
and depression episodes after that (Belmaker, 2004).
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Symptoms of Bipolar Disorder. People with bipolar disorder suffer from episodes of
manic disorder and episodes of depression in recurring cycles. Manic episodes can cause
thoughtless decisions such as alcohol abuse, relationship problems, or overspending of
money (Belmaker, 2004). Depression episodes can cause both abuse of self and others, a
lack of self-confidence, and low self-esteem. Severe episodes can lead to suicide
(Belmaker, 2004). People with bipolar disorder usually have problems with their
circadian rhythm, and suffer from sleep deprivation if they develop manic symptoms,
which may worsen their mood cycle (Harvey, 2008). They typically will oversleep to
overcome their depression symptoms, thus causing them to be late for work and miss
appointments, thereby making them unable to hold stable job (Bowden, 2005). Many
people with bipolar disorder also experience weight gain either because of the depression
or because of their medication (Bowden, 2005).
There are two types of symptoms of bipolar disorder: manic symptoms and
depression symptoms (Calabrese, Hirschfeld, Frye and Reed, 2004).
Depression Symptoms include.
•
Feeling sad or depressed
•
Having little interest or pleasure
•
Thinking of suicide and death
•
Feeling worthless or having guilt
•
Weight loss or gain
•
Problem sleeping or staying asleep
•
Anxiety and poor concentration
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Manic symptoms include.
•
Being overly optimistic
•
Abnormally talkative or feeling to talk too much
•
Lack of sleep or feeling no need to sleep
•
Agitation or restlessness
•
Risky behavior
•
Rapidly changing of thoughts
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Part II: Emotional and Physiological Responses to Environmental Stimuli
Artificial Lighting
Light is a form of energy that comes from the sun, fire, or electric light and makes
it possible to see our surroundings. The quality and quantity of light can affect our vision
(Kopec, 2006). Artificial light can create a mood, put emphasis on a piece of furniture or
highlight a decorative element in design (Nielson &Taylor, 2004). There are three main
types of artificial lighting: fluorescent lighting (luminous lamps), incandescent lighting
(light bulb with a tungsten element that glows by producing heat) and LED lighting
(Light-Emitting Diode) (Kopec, 2006). Fluorescent lighting can provide cool lighting or
warm spectrums, while, incandescent lighting produce only warm light. LED is a
microchip that converts electricity into light and remains cool to the touch and lasts
longer, making it eco-friendly (Nielson & Taylor, 2004). There are many uses for
artificial lights varying from any indoor lightings such as overhead lighting, task lighting,
emphasise lighting, and side lighting (Nielson and Taylor, 1990). For people with bipolar
disorder, it is important to provide more than one type of lighting and lighting fixture to
give them the option to change the level of lighting according to their mood shifts
(Leibenluft, et al. 1994).
Emotional response. Light or luminosity is radiant energy where the
electromagnetic radiation, which averages between the wavelengths of 400 and 700 nm,
can be seen by sight (Kopec, 2006). Incandescent lamps and light therapy have been used
for a long time to improve the mood of bipolar patients (Leibenluft, et al. 1994).
Leibenluft et al. concluded in their research that light therapy could have mood-altering
effects on patients with rapid cycling bipolar disorder. The data shows that morning light
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can increase mood cycling; however, midday light therapy has antidepressant effects. The
brightness emitted from the morning and evening light can cause phase shifts, but indirect
midday light can increase the amplitude of nocturnal melatonin secretion (Leibenluft, et
al. 1994). Moreover, a similar study conducted in 2007 on bipolar women by Sit et al
showed that morning light developed mixed states of mind whereas midday light of 7,000
lux developed a better result in enhancing women’s mood and eliminating depression.
Indoor lighting and color may also have effects on the mood of people working
indoors (Küller et al. 2006). A study conducted in four countries located on the north side
of the equator and closer to the equator showed significant changes in the worker’s mood
throughout the year in countries on the north portion of the equator (Küller et al. 2006).
The study also indicated that psychological mood would be significantly declined when
the light is too dim or too bright, and their mood would be improved when the light is just
right (Küller et al. 2006). In the study, the majority of the subjects were exposed to
lighting conditions that varied from 30 lux and 2000 lux but indicated that the light
condition is “just right,” which means that they got used to the light conditions in their
environment. Moreover, the study showed that interior colors have positive impacts when
it is colorful and bright (Küller et al. 2006). A study also shows that people prefer warmer
less luminance lighting more than cool, more bluish, bright light (Knez and Kers, 2000).
Finally, the color of light also has differential psychological effects on males and
females (Knez, 2001). A study investigating the influence of warm, cool and artificial
daylight found out that males perform work better in warm and cool lighting; whereas
females perform better in the artificial daylight white lighting (Knez, 2001). Females also
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appraised the room light in all light settings, but there were no effects on the mood of
non-depressed subjects from both genders (Knez, 2001).
Physiological response. Age and gender moderate the influence of indoor
lighting on physiological and psychological effects (Knez and Kers, 2000). For example,
Knez and Kers (2000) found differences owing to age and gender in the diurnal and
annual rhythms of melatonin and cortisol (a hormone that is released in response to stress
and low blood sugar) (Knez & Kers, 2000). It found that younger male subjects suffered
from negative mood swings in warm, more reddish, white lighting; whereas, older males
ages of 65 and above were not affected (Knez & Kers, 2000). Moreover, the study
showed that lighting with low, cool illuminance (300 lux) and warm white lighting with
high illuminance (1.500 lux) best preserved the subjects’ positive moods while working
on cognitive tasks for 90 minutes. Additionally, there is a gender difference between men
and women. It appeared that women see the room lighting either dimmer or more intense
than men (Knez and Kers, 2000).
One study compared mood, oxygen consumption, and body weight among
females suffering from seasonal and non-seasonal depression, and females not suffering
from depression, when treated with physical exercise and bright light. Sixty-three females
participated in this study; none of the subjects were on antidepressant medications and
did not exercise regularly (Pinchasov, Shurgaja, Grischin, and Putilov, 2000). Subjects
were divided into seven groups and were assigned to either receive physical exercise or
be exposed to a bright light of 2500-lux cool-white light (Pinchasov, Shurgaja, Grischin,
& Putilov, 2000). Both bright light and exercise reduced levels of depression and
enhanced the subjects’ mood in seasonal and non-seasonal depression. The study showed
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that the rate of oxygen inhalation was higher in seasonal affective depression SAD
subjects treated with bright light and the rate was lower in the control group (Pinchasov,
Shurgaja, Grischin, & Putilov, 2000). Body weight was also affected by the treatment,
and it decreased more among the treated group than the untreated group of SAD patients.
Moreover, the treatment also showed a significant change in oxygen consumption in nondepressed subjects (Pinchasov, Shurgaja, Grischin, & Putilov, 2000).
Daylight
The light of the sun has a full spectrum of colors, which makes colors of the
environment appear rich and vibrant. Natural light has psychological effects; it can be
cheerful and healthy. Natural light distributed to the interior can eliminate shadows and
reduce visual and physical fatigue (Nielson &Taylor, 1990). Windows, French doors, and
skylights can be good sources of sunlight. The orientation of the house is important for
the temperature and color of natural light. The southern-exposure light is warmer than the
northern light. Moreover, reflected light might take on the color of the surface it reflects
on. For example, sunlight reflecting the sea would appear bluer. Natural light color will
also appear different if it is cloudy or rainy than it is on a sunny day (Nielson &Taylor,
1990). Another type of natural light is combustion lighting which comes from fireplaces,
candle lights and lanterns. These kinds of light can have a dramatic effect on
surroundings creating a sense of coziness and charm. (Nielson &Taylor, 1990). That may
have positive impacts on the mood of people with bipolar disorder and get them more
relaxed (Nielson &Taylor, 1990).
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Emotional response. Seasonal changes which cause variation in daylight can have
significant effects on people, especially patients with the seasonal affective disorder.
Symptoms, like oversleeping, overeating, craving carbohydrates, and feeling depressed
are considered normal for these patients during the winter (Graw et al. 1999), whereas in
summer and spring, people are more active and energetic. Studies show that women with
SAD (seasonal affective disorder) spend more time during summer in outdoor light than
the control group, while they spend less time outdoors in winter than the control group
(Graw et al. 1999). Moreover, women with SAD compared to the control group not only
have higher rates of depression in winter but also in summer (Graw et al. 1999).
However, studies show that exposure to full-spectrum light in early morning and evening
may improve patients’ mood and eliminate their depression symptoms (Rosenthal et al.
1985). Circadian rhythm is especially more sensitive during early morning hours under
full light spectrum; in contrast, sleep deprivation can occur under high and low light
treatment (Rosenthal et al. 1985). Outpatients who received a treatment of 300-lux light
were oddly showing improvement under low light, which can be explained by abnormal
sensitivity to light in patients with the bipolar affective disorder. Moreover, many patients
agreed to use the bright evening light more than to be awakened by light therapy early in
the morning (Rosenthal et al. 1985). A study conducted by Genhart and her colleague on
normal elderly women showed that exposure to bright light made elderly women anxious
and irritated. Subjects in the study reported headaches, depression, dizziness and
irritability in the bright light session. On the other hand, none of the negative side effects
occurred in the dim light treatment (Genhart et al. 1993). A study conducted at 24 sites in
13 countries, spanning latitudes from 6.3 to 63.4 degrees from the equator, including data
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from both hemispheres, investigated mood changes in people with bipolar disorder
(Bauer et al. 2012). The study found that sunlight is the primary synchronizer of circadian
rhythmicity in humans (Bauer et al. 2012); therefore, the interruption of circadian rhythm
may have a great impact on the pathology of bipolar disorder.
Physiological response. In addition to the psychological effects of light on the
human body, there are physiological impacts. Some of the physiological impacts include
changes of circadian rhythms, suppression of nocturnal melatonin release and regulation
of heart rate, body temperature, alertness, and cognition, as well as psychological impacts
on the mood (Stephenson et al. 2012). The mood is an emotional state that may last
anywhere from a few minutes to several weeks. Mood has an effect on the way people
respond to stimuli (goodtherapy.org)
Circadian Rhythm is present in humans and most animals. It is generated by an
internal clock that is synchronized to light-dark cycles and other hues in an organism's
environment. This internal clock accounts for waking up at the same time every day, even
without an alarm clock. Circadian rhythms can be disturbed by changes in the daily
schedule (Craddock & Jones, 1999).
Light has positive effects on the circadian system, non-circadian system and nonvisual effects of light. Light is also important for alertness, mood, and sleep. The
interruption of the circadian rhythm is experienced in many situations such as work shifts
and jet lag, which may contribute to mood shifts (Stephenson et al. 2012). Circadian
disruption is one main symptom in seasonal affective disorder (SAD), which increases
during the winter and it may cause an increase in alcohol use and thoughts of suicide
(Stephenson et al. 2012). Moreover, mood affects the amount of alertness in many mood
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disorders such as depression, bipolar disorder, seasonal affective disorder and excessive
daytime sleepiness. Patients suffer from a state of lack of energy and alertness
accompanied with sleepiness during the day and sleep apnea (Stephenson et al. 2012).
Sleep apnea is a condition where a patient suffers from breathing irregularities during
sleep, which leads to sleep disturbance and sleepiness during the daytime. When exposed
to light, the circadian system increases alertness during the day, which therefore improves
the mood. On the other hand, Melatonin levels increase during the night, which decrease
alertness and remain low during the day, and therefore increases alertness (Stephenson et
al. 2012).
The circadian system can be measured by the amount of melatonin released by the
pineal gland. Sleep disturbances most likely are symptoms of patients with bipolar
disorder who suffer from their manic phase or depression phase (Plante and Winkelman,
2008). Sleep disturbance is a very critical factor because of the extent to which it can
affect life quality regarding productivity, and mood changes. There are many types of
sleep disturbance, such as insomnia, which is considered inadequate sleep/ sleep
deprivation, and hypersomnia, which is a sleep-wake disorder (a person can sleep for 12
hours and wake up exhausted). Knowing the type of sleep disturbance allows the doctor
to give the right cure for the condition (Plante & Winkelman, 2008).
People with bipolar disorder usually suffer from sleep deprivation, which may
worsen their mood cycle (Harvey, 2008). Harvey conducted a study on sleep and
circadian rhythms in patients with bipolar disorder. The study recommended that patients
with bipolar disorder are advised to go to bed even before getting sleepy to “begin the
process of down-regulating” and to wake up at the same time every day. It is important to
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stay in bed for at least 6.5 hours to avoid sleep deprivation (Harvey, 2008). It is also
essential for patients to use the bedroom and bed only for sleep and get out of it if they
cannot sleep. So, it is advised for people with bipolar disorder not to have a workspace
like a desk or entertainment devices in their bedrooms. Patients have to get “dark
therapy” if they developed manic symptoms and get “light therapy” if they developed
depressive symptoms (Harvey, 2008). Therefore, it is essential to have curtains and
blinds over the windows in the bedrooms.
Colors
We see colors through the subtractive color theory: when light hits a colored
object, all the color wave bands are absorbed except for the hues that are pigmented.
Most people see colors the same way (Nielson and Taylor, 1990). A color appearance can
change from natural light to artificial light or what is called metameric effect. Because of
this, the judgment of a color should be under a full spectrum of light such as sunlight
(Nielson and Taylor, 1990). Moreover, orientation can have an effect on the direction of
natural light, for example, the Eastern light is clear and bright, the Northern light is clear
and cool, the Southern light is constant, and worm, and the Western light is hazy and hot.
Artificial lighting offers a variety of spectrum, for example, incandescent lighting has
more warm wavelengths than cool, and fluorescent lighting contains cooler spectral
colors than warm (Nielson and Taylor, 1990).
There are many color theories that make us understand colors, how to use it, and
what its emotional and psychological effects are (Nielson and Taylor, 1990). These
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theories help us take full advantage of using colors in designing for people with
depression and bipolar disorder. Some theories are:
1. Standard Color-Wheel Theory. The original color wheel where three primary
hues -red, yellow, and blue- are placed equidistant. Secondary hues are placed
between primaries (Nielson and Taylor, 1990).
2. Munsell Theory. Formatting a color wheel and then expanding it to three
different coordinates with leaves of color variation (Nielson and Taylor, 1990).
3. Ostwald Theory. Plotted as triangular pages with hues varied not by Chromabut
by the amount of black and white (Nielson and Taylor, 1990).
Commission Internationale de L’Eclairage: CIE created a systematic way to
measure color called CIE System of Colorimetry in 1931(Schanda, 2007). The LAB color
measurement system depends on three axes, L in the luminance or the lightness
component that ranges from 0 to 100, parameter A is the parameter measuring colors
from red to green, and parameter B are measuring colors from blue to yellow. These two
Chomatic components range from -120 to 120 (Leon, Mery, Pedreschi and Leon, 2006).
Emotional response. Barrick, Taylor, and Correa (2002) suggest that color
sensitivity could be impaired if the person is feeling sad, depressed, or blue. The selfreport depression showed that the scale measuring color sensitivity, “colors seemed
cloudy, gray or lack of color,” correlates with the scale of feeling “depressed/ blue/ sad.”
This means that people with bipolar disorder seem to have a color impairment. As a
design solution for this, colors should be more saturated and deeper because pastel colors
could increase the feeling of cloudiness and gray colors. Different colors have different
effects on people’s moods and behavior (Nielson and Taylor, 1990). For example, blue is
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known for its relaxing effect, green can reduce anxiety, orange is the color of caution and
increases alertness, and red is the color of energy and vibration. Each color can be used to
stimulate specific behaviors (Call and Jantzen, 2011).
Physiological response. There are many studies on physiological response to color
using such measures as nm; blood pressure, heart rate, and eye blink frequency (Kaiser,
1984). Kaiser’s study showed different eye blinks respond to color where the highest
frequency was for red, less was for white and least for blue. The galvanic skin response
was mediated by sweating, which is related to emotional arousing (Kaiser, 1984). A study
was conducted to elicit negative and positive emotions by measuring heart rate, skin
conductance, and facial musculature (Fitzgibbons and Simons, 1992). The study showed
a linear relationship between facial EMG and heart rate with affective valence, whereas,
skin conductance was a linear function of arousal. There was also a strong relationship
between skin conductance response magnitude and slide valence. Moreover, positive
color slides were viewed longer than the negative color slides (Fitzgibbons & Simons,
1992).
It was believed in the 80’s that the Baker-Miller Pink wall color could reduce violent
activities and aggressive behaviors among clients, patients, or inmates (Schauss, 1985).
Studies showed that this color reduces stress and has calming effects. Moreover, pink has
a physiological response on the secretion of a hormone that works as a neurotransmitter
to the hypothalamus or pineal gland (Schauss, 1985). On the other hand, the color red can
evoke a feeling of danger and arouse attention such as the red light and red marks on a
student paper; however, red also indicate love, passion, lipstick and rouge (Elliot, and
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Maier, 2007). Wood is supposed to be a pleasant, agreeable, and warm material (Elliot,
and Maier, 2007).
Materials
The material is the substance out of which a thing is or can be made. Materials in
interior design define the different textures or the appearance of surfaces. Texture can be
determined by two ways: either by touching the surface or by visually reading it (Nielson
and Taylor, 1990). Smoothness and roughness of surfaces have physiological and
psychological effects on people. A smooth texture reflects more formal, high style
appearance, while a rough texture gives a more casual style. However, very smooth
textures can be cold and unwelcoming, and texture that is very rough can feel clustering
and heavy (Nielson & Taylor, 1990). Materials have been widely used in interior design;
many materials that were usually used outdoors like rocks and shingles are used indoors
nowadays to add a more contemporary feeling (Nielson and Taylor, 1990). Also, river
stones and natural unprocessed wood are used in interiors to bring the feeling of nature
into the home environment. Wood as a material has great aesthetic features that give the
products made out of wood (furniture, flooring and kitchen cabinets) great advantage
over other products (Broman, 1995). Moreover, the appearance and species of wood have
great impacts on people preferences. Darker wood is considered old-fashioned, while
lighter wood appears more modern. For example, dark wood such as mahogany, cherry,
and walnut are rated to be expensive, formal, and old-fashioned. Oak is considered
formal, warm and expensive. Maple is perceived as inexpensive and casual (Bumgardner
and Bowe, 2002). There are also gender differences between male and female
perspectives involving casualness and expensiveness, showing a preference over oak and
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pine wood finishes (Bumgardner & Bowe, 2002). Natural wood marks such as knots
received exceptional attention and preference from consumers. Studies showed that
character-marked wood furniture has more evaluation values and more favorable than
other products (Bumgardner, Bush, and West, 2001) and (Rice, 2004).
Emotional response. A study by Sakuragawa et al. (2005) found associations
between visual stimulation, depression and blood pressure. The study made a comparison
of physiological and psychological effects between wood veneer and steel wall panels.
The study showed a significant decrease in blood pressure and reduction in “depression/
dejection” in people who liked the appearance of Hinoki wood panels. However, no
stress was caused in subjects who disliked it. On the other hand, there was a significant
increase in blood pressure as well as an increase in the “sense of depression” and stress in
people who disliked the appearance of steel wall panels. Therefore, using wood in
interiors for flooring or wood panels can have positive effects on people (Sakuragwa et
al. 2005). In a study by Tsunetsugu and colleagues (2005), the physiological effect of
visual surrounding in a living environment was tested. Cerebral blood flow, pulse rate,
and blood pressure were investigated. The results showed that the two rooms showed no
significant physiological reactions. However, the room with regular interior design
caused calm and relaxed state, while the room with visible wooden columns and beams
caused an active and aroused state (Tsunetsugu, Miyazaki, and Sato, 2005).
Physiological response. Tsunetsugu and colleagues (2007) determined a study
for the visual effect of room interior with wooden materials on human’s, pulse rate, blood
pressure and brain activity. Subjects were exposed to actual rooms with different wood
ratios (0%, 45%, and 90%). These ratios are to the whole actual area of the ceiling, walls,
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and floor). In the 0% room, blood pressure decreased significantly. In the 45% room,
there was an increase in pulse rate and a decrease in blood pressure. The subjects rated
this room as the most comfortable setting. The 90% room caused a substantial decrease in
blood pressure; however, the large use of wood caused a decrease in brain activity and
increased pulse rate (Tsunetsugu, Miyazaki, and Sato, 2007). Another study was
conducted to determine the effects of wood on interpersonal perception using the interior
office environment. The result showed a more favorable first impression of the occupant
(Ridoutt, Ball, and Killerby, 2002). There was also a difference between European and
Asian subjects, where Europeans pay more attention to the work environment than Asian
subjects (Ridoutt, Ball, and Killerby, 2002).
Seasons and Climate
It is well known that changing of seasons have impacts on people and animal
behaviors. Usually, people may feel depressed during winter when it is cloudy and rainy
all the time. Cold weather makes people stay inside longer where there may be a lack of
activity, and could lead them to feel sad and unenthusiastic. Though people with bipolar
disorder feel depressed during springtime, when the sun is up for long hours, it can
trigger their mood swings as well (Silverstone et al. 1995).
Emotional response. Many studies show no seasonal patterns of mania episodes in
the northern and southern hemispheres (London and Dunedin). However, a study showed
a pattern of depression in spring in both the northern and southern hemispheres
(Silverstone et al. 1995). Moreover, the study conducted by Margrethe Christensen et al.
(2008) also shows no correlation between climatic factors and manic phases measured by
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(MAS) the Bech-Rafaelsen Mania Rating Scale; but found statistically significant
negative correlations between climatic changes and depression episodes measured by the
Hamilton Depression Scale (HAM-D) (Margrethe Christensen et al., 2008).
Furthermore, a study measuring the relationship between latitude, climate, season
and self-reported mood in bipolar disorder, on medicated patients living in five different
climate zones in the northern and the southern hemispheres (North and South America,
Europe and Australia), found that there were no seasonal patterns between self-reported
mood changes and seasonal changes (Bauer et al. 2009). The researchers explained these
results as that climate change does not have a great impact due to “adaptive innovations
such as air-conditioning, lighting, and central heating.” People mostly spend their time
indoors (Bauer et al. 2009).
Physiological response. A study in Taiwan found a correlation between high
temperatures over 24°C and increased admissions for patients with bipolar disorder.
“Higher ambient temperature and relative humidity in the face of lower air pressure have
been previously found to predict the relationships between low L-tryptophan availability
and violent suicide occurrence” (Sung, Chen, and Su, 2011. p298).
On the other hand, body temperature levels and circadian pattern may change
during the switch process between mania and depression. Poor sleepers have higher body
temperatures than good sleepers (Avery, Wildschiodtz, and Rafaelson, 1982).
Noise
Emotional and physiological response. The definition of noise according to Kryter
(1994) is the acoustic signals that have negative effects on physiological and
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psychological well-being of people. Noise can disturb humans and can affect one’s
ability to concentrate and function. Some symptoms of noise annoyance include
headaches, tiredness, sleep disturbance, aggregation, and irritability (Tarnopolsky et al.
1978). Noise can be avoided and reduced by using design solutions such as acoustic
ceilings, sound barriers, insulations, sound absorptive materials and sealed cracks and
holes (Kopec, 2006). There are two types of noise: natural noise such as the wind, ocean
waves, vibration and earth magnetic fields; and human-made noise such as traffic,
machines, ventilation systems, construction, and human voices (Kopec, 2006).
There is also an association between noise and psychological disorder. Many
studies showed that sensitivity to high noises is more likely to appear in women with
psychological disorder and anxiety and who are more sensitive to other environmental
stimulation (Stansfeld et al. 1985). A study by Tarnopolsky, Barker, Wiggins and
McLean (1978) found that people who have psychiatric symptoms and live near airports
have reported more annoyance from aircraft noise than people without psychological
disorders especially if they are young, are women, or people with higher education.
Annoyance can cause irritability, headaches, and depression; it also interferes with daily
activities (Tarnopolsky, Barker, Wiggins & McLean, 1978).
Aromatherapy
Emotional and physiological response. Perry and Perry (2006) reported that
aromatherapy and essential oils are used to control many physiological and psychological
issues such as anxiety, depression, chronic pain, and stress-related disorders.
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Aromatherapy provides a potentially effective treatment for a range of psychiatric
disorders (Perry and Perry, 2006). Essential oils such as lavender are used to reduce sleep
disorder and anxiety. Orange oil is used with patients who reported significant
improvement in mood and anxiety reduction. Antidepressant drug use was reduced for
patients with depression when exposed to citrus fragrance (Perry & Perry, 2006).
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Part III: Design Preferences
Principles and elements of design are the frameworks in which a good design is
created. The elements of design can be considered as the vocabulary of the designer, and
the eight principles as the grammar and rules for applying these elements (Adams, 2013).
Elements of design include materials, styles, forms, details, lighting, colors, patterns,
textures, lines and mass. Principles of design are balance, rhythm, emphasis, scale,
proportion, unity, variety and harmony (Nielson and Taylor, 2011). Many studies can be
conducted on one or two elements of design such as colors and lights. These studies don’t
look at design elements and principles as a whole. Research on elements and principles of
design is ongoing and the research-based design solutions are increasingly being
validated (Adams, 2013). Adams also recommends doing research on the impact of
elements and principles of design collectively rather than just the impact of some
elements. Principles and elements of design that have undergone scholarly inquiry are
presented in the following sub-sections.
Colors preferences
Colors have considerable influence on human emotions and feelings. In essence,
color is the most emotional element in interior design (Nielson & Taylor, 2006). Colors
in our environment come from two sources: spectral colored light and pigment. Color
psychology is a powerful tool that interior designers can use to fulfill users’ needs both
indoors and outdoors (Nielson & Taylor, 2006). Many studies have examined the
association between colors and emotion, and how colors affect emotions, mood, and
psychological states. Colors can also interact with gender and age of people, and color
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preferences can change, as the person grows older (Gao et al. 2007). Moreover, colors
have strong ties to the cultural background (Schloss and Palmer, 2009).
A study by Schloss and Palmer (2009) discussed the ecological valence theory
and color preferences of males and females. The ecological valence approach suggests
that people who share the same experience with specific colors can have the same
association with these colors (Schloss & Palmer, 2009). In other words, if specific colors
were preferred in culture for example, individuals of this culture would like the same
colors. This can also be applied to school colors, when a school has a color preference
such as red and black in the case of Texas Tech, students of this University prefer these
colors. Moreover, people like colors that are associated with objects and situations that
have positive effects and dislike colors that are related to negative situations and objects.
One study showed that females prefer colors from red to cyan while males prefer colors
from cyan to red (Schloss & Palmer, 2009) not sure what this means. Another study
stated that cool colors used in the East Cost of the USA offer an emotional escape for
anxiety and help enlarge the living areas (unknown author, 1975).
Several cross-cultural studies were conducted to determine color preferences in
different cultures. A study of cross-cultural color emotion relationship by Gao and his
colleague (2007) was conducted in seven regions in Asia and the Western region. The
study evaluated 214 color samples on 12 emotion variables classified into four categories
- activity index, potency index, definition index, and temperature index. Colors were
divided according to three factors, Chroma, lightness, and hue. Chroma is the brightness
or darkness of a color which mean what shade the color is. On the other hand, hue
determents what the color is, if the color is red or blue (ASTM International, 2013).
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The research found out that Chroma was more important to subjects from
Sweden, Hong Kong, and Italy, whereas hue is a more important factor for individuals
from Taiwan, Japan, and Spain. Both Chroma and hue were almost the same for people
from Thailand (Gao. et al. 2007). Another study measured British, Chinese, Japanese,
Thai and Hong Kong subjects on a color emotion scale. The study identified four coloremotions scale (warm-cool, heavy-light, active-passive, and hard-soft) for each single
color of the experiment. The results showed culture independence among the four coloremotions (Ou, Woodcock and Wright, 2004). The second part of this study examined the
color emotion association for two-color combinations. The study showed gender
differences between males and females in which females made more accurate color
emotion responses than males. However, there was no significant difference between
British and Chinese observers (Ou, Woodcock & Wright, part II, 2004). Moreover, color
meaning and preferences vary between cultures. The cool color palette was mostly
preferred by the Japanese and less by the English, as the color palette is characterized
with neutral hues, light values, and weak Chroma. The color palette with warm hues,
middle value, moderate Chroma and low-value contrast was most preferred by Americans
and least preferred by Koreans. Koreans preferred the color palette with neutral hues,
middle value, weak Chroma and medium to high contrast (Park and Guerin, 2002).
Hue, saturation, and brightness have a substantial impact on color preferences and
attention. A doctoral study was conducted in Turkey on 123 university students who
observed eight background colors. The students were asked to clarify which color attracts
most attention. The result showed that colors with maximum saturation and brightness
such as yellow-green, green, and cyan attracted the most attention followed by red and
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magenta. Additionally, colors with maximum saturation and brightness such as Blue, for
example, are the most preferred (Camgöz, 2000).
Many studies were conducted to discuss color-emotion relationship. Naz and
Epps conducted research in 2004 on 98 college students who were asked to indicate their
emotional response to principal hues, intermediate hues and achromatic colors. Like the
previous study of Gao, colors in this study were related to cultural background and
previous experience of the students (Naz and Epps, 2004). For example, the color white
was associated with pureness, cleanliness, and sense of being refreshed for most students,
except some Asian students who related white to death because in their culture white is
the color of death. Whereas Western students associated black with death and funerals,
but it was also related to fashion, power and sports cars. The color blue-green was
associated with the ocean, the sky and also reminded some participates of mint and
toothpaste. The color yellow red was associated with fall season and Halloween (Naz &
Epps, 2004).
In a study on colors and emotions among college students (Hemphill, 1996)
subjects completed a self-administered questionnaire where they listed their favorite
color, the color they wear most, and their emotional response to colors. Women appeared
to have a more positive emotion towards colors than men. Bright colors such as white,
red, yellow, pink, purple, blue and green were more popular among women and elicited
more positive responses than darker colors. Both studies of Naz and Hemphill showed
that Blue is the color worn most in both genders, which indicated an overlap in
preferences between the genders (Hemphill, 1996) (Naz & Epps, 2004). On the other
hand, a study by Ellis and Ficek (2001) showed that males prefer the color blue more
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than females. Furthermore, the color blue is also considered calming and relaxing, and it
promotes deep thoughts. Therefore, blue is associated with hospitals such as the use of
blue beds (Kaya and Crosby, 2006).
Arousal is found to increase strongly with color saturation and decrease with a
higher level of color brightness (Kaya & Crosby, 2006; Valdez and Mehrabian, 1994).
Bright and low saturation of colors evokes low levels of dominance (Valdez &
Mehrabian, 1994). Light colors create the feeling of openness, whereas darker colors give
the impression of closeness and make places look smaller (Kaya & Crosby, 2006). The
research of Kaya and Crosby found the association between colors and buildings. Red
and yellow are associated with school bricks and school buses. Gray is associated with
official buildings such as courthouses and city halls. Moreover, entertainment buildings
such as restaurants, shopping malls, and movie theaters are associated with the color red
(Kaya & Crosby, 2006).
Interior preference
Kaplan, Fitzpatrick and Docherty (1982) developed a preference framework that
indicates how people prefer scenes that are more engaging and involving rather than
scenes that tend to be boring and simple .There are four elements in this framework: (a)
coherence, which refers to how the objects in a scene come together to form
comprehensible contexts, (b) legibility, which refers to one’s understanding of the scene
and how he/she can categorize the objects within a scene, (c) complexity, which refers to
the number of elements within a scene, and (d) mystery, which is related to hidden
objects such as built-in cabinets and closets (Kaplan, Fitzpatrick & Docherty,1982)
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A study comparing visual attributes in interior environments between China and
America examined the biological aspects of environmental preferences including the
variables complexity, coherence, and environmental content (Ham and Guerin, 2004).
The results showed that complexity correlates positively with design preference in both
China and America. Although previous studies found that coherence has an influence on
preference, the study by Ham and Guerin did not find a clear relationship between
coherence and preference. Visual analysis showed that the Chinese had a higher
preference level for coherence than Americans. In environmental content, the study
showed preference differences between the American and the Chinese. The Chinese
disliked the scenes of darkness at the focal point of view more than the Americans. The
study also showed that the Chinese liked the American Interior style more than
Americans. Moreover, the Chinese preferred certain functional settings compared to the
Americans (Ham & Guerin, 2004).
Cultural differences have always been an issue in interior preferences (Kopec,
2006). Lee and Park conducted research to examine cultural differences in residential
design for Korean families. 27 Korean women reported some differences in room design
that they considered negative such as carpeted floor, interior lighting, a heating system,
foyer, and bathroom condition. These differences had impacts on the Korean lifestyle
such as sitting on the floor, being barefoot when being inside the house, and their strong
preference for bright natural lights. Positive perceived elements of design in the United
States houses were the open kitchen to the living area and walk-in closets (Lee and Park,
2011).
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A study was done by Van den Berg, Koole, and Van Der Wulp (2003) compared
between stimulated natural environments and stimulated built environments. Results
showed that the stimulated natural environment was rated more beautiful. Subjects’ mood
was investigated after watching a horror movie and then watching natural or built
environments; then subjects were asked to rate which environment is more beautiful. The
result showed that subjects preferred the natural environment and thought it is more
beautiful than the built environment. The study also showed a positive association
between mood enhancement and exposure to the natural environment. It was also found
that people who are stressed but not fatigued preferred the natural environment to the
built environment (Van den Berg, Koole, & Van Der Wulp, 2003). The natural and built
environments can have different restorative potentials. The interaction between physical
and social factors has restorative meaning (Scopelliti and Giuliani, 2004). Natural
environment evokes positive responses (Boggavarapu, 2005).
The attention restoration theory is related to voluntary and involuntary attention,
which means that situations that require mental effort cause us to engage in direct
attention (voluntary) that require more effort over time (Kopec, 2006). Natural vegetation
such as plants, trees, and water bodies were more preferred than man-made structures in
research conducted by Boggavarapu for group homes (2005). Boggavarapu suggested
that designers and architects take advantage of the site affordance and design of the
rooms with outdoor views such as patios, living rooms, and bedrooms (Boggavarapu,
2005).
The research was done to examine the relationship between novelty and aesthetic
preference. Eighty-eight chairs were selected and three aspects were measured:
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trendiness, complexity, and emotion. The results showed a positive relationship between
novelty and the three aspects (Hung and Chen, 2012). Chairs with a moderate level of
originality can draw a wide range of aesthetic preferences from beautiful to ugly (Hung
and Chen, 2012).
Natural environment preference
Nowadays, people live in urbanized societies and the only nature-like experience
is determined by everyday experience through the built environment (Hartig and Evans,
1993). In one’s everyday life, a person is exposed to nature experience that is not manmade such as watching the sunset from a city street, a view through a window,
aquariums, houseplants or images (Hartig & Evans, 1993). Green nature and natural
water environment may have a considerable effect on mood and can promote relaxation.
Exposure to a natural environment can lead to lower levels of stress. Being around nature
is restorative, and it is where people can feel better when they are stressed out. Therefore,
people will appreciate opportunities to access nature (Regan and Horn, 2005). A study
conducted to examine preferences on house landscape either through wilderness
landscape or neat landscape showed that most students preferred more trees and neat
landscape. On the other hand, students with wildlife science majors and those whose
parents have better education preferred a more natural landscape. This means that
students who have greater knowledge on nature should prefer a more ecologically
sustainable landscape. Moreover, male students with a higher level of education and
students from large cities preferred neat, clean and artificial landscape (Zheng, Zhang and
Chen, 2011).
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Lighting preference
Artificial and natural light is a very important element of interior design. It is
through the light that we see colors and recognize objects in our environment (Nielson &
Taylor, 2006). There are many aspects that we need to take into consideration when
designing interior lighting. For example, lighting should be effective for the purpose and
activities of the space like using task lighting and counter lighting. Lighting should be
aesthetically pleasing, psychologically useful and economically efficient (Nielson &
Taylor, 2006). Lighting and daylighting have great psychological and physiological
impacts on people (Kopec, 2006). People experience mood variation where in sunny days
they feel happy and full of energy while dark cloudy days may have more negative
effects (Nielson & Taylor, 2006). Similarly, artificial lighting can have positive effects if
it is in the right amount, but it can also have a negative downside effect such as headache
and exhaustion when the lighting is too bright or too dim (Nielson & Taylor, 2006).
Studies show that exposure to dimmer lighting can stimulate lack of behavioral
inhibition. Subjects with high level of bulimic symptoms preferred dimmer lights while
eating compared to subjects with no bulimic symptoms (Kasof, 2002). Artificial lighting
such as task lighting had a large effect on visual function (Haymes and Lee, 2006).
A study was conducted to measure four concepts related to lighting and the end
users’ preferences. The four concepts include, technical aspects of lighting, the effects of
lighting on people, preferences of lighting, and importance of lighting. The results
showed that end users preferred control over lighting. However, in the experiment,
subjects did not have enough control and did not ask for more control. Subjects also
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believed that fluorescent lighting is harmful to the health whereas natural daylight is
superior to electric light (Veitch, Hine and Gifford, 1993).
Many studies were conducted to determine the impacts of lighting and color on
the mood of people. Küller et.al. conducted a study to determine the impacts of color and
indoor lighting on the mood of people working indoors. The study was conducted in four
countries with different latitudes. The countries far from the equator showed significant
changes in psychological mood over the year, which did not occur in the countries closer
to the equator. When considering the four countries together, colors and lighting of the
work place had a significant influence on workers’ mood. The workers’ mood was at a
higher level when the lighting is just right, not too bright or too dim. A good color design
was also correlated with positive mood. The emotional status was higher for workers who
had brighter and more colorful work space. However, some laboratory studies of color
and mood showed that very strong colors were undesirable. It was also suggested that
windows should cover at least 20% of the wall area (Küller et al. 2006). Additionally,
another study showed that subjects performed better under warm lighting. Lighting also
has effects on short-term memory and problem-solving tasks (Knez, 2001).
Park’s cross-cultural dissertation on indoor lighting perception and preferences
examined the impact of different fluorescent color temperatures in two cultures,
American and Korean. The results showed that Americans found the room lighting more
arousing as opposed to the Korean. The higher color temperature of 5000 K was more
arousing than the lower color temperature of 3000 K in both cultures. On the other hand,
the Korean respondents preferred the lower temperature of 3000 K lighting, which was
also reported as less glaring. Further, visual clarity was affected by changing the color
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temperature of the lighting - higher the temperature, the more was the visual clarity. All
subjects preferred the lower color temperature than the higher one (Park, 2001). A more
recent study of hotel lighting preferences between Americans and South Koreans stated
that the Americans preferred hotel rooms with low intensity and warm color lighting and
found that dim lighting is more arousing than bright lighting. On the other hand, Korean
subjects perceived bright lighting as more arousing than dim lighting. Hotel lighting
should have a variety to fit all cultural differences (Park, Pae, and Meneely, 2010). On
the other hand, low level of lighting is associated with falls, depression, and visual
performance for elderly people. Dim lighting reduces object recognition for adults
(Bakker, Iofel and Lachs, 2004).
In conclusion, bipolar disorder is an illness that can be affected by two major
factors: the genetic code of a person and their environmental surrounding. People with
bipolar disorder can better cope with their stress using their own environment. Factors
such as light, colors, materials, temperature, noise and climate change can make a huge
impact on people’s moods, circadian rhythms, and behaviors. Each element of the
environment has physical and psychological effects on people in general and on people
with bipolar disorder. For example, light was used to improve the mood of patients with
bipolar disorder. Light therapy had mood-altering effects on patients made them feel
better in midday light and had mood shifts in early morning and evening light. Moreover,
the color of indoor light has effects on people’s moods and preferences which would be
determined also by their gender. Exposure to light also lowers depression levels in
women suffering from seasonal and non-seasonal depression. On the other hand, the age
of patients may influence how they perceive light therapy. Elderly women showed
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anxiety and irritation toward bright light. In addition, exposure to bright light in the
evening may cause sleep deprivation which is an important symptom of bipolar disorder
patients.
Color is a very important factor for how we observe the environment around us.
People who suffer from depression may have a color sensitivity impairment. They may
see colors more dull or grayish. Different colors have different effects on moods and
behaviors of people. Colors also have physical impacts on our blood pressure, heart rate
and eye blink frequency. In addition, colors were used broadly in interior design to alter
human behaviors and improve their perception of the environment.
Material is another factor of the built environment that has a great influence on
how people sense their environment. Materials can be determined either by our vision or
touch. The texture of the surfaces has physical and psychological impacts on people’s
perception. Too smooth of a texture can give an impression of coldness and unwelcomeness. In contrast, rough texture can make you feel clustered and heavy. People
have different preferences to natural materials such as wood. Dark wood is considered
more formal, and a lighter colored wood is more casual and modern. Wood also has a
relation to physical and psychological impacts on blood pressure, pulse rate, brain
activity, depression and visual stimulation.
Other environmental factors such as climate, season change, noise and aroma also
have impacts on peoples’ moods and behaviors, especially people with mental disorders
such as bipolar disorder. This study concentrated on three main environmental factors:
materials, color contrast, and daylight. Changing and manipulating these three factors
gave us different results.
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CHAPTER III
METHODOLOGY
Specific Aim
The specific aim of the study was to explore the emotional responses of people with and
without bipolar disorder to changes in interior daylighting, color contrast, and wood
materials.
Research Question
The study’s main questions were:
(1) How do people with bipolar disorder emotionally respond to differences in
interior daylighting, color contrast, and wood materials?
(2) Are there any differences between how people with and without bipolar
disorder respond to these changes?
(3) Does age of people with bipolar disorder influence their responses?
Research Design
A qualitative, non-experimental design was adopted for the study. The main data types
involved the subject’s qualitative responses to investigator’s questions while viewing a
series of images with systematic variations in daylight condition, color contrast, and
wood materials. Institutional Review Board (IRB) approval was obtained from TTU to
conduct the study.
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Subjects
A total of 20 subjects were targeted for the study: half of the subjects without and the
other half with bipolar disorder. Subjects were solicited from two different locations in
Lubbock, Texas. The first location was Texas Tech University and the second location
was a private clinic. Considering the exploratory nature of the study, a sample size of 20
was considered as sufficient to identify preliminary associations. A larger sample and
quantitative studies will be targeted in future phases.
Inclusion Criteria. Subjects must be diagnosed with bipolar disorder II or
Cyclothymia. The subjects should also be able to speak English well enough to
understand and answer the investigator’s questions.
Subjects were targeted in two age groups –21-34 years and 35+ since studies have
reported more symptoms for younger adults between the age of 21- 34 years than older
adults (Calabrese et al. 2003). In addition, both sexes were targeted in the study. Gender
comparisons show that men reported more mania at the onset of bipolar I disorder and
behavioral problems. Men also had higher alcohol abuse; cannabis abuse and
pathological gambling (Kawa et al. 2005). On the other hand, women reported eating
disorder, weight changes, appetite changes and middle insomnia during depression
(Kawa et al. 2005). Both single and married people were considered in this study. Also,
people living with someone. Finally, Caucasian subjects were solicited for this study.
There was one African American and one Hispanic American in the final sample. Since
ethnicity and cultural background may moderate the associations between environmental
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stimuli and emotional responses, ethnic and cultural variations will be targeted in future
studies.
Exclusion Criteria. Several exclusion criteria were used during subject selection.
People with chronic health were not included in the study, since health conditions may
interact with the key associations examined. People using strong mood-altering
medications were excluded from the study since their condition may bias the data. People
experiencing major recent life events, such as loss of job, death in family, or divorce were
excluded from the study, since their stress condition may affect study data. Major life
events may change the meaning of previous daily events such as preparing meals or
taking care of children. This can result in minor annoyances which can become
overwhelming. Some major life events include job disruption and life transitions
(Wagner, Compas, and Howell, 1988). Some life events include: serious illness or injury
to subject or to close relative, death of first-degree relative including child or spouse,
death of close family friend or second-degree relative, separation due to martial
difficulties, broke off a steady relationship, serious problem with a close friend, neighbor
or relative, unemployed/ seeking work for more than one month, subject sacked from job,
major financial crisis, problems with police and court appearance, or something valuable
lost or stolen (Brugha, Bebbington, Tennant and Hurry, 1985).
Pregnant women were excluded from the study as hormonal changes during
pregnancy could affect the data being gathered. People not conversant in English were
excluded in this phase of the study.
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Sampling and Subject Recruitment
A non-probability, purposive-quota sampling strategy was used in the study.
Subjects were recruited until a specific quota (with or without bipolar disorder, sex, and
age) was filled on a first-come basis.
The subjects were recruited from Texas Tech University and one private clinic in
Lubbock, Texas – Dr. Hooten Clinic. Dr. Hooten is a psychiatrist who counsels
individuals suffering bipolar disorder.

