The psychological adaptation of psychologists in clinical training: the role of cognition,coping and social support

The current study sought to profile the psychological adaptation of psychologists in clinical training and examine the extent to which appraisal, coping and social support were related to psychological adaptation. A cross-sectional survey questionnaire design was used. A sample of 183 psychologists in clinical training (60.2% response rate) from 15 British clinical psychology training courses participated. They completed measures of cognition (appraisals of threat and control over course-related stressors), coping and social support. A multidimensional assessment of psychological adaptation included measures of perceived stress, self-esteem, anxiety and depression. Trainee clinical psychologists reported high levels of stress, but did not experience extensive problems of psychological adaptation in terms of anxiety, depression, self-esteem problems, marital problems, family problems, external stressors, interpersonal conflict, work adjustment or substance abuse. However, a significant subgroup reported self-esteem problems, work adjustment problems, depression and anxiety. Gender, age, current clinical placement and training course were related to psychological adaptation. Appraisal processes, coping and social support predicted a significant amount of variation in psychological adaptation. Appraisals of threat, avoidance coping, emotional support from clinical supervisors, emotional support from courses and emotional support from a confidante at home all predicted the variance in psychological adaptation. The findings were discussed in terms of a cognitive theory of stress and adaptation and implications for clinical psychology training were considered. Copyright © 1998 John Wiley & Sons, Ltd.     

Coping style,cognitive hardiness,and health status

This study investigates the effects of coping style and cognitive hardiness on physical and psychological health status. Measures of coping styles (intrusive positive thoughts, intrusive negative thoughts, avoidance, problem-focused coping), cognitive hardiness, stress, health habits, psychological distress, and physical illness were collected for 194 professional employees. Multiple regression analyses revealed that intrusive negative thoughts and avoidance coping approaches significantly contributed to predictions of psychological distress and physical illness outcomes, respectively. Cognitive hardiness significantly contributed to predictions of psychological distress but not physical illness outcomes. Health habits were significantly related to both measures of health status. Two coping approaches, intrusive positive thoughts and problem-focused coping, did not significantly contribute to predictions of either physical or psychological health status.     

A Social Problem-solving Intervention for Children at High Risk for Later Psychopathology

Children manifesting early difficulties in interpersonal relations, particularly with peers, have been shown to be at risk for later maladjustment and psychopathology. This study examined the efficacy of an intervention program designed to improve social problem-solving skills in child psychiatric outpatients exhibiting behavior problems. This intervention was expected to both lessen maladaptive behaviors and to engender competent and generalizably adaptive behaviors, which would preventively equip children to better cope with stressful events. Thirty-five boys, aged 7-12, served as subjects; due to attrition, 23 completed the study. Subjects received pre-intervention and post-intervention testing on behavioral and cognitive measures. Experimental subjects participated in a group social problem-solving (SPS) intervention, whereas controls received usual and customary treatment provided by the clinic. Results demonstrated improvement for experimental subjects in social-cognitive skills, reduction of behavioral problems, and increase in behavioral competencies compared to controls. Findings suggest that the social problem-solving intervention is an effective and efficient treatment strategy for behavior-disordered children.     

Web-based treatment for infertility-related psychological distress

Infertility has been associated with stigma and negative psychosocial functioning. However, only a small proportion of this population actually receives care. Fertility patients predominantly use the Internet for information gathering, social support, and assistance with decision-making; yet, available web resources are unreliable sources of mental health care. Web-based alternatives also have the potential to assist with intervention access difficulties and may be of significant lower cost. This study evaluated the efficacy of a web-based approach to providing a cognitive behavioral intervention with 31 infertile women seeking medical reproductive technologies. Following randomized assignment, participants using the web-based intervention were compared with those in a wait-list control condition on general and infertility-related psychological stress measures. Results were mixed regarding intervention efficacy. Significant declines in general stress were evidenced in the experimental group compared with a wait-list control group. However, website access did not result in statistically significant improvements on a measure of infertility-specific stress. These findings add to the literature on psychological interventions for women experiencing fertility problems. Moreover, despite the widespread use of the Internet by this population, the present study is one of the first to investigate the usefulness of the Internet to attenuate stress in this population. Preliminary results suggest general stress may be significantly reduced in infertile women using an online cognitive behavioral approach.     

Psychological,Cognitive, and Interpersonal Correlates of Attributional Change in Adolescents

Examined the role of attributional style in adolescent's psychological functioning. Specifically, we examined the cross-sectional correlates of attributional style, as well as the correlates of changes in attributional style over time. A sample of 841 adolescents with either maladaptive or adaptive attributional styles completed a battery of self-report measures at 2 points in time, 1 year apart. Measures assessed depressive symptoms and suicidality, cognitive functioning (self-esteem, pessimism, coping skills), and interpersonal functioning (social competence, conflict with parents, social support from family and friends). Results indicated that attributional style is associated with multiple depression-related variables. In addition, youth experienced significant changes in their attributional styles over time (from adaptive to maladaptive and vice versa). Finally, changes in attributional style were associated with changes in psychological symptoms and other psychosocial variables. Results are discussed in terms of their implications for the prevention and treatment of adolescent depression.     