The researcher sent out a flier to potential bipolar subjects through Dr. David
Hooten private clinic. The researcher also put the study announcement through
TTU newsletter to enlist non-bipolar subjects. Subjects who would like to
participate in the study contacted the researcher. The contents of the flier and
TTU announcement were identical, and are shown in Appendix I.

Subjects filled out a form for the investigator to determine if they met the
inclusion/ exclusion criteria. The researcher developed the form to demonstrate if
the subjects met the inclusion/ exclusion criteria. The form is shown in Appendix
II.

Subjects met the inclusion criteria if they are from both genders, Caucasian,
single, the age of 21 and older, with or without bipolar disorder and did not have
major social or health conditions and not pregnant.

Dr. Hooten recruited the subjects who would fill the forms.

The researcher contacted the subjects via email or phone to schedule a meeting.

All information was kept private, and only the researcher had access to it. All
subjects were assigned a code number, which they were referred to in the study.
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This ensured confidentiality and privacy of information. The forms were stored at
the Principal Investigator’s office.
Research Setting
Data collection were conducted in a room of sufficient size to accommodate: (1) the
investigator and one subject, (2) sufficient desk space for the subject to fill out the
consent form, and (3) a projector and a screen for projection of the intervention images.
The room ideally did not have any windows in order to eliminate confounding effects of
daylight variations depending on the time of the day when the data was being collected.
Variables
Outcome Variables. The main outcome variables of interest were emotional and
affective responses of the subjects.
Influencing Variables. Three visual factors were systematically manipulated in the
study intervention: (1) wood materials, (2) color contrast, and (3) daylight.
Influencing factors were limited to these three since these were the only factors that
were found in the literature related to bipolar disorder and depression. It is envisaged
that future studies will include a larger number of environmental attributes. Natural
materials, more specifically wood (versus other natural materials), were considered as
the intervention in interior materials since there was a study explaining the
relationship between wood panels and depression and physical changes (Sakuragawa
et al. 2005). Wood was also found to have stress reduction effects on subjects in an
office environment, which also found that 45 percent of wood surfaces was
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considered pleasing (Tsunetsugu, Miyazaki and Sato, 2007). Another study also
showed a stress-reducing effect of wood when compared with a non-wood
environment (Fell, 2010).
A set of images were prepared, with each having a different combination of the three
visual factors. Each visual factor had three levels – low, neutral and high. The
development of the intervention and values for each influencing variable were
discussed in detail in the ‘Intervention’ section.
Confounding Factors.
Several factors could introduce bias in the study data. Those include: (1) time of the
day, the day of the week, external weather condition, season; (2) physiological and
mental state of the subject on the day of data collection; (3) variations in rhythm,
balance, emphasis, scale, unity, variety, and harmony in the image set; (4) exterior
view condtions through the window in the images; and (5) eye point and height
from the floor.
For the first factor, the experiment was held in the conference room of the
Department of Design in the human sciences college building. This room does not
have any windows, which eliminated the outdoor conditions such as the weather.
The experiment was held only on sunny days, weekdays, and in the afternoon in fall
2016. For bipolar subjects, the Beck mood test questionnaire was given at the
begining of the experiment to determine their mood. For the third factor, the design
was checked for design principles by three designers from the department of
Design. The first designer was doctorial candidate in the Department of Design. She
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had both an art and interior design background. The second designer had a bachelor
degree in interior design, and she did freelance for residential design. The third
designer had a master in interior design and fine arts and had a background in fine
arts. The designers checked for the following principles: rhythm, balance,
emphasis, scale, unity, variety, and harmony. Each principle was rated from 1 to 5,
1 as no rhythm, no balance and five as good rhythm, good balance. The designers
were recruited by email. After that, the researcher calculated the range of each
principle for each image. The results showed an average of 4.3 and 3.6 in all design
principles. The lowest score was 2 in variety of low wood, neutral contrast, and low
daylight. A score of 2 in emphasis was reported in neutral wood, neutral contrast,
and low daylight. The setting of high wood, neutral contrast, and low daylight has
the lowest scores in rhythm (2), emphasis (2.3), and variety (2). The highest score
was recorded for two settings: low wood, high contrast and neutral daylight; and
low wood, high contrast and high daylight. The average rhythm is 3.64, balance
3.82, emphasis 3.48, scale 3.91, unity 3.61, variety 3.46, harmony 3.5. This shows
that there was no major problem in the design. The low score was found in neutral
contrast and low daylight. This may be explained by the low condition of light in
those settings. The design was altered to fix any problems such as changing
materials, wall colors or furniture. For the fourth factor, the outdoor conditions in
the images were a natural view during midday on a sunny day. The last
confounding factor was eye point and the height from the floor, which was fixed at
a specific location in all images. The view in the images showed the window wall in
the middle of the room.
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Intervention
The intervention included a set of 27 images with different values. Each image
varied in the level of wood materials, color contrast, and daylight. Each factor had three
values, low (L), neutral (N), and high (H). Three influential factors times three values
each result in a total of 27 combinations. Images had different settings according to Table
3.1 below, which shows all the possible combinations of influencing factors and values.
Table 3.1
Settings Combinations of Materials (M), Color (C), and Daylight (D), and Different
Values Low (L), Neutral (N) and High (H).
LM, LC, LD
NM, LC, LD
HM, LC, LD
LM, LC, ND
NM, LC, ND
HM, LC, ND
LM, LC, HD
NM, LC, HD
HM, LC, HD
LM, NC, LD
NM, NC, LD
HM, NC, LD
LM, NC, ND
NM, NC, ND
HM, NC, ND
LM, NC, HD
NM, NC, HD
HM, NC, HD
LM, HC, LD
NM, HC, LD
HM, HC, LD
LM, HC, ND
NM, HC, ND
HM, HC, ND
LM, HC, HD
NM, HC, HD
HM, HC, HD
The ratio of wood material was the area covered by wooden materials (floor,
walls, and ceiling), which was 0%, 45%, and 90% (Tsunetsugu, Miyazaki and Sato,
2007). A study showed that using 90% wood covering has physiological responses such
as a decrease in systolic blood pressure, a decrease in brain activity and an increase in
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pulse rate (Tsunetsugu, Miyazaki, & Sato, 2007). In the current study, the living room in
the images was 28’ 7” * 28’ 5” * 8’ 6.” To calculate 90% of the area, we calculated the
area of the three walls shown in the image, the ceiling and the floor (246.82+246.82
+275.2+817.95 + 817.95). If we want to cover 90% of the area with wood, we needed to
cover the ceiling and floor and two walls. One wall was painted, which is about 10% of
the area (246.82). The neutral wood material setting is 45% of the area; it would be the
flooring and half the height of the two walls showing in the images. This area was
covered with wood flooring and wall molding. The setting of 0% of wood material had
tile or marble flooring instead of the wood flooring.
The living room had a wall with floor to ceiling windows. Daylight setting was
manipulated by the use of fabric blinds. In the low setting of daylight, the entire windows
were covered by fabric blinds. The neutral setting of daylight had blinds covering the
windows half way. The high setting of daylight had no blinds at all.
Color contrast the difference between two colors (Feisner & Reed, 2013).
Sensitivity to contrast under different lighting can be assessed by using different color
combinations of two or four colors put in proximity to each other (Hashimoto, Yano,
Shimizu, and Nayatani, 2007). Color contrast settings were created by using different
color materials in the Homestyler Beta website. The contrast was measured in the
Contrast Ratio website (http://leaverou.github.io/contrast-ratio). The ratio contrast is
measured by using this equation (L1+0.05) / (L2+0.05) where

L1 is the relative luminance of the lighter of the colors, and

L2 is the relative luminance of the darker of the colors
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Contrast Ratio website has contrast values from 1 to 21, 1 as being the lowest
contrast ever and 21 as the highest contrast ever. The contrast ratio icon turns red in low
contrast from 1:1 to 1:3 which means relatively low contrast, yellow in moderate contrast
from 1:3 to 1:6, and turns greener as the contrast goes higher. The color contrast between
the walls, flooring, ceiling and furniture was measured by taking a color swatch for each
element and comparing it in the Contrast Ratio website. The neutral setting of contrast
was the original design with moderate contrast ratio. Moderate contrast ratio showed a
yellow button. The researcher used materials that were in the same color range to create a
low setting of contrast. The goal was to create the lowest contrast between the elements
in the image (walls, ceiling, floor, and furniture). The contrast ratio between elements
was between 1 and 3 in low contrast setting. To create high contrast setting in Homestyler
Beta, the researcher used dark wood for the flooring and the ceiling and dark wall paint.
Furniture remained the same in all images. High contrast was also tested in the Contrast
Ratio website. Higher than six is considered high contrast. (Figure 3.1) below shows the
setting of high wood material (HW), which has wood finish in flooring, ceiling and two
walls, low contrast (LC) which has elements in the same color range and low daylight
(LD) where blinds are covering the whole windows. (Figure 3.2) is the living room with
high material (HM), which has wood finish in the ceiling, floor and two walls, high
contrast (HC) which has dark wood on floor and ceiling and lightwood and paint on the
walls and Low daylight (ND) where blinds are covering the windows half way. (Figure
3.3) is the room with low material (LM), which has marble floor and painted walls, high
contrast (NC), which has high contrast between materials, and high daylight (HD) where
windows are not covered at all. Lastly, (Figure 3.4) is the living room with neutral wood
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material (NM), which has a wood floor and wood molding, high contrast (HC), which has
high contrast between materials and neutral daylight (ND) where windows are covered
half way.
The change in color contrast in the images was controlled using the light
reflectance value (LRV) of the colors. LRV is listed on the back of most color swatches,
and it indicates the quantity of visible and useable light reflected by the surface in all
directions and all wavelengths when exposed to incident light (Sawaya, 2005). LRV is
usually confused with the intensity of colors. Color intensity tells us the vividness or
dullness of the color, which reveals the clarity of the color, while LRV measures how
much light a color reflects. LRV is a percentage scale from 0% to 100%; 0% is absolutely
black, and 100% is pure white, which does not exist in real life. The darkest black is
about 5% LRV, and the whitest white is 85% (Sawaya, 2005). Yellow can have LRV of
80% or 90% but would have a high visual brightness. The visual brightness of yellow
would be considered more than LRV in this case (Sawaya, 2005).
All 27 images were created in the Homestyler Beta website, each with a different
setting. Homestyler Beta is a website that allows you to create your design from scratch.
It also allows you to use different materials, wall paint, and choose furniture. Homestyler
Beta also renders the finishing design in a professional way. Photoshop was used to
manipulate the low wood material image set to fix the tables to appear with no wood
finish. The researcher designed a 28’ 7” * 28’ 5” living room with two seating areas (see
Appendix IV). One is a seating area for reading, which is by the outdoor porch and the
second seating area is for entertainment. The living room has a whole wall of
windows for natural daylighting. The low light setting will be managed by using
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Figure 3.1. Living Room with High Wood, Low Contrast and Low Daylight (HMLCLD).
Figure 3.2. Living Room with High Wood, High Contrast and Neutral Daylight
(HMHCND).
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Figure 3.3. Living Room with Low Wood, High Contrast, and High Daylight
(LMNCHD).
Figure 3.4. Living Room with Neutral Wood, High Contrast and Neutral Daylight
(NMHCND).
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blinds windows for natural daylighting. The low light setting will be managed by using
blinds that will cover the entire windows. The neutral daylight setting will be managed by
covering all windows halfway, and the high daylight setting will have no blinds. Nine
images had low wood material setting with tile or marble flooring (Yellow Marble for
low contrast, La Paz tiles for neutral contrast, and Sand Marble for high contrast) and
painted walls. The second set of nine images had wood floor and half wall moldings as
the neutral setting of natural material (Oak Cashmere for low contrast, Doc Pisa for
neutral contrast and Maple Sambuca for high contrast). The last nine images had wood
covering the ceiling, floor and two walls as the high setting of wood materials. Color
contrast was illustrated by using different materials with different colors and finishes
(Rovere wood for low contrast, Doc Pisa for neutral contrast, and Maple Sambuca for
high contrast). Table 3.2 shows values for color contrast, materials, and daylight setting
used in the study.
Table 3.2
Values of Natural Materials, Contrast, and Daylight
Low
Materials
Neutral
High
45% use of wood
90% use of wood
Yellow Marble
(Wood flooring and
(Wood flooring,
for low contrast,
wood molding on
ceiling, and two
La Paz tiles for
walls)
walls)
No wood
neutral contrast,
and Sand Marble
for high contrast
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Color
1- 3 (Red icon in
Contrast
Contrast Ratio
3-6 (Yellow icon)
Over 6
(Green icon)
website)
Daylight
Blinds over the
Blinds covering the
whole windows
windows half way
No blinds
Instrument
The Question List.
The study adopted and tested a list of questions for qualitative assessment of
different dimensions of emotional and affective response. Towards this objective, a
literature review was conducted to identify quantitative scales that have already been
validated and used in earlier studies. The scales have a numerical scale from 1to 9
attached to it to give a numerical score for each emotion (Bradley and Lang, 1994)
(Dazkir and Read, 2011). However, in the current study, the researcher used only the
bipolar emotional and affective scales, which means the scales were qualitative. The
following scales were found most appropriate for the study: (1) Bradley & Lang (1994)
(see Table 3.3); (2) Dazkir & Read (2011) (see Table 3.4).
Table 3.3
Semantic Differential Scale (Emotion) (Bradley & Lang, 1994).
Happy
Unhappy
Pleased
Annoyed
Satisfied
Unsatisfied
Contented
Melancholic
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Relaxed
Bored
Stimulated
Relaxed
Excited
Calm
Frenzied
Sluggish
Jittery
Dull
Wide awake
Sleepy
Aroused
Unaroused
Controlling
Controlled
Influential
Influenced
In control
Cared for
Important
Awed
Hopeful
Despairing
Dominant
Submissive
Autonomous
Guided
Table 3.4
Emotional Responses Toward Interior Environment (Dazkir & Read, 2011)
Aroused
Unaroused
Exited
Calm
Frenzied
Sluggish
Jittery
Dull
Wide awake
Sleepy
Stimulated
Relaxed
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Table 3.5
Emotional and Affective Responses to be used in the Current Study
Set A
Set B
Wide awake
Sleepy
Relaxed
Stimulated
Peaceful
Anxious
Unstressed
Stressed
Like
Dislike
Prefer
Don’t prefer
Emotional and affective response scale in Table 3.5 was used in the current study.
There are two sets of them: set A (wide awake, relaxed, peaceful, unstressed, like and
prefer) and set B (sleepy, stimulated, anxious, stressed, dislike and, don’t prefer). The
researcher assigned these term (A and B) because the emotional responses in column B
were not unnecessarily negative or undesirable such as sleepy and stimulated. The
researcher chose the emotional response that fit the current study. Only those emotional
responses expected to be evoked by the physical design of residential interiors were
selected for inclusion in the study. Other responses such as controlling, in control and
influenced were not expected to be evoked by the specific design condition being
examined. The researcher was looking in particular to the emotional response for the
subjects. Each subject was asked to explain his/her response to each image. After they
had chosen a response from the bipolar scale as displayed above, they explained their
responses verbally. For example, if an image made them feels stressed, they were also
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asked to elucidate the possible reasons behind their responses. The investigator gave the
subjects ample opportunity to think about specific environmental attributes that may be
contributing to their emotional response. Some responses in the emotional bipolar scale
are positive responses such us wide-awake, relaxed, peaceful, and unstressed. The
negative responses are stimulated, anxious and stressed.
Data Collection
Each subject was assigned a date and time to participate in the interview. The
interview was held in the conference room of the Department of Design in the College of
Human Sciences. When the subjects first arrived at the site, they signed the consent form
(see Appendix III). After the subjects sign the consent form, they began evaluating the
images. Each subject was assigned to evaluate the 27 images on each dimension of the
emotional and affective scale. Each image was presented on a large projector for one
minute while the subjects were choosing their responses. The subject explained the
responses on his/her emotional response to a particular image and what design element
affected his or her response. The researcher recorded the subjects’ responses.
The study used an emotional and affective response scale measuring many
emotions combinations such us sleepy – wide awake, relaxed – stimulated, peaceful –
anxious, unstressed – stressed. Affective responses covered like – dislike as well as prefer
– reject (see Table 3.5). These responses were randomized for each image so the subject
would not get a sense of systematic responses. The images were also randomized so the
setting of each image was different and not in sequence to achieve different settings in
wood material, contrast, and daylight. Questions listed in Table 3.6 were uniformly posed
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to all subjects. The researcher used the scales to find out how interior elements of the
living room can affect subjects. The researcher also used a mood self-test that the
subjects filled out during their time in the room. The Beck depression inventory tests
patients’ mood at the time of taking the test. If the subjects were under depression, this
might impact their emotional response. That may show some differences between the
emotional responses of subjects with and without bipolar disorder.
Table 3.6
Questions of the interview
Instructions 27 images will be presented on the projector in front of you with
different interior design settings. For each image, you will need to
choose your emotional and affective response for each bipolar scale
provided. Take your time and think thoroughly of the emotions you feel
for each image. Each image will be presented for 1 minutes.
Question 1
Why do you have this emotional response to these images?
Question 2
What component in the design makes you have this emotional response?
Data collection will include these main steps:

A form of personal information such as age, gender, marital status, and education
was filled by the subjects. The form has also questions about any major life or
health condition. This helped the researcher categorize the subjects (see Appendix
II).

Subjects signed the consent form (see Appendix III).
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
Subjects were given a form with the emotional and affective scale while the
images are presented, subjects chose their emotional responses.

Subjects were given the Beck mood test form (see Appendix V). This helped the
researcher understand the subjects’ mood when they made the observation. If the
subjects were under depression, this might impact their emotional responses.