Relations between social support, appraisal and coping and both positive and negative outcomes in young carers

This study examined a stress/coping model of adjustment in early caregiving. It was hypothesized that better adjustment would be related to higher social support and approach coping, and lower stress appraisals and avoidant coping. One hundred young carers aged 10-25 years completed questionnaires. Predictors included choice in caregiving, social support, stress appraisal and coping. Dependent variables were global distress and positive outcomes (life satisfaction, positive affect, benefits). Correlations supported all hypothesized relations between the stress/coping predictors and adjustment outcomes. Regression analyses showed social support as the strongest predictor of adjustment, whereas coping and choice in caregiving emerged as weaker predictors and stress appraisal was unrelated to adjustment. The stress/coping framework and findings have the potential to inform interventions designed to promote well-being in young carers.     

The ecology of adolescent maltreatment: a multilevel examination of adolescent physical abuse, sexual abuse, and neglect

This study examined the individual characteristics, family relations, and stress/social support of 50 maltreated adolescents and their mothers. Dyads were divided into 4 demographically similar groups: neglect, physical abuse, sexual abuse, and nonmaltreatment control. Results show that adolescent neglect was primarily associated with extrafamilial difficulties and social isolation. Adolescent physical abuse was linked more with rigidity in family relations, poorer maternal understanding of child developmental skills, and adolescent externalizing behaviors. In contrast, adolescent sexual abuse was related to maternal emotional problems and adolescent internalizing behaviors. In general, each group of maltreated adolescents experienced lower levels of family cohesion, more attention problems, and more daily stress than did their nonmaltreated counterparts. Findings are consistent with an ecological model of adolescent maltreatment.     

心理干预对乳腺癌患者应对方式及社会支持的影响

目的探讨综合性心理干预对化疗期间乳腺癌患者应对方式及社会支持的影响方法将83例化疗期乳腺癌患者随机分为实验组和对照组，实验组除接受常规化疗及护理外，还进行为期8周的综合性心理干预，对照组仅接受常规化疗及护理，以乳腺癌患者防御方式（DSQ），社会支持（SSRS）为指标，评价心理干预对乳腺癌患者防御方式及社会支持的影响。结果心理干预后，对两组进行比较显示，实验组比对照组更多地采取积极防御方式，较少地采取消极的防御方式（P〈0.05）。心理干预后，实验组在社会支持总分、主观支持得分、支持利用度等方面较心理干预前均有明显提高（P〈0.05），而对照组前后无明显变化（P〉0.05）。结论综合性的心理干预能够使乳腺癌患者的积极应对方式增加，对社会支持的利用度增加，从而降低负性情绪的影响，提高其生存质量。     

Communication avoidance,coping and psychological distress of women with breast cancer

This study examined the relationship between communication avoidance of cancer-related topics with psychological distress, and the mediating role of coping strategies, in women with breast cancer. Women diagnosed with breast cancer (N = 338) completed an online survey including measures of self- and perceived-partner communication avoidance, psychological distress (depression, anxiety and stress), and coping strategies. Linear regression analyses indicated that women’s and perceived-partner’s communication avoidance was associated with anxiety, depression, and stress in the cancer-affected women. Bootstrapping analyses showed significant mediation effects of self- and perceived-partner communication avoidance on all distress outcomes through greater disengagement coping, and on anxiety through lower engagement coping. Emotionally valenced topics (i.e., disease progression and sexuality) were most avoided and practical issues were least avoided. Enhancing couple communication about cancer and women’s adaptive coping skills (i.e., discourage use of disengagement coping strategies and promote use of engagement coping strategies) may be important targets for psychosocial intervention.     

The relation between coping,social support and psychological and somatic symptoms among torture survivors in Nepal

BACKGROUND: Little is known about the relation between coping, social support, and psychological and somatic symptoms among survivors of torture living outside the West. METHOD: In a population-based dataset of 315 tortured Bhutanese refugees, univariate and multivariate relationships between coping and social support and symptoms were estimated. These relationships were verified in a second sample of 57 help-seeking Nepalese torture survivors. RESULTS: A relationship was observed between the total number of coping strategies used and anxiety and depression. Negative coping, in contrast to positive coping, was related to all symptom outcome measures. Received social support was stronger related to symptoms than perceived social support. The findings from the first sample were replicated in the second sample. CONCLUSION: We found hypothesized relationships between coping, social support, and psychological and somatic symptoms among survivors of torture living in Nepal. The findings from this study confirm the importance of understanding specific types of coping and social support to develop intervention programmes for torture survivors in Non-western settings.     