The interview was recorded using a digital audio voice recorder.
Data Analysis
All 27 images had six bipolar emotional responses (Wide-Awake, RelaxedStimulated, Peaceful-Anxious, Stressed-Unstressed, Like-Dislike, Prefer-Don’t Prefer)
for both the control group and the bipolar disorder group. Each subject was instructed to
choose one of the bipolar responses and give a comment about which component in the
image made them feel this way. In the interviews, the images were presented in random
order to the subjects. Therefore, the images were subsequently rearranged according to
their setting of materials, contrast, and daylight for easier analysis. In preparation for
analysis, the images were divided into three groups of nine images each. Each of the nine
images was given a color code (gray for low material, yellow for neutral materials, and
blue for high materials). Images were had three setting of daylight: low, neutral and high.
These three groups were also divided into three subgroups according to the contrast
differences in each group. See Table 3.7 below.
Table 3.7
Color Coded Settings Combination of Materials (M), Color Contrast (C), and Daylight
(D), and Different Values Low (L), Neutral (N) and High (H)
LM, LC, LD
NM, LC, LD
HM, LC, LD
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LM, LC, ND
NM, LC, ND
HM, LC, ND
LM, LC, HD
NM, LC, HD
HM, LC, HD
LM, NC, LD
NM, NC, LD
HM, NC, LD
LM, NC, ND
NM, NC, ND
HM, NC, ND
LM, NC, HD
NM, NC, HD
HM, NC, HD
LM, HC, LD
NM, HC, LD
HM, HC, LD
LM, HC, ND
NM, HC, ND
HM, HC, ND
LM, HC, HD
NM, HC, HD
HM, HC, HD
For each emotional scale, the researcher analyzed the outcomes from bipolar
subjects and non-bipolar subjects. The researcher compared how each emotional bipolar
scale was different between the two groups. For example, we want to see whether one
emotional scale was simulated or relaxed. We also want to see the reasons behind that by
comparing the recorded responses for each group. The researcher found out which design
had the most responses by each group and which design element influenced these
responses. The researcher calculated which design gained the most responses such as
wide awake, relaxed, peaceful, stressed, like and prefer. The beck mood test also allowed
the researcher to make a comparison between subjects with good mood or low mood. The
mood of the subjects may affect their responses.

A proportion analysis was conducted on the bipolar and non-bipolar
subjects’ responses and the two bipolar age group using the steps below:

Calculate the proportion of all responses (Awake, Relaxed, Peaceful,
Stressed, Like, Prefer) for each image for all groups.
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
Calculate the proportion average between the groups.

Proportions were compared and color coded.

The researcher assigned an arbitrary minimum of 0.10. Ten images had
proportion average of more than 0.1, as shown in Table 3.8 below.
Table 3.8
Proportion Average Between Bipolar and Non-Bipolar and Their Materials, Contrast,
and Daylight Settings
Image
Proportion Dif. Materials
Contrast
Daylight
Image 19
0.22
High
Low
High
Image 11
0.18
Low
High
Low
Image 27
0.17
Neutral
High
High
Image 6
0.17
Low
Low
Neutral
Image 18
0.15
Low
Neutral
Low
Image 20
0.15
Neutral
High
Low
Image 1
0.13
Neutral
Low
Neutral
Image 25
0.12
Neutral
Neutral
Low
Image 17
0.12
Neutral
Neutral
High
Image 13
0.10
High
Neutral
Low
Image 10
0.10
Low
Neutral
High
Steps for analyzing the data:

Divide the data into two main categories: bipolar and non-bipolar.

Subjects with low mood or depression were addressed.

Bipolar subjects were divided into two age groups.

Calculate the proportion of all responses for each image

Calculate the average between the overall proportion of both groups

Compare between the groups’ responses.
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
Find out which setting had the most responses and which setting had the
least responses.

Find out the reasons behind high and low responses.

Answer the research questions
(1) How do people with bipolar disorder emotionally respond to differences in
interior daylighting, color contrast, and wood material?
(2) Are there any differences between how people with and without bipolar
disorder respond to these changes?
(3) Does age of people with bipolar disorder influence their responses?
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CHAPTER IV
FINDINGS
Final Sample
Both the control group and the bipolar disorder group had 10 subjects each. The bipolar
group had one male and nine females. Eight subjects were Caucasian; one was African
American, and one was Hispanic American. Five of the bipolar subjects were from the
24-37 age group, and five were from the 40-54 age group. The group of non-bipolar
subjects consisted of eight females and two males. All non-bipolar subjects were
Caucasian. The 22-32 age group had six subjects, and the 45-55 age group had four
subjects.
All subjects signed the consent form and took the Beck depression test before evaluating
the images. Only three of the bipolar subjects had a score of more than 30 (37, 45, and
53), which indicated that they had some depression, and two of them had a score of 27
and 28.
There were some data missing; one of the non-bipolar subjects neglected to choose an
emotional response of wide awake or sleepy to the first image, peaceful or anxious to the
second image, or peaceful or anxious to the seventh image. One bipolar subject neglected
to choose a response of relaxed or anxious to image number 3. Another bipolar subject
neglected to choose a response of wide awake or sleepy to image number 22. The second
bipolar subject chose both emotional responses of relaxed and stimulated for image
number 10, image number 23, and image number 27. The first bipolar subject did not
comment on the images, and the comment of a non-bipolar subject was missing on image
number 10. There was also a comment missing for another non-bipolar subject on image
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number 20. These subjects were not eliminated from the analysis because the number of
subjects was limited.
Images of High Proportion Average Between Bipolar Subjects and Non-Bipolar
Subjects
Table 4.1 below contain the proportion average between bipolar and nonbipolar and their materials, contrast, and daylight settings which were mentioned in the
previous chapter.
Table 4.1
Proportion Average Between Bipolar and Non-Bipolar and Their Materials,
Contrast, and Daylight Settings
Image
Materials
Contrast
Daylight
Image 19
Proportion
average
0.22
High
Low
High
Image 11
0.18
Low
High
Low
Image 27
0.17
Neutral
High
High
Image 6
0.17
Low
Low
Neutral
Image 18
0.15
Low
Neutral
Low
Image 1
0.13
Neutral
Low
Neutral
Image 25
0.12
Neutral
Neutral
Low
Image 17
0.12
Neutral
Neutral
High
Image 20
0.11
Neutral
High
Low
Image 13
0.10
High
Neutral
Low
Image 10
0.10
Low
Neutral
High
High Materials, Low Contrast, and High Daylight. Image number 19 (Figure
6) showed a setting of high materials (wood covering the ceiling, floors, and two walls),
low contrast, and high daylight. This image had the highest proportion of the difference
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between people with and without bipolar disorder, with a score of 0.22. Three out of ten
of non-bipolar subjects felt relaxed, while seven of the bipolar subjects felt relaxed when
observing this image. Eight of the bipolar subjects preferred this image, while only two of
the non-bipolar subjects preferred it. Eight of the bipolar subjects felt peaceful, while
only five non-bipolar subjects felt peaceful toward this image. The image had similar
emotional responses of awake and stressed, with only a one-person difference, and had
the same number of people from each group who liked it.
Figure 4.1. Image 19: Living Room with High Materials, Low Contrast, and High
Daylight (HMLCHD).
Eight of the non-bipolar subjects did not prefer image number 19 (Figure 4.1)
They commented that the wood on the ceiling, floors, and the walls was too much, too
stimulating, and too bright, especially as it was all the same color tone and same material.
They also commented that they felt closed in. One of the subjects implied that the room
was stressful because the ceiling seemed to be too low. Subjects said that the room felt
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stimulating because there was a lot of daylight coming in and the wood reflected the light
around the room.
On the other hand, eight bipolar subjects preferred this image. One subject, who
had a Beck score 37, which indicates that she was somewhat depressed, commented that
the room felt like a beach house and that it looked cozy because the ceiling, floor, and
walls were all matching. Bipolar subjects stated that the room felt like it was outside of
the house, and it was not boxy. Another subject commented that the room looked cool.
They stated, “This is very peaceful and relaxing because of those floor boards. Makes me
wonder how long it goes. I want to know the beginning and the end of it. When I find
something that I have to decode, I feel relaxed, because I can focus on one thing.” A third
subject, who also had depression, with a Beck score of 53, commented that the image
made her feel unstressed. It made her want to get up and motivate people. She stated, “I
probably prefer this. I like the white wall by the TV, but I don’t like the layout.” Even
though some of the subjects felt that the room is closed in and boxed, they still preferred
it.
In general, image 19 – which had light wood covering the walls, floors, and
ceiling and had full open windows – was rated by subjects with bipolar disorder more
frequently as evoking emotions from set A of the binary emotional scale. Bipolar subjects
mentioned the light wood and the daylight as the reasons they rated it relaxed and
peaceful. On the other hand, non-bipolar subjects complained that the wood covering the
environment was the main reason they felt boxed in.
Low Materials, High Contrast, and Low Daylight. Image number 11 (Figure
4.2) had proportion average of 0.18. All non-bipolar subjects felt sleepy toward this
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image, while only three bipolar subjects felt awake. All non-bipolar subjects felt relaxed
in this setting, while only four of the bipolar subjects felt relaxed. Nine subjects from the
control group felt peaceful, and only one of them felt stressed toward this setting.
However, three of the bipolar subjects felt peaceful, and six of them felt stressed toward
this setting. Six of the non-bipolar subjects liked this setting, and five of them preferred
it. Three of the bipolar subjects liked it, and only one bipolar subject preferred it.
Non-bipolar subjects felt that the room’s setting was relaxing and made them
sleepy because of the dark walls and closed blinds. They liked the overall look of the
room, but they did not like the lack of natural light. The lack of daylight led subjects to
feel less stimulated and less awake. One subject commented on this image, “I don’t like
the black walls and the covered windows, but I like the white floor and ceiling, which
looks like looking down a train tunnel.”
Figure 4.2. Image 11: Living Room with Low Materials, High Contrast, and Low
Daylight (LMHCLD).
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Bipolar subjects seemed to dislike this image because of the dark walls and the
lack of natural lighting. It made them feel boxed in and shut them down because it felt
very small and tiny. One bipolar subject did not like the white floor and ceiling, saying,
“It feels like the bottom is going to fall out. It does not look stable.” Another subject, an
African American, liked the flooring. She felt it was vibrant and suitable for young
couples, but she did not like the dark walls. Only one bipolar subject liked the contrast.
She said, “You can see everything in the space even though the windows are shut for a
more relaxing and peaceful setting.”
Image 11 had marble, light flooring, dark walls and closed blinds. In general, the
image was rated mostly sleepy by both groups. More non-bipolar subjects felt relaxed
and peaceful than did bipolar subjects. Non-bipolar subjects felt the room was not
stimulating because of the dark walls, which made them feel relaxed, while bipolar
subjects didn’t like the room and stated that they felt boxed in because of the dark walls.
Neutral Materials, High Contrast, and High Daylight. The setting for image
number 27 (Figure 4.3) had neutral materials (wood floors and wood panels on walls),
high contrast, and high daylight. The proportion average was 0.17. All non-bipolar
subjects and eight of the bipolar subjects felt awake in response to the setting. Only three
of the non-bipolar subjects felt relaxed toward this setting, while seven of the bipolar
subjects felt relaxed. Only three subjects of the non-bipolar group felt stressed, and five
of the bipolar subjects felt stressed. Almost the same number of subjects in both groups
liked this image. A similar number of subjects in both groups felt peaceful. Only four
non-bipolar subjects preferred this setting, while seven of the bipolar subjects preferred
this setting.
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Non-bipolar subjects commented that this setting was their favorite of the all the
black settings (high contrast settings) because the white wood paneling on the walls
broke up the dark walls, making the walls more inviting and not overwhelmingly dark.
The space was stimulating, felt wide awake, had high energy, and was relaxing and
peaceful. The non-bipolar subjects who had a negative feeling about this setting
described the dark walls and floors as stressful, feeling like an office, making them feel
anxious. A subject commented that she did not like the darkness of the walls and the
floors, saying the space made her feel like she was in a place that she was supposed to be
in, though she did not want to be there. Another subject implied that she was afraid of not
having any covering on the windows.
Figure 4.3. Image 27: Living Room with Neutral Materials, High Contrast and High
Daylight (NMHCHD).
Bipolar subjects agreed that this setting with the white panels on the walls was the
best of all the high contrast images, especially as the ceiling was white and the windows
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were uncovered. Some positive comments included that the place felt comfortable and
airy and that the shiny floors are unique and made the place balanced. They saw the space
as a vacation home, a peaceful place. A depressed bipolar subject commented that it was
a space that she would have in her house. Another bipolar subject commented that the
setting did not feel closed in because of the light color on the ceiling and the appropriate
amount of the black accent color that did not overwhelm the room. Negative responses
included that the dark walls and floors brought them down, that the ceiling looked like a
tornado hit it, and that the paneling did not look right because of the images hanging over
it. A depressed bipolar subject thought that the dark walls made her want to clean.
In general, image 27 – which had wood floors, wood panels, dark walls and full
open windows - was rated as evoking emotions from set A more frequently by bipolar
subjects than by non-bipolar subjects. Both bipolar and non-bipolar subjects mentioned
that this room was there favorite of all the black settings. They mentioned the good and
balanced contrast between the walls and the white panels. Bipolar subjects mentioned
that the white ceiling and uncovered windows made them feel this way.
Low Materials, Low Contrast, and Neutral Daylight. Image number 6 (Figure
4.4) had a proportion average of 0.17 between bipolar subjects and without bipolar
disorder. This image had low materials with tile floors, low contrast, and neutral daylight
with the window blinds half open. All subjects with and without bipolar disorder felt
wide awake in response to this setting, except one non-bipolar subject who felt sleepy.
None of the non-bipolar subjects felt stressed, while only two with bipolar disorder felt
stressed. All non-bipolar subjects felt peaceful, and they all liked and preferred this
setting. Six bipolar subjects felt peaceful; seven liked it, and six preferred this image.
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Non-bipolar subjects felt good about image 6 because there was enough daylight
coming into the room. They also liked the marble flooring, which made the room look
different and more inviting. Only one non-bipolar subject felt it was too bright and would
like to shut some of the blinds. The subjects commented that the colors of the room were
natural, had sufficient contrast, and made them feel comfortable.
On the other hand, four bipolar subjects did not prefer this setting, because it did
not have enough contrast and was neither interesting nor inviting. One subject stated, “I
would add more color to it.” Some of the bipolar subjects considered this room too bright
and stressful, with a floor that was too shiny. One subject felt that the floor looked vibrant
and different; she commented, “It speaks out to me. It makes me feel different.” Another
subject, who had depression, liked the room as she could envision reading or watching
TV there. However, she did not like the excess of seating in the room. Bipolar subjects
who liked the setting in image 6 implied that the light in the image was good. The change
of the flooring was seen as a good change, with everything seeming sharp, clean, and
organized. One subject said, “I like this one the best of them. It does not feel too stark. It
doesn’t feel too dark. It is peaceful and relaxing.”
In general, image 6 - which had tile floors, low contrast colors, and half-open
windows - was rated as evoking emotions from set A more by non-bipolar subjects than
by bipolar subjects. Both groups had the similar emotional responses. Non-bipolar
subjects mentioned the daylighting and the tile floors as the main reasons for their
responses. On the other hand, bipolar subjects considered the floor too shiny, but they
liked the light in the room.
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Figure 4.4. Image 6: Living Room with Low Materials, Low Contrast, and Neutral
Daylight (LMLCND).
Low Materials, Neutral Contrast, and Low Daylight. Image number 18 (Figure
4.5) had a setting of low materials, neutral contrast, and high daylight. This image had a
proportion average between people with and without bipolar disorder score of 0.15. Only
three non-bipolar subjects preferred this setting and none of the bipolar subjects preferred
it. Four of the non-bipolar subjects liked it, while only one bipolar subject liked it. Two
non-bipolar subjects felt stressed and five bipolar subjects felt that way. Moreover, only
four of the bipolar subjects felt peaceful toward this setting, and double of the control
group felt the same.
Non-bipolar subjects commented that image 18 was “okay.” It was seen as a
relaxing and peaceful room, but one that made them sleepy, because the window shutters
were down. It was a natural setting and there was not a lot of wood. They also
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commented that it felt like a home where you could relax and read a book. On the other
hand, bipolar subjects felt that the room was too dark and they needed to see what was
outside the closed windows, as they were not able to see with the blinds down. One
Figure 4.5. Image 18: Living Room with Low Materials, Neutral Contrast, and Low
Daylight (LMNCLD).
subject with bipolar disorder, who was 51 years old, said, “The walls are inviting. The
ceiling has a grounding effect to it, but I don’t like the floors and the furniture is too
squared and there is no feel to it.” Another subject felt the room was neither cozy nor
warm, that it was too cold, because it has tile flooring. However, one subject liked the tile
flooring. Many bipolar subjects implied that they would feel depressed in this room and
would seclude themselves from other people and sleep all day in that room.
In general, image 18 – which had neutral tile floors, neutral walls and closed
windows - was rated as evoking emotions from set A more by bipolar subjects than by
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non-bipolar subjects. Very few of both groups liked or preferred this setting. Bipolar
subjects complained that the lack of an outside view and the darkness of the room were
the main reasons they felt depressed and secluded. Non-bipolar subjects reported that the
room was relaxing and peaceful because it was natural, with soft lighting and tile floors.
Neutral Materials, Low Contrast, and Neutral Daylight. The setting in image number
1 (Figure 4.6) consisted of neutral materials, low contrast, and neutral daylight. The
proportion average was 0.13. Subjects with and without bipolar disorder had similar
emotional responses of wide awake, relaxed, and peaceful. None of the control group felt
stressed, and only two of the bipolar subjects felt stressed. All of subjects liked this
image, and five of them preferred it. Non-bipolar subjects liked and eight subjects
preferred this setting, while six the bipolar non-bipolar subjects commented that the
image number 1 setting was clean, organized, and well-lit. It was perceived to be a
healthy environment, with soft and inviting daylight. Some of the subjects liked the
modern aesthetic of the room, and some of them did not prefer that feature. One nonbipolar subject said, “I like the openness, the white, and the light colors. It is very
symmetrical. There is good division between spaces. I like the lights and a lot of
windows.”
A bipolar subject liked the setting but implied that she could not live there,
because it was too organized and clean. Other comments included sentiments that the
place felt sterile, suffocating, hospital-like, with too much white, appearing stark. Positive
impressions toward this setting from bipolar subjects were based on the sense of a
calming environment that was relaxing, clean, and bright. A depressed subject implied
that this setting made her feel happy because of the open windows and its peacefulness.
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Figure 4.6. Image 1: Living Room with Neutral Materials, Low Contrast, and Neutral
Daylight (NMLCND).
The African American subject commented, “It’s an empty space; I can be by
myself. I can think. I can scream, cry in my own area. There is no one there to upset me.
The windows are open, even though I am inside the room, I have the freedom to look
outside. In the room, I am not connected to the world, but I can see outside and be
connected.”
In general, image 1 – which had wood flooring and half wall panels, low contrast
and half opened blinds. Bipolar subjects felt stressed, sleepy, and most of them didn’t like
or prefer this setting. Many of the non-bipolar subjects felt relaxed and peaceful and half
of them liked and preferred it. Bipolar subjects felt stressed and only one bipolar
depressed subject like this setting, preferred it, and felt peaceful. Non-bipolar subjects
stated the office feel to the room and the soft lighting were the reasons to feel this way.
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Bipolar subjects reported that the dark walls, flooring and covered windows were the
reasons to feel stressed.
Neutral Materials, Neutral Contrast, and Low Daylight. Image 25’s (Figure 4.7)
setting was comprised of neutral material, neutral contrast, and low daylight. The
proportion average between subjects with and without bipolar disorder score was 0.12.
Only two non-bipolar subjects felt awake, and none of them felt stressed. All non-bipolar
subjects felt relaxed and peaceful, but only seven liked this setting, and six preferred it.
Of the bipolar subjects, only two felt wide awake, and four of them felt stressed. Seven
bipolar subjects felt relaxed and peaceful, but only four liked and preferred this setting.
The characteristic of the room that most stood out to non-bipolar subjects was the
covered windows. Some subjects thought it was peaceful and relaxing, but also felt
sleepy and that the space seemed smaller. One non-bipolar subject commented that the
image felt peaceful and sleepy, but not in a positive way, because of the colors of same
tones and the covered windows.
The setting of image 25 evoked opposite opinions from bipolar subjects. Positive
responses included that the setting felt like it was cold or raining outside and that the
colors and lights felt warm. The panels looked “so cool,” according to one subject, who
stated that the side walls “say something to me.” Other responses included: “If I were
retired I would live there;” “I could sit there and watch Netflix and get some work done
on my computer.” On the other hand, negative responses included: “I dislike everything
about this one;” “The white paneling doesn’t do anything for it. It feels like you’re in a
horse stable and you’re … closed in;” “It feels blah and there’s not enough contrast;” and
“I am not claustrophobic, but I don’t like when I can’t see outside. It makes me not want
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to do anything and just veg on the couch.”
Figure 4.7. Image 25. Living Room with Neutral Materials, Neutral Contrast, and Low
Daylight (NMNCLD).
In general, image 25 – which had wood flooring and half wall panels, neutral
color contrast and closed blinds. Bipolar and non-bipolar subjects felt sleepy, relaxed and
peaceful; however, bipolar subjects meant it in a negative way because of the similar
tones and covered windows. Non-bipolar subjects stated the closed windows made them
feel sleepy.
Neutral Materials, Neutral Contrast, and High Daylight. The setting in image 17
(Figure 4.8) had neutral materials, neutral contrast, and high daylight. This image had the
same setting as the previous image, image number 27, but with the windows all
uncovered. The proportion average was 0.12. Subjects with and without bipolar disorder
had similar emotional responses of wide awake and relaxed. All non-bipolar subjects felt
peaceful and seven bipolar subjects felt the same. None of the non-bipolar subjects felt
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stressed, and only three bipolar subjects felt stressed. Most of the non-bipolar subjects
liked and preferred this setting. However, five bipolar subjects liked this setting, and
seven preferred it.
Figure 4.8. Image 17: Living Room with Neutral Materials, Neutral Contrast, and High
Daylight (NMNCHD).
The main comments on image 17 from non-bipolar subjects were that it felt open,
and they liked the color palette variation. They liked the fact that all windows were open,
as well as the amount of light coming in, and the wood floors. Two subjects implied that
the setting’s darker floors and furniture with the color getting lighter toward the ceiling
added to the design and pulled your eyes up, making it feel more open. The only subject
that did not like or prefer this room commented, “It’s alright.”
What bipolar subjects liked about image 17 was the amount of light which
balanced the dark wood flooring. They also liked the contrast between the floors and the
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rest of the space. One subject commented, “I would walk by this room and not step foot
in it, because it looks so good. I wouldn’t want it to get dirty. It would be like a
showroom in my house. You don’t walk into it; you just look at it.” On the other hand,
bipolar subjects who did not like this setting commented that the wood items blended into
each other - the wood on the tables looks like it is part of the floor and walls. It is too
bright like you went to the mall. One bipolar subject added that the floors were too dark
and reminded her of her grandmother’s house in Alabama.
In general, image 17– which had light wood covering the floors and white wood
panels, neutral colors, and full open windows – was rated by subjects without bipolar
more frequently as evoking emotions set A of the binary emotional scale. Even though
bipolar subjects had a high rating for this image, only 5 liked it. Non-bipolar subjects
mentioned the dark wood, the color palette variation, and the daylight as the reasons for
their rating. On the other hand, bipolar subjects complained that the dark wood and the
room was too clean as the main reasons for their rating.
Neutral Materials, High Contrast, and Low Daylight. Image 20’s (Figure 4.9) setting
included neutral materials, high contrast, and low daylight. The proportion average was
0.11. This setting had low emotional responses from people without bipolar disorder.
Only two non-bipolar subjects felt awake; three felt stressed; five liked it and felt
peaceful; while only 4 preferred it; and seven felt relaxed. Bipolar subjects also had a
lower rating for this setting. Only three felt wide awake, four felt relaxed, and seven felt
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stressed. Only one bipolar subject who was depressed, with a Beck score of 37, liked this
setting.
Figure 4.9. Image 20: Living Room with Neutral Materials, High Contrast and Low
Daylight (NMHCLD).
Non-bipolar subjects who liked this setting commented that it was really different,
has an office feel to it, which would make them more productive. They found the lights
appealing and relaxing. It was not perceived as a sleepy setting, but one that would keep
you awake and active. Subjects who did not like this setting implied that it is stressful
with the dark walls and floors and lack of light. One subjects commented that the
artificial light was too harsh on the eyes, making her feel anxious and like it was a
smaller space.
Most of the bipolar subjects did not like this setting because of the dark walls,
flooring and the covered windows. They felt it was like a dungeon, making them anxious
and feeling like something bad was going to happen, like it was a scary movie, which
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brought their mood down. The only subject who liked this setting had depression; she
commented that she liked the dark floors and dark walls compared to the white curtains
and the half walls. She thought it felt comfortable.
In general, image 20 had dark wood floors, dark walls and shut windows. Bipolar
subjects felt stressed, sleepy, and most of them didn’t like or prefer this setting. Many of
the non-bipolar subjects felt relaxed and peaceful and half of them liked and preferred it.
Non-bipolar subjects stated that the office feel to the room and the soft lighting made
them feel this way. Bipolar subjects reported that the dark walls, flooring and covered
windows were the reasons to feel stressed.
High Materials, Neutral Contrast, and Low Daylight. The setting in image 13
(Figure 4.10) had high materials (wood covering the ceiling, floors, and two walls). The
proportion average between bipolar and non-bipolar subjects was 0.10, the lowest score
of the proportion averages. Only one subject of the bipolar group and one from the
control group felt wide awake. Eight non-bipolar subjects felt relaxed, while only five of
the bipolar group felt relaxed. Only three non-bipolar subjects felt stressed, and five of
the bipolar subjects felt that way. A similar number of subjects of both groups felt
peaceful. Half of the control group liked and preferred this setting, while only three of the
bipolar group liked and preferred it.
Non-bipolar subjects who liked this setting commented that the wood looked nice,
stating that it was a peaceful and relaxing setting, like a bedtime setting. One subjects
commented that “It is not monotone. It has the lighter wall, the light rug. But having the
was because of the lack of natural light, which made them feel sleepy and claustrophobic
windows covered makes it feels closed in.” Subjects who did not like this setting said it.
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Bipolar subjects who did not like this image described the setting as gloomy, dreary, and
boxed in. One bipolar subject commented, “It feels like a 1970s-smoke lounge. It feels
like my grandparents’, except they would have Avocado couch and shag carpet. I don’t
like it. It’s dark and dreary.” However, subjects who liked this setting described it as a
homey setting with an earthy feel to it. They felt it was cozy, because of the warm tones,
but that it needed more plants. They found it to be serene and quiet. One bipolar subject
said, “If I sit still on that couch, I could hear myself breathing. I could think about the
things around me. Very soothing to look at and very meditative.”
Figure 4.10. Image 13: Living Room with High Materials, Neutral Contrast, and Low
Daylight (HMNCLD).
In general, Image 13 – which had wood covering the floors, ceilings and walls,
neutral color contrast and covered windows - was rated low by subjects of both groups as
evoking emotions from set A of the binary emotional scale. Non-bipolar subjects had
high rating for relaxing and peaceful. They mentioned the wood covering and the low
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lighting, On the other hand, bipolar subjects described the setting as too gloomy, and they
felt boxed in, their main reasons for their rating was the closed windows and dark colors.
Neutral Materials, High Contrast, and Neutral Daylight. The setting in Image
10 (Figure 4.11) consisted of low materials, neutral contrast, and high daylight. The
proportion average between bipolar and non-bipolar subjects was 0.10. A similar number
of subjects in both groups felt wide awake, peaceful, and liked the setting. Only one
subject from each group felt stressed and seven preferred it. All bipolar subjects felt
relaxed, and only seven of the non-bipolar subjects felt that way.
There were opposing opinions about the uncovered window among non-bipolar
subjects. Some subjects thought it is nice the way it allowed plenty of natural light into
the room, while others thought it would be difficult to control the light and difficult to
maintain privacy. One subject felt that people would watch her like she was in a fish
bowl. Positive responses were related to the light ceiling, dark walls, darker floors, and
the color organization overall. The subjects felt the room looked very bright, because
there was wood. They liked that the ceiling and floors looked different from one another
and everything is visible. To these subjects, the room did not seem like a workspace; it
was more of living space. The shiny floors really stood out. The white ceiling felt open to
them. Even though the windows were all uncovered, two non-bipolar subjects
commented that this setting made them feel sleepy. Some negative responses included
that the full lighting and hard reflection on the flooring was a turn-off. These subjects felt
that the glare overwhelmed any friendly or inviting feeling.
Bipolar subjects felt similarly positively about the color organization of this
setting, in which the ceiling was white, and the floors were darker, providing balance.
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The open windows were considered a positive characteristic of the setting, because there
was visual access to the outside, with a view of the trees. The African American bipolar
subject commented, “I like lots of natural sunlight. I can see trees outside. It excites me.
Looks like an open field and it is my own space; it is my kingdom.” One bipolar subject
that did not like or prefer this setting commented that “this setting is even more sterile. I
can’t stand beige, feels like a doctor’s office, cold and sterile.”
Figure 4.11. Image 10: Living Room with Low Materials, Neutral Contrast, and High
Daylight (LMNCHD).
In general, Image 10 – which had tile floors, neutral color contrast, and full open
windows – was rated high by both groups as evoking emotions from set A of the binary
emotional scale. Non-bipolar subjects had high rating for awake, relaxing and peaceful
but complained about the uncovered windows for privacy reasons. Bipolar subjects
described the setting as balanced with the white ceiling and dark flooring. Open windows
were also a positive feature of this setting.
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Images Showing High Proportion Average Between Two Age Groups of Bipolar
Subjects
The ten bipolar subjects were divided into two groups. There were five subjects in
the 24-37 age group. All of them were females, and two of them have depression, with
Beck test scores of 37 and 45. The other five bipolar subjects were from the 40-54 age
group. There were four females and one male, and one subject had depression, with Beck
score of 53. Twelve images had a threshold more than 0.10 on the proportion average
between the two age groups. The proportion average of these images ranged from 0.23 to
0.10. Two of the images had low material settings, with low and high contrast, and
different daylight setting. Five images had neutral materials settings with low and high
contrast and different daylight. Five images had the high materials settings with low,
neutral, and high contrast and different daylight settings. The proportion average ranged
between 0.23 and 0.10 showed in Table 4.2 below.
Table 4.2
Images Proportion Average Between Two Bipolar Age Groups and The Images’
Materials, Contrast and Daylight Settings.
Proportion
Average
Materials
Contrast
Daylight
Image 7
0.23
Neutral
High
Neutral
Image 19
0.23
High
Low
High
Image 23
0.23
Low
High
Neutral
Image 9
0.20
High
Neutral
Neutral
Image 1
0.17
Neutral
Low
Neutral
Image 5
0.17
High
High
Low
Image 16
0.17
Neutral
Low
Low
Image 20
0.13
Neutral
High
Low
Image 22
0.13
High
Low
Low
Image 11
0.13
Low
High
Low
Image 12
0.10
Neutral
Low
High
Image 21
0.10
High
Neutral
High
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Neutral Materials, High Contrast, and Neutral Daylight. The setting in image
7 (Figure 4.12) included neutral materials, high contrast, and neutral daylight. The
average was 0.23. All subjects from the older group (40-54) felt wide awake, and only
three of the younger group (24-37) felt the same. Two subjects from the younger group
felt relaxed and peaceful; both liked it and one subject preferred it. Four subjects from the
younger group felt stressed toward this setting. Three subjects from the older group felt
relaxed and peaceful, and they liked it and preferred it. Only two older subjects felt
stressed.
Younger subjects who did not like this setting commented that it felt stoic, not
cozy. The dark colors on the walls and limited light brought them down. They felt the
dark walls and floors would require more cleaning. One subject felt the space was
ominous, “like something bad is going to happen,” and that it was not as pleasant to look
at as the other images. The only young subject that liked this setting commented, “I feel
stimulated and relaxed. I can think creatively and I can relax and move in the space. I feel
sleepy in this room; it’s a good nap room.”
Older subjects felt that there were too much seating and furniture in the room.
One subject stated that “too many people would be there and drive me crazy.” A male
bipolar subject implied that the dark walls and floors take him back to depression. Three
subjects liked this setting, because it let the light come in, felt homey and natural, like an
outdoor feeling. They felt it was a relaxing environment and with sufficient contrast.
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Figure 4.12. Image 7: Living Room with Neutral Materials, High Contrast and Neutral
Daylight (NMHCND).
In general, image 7 – which had wood floors and wood panels, dark walls and
half open windows – was rated high by the older group as evoking emotions from set A
of the binary emotional scale. Older bipolar subjects felt relaxed and awake because of
the natural lighting and the sufficient contrast. Younger subjects had lower rating for this
setting and most of them felt stressed. They mentioned the dark walls and limited light as
the reasons for their rating.
High Materials, Low Contrast, and High Daylight. Image 19’s (Figure 4.13)
setting had high materials, low contrast, and high daylight. The proportion average
between the two age groups was 0.23. Almost all subjects from both groups felt wide
awake. All subjects of the younger group felt relaxed, peaceful, and preferred the room.
Only one bipolar subject from the younger group felt stressed. Three subjects from the
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younger group liked this setting, and only one subject from the older group liked
Moreover, three subjects felt peaceful and preferred this setting.
The younger group subjects liked the light colors of the wood (Rovere wood) and
the open windows. In their view, the setting seemed relaxing, peaceful, and not washed
out. One subject suggested that the floor boards made her wonder how long the floor
extended. She said “I want to know the beginning and the end of it. When I find
something that I have to decode, I feel relaxed, because I can focus on one thing.”
Another subject described this setting as a cozy beach house, stating that it felt like an
outdoor space, but that she did not like the ceiling.
A 51-year-old bipolar subject described image 19 as feeling like she needed to
walk on the ceiling, floors, and walls because it felt like a rubber room. Other subjects
implied that the room was a little too bright and closed in because of the wood on the
ceiling, walls, and flooring. One older bipolar subject who preferred this setting stated
that the room made her unstressed - the room made her want to get up and motivate
people.
In general, image 19 – which had wood floors, ceiling and walls, light contrast
and opened windows was rated high by the younger group as evoking emotions from set
A of the binary emotional scale. Older bipolar subjects felt wide awake and peaceful
because the room was too bright and closed in. Younger subjects had higher rating for
this setting, feeling relaxed, peaceful and not washed out. They mentioned the wood
covering and the daylight as the reasons for their rating.
Low Materials, High Contrast, and Neutral Daylight. The setting in image 23
(Figure 4.15) was comprised of low materials (sand marble tiles on the floor), high
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Figure 4.13. Image 19: Living Room with High Materials, Low Contrast, and High
Daylight (HMLCHD).
contrast, and neutral daylight. The proportion average score was 0.23. All young bipolar
subjects felt relaxed, peaceful, and preferred this setting. Four young subjects felt wide
awake; one felt stressed, and three liked it. All older subjects felt wide awake; two felt
relaxed, peaceful, liked and preferred this setting; and three felt stressed toward this
setting.
Young bipolar subjects preferred this setting because of the open window, the
amount of light, and the light-colored ceiling and floors. The contrast seemed
comfortable because the floors had a light color. One young bipolar subject that has Beck
score of 27, which is close to the depression score (30), felt that this setting was
depressing. She commented, “It is so perfect, but that wall throws me off. The room was
just fine till you added that black to the walls and it really bothers me.”
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Bipolar subjects of the older group did not like this setting because it was too
bright, with many light colors on the top and dark colors on the bottom. The only thing
that felt good was the walls, while everything else felt sterile and blue.
In general, image 23 – which had marble floors, high contrast, and half-opened
windows – was rated higher by the younger group as evoking emotions from set A of the
binary emotional scale. Younger bipolar subjects felt relaxed and peaceful because of the
lighting and the light floors and ceilings. Older subjects reported that the room was too
bright which felt wide awake but stressed.
High Materials, Neutral Contrast, and Neutral Daylight. The setting in image
9 (Figure 4.16) included high materials, neutral contrast, and neutral daylight. The
proportion average was 0.20. Only one subject from each group felt awake. Two from the
younger group felt relaxed, and another two felt stressed. Three felt peaceful, but none of
the younger subjects liked or preferred this setting. However, four subjects of the older
group felt relaxed and peaceful. Only one subject felt stressed, and two liked and
preferred it.
Younger subjects did not like the boxed in feeling of this setting because of the
wood on the ceiling, walls, and floors. A younger depressed bipolar subject stated, “All
the wood makes me feel comfortable, but I don’t like the shininess; it makes me feel
clinical again.”
Subjects of the older group also did not like this setting, because it was too dark
and made them feel depressed. They felt there was too much gloom in it. They felt
everything blended together; nothing stood out. One positive response was, “I like that
the darker ceiling and the wall make that image pop. It has a warm glow to it.”
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Figure 4.15. Image 23: Living Room with Low Materials, High Contrast, and Neutral
Daylight (LMHCND).
Figure 4.16. Picture 9: Living Room with High Materials, Neutral Contrast, and Neutral
Daylight (HMNCND).
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In general, image 9 – which had wood floors, ceiling and walls, neutral contrast
and half-opened windows – was rated higher by the older group as evoking emotions
from set A of the binary emotional scale. Older bipolar felt relaxed and peaceful; they
mentioned the darkness and gloominess of the room. Younger subjects reported that they
felt boxed in because the wood covering on the walls, ceiling, and floors.
Neutral Materials, Low Contrast, and Neutral Daylight. The setting in image
1 (figure 4.17) had neutral materials, low contrast, and neutral daylight. The proportion
average between the two age groups was 0.17. A similar number of subjects from both
groups felt wide awake, peaceful, and stressed. More subjects in the younger age group
(24-37) felt relaxed, as well as liked and preferred the image than the older group (4054). Only one subject of the older group preferred this setting, and two liked it.
Subjects from the young group who liked this setting commented that it was airy,
relaxing, and clean. The lighter wood color, open floor plan, and open windows helped to
give this feeling. Nevertheless, one subject that preferred this setting commented that she
liked it, but stated that she could not live there, because it is too clean. An African
American subject commented, “It is an empty space. I can be by myself. I can think; I can
scream, cry in my own area. There is no one there to upset me. The windows are open,
even though I am inside the room, I have the freedom to look outside. In the room, I am
not connected to the world but I can see outside and be connected.”
Older subjects who did not like this image’s setting argued that there was too
much white, giving the space a sterile and stark hospital feel. One subject commented
that it was not her style and that she did not like too much unity in her room. Even though
she thought it was a comfortable and peaceful room because the windows were open,
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Figure 4.17. Image 1: Living Room with Neutral Materials, Low Contrast, and Neutral
Daylight (NMLCND).
she still did not like or prefer the room. Another subject suggested that if all the white
was replaced with more natural colors, the room would look better. A 51-year-old subject
who had Beck depression test score of 28, near the score that indicates depression (30),
implied that the room felt sterile and suffocating to her. She also did not like the light
wood floor at all.
In general, image 1- which had light wood floors and wood panels, low contrast
and half-opened windows – was rated higher by the younger group as evoking emotions
from set A of the binary emotional scale. Younger bipolar subjects felt wide awake,
relaxed and peaceful because of the light wood, open floor plan, and open windows.
Older subjects reported that the room was too white and hospital-like which felt wide
awake, relaxed and peaceful.
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High Materials, High Contrast, and Low Daylight. The setting in image 5
(Figure 4.18) setting had high materials, high contrast, and low daylight. The proportion
average was 0.17. Only one older bipolar subject felt awake, and two subjects felt
relaxed, another two peaceful, liked and preferred it, and another two felt stressed.
Younger subjects have higher proportions: two felt awake, peaceful, liked it and prefer it,
another four felt relaxed, and another four felt stressed.
Younger subjects who did not like this setting explained that the space felt closed
in, because the ceiling and floor are the same dark color. They said the room did not feel
bright at all, with insufficient light and a general lack of stimulation. One of the two
subjects who liked this setting commented “The change of the floor; I actually like it.
This one is very calming. It stimulates me. It would be the two chairs on the side wall. If
there were people with me, sitting in these side chairs, I would feel powerful, and I think
this would give me different presence than sitting on the couch, which would make me
feel depressed.” The other subject stated that the room “feels cozy with the lamps on. It
feels homey. It’s dark, but it has enough light if you want to read.”
The one male bipolar subject (50 years old) implied that he did not like the image
at all and that it reminded him of when he was depressed. Another subject said she did
not like it because of the closed windows, which made her anxious, as if there might be
someone approaching the window that she could not see. The subject who liked this
setting liked the black and gray tones which complemented each other and made her feel
grounded.
In general, image 5 – which had wood covering, floors, walls and ceiling, dark
walls and closed windows – was rated higher by the older group as evoking emotions
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from set B of the binary emotional scale. Younger bipolar subjects felt sleepy, anxious,
stimulated and unstressed because of the dark wood on the ceiling and floors, and the
closed windows. Older subjects mentioned the dark tones in the environment was the
reason to feel depressed and anxious.
Figure 4.18. Image 5: Living Room with High Materials, High Contrast, and Low
Daylight (HMHCLD).
Neutral Materials, Low Contrast, and High Daylight. The setting in image 16 (Figure
4.19) consisted of neutral materials, low contrast, and high daylight. The proportion
average between two bipolar age groups was 0.17. None of the older bipolar group felt
awake, and only two of the young bipolar group felt awake. The same number of both
groups felt peaceful, relaxed, or stressed. Three subjects from the younger group liked
this setting and only one from the older group liked it. Two of the younger subjects
preferred it and only one from the older group preferred it.
Younger bipolar subjects commented that this setting was cozy and warm, but to
be careful with the window covering, because it can make you feel anxious, stressed, and
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depressed. One subject said she could sleep on that couch all day. Some felt that there
was enough light and it was not too dark. Another younger bipolar subject, who had Beck
score of 45, which indicated depression, commented that she did not like this setting
because it was closed in.
Older bipolar subjects implied that lack of daylight made the room feel too small,
busy, and closed in. One subject said, “The wall panels don’t do anything for it.” One
subject gave a positive response, commenting that she liked the paint on the walls and
that it made her feel sleepy because of the blinds.
In general, image 16- which had light wood floors, and wood panels, white walls
and closed windows – was rated higher by the younger group as evoking emotions from
set A of the binary emotional scale. Younger bipolar subjects felt relaxed and peaceful
because the room was cozy and warm. Older subjects mentioned the lack of daylight in
the environment as the reason for feeling closed in.
Figure 4.19. Image 16: Living room with Neutral Materials, Low Contrast, and High
Daylight (NMLCHD).
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Neutral Materials, High Contrast, and Low Daylight. The setting in image 20 (Figure
4.20) consisted of neutral materials, high contrast, and low daylight. The proportion
average was 0.13. Three subjects from the younger bipolar group felt wide awake toward
this setting. Two subjects from the younger group felt relaxed, and only one felt peaceful,
liked it, and preferred it. Only one subject of the older group felt wide awake, two felt
relaxed, and four felt stressed. None of the bipolar older group felt peaceful, liked, or
preferred this setting.
One younger bipolar subject stated that she liked the black floors and walls
compared to the white curtains and the half walls, stating that it felt comfortable. Another
younger subject commented, “There are sometimes that I would walk in there and feel
this is really cool. Maybe if the furniture were white it would look super modern. But the
furniture makes me feel dreary. The windows are closed. I wouldn’t live there because I
am super messy.” Negative responses were that the room felt like a dungeon and the
black made the observer feel anxious, like something bad was about to happen. Some
subjects felt it looked like a scary movie. This space tended to bring the mood down. One
young bipolar subject stated “black to me is death and gloomy. It’s not nice, not
pleasant.”
Subjects from the older group did not like the setting in image 20 because of the
windows and the dark wood (Maple Sambuca). It did not feel open, but instead closed in.
In general, image 20 – which had light wood floors, and wood panels, dark walls
and closed windows – was rated higher by the younger group as evoking emotions from
set A of the binary emotional scale. Younger bipolar subjects felt comfortable in the
room environment because of the good contrast between walls, blinds, and ceiling. Older
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subjects mentioned the lack of daylight and dark walls in the environment as the reasons
to feel closed in.
High Materials, Low Contrast, and Low Daylight. The setting in image 22 (Figure
4.21) demonstrated high materials, low contrast, and low daylight. The proportion
average between two bipolar age groups was 0.13. Two subjects from the younger age
group (24-37) felt wide awake, stressed, like it, and preferred it. Four subjects of the
young group felt relaxed and three felt peaceful. Two subjects of the older group (40-54)
felt wide awake, relaxed, and peaceful. Three of the older bipolar group felt stressed, and
only one subject liked and preferred this setting.
Younger bipolar subjects did not like this room, because the windows were
closed, and the colors were too dark for the room to have closed windows. Subjects who
liked this setting stated that the room felt warm and cozy, because the lamps were on, and
the shades were completely drawn. One subject commented, “This one is fun. It is
peaceful. It also makes me sleepy, but I feel wide awake because of the colors around me.
It isn’t so dark, even if I closed my eyes, because I know what it looks like. I can feel the
light. Looking at it, you can see that everything is aligned properly. I think about
meditation. I want to open the blinds and move things around.”
Subjects of the older group stated that though it was a darker room, it was not
bothersome. It was seen as a room for watching TV, but not doing anything that required
energy. A 51-year-old bipolar subject commented, “The ceiling is not distracting; you
don’t feel like you want to walk on it. The lighting in the room on the right is more
inviting than the lighting on the left side. The light across the top is annoying. It is too
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Figure 4.20. Image 20: Living Room with Neutral Materials, High Contrast, and Low
Daylight (NMHCLD).
Figure 4.21. Image 22: Living Room with High Materials, Low Contrast, and Low
Daylight (HMLCLD).
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bright and who wants a light over the TV? It is going to cause a glare. It doesn’t go with
it.”
In general, image 22 – which had light wood floors, ceiling and walls, low
contrast and closed windows – was rated higher by the younger group as evoking
emotions from set A of the binary emotional scale. Younger bipolar subjects felt relaxed
and peaceful but didn’t like the setting because the room was too dark to have closed
windows. Older subjects mentioned lack of daylight in the environment as the reasons to
feel sleepy, relaxed and peaceful.
Low Materials, High Contrast, and Low Daylight. The setting in image 11 (Figure
4.22) included low materials, high contrast, and low daylight. The proportion average
was 0.13. Subjects from the younger group gave a low rating for this setting. Only one
subject felt awake, peaceful, and liked it. Two young subjects felt relaxed, three felt
stressed, and none preferred it. Two subjects of the older group felt awake, relaxed,
peaceful, and liked it. Three subjects felt stressed, and only one subject preferred it.
Younger bipolar subjects did not like this setting because of the closed windows,
light floors, and the dark walls, which made the space feels like a dark waiting room.
They added that “it feels closed in and boxed.” One young subject who liked this setting
stated, “This one is very interesting. Even though the blinds are back and the walls are
dark, the floors are vibrant; the floor attracts me. The tile I picked in my house depended
on my mood that day. It looks edgy, looks like a cool space. Looks like it suits young
couples, but I don’t prefer it because I don’t like the walls.”
Subjects’ from the older age group negative responses included: “I don’t like the
flooring and the blinds. There is no good lighting in there. I can’t see outside, which
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make me anxious and nervous;” “I don’t like the white floor and white ceiling. Feels like
the bottom is going to fall out. It does not look stable.” However, a 54-year-old subject
commented that she liked the contrast, even though the natural light is shut out for a more
relaxing and peaceful setting. It made the area less warm, but you can still see everything
well.
Figure 4.22. Image 11: Living Room with Low Materials, High Contrast, and Low
Daylight (LMHCLD).
In general, image 11 – which had light marble floors, dark walls and closed
windows – was rated higher by the older group as evoking emotions from set A of the
binary emotional scale. Younger bipolar subjects felt stressed because the room settings
had dark walls, light floors, and closed blinds. Older subjects mentioned the lack of
daylight and light floors as the reasons to feel stressed.
Neutral Materials, Low Contrast, and High Daylight. The setting in image 12 (Figure
4.23) included neutral materials, low contrast, and high daylight. The proportion average
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was 0.10. All subjects from both age groups felt wide awake. Three young subjects felt
relaxed and peaceful. Four of them liked and preferred the setting, and none of the young
subjects felt stressed. Two subjects from the older group felt relaxed, peaceful, and
preferred this setting. Four of the older subjects felt stressed, and only one subject liked
it.
Subjects from the younger group had positive responses about this setting.
Subjects stated that the room felt calming, bright, airy, and open because of the open
windows and the colors. One subject commented, “That one is amazing. I don’t know
why I like it but I do. I like the openness of the room, the lamps.”
Figure 4.23. Image 12: Living Room with Neutral Materials, Low Contrast, and High
Daylight (NMLCHD).
On the other hand, subjects from the older group stated that the colors were too
bright. They felt it was too white and sterile; they found it uninteresting. They stated that
it was too stark, and it felt like a hospital. One positive response was from a 40-year-old
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depressed subject was, “The one thing I like about this is the white walls and the
windows are open. I prefer this over anything. It makes me feel relaxed, and I can do
what I need to do. I don’t like it because of the layout, too many things.”
In general, image 12 - which had light wood floors and white panels, white walls
and full-opened windows – was rated higher by the younger group as evoking emotions
from set A of the binary emotional scale. Younger bipolar subjects felt wide awake,
relaxed and peaceful because of the open windows. Older subjects reported the room was
too bright and hospital-like because of the light color tones.
High Materials, Neutral Contrast, and High Daylight. The setting in image 21 (Figure
4.24) displayed high materials, neutral contrast, and high daylight. The proportion
average was 0.10. Four subjects of the younger bipolar group felt wide awake and
peaceful. Two of them felt relaxed and stressed, and three liked and preferred this setting.
Three of the older bipolar group felt wide awake and relaxed. Four of the subjects felt
peaceful, and one felt stressed. Only two of the older group liked and preferred this
setting.
Younger bipolar subjects liked this setting, because there was a lot of light
coming in, and the space was open. One subject stated “I like it, right here, right now. I
like the light. I wouldn’t like it all day long.” The African American subject commented,
“This is very peaceful, yet stressful at the same time. It’s the lines again. I want to know
where they are going. I need to find the end-point of it. That stresses me out, but at the
same time I like solving problems.”
On the other hand, subjects of the older group did not like settings of Image 21,
because it felt like a box even though the windows were open. Having the ceiling, floors,
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and walls the same color of wood made it feels like a box. A 51-year-old bipolar subject
commented, “I feel like I am in a boat, wood all around, almost like a cabin fever feel to
it and it is closed in. With a lot of lighting coming in. It’s uninteresting.”
In general, Image 21- which had light wood floors and white panels, white walls
and full opened windows – was rated higher by the younger group as evoking emotions
from set A of the binary emotional scale. Younger bipolar subjects felt wide awake, and
peaceful because of the open windows and the neutral tones. Older subjects mentioned
wood covering everything as the reason to feel boxed in.
Figure 4.24. Image 21: Living Room with High Materials, Neutral Contrast, and High
Daylight (HMNCHD).
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Comparison Between Images with High Proportion Average between Bipolar
Subjects and Non-Bipolar Subjects
High Materials, Low Contrast, and High Daylight VS High Materials, Neutral
Contrast, and Low Daylight. Image 19 and 13 had high material setting with wood
covering the ceiling, floors and two walls. This amount of wood is considered 90% of the
room. Image 19 has low contrast and high daylight while Image 13 has neutral contrast
and low daylight. Image 19 had the largest proportion average between subjects with and
without bipolar disorder with a score of 0.23 while Image 13 had the least proportion
average of 0.13. Most subjects of both groups felt wide awake toward Image 19 with the
low contrast and the high daylight while only one subject of both groups felt wide awake
toward Image 13 with the neutral contrast and low daylight. More bipolar subjects felt
relaxed towards Image 19 while more non-bipolar subjects felt relaxed towards Image 13.
Bipolar subjects preferred Image 19 than Image 13.
Moreover, most bipolar subjects preferred Image 19 with the high materials, low
contrast and high daylight because it looks cool, relaxing and motivating. Moreover,
Bipolar subjects who liked Image 13 described it as homey, earthy and meditating.
Bipolar subjects who did not like Image 13 commented it is gloomy, and boxed in
because of lack of natural light and the dark tones of wood.
Non-bipolar subjects did not prefer room settings of Image 19 because of the high
amount of light entering the room and reflecting off the wood and the amount of wood
covering the ceiling, floors and walls. However, non-bipolar subjects who liked Image 13
though the wood looks nice and it is a peaceful setting. The reason some subjects did not
like Image 13 is the lack of natural light.
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Low Materials Settings. Image 11, Image 18, Image 6 and Image 10 all have low
materials with tile flooring, painted walls and ceiling. Image 11 has high contrast and low
daylight. Image 18 has neutral contrasts and low daylight. Image 6 has low contrast and
neutral daylight. Last, Image 10 has low contrast and high daylight. Subjects of both
groups felt more awake towards Image 6 with the neutral daylight and 10 with high
daylight than Image 11 and 18 with the low daylight which have covered windows. Most
non-bipolar subjects felt relaxed towards all images. All bipolar subjects felt relaxed
towards Image 10 while only four subjects felt relaxed towards Image 11 and seven
subjects felt relaxed towards Images 18 and 6. More non-bipolar subjects felt peaceful
towards all these images than subjects with bipolar. Subjects of both groups preferred and
liked Images 6 and 10 more than the other two images.
Non-bipolar subjects liked the overall look of Image 11 but did not like the lack
of natural light. All images have no wood flooring. On Image 18 there is no wood
flooring (tile flooring) which seemed acceptable by subjects without bipolar. Image 6
also has tile flooring but has the windows half covered which allow natural light. This
helped subjects of both groups feel wide awake. Image 6 was preferred by non-bipolar
subjects because of the color scheme and the amount of daylight
On the other hand, bipolar subjects disliked Image 11 because of the dark walls
and the closed windows. One bipolar subject implied that the white flooring looked like it
was not stable and that it seemed like it was going to fall out. Image 18 did not feel cozy,
and it was depressing for bipolar subjects because of the tiles and the closed windows.
However, the color palette felt appealing to one bipolar subject. Image 6 did not seem to
have enough contrast, too bright and the floor is too shiny to bipolar subjects. On the
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other hand, Image 10 was more appealing for bipolar subjects than the other three
images. The subjects implied it was relaxing, not too bright and it was more balanced
because the windows are open and the ceiling is not dark. Moreover, being able to see
outside view adds up to the setting of Image 10.
Neutral Material Settings. Images with neutral materials setting (wood covering the
floors and wood panels on half of the walls) have the most proportion average between
subjects with and without bipolar ranging from 0.15 to 0.11. Image 1, 20, 27, 25, and 17
have neutral materials setting, Image 1 has low contrast and neutral daylight. Image 20
and 27 have high contrast while Image 25 and 17 have neutral contrast. Image 20 and 25
have low daylight, and Image 27 and 17 have high daylight.
Image 1 seems to get positive responses from non-bipolar subjects and negative
responses from bipolar subject who described it as sterile, hospital-like and suffocating.
A depressed bipolar subject felt the place makes her happy and relaxed because how
clean, organized and well-lit it looks.
Image 20 and 27 have the same setting but with different daylight settings (20
with covered windows and 27 with uncovered windows). This setting was preferred more
than the other high contrast setting (dark walls and flooring or dark walls, ceiling, and
floors). This setting has white panels covering half of the walls and white ceiling which
balanced the dark walls and flooring making the setting more pleasing. Some non-bipolar
subjects implied that the setting had an office feel to it which made them more productive
and wide awake while bipolar subjects described it as a vacation home and that it had an
enough accent color of black that doesn’t overwhelm the room. Bipolar subjects didn’t
like the room when the windows were covered because they said it felt like a dungeon,
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and it made them feel anxious. However, they liked the room when the windows were
open.
Image 25 and 17 have a neutral contrast and different daylight (windows all
covered or windows uncovered). Most subjects of both groups felt relaxed, and peaceful.
Moreover, non-bipolar subjects liked and preferred this setting than the bipolar subjects.
Bipolar subjects felt more stressed than non-bipolar subjects in both high and low
daylight settings. For bipolar subjects, there were two main reasons that made them not
like this setting. The first reason is the lack of daylight with the windows all covered in
Image 25 which made them feel closed in. This was not the case for Image 17 that has the
open windows. The second reason appeared in both images was not having enough
contrast in the color scheme being all browns. Non-bipolar subjects seemed to prefer the
natural color in this room either with low or high daylight. They liked how the colors go
from dark tones on the floors and lighter on the ceiling.
Comparison Between Images with High Proportion Average Between Two Age
Groups of Bipolar Subjects (24-37) (40-54)
Low Materials. Image 11 and 23 have a setting of low materials (instead of wood floors,
Sand Marble floors and painted walls) and high contrast. The difference between the two
Images is daylight setting: one with low daylight Image 11, and neutral daylight Image
23. The setting with neutral daylight has a higher number of subjects from both age
groups and feeling wide awake. More subjects of the young bipolar group (24-37) felt
relaxed towards Image 23 than older bipolar subjects and the same number of both
groups felt relaxed towards Image 11. The Image of higher daylight had more subjects
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feeling peaceful than the Image with lower daylight. On the other hand, young bipolar
subjects felt less stressed in the higher daylight than the lower daylight, while older
subjects felt the same stress in both settings which meant that daylight didn’t make a
difference but color and materials setting led to this result. Young subjects liked and
preferred the setting with higher daylight. Only one young subject liked this room setting
in low daylight and no one preferred it. About the same number of older subjects liked
and preferred this setting in both low and neutral daylight.
Young bipolar subjects preferred this setting in the natural daylight because of the
amount of light coming in and the light color ceiling and floors. As well as older bipolar
subjects who liked it because it is bright and there are lots of light colors. This relates to
the study of Rosenthal et al (1985) that showed exposure to light may improve a patient’s
mood and eliminate depressing symptoms. However, old subjects stated that the walls
feel good but everything in the room feels sterile and blue.
On the other hand, young subjects didn’t like the room in the dark setting when
the blinds are closed. They didn’t even like the light color floors which they liked in the
higher daylight setting. Moreover, older subjects apparently had the same feeling about
the room in the low daylight setting. They did not like the light floors and white ceiling.
One subject stated “the floor feels like it is going to fall off. it doesn’t feel stable. Only
one young subject and other old bipolar subject liked the contrast in this setting and they
felt that the blind were closed for more relaxing and peaceful setting.
Neutral Materials and Low Contrast. Images number 1, 12, and 16 had the same
neutral materials (Oak Cashmere wood on the floors and white wood panels covering the
lower part of the walls) and low contrast. Image 1 had neutral daylight, 12 had high
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daylight, and 16 had low daylight. The proportion average is 0.17 for Image 1, 0.10 for
Image 12, and 0.17 for Image 16. Subjects of both groups felt wide awake in both neutral
and high setting and felt sleepy in the low setting when the windows are all covered.
Higher proportion of subjects of both groups felt relaxed in the low daylight and the
neutral daylight (windows half covered) and felt more stimulated in the high daylight
setting. More subjects of the young group felt peaceful than subjects on the old group.
Four subjects of the old group felt stressful in the high daylight setting while none of the
younger group felt this way toward the same setting. Moreover, the same number of
subjects felt stressed toward images with low and neutral daylight setting. More subjects
of the young group liked and preferred in all images (1,12,16) while fewer subjects of the
older group liked and preferred this setting in all daylight conditions.
Young bipolar subjects stated that the setting of neutral material and low contrast
is cozy and warm in the low daylight setting but be careful with the blinds because it can
make you stressed, anxious or depressed. When the blinds were half open, young bipolar
subjects stated that the room is airy, relaxing and clean with the lighter wood color, open
floor plan, and the open windows. Additionally, young subjects also liked the room in the
high daylight setting. They described the room as airy, calming, and bright because of the
open windows and the light colors.
On the contrary, older bipolar subjects stated that the room felt smaller, busier and
there is too much going on in the low daylight setting. In the neutral daylight setting,
older bipolar subjects thought that there is too much white in the room, feels like a
hospital, sterile and stark. A 51 years old bipolar subject indicated that the room feels
sterile and suffocating to her because she didn’t like the light wood flooring. Moreover,
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older subjects did not prefer this room in the high daylight setting because it is too bright,
hospital-like and there is no interest to it.
Neutral Materials and High Contrast. Images 7 and 20 have neutral materials and high
contrast setting. Image 7 has neutral daylight and Image 20 has low daylight. The
proportion average between the two age groups is 0.23 for Image 7 and 0.13 for Image
20. The same number of young bipolar subjects felt awake and relaxed toward this
setting in both low and neutral daylight. In contrast, all older subjects felt awake in the
neutral daylight setting and only one subject felt awake in the low daylight setting. Only
one young subject felt peaceful in the low daylight setting while none of the older
subjects felt peaceful. Four subjects of the young group felt stressed toward the neutral
setting and four of the older subjects felt stressful toward the low daylight setting.
Subjects of the older group liked and preferred the room when the blinds are half open
and no one of the older group liked or preferred the room when the blinds are closed.
Subjects of the young bipolar group didn’t like the neutral daylight setting (Image
7) because it felt stoic and not cozy. “The dark walls and closed windows bring you
down” one subject commented. In the low daylight setting (Image 20), young subjects
stated that the room felt like a dungeon and brings the mood down. One young subject
stated “it feels anxious like there is something bad going to happen. It is like a scary
movie.” Another subject said “black to me is death and gloomy. It is not nice, not
pleasant.” A young subject who liked this setting noted that she liked the black floors and
walls compared to the white curtains and half walls.
Subjects of the old group stated that the room has too much furniture and felt
busier. One male bipolar subject commented that the room took him back to depression.
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Moreover, older subjects didn’t like the low daylight setting because of the closed
windows and the dark wood (Maple Sambuca) flooring.
High Materials and Low Contrast. Images number 22 and 19 have high materials
(Rovere wood covering 90% of the room, wood floors, ceiling and two walls), low
contrast. Image 22 has low daylight (covered windows) and Image 19 high daylight (no
window covering). The proportion average is 0.23 for Image 19 and 0.13 for Image 22.
Almost all subjects from both groups felt wide awake toward Image 19 and only two
subjects from both groups felt awake toward Image 22. More subjects from the young
group (24-37) felt relaxed and peaceful towards high daylight setting than low daylight
setting. In contrast, about the same number of subjects of the old group (40-54) felt
relaxed and peaceful to both low and high daylight settings. More subjects of both groups
felt stressed towards Image 22 than Image 19. More subjects of both groups preferred the
high daylight setting than the low daylight setting.
Young bipolar subjects liked the light colors of wood which to them felt like a
cozy beach house or like outside of a house but they did not like the wood ceiling. When
the windows are closed in Image 22, young bipolar subjects didn’t like the closed
windows and the colors are too dark for the room to have closed windows. Subjects who
liked the low daylight setting described the room as cozy and warm because the lamps
are on and the shades are completely drawn.
An old bipolar subject commented on Image 19 and said, “I feel like I need to
walk on the ceiling, walls, and floors, it feels like a rubber room.” The same subject
commented on Image 22 with the lower daylight stated, “The ceiling is not distracting;
you don’t feel like you want to walk on it.” Other older subjects implied that the room is
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too bright and closed in because of the wood on the ceiling, floors and walls. In the low
daylight setting, older subjects described the room as a darkroom. It is a room for
watching TV but no energy to do anything.
High Materials and Neutral Contrast. Images number 9 and 21 have high materials
(Doc Pisa wood covering the ceiling, two walls, and floors), and neutral contrast. Image 9
has neutral daylight (windows half covered) and Image 21 has high daylight (windows
uncovered). Image number 9 has proportion average of 0.20 and Image 21 has proportion
average of 0.10. Young subjects felt wide awake towards the high daylight setting and
only one young subject felt awake to neutral daylight setting. In contrast, three subjects of
the older group felt awake towards Image 21 with the high daylight and only one old
subject felt awake towards Image 9 for the neutral daylight. About the same number of
young bipolar subjects felt relaxed, peaceful and stressed towards both images. More old
subjects felt relaxed and peaceful toward the neutral daylight setting than the high
daylight setting. The same number of old subjects liked and preferred both neutral and
high daylight setting. Three of the young group liked and preferred the high daylight
setting and none of them liked or preferred the neutral daylight setting.
Young subjects didn’t like the setting with neutral daylight because it is boxed in
with the wood covering the ceiling, walls, and floors. They also didn’t like the shininess
of the wood which makes feel clinical. In contrast, young subjects liked the room when
the window are uncovered. They like the amount of light coming in and the openness of
the room.
Older subjects stated that the room was mixed together, nothing stood out. There
was a gloomy feeling to the room because the wood is too dark. Furthermore, old bipolar
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subjects didn’t like the room in the high daylight setting either. The room still felt boxed
in for them. One old subject described the room as a boat.
Liked and Preferred Images for Bipolar and Non-Bipolar Subjects
Table 4.3
The Most Liked and Preferred Images for Bipolar and Non-Bipolar Groups
Non-Bipolar Subjects
Bipolar Subjects
Like
Prefer
Materials
Contrast
Daylight
Like
Prefer
Materials
Contrast
Daylight
Image 6
1
1
Low
Low
Neutral
Image 10
0.9
0.7
Low
Neutral
High
Image 1
1
0.8
Neutral
Low
Neutral
Image 4
0.9
0.7
Neutral
Neutral
Neutral
Image 4
0.9
0.9
Neutral
Neutral
Neutral
Image 8
0.7
0.8
Low
Neutral
Neutral
Image 17
0.9
0.9
Neutral
Neutral
High
Image 6
0.7
0.6
Low
Low
Neutral
Image 15
0.8
0.7
Low
Low
High
Image 27
0.6
0.7
Neutral
High
High
Image 8
0.8
0.8
Low
Neutral
Neutral
Image 10
0.7
0.7
Low
Neutral
High
Image 25
0.7
0.6
Neutral
Neutral
Low
Low Materials, Low Contrast, and Neutral Daylight. Table 4.3 shows that all nonbipolar subjects liked and preferred Image number 6 (Figure 4.25) the most which had
settings of low materials, low contrast and neutral daylight. Subjects like this setting
because all the natural daylight was coming to the room, the lighter Marble floors, and
the color pallet. They say it was not too bright, the floor was shiny, and it seemed sharp
and organized. One subject commented that she would put more colors.
Neutral Materials, Low Contrast, and Neutral Daylight. The second setting
that non-bipolar subjects liked and preferred the most was Image 1 (Figure 4.26) with
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Figure 4.25. Image 6: Living Room with Low Materials, Low Contrast, and Neutral
Daylight (LMLCND).
Figure 4.26. Image 1: Living Room with Neutral Materials, Low Contrast, and Neutral
Daylight (NMLCND).
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Figure 4.27. Image 10: Living Room with Low Materials, Neutral Contrast, and High
Daylight (NMLCND).
neutral materials, low contrast, and neutral daylight. All subjects liked this setting and 8
out of 10 preferred it. Subjects liked the organization of this room. The light in the room
is bright. They also liked the open floor plan of this room, how symmetrical it looked and
the division between spaces.
Low Materials, Neutral Contrast, and High Daylight. On the other hand,
bipolar subjects liked and preferred Image number 10 (Figure 4.27) the most, and it was
with low materials, neutral contrast, and high daylight. Nine bipolar subjects liked this
setting and seven preferred it. Bipolar subjects like this setting because the shades are all
gone and they can see the view outside the windows. Another feature that the subjects
liked was the lighter ceiling and wall colors.
Neutral Materials, Neutral Contrast, and Neutral Daylight. Table 9 also
shows that the second most liked and preferred setting for bipolar subjects is the setting
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of Image 4 (Figure 4.28) with neutral materials, neutral contrast and neutral daylight.
Nine out of ten subjects liked this setting and seven preferred it. This setting felt homier
to them than the other settings according to bipolar subjects. Subjects liked that they can
see outside and they liked the amount of light coming into the room. One subject
commented “I can move things around. This I can move around, but I would open the
windows all the way.” Another subject implied that she could invite her guests in this
room.
Figure 4.28. Image 4: Living Room with Neutral Materials, Neutral Contrast, and Neutral
Daylight (NMNCND).
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Table 4.4
The Least Liked and Preferred Images for Bipolar and Non-Bipolar Subjects
Non-Bipolar Subjects
Bipolar Subjects
Like
Prefer
Materials
Contrast
Daylight
Like
Prefer
Materials
Contrast
Daylight
Image 5
0.3
0.3
High
High
Low
Image 18
0.1
0
Low
Neutral
Low
Image 24
0.4
0.2
High
High
Neutral
Image 20
0.1
0.1
Neutral
High
Low
Image 21
0.4
0.3
High
Neutral
High
Image 24
0.2
0.2
High
High
Neutral
Image 9
0.4
0.2
High
Neutral
Neutral
Image 9
0.2
0.2
High
Neutral
Neutral
Image 19
0.4
0.2
High
Low
High
Image 11
0.3
0.1
Low
Neutral
Low
Figure 4.29. Image 5: Living Room with High Materials, High Contrast, and Low
Daylight (HMHCLD)
High Materials, High Contrast, and Low Daylight. Table 4.4 shows the least liked and
preferred settings for both bipolar subjects and non-bipolar subjects. Non-bipolar subjects
liked and preferred the least was Image number 5 (Figure 4.29) with high materials, high
contrast, and low daylight. Non-bipolar subjects disliked this setting, because the dark
colors made it feel like a basement with the black ceiling and floors. The setting was
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Figure 4.30. Image 24: Living Room with High Materials, High Contrast, and Neutral
Daylight (HMHCND).
Figure 4.31. Image 18: Living Room with Low Materials, Neutral Contrast, and Low
Daylight (LMNCLD).
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stressful and seemed much smaller. The subjects also felt like falling sleep time because
the blinds were down.
High Materials, High Contrast, and Neutral Daylight. The second least liked and
preferred setting was Image 24 (Figure 4.30) with high materials, high contrast, and
neutral daylight. Four non-bipolar subjects, they liked this setting, and only three
preferred it. Subjects did not like the reflection of light on the dark ceiling and floors. It
felt heavy and uncomfortable to them.
Low Materials, Neutral Contrast, and Low Daylight. On the other hand, what bipolar
subjects liked the least was Image 18 (Figure 4.31). Only one subject with bipolar
disorder liked this setting and none of them preferred it. Subjects disliked this setting
because of the closed windows and dark color pallet. The room does not feel cozy and
warm. Subjects implied that they would feel stressed, depressed, and secluded in this
room.
Figure 4.32. Image 20: Living Room with Neutral Materials, High Contrast, and Low
Daylight (NMHCLD).
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Neutral Materials, High Contrast, and Low Daylight. The second least liked and
preferred setting for bipolar subjects was Image number 20 (Figure 4.32) with neutral
materials, high contrast, and low daylight. Only one subject liked and preferred this
setting. Subjects did not like this setting because the windows were covered and the dark
walls and ceiling made it feel like one is in a dungeon, and it felt closed in. One subject
suggested that if the furniture is white, it will look super modern, but the furniture makes
it feels jury?
Liked and Preferred Images for Two Bipolar Age Groups
Table 4.5
The Most Liked and Preferred Images for Two Bipolar Age Groups (24-37) and (40-54).
Age
(24-37)
Image
10
Image
19
Like
Prefer
Materials
Contrast
Daylight
1
0.8
Low
Neutral
High
Age
(40-54)
Image
10
0.6
1
High
Low
High
Image 1
0.8
0.8
Neutral
Low
Neutral
Image 4
0.8
0.8
Neutral
Neutral
Neutral
Image 6
0.8
0.8
Low
Low
Neutral
Image 8
Image
12
0.8
0.8
Low
Neutral
Neutral
0.8
0.8
Neutral
Low
High
Image 3
Image
17
Image
23
0.6
0.8
High
High
High
0.6
0.8
Neutral
Neutral
0.8
0.6
Low
High
Like
Prefer
Materials
Contrast
Daylight
0.8
0.6
Low
Neutral
High
Image 4
0.8
0.6
Neutral
Neutral
Neutral
Image 8
Image
27
0.6
0.8
Low
Neutral
Neutral
0.6
0.8
Neutral
High
High
0.6
0.6
Neutral
High
High
0.6
0.6
Low
Low
High
0.4
0.6
Low
High
High
0.4
0.6
Neutral
Neutral
High
High
Image 7
Image
15
Image
14
Image
17
Image
19
0.2
0.6
High
Low
High
Neutral
Image 6
0.6
0.4
Low
Low
Neutral
Table 4.5 shows that subjects of the young age n group (24-37) liked and
preferred three images of the high materials, four of the neutral materials and five of the
low materials. The young age group also liked and preferred two images with high
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contrast, five with the neutral contrast and five of the low contrast. Moreover, young
subjects liked and preferred seven images with high daylight and five of the neutral
daylight and none of the low daylight setting. The table shows that old subjects (40-54)
preferred none of the images with high materials. They liked and preferred three images
with neutral materials and three images with low materials. Old subjects liked and
preferred two images with high contrast, three with neutral contrast and one with low
contrast. Additionally, old subjects liked and preferred four images with high daylight
and two with neutral daylight.
From the Table 4.5 above it appears that subjects of the young group (24-37)
liked and preferred images with high materials more than subjects in the old group (4054). Subjects of the young group liked and preferred setting with low contrast more than
subjects of the old group. Moreover, subjects of the young group liked and preferred
images with high daylight more than the subjects of the old group.
Low Materials, Neutral Contrast, and High Daylight. Table 4.5 shows the most liked
and preferred by both bipolar age groups (24-37) and (40-54). Image 10 (Figure 4.33)
with low materials, neutral contrast, and high daylight is the most liked and preferred by
the younger bipolar age group. All subjects liked this setting and 4 out of five preferred it.
Subjects like this setting because the light is not too bright, and the deep color of the
floors. Moreover, Image 10 (Figure 37) was the most liked and preferred setting by the
older bipolar age groups. Four out of five liked this setting and three preferred it. Older
bipolar subjects liked this setting because they can see the outside view with the windows
all open and it did not look too busy. On the other hand, subjects who did not like this
setting claimed that the room is sterile and that it felt like a doctor’s office.
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High Materials, Low Contrast, and High Daylight. Image 19 (Figure 4.34) settings
with high materials, low contrast, and high daylight were the most preferred setting by
the young age group (24-37). All subjects of the young group preferred this setting and
three out five liked it. The setting of Image 19 seemed peaceful, relaxing and very
neutral because of the colors, lights and the floors boards. The negative feature of this
setting was the wood ceiling.
Figure 4.33. Image 10: Living Room with Low Materials, Neutral Contrast, and High
Daylight (LMNCHD).
Neutral Materials, Neutral Contrast, and Neutral Daylight. Image 4 (Figure 4.35) is
the second most liked and preferred setting by the older age group (40-54). Setting had
neutral materials (wood floor covering and half walls wood panels), neutral contrast and
neutral daylight (blinds covering half way). Subjects of the older bipolar group liked this
setting because it felt homier, warmer, more comfortable and it made them feel
destressed. The lights were not too bright and just enough to study.
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Figure 4.34. Image 19: Living Room with High Materials, Low Contrast, and High
Daylight (HMLCHD).
Figure 4.35. Image 4: Living Room with Neutral Materials, Neutral Contrast, and Neutral
Daylight (NMNCND).
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Table 4.6
The Least Like and Preferred Images for Two Bipolar Age Groups (24-37) and (40-54).
Age
(24-37)
Image 9
Image
18
Image
11
Image
24
Like
Prefer
Materials
Contrast
Daylight
0
0
High
Neutral
Neutral
0.2
0
Low
Neutral
Low
0.2
0
Low
High
Low
0.2
0.2
High
High
Neutral
Age
(40-54)
Image
20
Image
18
Image
24
Image
22
Like
Prefer
Materials
Contrast
Daylight
0
0
Neutral
High
Low
0
0
Low
Neutral
Low
0.2
0.2
High
High
Neutral
0.2
0.2
High
Low
Low
Figure 4.36. Image 9: Living Room with High Materials, Neutral Contrast, and Neutral
Daylight (HMNCND).
High Materials, Neutral Contrast, and Neutral Daylight. Table 4.6 shows the least
liked and preferred images settings by both bipolar disorder age groups (24-37) and (4054). Image 9 (Figure 4.36) setting with high materials (wood covering the floors, ceiling,
and two walls), neutral contrast, and neutral daylight were the least liked or preferred
setting by the younger bipolar group (24-37). One bipolar subject commented on this
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setting that everything was not in its exact place and the reflection on the ceiling was not
appealing. Other bipolar subjects from the young group also did not like the shininess of
the wood ceilings.
Low Materials, Neutral Contrast, and Low Daylight. Image 18 (Figure 4.37) with low
materials (tile flooring), neutral setting, and low daylight was the least liked and preferred
the image by both bipolar age groups (24-37) and (40-54). Only one subject from the
younger group liked this setting. This subject commented that the room was stressing and
peaceful at the same time. She said she could sleep all day in that room, and that was why
she did not prefer this image; because she would be sleeping all day and seclude herself
from everyone. Other younger bipolar subjects did not like the tile flooring, as it seemed
cold and uninviting to them.
Figure 4.37. Image 18: Living Room with Low Materials, Neutral Contrast, and Low
Daylight (LMNCLD).
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Moreover, subjects from the older group (40-54) also did not like or prefer this
setting. Older bipolar subjects disliked this setting because it was too dark, which made
them anxious, stimulated and depressed. Closed windows made subjects of the old group
feel sleepy and prevented them from seeing behind the shutters.
Figure 4.38. Image 20: Living Room with Neutral Materials, High Contrast, and Low
Daylight (NMHCLD).
Neutral Materials, High Contrast, and Low Daylight. Image 20 (Figure 4.38)
with neutral materials (wood flooring and wood panels), high contrast and low daylight
was not liked or preferred by any of the subjects of the old group (40-54). Subjects from
the older group did not like the darkness and closeness of this setting. One old bipolar
subject liked the contrast of this setting.
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CHAPTER V
DISCUSSION
This study explored the emotional responses of people with bipolar disorder to the
interior residential environment. The study adopted a living room with two seating areas:
one for entertainment and one for reading and studying with different materials, contrast
and daylight settings. The research questions were: (a) How do people with bipolar
disorder emotionally respond to differences in interior daylighting, color contrast, and
wood materials? (b) Are there any differences between how people with and without
bipolar disorder respond to these changes? (c) Does age of people with bipolar disorder
influence their responses?
Twenty subjects, ten bipolar subjects and ten nob-bipolar subjects were selected
for all study purposes using a non-probability, purposive-quota sampling strategy. Not all
subjects were Caucasian, there was one African American, and one Hispanic American.
27 images were created with different settings of materials, contrast, and daylighting for
the subjects to respond to them using a semantic differential emotional and affective
bipolar scale. There were some data missing which subjects neglect to choose emotional
responses. The subjects’ other responses were not eliminated from the study and the
missing responses were considered zero. The subjects were tested for depression using
the Beck mood test. They were also asked to explain their responses. Interviews were
held in the conference center in the Department of Design at Texas Tech University.
Times of interviews were set according to the convenience of the subjects. Data were
collected during Fall 2016.
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The difference between bipolar and non-bipolar subjects’ responses were
addressed in the study. Moreover, the differences between two bipolar disorder age
groups (24-37) and (40-54) were also collected. In this chapter, results showed in Chapter
IV are used to address and answer the second and third questions of the study: Are there
any differences between how people with and without bipolar disorder respond to these
changes? Does age of people with bipolar disorder influence their responses?
Theoretical Implications
Relating the Theory to the Findings
The study adopted two main design theories: the integration theory, the
stimulation theory. First, the human and the environment are always interacting with each
other and influencing each other (Kopec, 2006). The integration theory states that
elements in the environment work in harmony to facilitate a particular behavior (Kopec,
2006). These elements are: (1) common characteristics of an environment such as
artificial light or daylight, furniture, and the overall atmosphere of the place (2) stimuli
that trigger our behaviors such as light, noise, colors, and finishes (3) a situation that
bring disappointment or pleasure, this can relate to a person’s memories and experience
(4) environment that facilitate or restrict our behavior (5) features in the environment that
guild us what we can do and where we go (Kopec, 2006). The emotional and affective
responses of the subjects in this study give us an idea of how they would react to each
setting. Three main elements of design were manipulated to measure subjects’ responses.
Study data suggests that different settings of materials, contrast, and daylight had
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different responses from bipolar and non-bipolar subjects. Data also showed different
responses between the two bipolar disorder age groups.
The study demonstrated the way in which people react differently to each setting.
Some Bipolar disorder subjects absorb the image setting noticing the lighting, the wall
colors, the different finishes of the floor and ceiling; and then relate all of that to their
personal experience and memories. This affects their responses to the settings; for
example, one bipolar subject reacted to some settings that had dark wood on the floors,
ceiling, and walls based on her memories of her grandmother’s house. She replied to this
image that she did not like it and she felt anxious about it. This setting perhaps triggered
in her unpleasant memories from her childhood.
Second, with reference to the interactional theory, which indicates that the
interacting relationship between the human and the environment with each other
influence each other (Kopec, 2006); the study showed how different design settings can
affect people with bipolar disorder with the amount of light coming in the room or the
color and finishes of the floors, walls and ceiling. As mentioned in the previous
paragraph, a bipolar subject was influenced by the settings which probably reminded her
of unpleasant childhood memories and made her feel anxious.
This also relates to the stimulation theory that explains the relationship between
the environment and humans. The stimulation theory states that the environment is full of
sensory information that we need to process (Kopec, 2006). Our mind is always working
to process information that we get from our five senses such as smell, touch, taste, sight
or hearing (Kopec, 2006). When daylight in the setting of the living room was too bright,
the senses were overstimulated, making the subject felt anxious or uncomfortable. On the
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other hand, when the setting was too dark and dim, subjects replied that it was too dark
and felt like a dungeon.
Difference Between Bipolar and Non-Bipolar Subjects.
Table 5.1
Bipolar
Picture 19
Room Element
NonBipolar
Room Element
Daylight- ceiling wood
Daylight
Dark walls
Closed blinds- Dark
walls
white panels
White panels and
ceiling - daylight
Too bright light
Daylight - marble
floors
Dark colors- no outside
view
Soft lighting- neutral
colors- tile floors
Too much white
Same color tonescovered window
Modern aesthetic
Picture 17
Dark wood- too clean
and organized
Color palette variation
_daylight
Picture 20
Dark walls and flooringcovered windows
Picture 13
Closed windows- dark
colors
Color tonesorganization and outside
view
Picture 11
Picture 27
Picture 6
Picture 18
Picture 1
Picture 25
Picture 10
Covered windows
y
Office feeling- soft
lighting
Wood covering - low
lighting
Color contrast
Table 5.1 shows the rating of the proportion average of bipolar subjects and nonbipolar subjects. It also shows the room element that triggered the rating. The blue arrows
are the averages higher than 0.50 and the red arrows are the averages below 0.50.
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Materials. Responses from each group produced almost the opposite results for images
with high materials. Non-bipolar subjects stated the room was uncomfortable and boxed
in because of the wood covering the ceiling, walls, and floors. On the other hand, bipolar
subjects felt it was like a beach house and not boxy.
A study by Sakuragawa et al. (2005) found associations between visual
stimulation, depression, and blood pressure. The study showed that the appearance of
Hinoki Wood panels was related to reduction in stress and sense of depression. The
lighter wood color used in this setting is considered inexpensive, casual, and more
modern in appearance (Bumgardner and Bowe, 2002). The results showed that bipolar
subjects had higher rating when the setting had high wood but they did not like shiny
wood on the ceiling. Moreover, wood panels add to the design for some subjects
especially of the older age group. Some bipolar subjects said that the room felt like the
outside of a house. It is known that natural wood is used in interiors to bring the feeling
of nature into the home environment (Broman, 1995).
The findings from the study for Image 18 as mentioned in the previous chapter
demonstrated contrasting views of relaxed and depressed by non-bipolar and polar
subjects, respectively. Also, Image 25 made both groups feel sleepy. Settings with tiles
were not preferred by some subjects of the bipolar group. The smooth texture of the tile
floors made it cold and unwelcoming for bipolar subjects (Nielson & Taylor, 1990).
Color Contrast. The findings from the study for Image 11 as mentioned in the previous
chapter demonstrated an analogous mostly sleepy rating from both groups, while Image
27 was found to be the most favorite one of all the high contrast settings. Setting with
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dark contrast received lower rating from bipolar subjects making them felt depressed,
anxious and concerned about the cleanness of the space. The black and white tones made
the living room feel cold especially if the lights were dim. This implied that bipolar
subjects demand more vibrate colors in their environment.
Barrick, Taylor, and Correa (2002) suggest that color sensitivity could be
impaired if the person is feeling sad, depressed, or blue. The self-report depression
showed that the scale measuring color sensitivity, “colors seemed cloudy, gray or lack of
color”, correlates with the scale of feeling “depressed/ blue/ sad.” Some the bipolar
subjects were depressed according to the Beck mood test. This means that they might
have color impairment.
Daylight. The findings from the study for Image 17 as mentioned in the previous chapter
demonstrated a higher rating of set A by non-bipolar subjects unlike bipolar subjects,
while for Image 10 both groups felt good about the color organization, outside view, and
amount of daylight. Bipolar subjects were more energetic and want to move around when
the setting of the room had open windows or half opened windows.
These findings imply that the daylight has great effects on people with bipolar
disorder. Studies show that exposure to light in early morning and evening may improve
patients’ moods and eliminate their depression symptoms (Rosenthal et al. 1985). Green
nature and natural water environment may have a considerable effect on the mood and
can promote relaxation. Exposure to a natural environment can lead to lower stress levels.
Being around nature is restorative where people can feel better when they are stressed
out. Therefore, people will appreciate opportunities to access nature (Regan & Horn,
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2005). Also, indoor lighting and color may have effects on people’s moods who are
working indoors (Küller et al, 2006). The study indicated that psychological mood would
be significantly declined when the light is too dim or too bright, and their mood would be
improved when the light is just right (Küller et al, 2006). A study showed a positive
association between mood enhancement and exposure to the natural environment (Van
den Berg, Koole, & Van Der Wulp, 2003).
Differences Between Bipolar Age Groups
Table 5.2
Age 24-37
Room Element
Age 40-54
Room Element
picture 7
Dark walls - limited
light
Daylight - good contrast
picture 19
Daylight- wood
covering
Too bright- closed in
picture 23
Daylight- light wood
Wood covering walls,
ceiling, floors
Too bright
Light wood color
Too white walls
Dark tones- closed
windows
Dark wood covering
ceiling, walls and floors
Warm environment
Lack of daylight
Good contrast
Lack of daylight- dark
walls
picture 22
Closed windows- dark
tones
Closed windows
picture 11
Closed windows- light
floors
Closed windows- light
floors
Daylight
Light color tones
picture 9
picture 1
picture 5
picture 16
picture 20
picture 12
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picture 21
Open windows- neutral
color tones
Wood covering
Table 5.2 shows the rating of the proportion averages of younger bipolar and
older bipolar subjects. It also shows the room element that triggered the rating. The blue
arrows are the averages higher than 0.50 and the red arrows are the averages below 0.50.
Color Contrast. The findings from the study for Image 7 as mentioned in the previous
chapter demonstrated that while older bi-polar subjects felt relaxed, younger subjects felt
stressed and these findings were reversed for Image 23. Responses for Image 5 were
mixed for both the groups. Findings of Image 20 and Image 11were both bipolar group
felt the room was like a dungeon and made them feel anxious. This referred to the closed
windows and limited light coming to the room. Moreover, the findings from the study for
Image 1 and Image 16, as mentioned in the previous chapter demonstrated a contrasting
response as older subjects did not like the settings as against young people, which was
found to same in the case of settings in Image 16 and Image 12.
Studies show that younger bipolar patients get their manic episodes in their
younger age more than they get it in their older age. This is the only difference between
younger and older bipolar subjects (Belmaker, 2004). Younger bipolar subjects might be
manic which made them more active. They preferred lower color contrast settings with
light wood and white walls, which made them peaceful and stimulated. On the other
hand, settings with limited lights in the room influence peoples’ mood and cause them to
feel low or depressed (Küller et al, 2006). Moreover, the study showed that interior colors
have positive impacts when it is colorful and bright (Küller et al, 2006). Older bipolar
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subjects found darker contrast settings more appealing and vibrate. Brighter setting made
them anxious and stressed which might corresponded to their manic or depression
symptoms.
Materials. The findings from the study for Image 19 and Image 22, as mentioned in the
previous chapter demonstrated similar responses from both the age groups.
Correspondingly for images 9 and 21 both the groups gave the same responses. Younger
bipolar subjects felt cluster phobic because of the wood surroundings.
The study by Sakuragawa et al. (2005) showed that the visual appearance of
Hinoki wood (light Oak wood) may have positive effects on people by lowering stress
levels and depression. Bipolar subjects who had depression liked the wood appearance of
the room but did not like the wood on the ceilings. Having wood materials made the
room homey and added to the design.
Daylight. Younger bipolar subjects preferred settings with the open windows allowing a
lot of light coming to the room with higher responses of set A. Another reason for their
preference was accesses to outside view, which made them happier and motivated.
Moreover, both bipolar groups preferred the open windows for safety reasons. On the
other hand, older bipolar subjects preferred settings with half open windows with less
bright light coming to the room. Moreover, older bipolar subjects complemented on the
dim artificial light in settings with closed blinds where they can relax and read. Younger
bipolar stated that dim artificial light made them think they want to watch TV or sleep on
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the couch. These results relate to the literature of daylight and light therapy discussed in
chapter II.
A study conducted by Genhart and her colleague on normal elderly women
showed that exposure to bright light made elderly women anxious and irritated. Subjects
in the study reported headache, depression, dizziness and irritability in the bright light
session. On the other hand, none of the negative side effects occurred in the dim-light
treatment (Genhart et al, 1993). Outpatients who received a treatment of 300-lux light
were oddly showing improvement under low light, which can be explained by abnormal
sensitivity to light in patients with bipolar affective disorder. Moreover, many patients
agreed to use the evening bright light more than to be awakened by light therapy early in
the morning (Rosenthal et al, 1985). A study also indicated that psychological mood
would be significantly declined when the light is too dim or too bright, and their mood
would be improved when the light is just right (Küller et al, 2006). Another study also
shows that people prefer warmer less luminance lighting more than cool, more bluish,
bright lighting (Knez and Kers, 2000).
Implications for Practice
Design Preferences for Bipolar Disorder
Table 5.3
Living Room Preferences for Bipolar People.
Image
Desired
Undesired
Image 19
Open windows
No wood on the ceiling
More wood is preferred
Light color wood (Rovere)
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Image 11
Light color ceiling and floors
Dark wall paints
Good contrast is interesting
All windows covered by blinds
Not able to see outside
Image 18
Closed blinds are not preferred
Tiles feel cold
Room colors were too dark
Image 6
Lighting is good (blinds half
Too bright setting
open)
Low contrast is boring
Marble tiles are acceptable
Marble floors can be too shiny and
More contrast is preferred
bright
Add more color
Image 1
Good lighting with blinds half
Too much white make it stark and
open
feel like being in a hospital
Less cluttered space is preferred
Light floors not preferred
Too clean and organized is not
preferred
Image 27
Dark walls can be combined with
No window covering can be a
light wood panels
problem
Light color on the ceiling
White ceiling
Good contrast is preferred
Dark flooring (Maple Sambuca)
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Image 25
Image 17
Good warm artificial light
Windows all covered
Warm brown colors
Low contrast
Daylight with dark wood
Too bright room
(Doc Pisa)
Too dark flooring
Good contrast
Image 20
Good contrast
Black walls and floors
Balanced colors
Covered windows
Harsh artificial light
Image 13
Dark wood
Dark wood on ceiling, floors, and
(Doc Pisa)
walls
Brown color tones
Window covering
contrast
Design preference for Younger Bipolar
Table 5.4
Living Room Preferences for People with Bipolar Disorder Age (24-37).
Image
Desired
Undesired
Image 7
Too dark floors (Maple Sambuca)
Black walls
Image 19
Light wood color (Rovere)
Wood on ceiling
Wood boards
Image 23
Lighter wood colors
Strong contrast
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Open windows
Amount of light coming in
Open floor plan
Color Contrast
Image 1
Lighter wood colors flooring
Too clean space
Half open windows
Open floor plan
Access to outside view
Image 5
Image 16
Furniture arrangement
Ceiling and floors are the same dark
The lamps
color
High contrast
Not enough light
Natural colors
Closed windows can make you
anxious and stressed
Feels busy and closed in
Image 20
Image 22
Image 11
Black floors and walls
closed windows
White panels and ceiling
Black is not pleasant
High contrast with modern style
Feels like you’re in a dungeon
Color tones are warm and cozy
Lights over the TV
Soft lighting
Dark color tones
Furniture alignment
Closed windows
Soft lighting
Light flooring and dark walls
Flooring is vibrant
Closed blinds with not enough
lighting coming in
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No access to outside view
Image 12
Open windows
Light colors made the room seem
more open
Image 21
Amount of light coming into the
room
Open space
Image 9
Cluster phobic sensation because of
the wood surrounding all directions
The shininess of the wood
Design Preference for Older Bipolar
Table 5.5
Living Room Preferences for People with Bipolar Disorder Age (40-54).
Image
Desired
Undesired
Image 7
Open windows
Too much seating
A lot of light coming in
Black walls
Dark colors make the space
depressing
Image 19
Too bright room
Wood on ceiling, walls, and floor
Image 23
Open windows
Too much white colors
Too much unity
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Replace white with more natural
Light wood floors
colors
Image 1
Half open windows
Too much white color
More natural colors
Light wood on the floor (Oak
Cashmere)
Too much unity
Image 16
Natural colors
Closed windows can make you
anxious and stressed
(Feels busy and closed in)?
Image 5
Image 20
Black and gray tones complement
Ceiling and floors—same dark color
each other
No access to outside view
White panels and ceiling
Very dark wood (Maple Sambuca)
Closed windows
Image 22
Room for relaxing and watching TV Lights over the TV
Wood ceiling
Image 11
Contrast
White flooring and white ceiling
Soft lighting
Closed blinds
No access to outside view
Image 12
Open windows
Light colors are too bright
The room feels like a hospital
Image 21
Room feels like a box because the
same material coverings.
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Image 9
Dark ceiling make the room pop
Wood that is too dark makes the
room too gloomy
The results showed that bipolar subjects from the younger group seemed to have
more responses of wide awake, unstressed, peaceful, and relaxed to the settings with a
high amount of light wood (Rovere) and open windows that allow a lot of natural light.
However, they did not like the wooden ceiling. They preferred lighter colored ceiling and
the open space concept.
Alternatively, bipolar subjects from the older group demonstrated more responses
of wide awake, unstressed, peaceful, and relaxed for settings with natural colors with
darker wood colors (Doc Pisa). The older bipolar subjects preferred softer lighting and
the dark colored ceiling, which made the room pop. Both groups demanded access to an
outside view for safety reasons. Some subjects from both groups also complemented the
color of the apples on the tables and suggested adding accent colors to the room design.
In contrast, both groups liked the room with neutral colored marble flooring and
open windows. Moreover, settings with very dark tones of wood (Maple Sambuca) were
appreciated only when there was enough daylight and good contrast with white ceiling
and wood panels.
Recommendation for Bipolar People for Two Age Groups

Light color wood or tiles

No wood ceilings

Add accent colors to add more interest to the design
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
Open windows are recommended

Use window covering that allow outside view access

Using accent materials on walls to add to the design

Younger bipolar subjects preferred lighter wood while older subjects preferred
darker tones

It is important to give a verity of artificial lighting
Limitation and Challenges of the Study
There was a limited access to the population due to their special condition. A
majority of patients with bipolar disorder are not diagnosed and do not visit psychiatric
clinics or a psychologist. Due to patients’ privacy rights, additionally, it is hard to have an
access to patients’ information and reach out to them. Moreover, patients’ moods and the
effects of the environment in addition to many factors can affect their mood cycle and
their medications. The limited number of the study subjects in the research can be
attributed to the limited access to the patients and the limited timeline of the study. To
ensure credibility, the sampling needed to be random; however, the sampling adapted to
this study was purposive sampling due to the specific condition of the study and the
inclusion/exclusion criteria of choosing the subjects. Moreover, triangulation involved
using more than one way of measurement, which was a shortcoming of the current study.
Measuring Reliability and Trustworthiness

Applicability of the Study. Indicates the applicability of the findings to other
contexts and settings or other groups (Krefting, 1991). This can be addressed
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by giving detailed information about the study procedure and the subject
groups. This information can subsequently help researchers in the future to
replicate the study in other settings and other groups. For example, the
researcher provided information about (1) specific definition for the terms of
the study, (2) detailed information about the subjects’ criteria (exclusion/
inclusion), (3) how to determine specific values of the visual variables of the
study (wood materials, color contrast, and daylight). All this information was
specified in the method section.

Neutrality. Refers to the necessity of results of the study to be unbiased
(Krefting, 1991). This can be addressed when the subjects autonomously
choose their individual emotion of how they feel towards each picture and
subsequently explain their response in their own words. Correspondingly,
displaying the images in random order and randomizing the emotional scale
for each image will minimize response biases. The researcher was neutral to
the study by not asking leading questions or influencing responses through
personal opinions. The researcher only explained the interview instructions
and asked the question in a neutral manner and gave the subjects the
opportunity to think about their responses.

Credibility. This refers to the use of correct measures in the study (Shenton,
2004). In the current study, emotions were measured using the emotional
bipolar scale. The study adapted purposive sampling in this study because it
focused on bipolar subjects in specific age groups. For triangulation, using
more than one method to collect the data is recommended (Shenton, 2004).
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However, in the current study, the researcher used only one method. The
researcher recorded the subjects’ responses and collected their emotional and
affective responses on paper. Moreover, collecting background information
about the subjects may help explain their behavior. To ensure credibility,
subjects should have the right to withdraw without further explanation
(Shenton, 2004). The researcher ensured peer scrutiny of the design so that the
design meets the principles of design (Shenton, 2004). Lastly, it was important
to consider the findings from previous studies to assess the results of the new
study (Shenton, 2004). For example, wood use in previous studies showed
antidepressant and stress reduction effects (Sakuragwa et al, 2005)
(Tsunetsugu, Miyazaki and Sato, 2007). Likewise, people can suffer from a
color impairment if they are depressed (Barrick, Taylor, and Correa, 2002).
Moreover, studies show that morning exposure improves the mood of patients
with bipolar disorder (Rosenthal et al, 1985).

Transferability. With reference to external validity/generalizability, the
findings of the qualitative research are precise to certain environments and
populations, which implies it is hard to generalize the findings to a larger
population (Shenton, 2004). To ensure that the results can be transferred to
future studies, the researcher needed to ensure the provision of all information
about the design setting, the number of people participating in the study, any
restrictions on the type of participants, data collection methods, and the time
period to collect the data (Shenton, 2004). In the current study, the researcher
followed these steps to ensure transferability of the study.
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
Dependability. This refers to the argument that repetition of the same work,
with the same participants and using the same methods; will yield similar
results (Shenton, 2004). To ensure dependability of the study, the study needs
to be reported in detail. The researcher has ensured that all aspects of the
study are reported in detail.

Confirmability. Ensures that the instruments used in the study are not
dependent on human skills or perceptions (Shenton, 2004). Confirmability is
to ensure that the findings of the study are the results of the study with no
biases from the researcher (Shenton, 2004). To avoid the bias of the
researcher, the researcher restricted her opinion and limited her dialog to
explaining the instructions and asking the questions. A detailed method
description showed the reader how the data collection, analysis, and
recommendations can be accepted (Shenton, 2004).
Future Studies
Because designing for people with bipolar disorder is a new field, the current
study projects a new systemic discussion in a new research area in the environmental
design. Owing to the novelty of the concept, it is essential that many areas should be
explored to expand upon this research. Correspondingly, interviewing a larger group of
people with bipolar disorder would provide a more specific idea of their emotional
responses and design preferences, with improved applicability. Investigating gender
differences was a short come of this study because of the limited access to bipolar
patients and the time frame of the study. It is recommended that future studies should
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investigate gender along with age impacts. Also, relatively, interior aspects of design in
other rooms like bedrooms can impact the circadian rhythm in people with bipolar
disorder. Moreover, if funding is available, designing an actual room to test different
design elements and its impacts on people with bipolar disorder would provide more
accurate results and the opportunity to observe subjects over a long period, which would
also be extremely beneficial.
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APPENDIXS
Appendix 1. Study Flier
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Appendix II: Form I (Recruitment Form)
Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Phone _ _ _ _ _ _ _ _ _ _ _ _ _Email_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Age _ __ _ _ _ _ _ _ _ _ _ _ _ Gender_ _ _ _ _ _ _ _ _
Martial States: Married _ _ _ _ single_ _ _ _ divorced _ _ _ _
Are you living with someone and who? Yes _ _ _ No _ _ _ Who? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Ethnicity_ _ _ _ _ _ _ _ _ _ _ Pregnant _ _ _ _ _ _ _ _
Is English your native Language Yes_ _ _ _ No _ _ _ _
Are you diagnosed with bipolar disorder or Cyclothymia from your doctor? When?
Yes_ _ _ _ No_ _ _ _ Date_ _ _ _ _ _ _ _ _ _ _ _
Do you use any medication for your condition?
Yes _ _ _ _ No _ _ _ _ what? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Was there a major social event recently? For example:
Serious illness or injury to subject or to close relative/ Death of first-degree relative including child or
spouse/ Death of close family friend or second-degree relative/ Separation due to martial difficulties/
Broke off a steady relationship/ Serious problem with a close friend, neighbor or relative,
Unemployed/ Seeking work for more than one month/ Subject sacked from job/ Major financial crisis/
Problems with police and court appearance/ Or something valuable lost or stolen.
_______________________________________________________
Any other medical conditions?
_______________________________________________________
This form should be sent by email to [email protected]
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Appendix III. Informed Consent Form
What is this project studying?
The aim of this study was to investigate the emotional and affective responses for people with and
without bipolar disorder. The study will examine different design setting to find the different responses
of the subjects. This will shed a light on how interior environment can affect peoples’ preferences and
whither there are differences between the emotional and affective responses of subjects with and
without bipolar disorder.
What would I do if I participate?
First, you will answer some demographic information such as your age and your gender.
Second, you will be introduced to some images and will ask to choose your emotional and affective
response to each image.
Third, you will take the Beck mood test to examine your mood states.
How many people are participating?
Twenty people, including you, are participating in this study.
How long will participating take?
The study will need thirty minutes of your time. As compensation for your time, you will enter to win a
$15 gift card from Starbucks.
Can I quit if I become uncomfortable?
Dr. Najjar has reviewed the questions and thinks you can answer them comfortably. However, your
participation in this study is voluntary and you may discontinue participation at any time without
penalty or loss of benefits.
How are you protecting my privacy?
The researcher will be able to match your code number with your name. Your personal information will
be stored separately from the data. No one, other than the researcher, will have access to your personal
information. Your name will not be used in the data analysis, final report, or any publication resulting
from the study. Once the data is collected, it will be stored and locked in the Principal Investigator’s
office.
Are there any risks to me?
This study does not represent any risk for the subjects beyond normal everyday life activities since it is
geared toward the built environment.
Are there costs associated with this study?
There are no costs to you.
I have some questions about the study. Who can I ask?
Debajyoti Pati, Ph.D., in the Department of Design at Texas Tech University, is in charge of the study.
If you have questions, you can call her at (806) 834-0850 or e-mail him at [email protected]. You may
also call the Co-PI, Dr. Najjar at (806) 407-4447 or email at [email protected].
•
TTU also has a Board that protects the rights of people who participate in research. You can
ask them questions at (806) 742-2064. You can also mail them at Institutional Review Board for the
Protection of Human Subjects, Office of the Vice President for Research, Texas Tech University,
Lubbock, Texas 79409 or email them to [email protected].
Signature of Subject ____________________________________ Date__________
Subjects can skip questions and still receive the benefits of participating.
This consent form is not valid after May 31, 2017.
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Appendix IV. Living Room Floor Plan
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Appendix V. Beck Mood Test.
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