Matching alcoholics to coping skills or interactional therapies: two-year follow-up results.

Ninety-six subjects were recruited from an inpatient alcoholism treatment program and randomly assigned to aftercare group treatment with either coping skills training or interactional therapy. Survival analyses using 2-year outcome data provided evidence for the durability of matching interaction effects. The data supported a priori hypotheses that individuals scoring high on measures of sociopathy or global psychopathology have better outcomes in coping skills treatment, whereas patients low on these dimensions have better outcomes in interactional treatment. Contrary to the original hypothesis, patients with cognitive impairment had better outcomes in interactional treatment, and patients without cognitive impairment did better in coping skills treatment.     

Coping and adjustment to genital herpes

The current study examined how individuals deal with genital herpes, a recurrent, incurable disease with a great psychological impact. An assessment battery composed of cognitive and problem-focused coping, attribution, and social support mechanisms was employed. These coping mechanisms were correlated with measures of psychological adjustment: self-esteem, depression, sexual adjustment, and amount upset by herpes. Subjects were 152 people with herpes recruited from self-help groups and people from the community who volunteered to participate in the study. Results supported several hypotheses derived from previous research on coping with life stressors. Cognitive coping mechanisms, especially negative thoughts, along with wishful thinking and characterological self-blame, were significant predictors of poor psychological adjustment. Social support was correlated with better psychological adjustment. In addition, the repeated use of disease management strategies was found to correlate with poor psychological adjustment. Further research in the area of coping with chronic illness is suggested.     

心理干预对飞行人员应对方式和社会支持的影响

目的探讨心理干预对飞行人员应对方式和社会支持的影响。方法选取来院疗养的119名军事飞行人员,随机分为干预组和对照组,对干预组实施心理干预,对照组不进行任何心理干预,采用社会支持量表及应对方式问卷对心理干预前后两组飞行人员进行测评,并对干预前后的结果进行比较。结果①心理干预前两组飞行人员应对方式和社会支持量表得分无统计学差异(t=0.12,0.74,-0.30,0.67,-0.37,-0.67;P>0.05);②心理干预后干预组飞行人员的积极应对维度(t=2.67,P<0.01)、主观支持度(t=2.85,P<0.01)、对支持利用度的得分(t=2.45,P<0.05)及社会支持总分(t=2.82,P<0.01)高于干预前,消极应对维度得分低于干预前(t=4.11,P<0.01),对照组前后测的各量表得分无显著变化;③干预组心理干预后飞行人员的积极应对维度(t=2.45,P<0.05)、主观支持度(t=2.90,P<0.01)、对支持利用度得分(t=2.61,P<0.01)及社会支持总分(t=3.42,P<0.01)均高于同时期的对照组,消极应对维度得分低于对照组(t=-2.72,P<0.01)。结论心理干预能改善飞行人员的应对方式,提高飞行人员的社会支持水平。     

初中生应激生活事件、社会支持、应对方式与心理症状关系的结构模型

目的:构建初中生应激生活事件、社会支持、应对方式与心理症状的关系模型.方法:对1009名初中生分别采用应激生活事件问卷、应对方式问卷、社会支持问卷和症状自评量表进行测量,进而用结构方程模型的方法构建了潜变量之间的关系模型.结果:应激生活事件、社会支持、积极应对、消极应对对症状总分有直接影响(权重分别是0.565、-0.064、-0.172、0.377),应激生活事件、社会支持、消极应对对症状总分有间接影响(权重分别是0.161、-0.042、-0.115).结构方程分析表明,女生的社会支持、消极应对对症状总分的影响比男生组更大(女生权重为-0.142和0.292,男生权重为-0.097和0.198).结论:应激生活事件、社会支持、应对方式对心理症状的作用得到结构方程模型的有力支持.     

Intergenerational benefits of family-based HIV interventions

The longitudinal impact of a family-based intervention on grandchildren of parents with HIV (PWH) is evaluated. Because PWH and their daughters demonstrated gains over 6 years when randomized to a coping skills intervention compared with a control condition, the adjustment of the PWH's grandchildren was also compared across conditions. Grandchildren in the intervention condition reported significantly fewer internalizing and externalizing behavioral symptoms compared with grandchildren in the control condition. There is weak evidence that grandchildren in the intervention condition had higher scores on measures of cognitive development and more positive home environments. These results suggest that there are possibly long-term, intergenerational benefits of an intervention for families coping with HIV.     

Childhood chronic illness as a family stressor.

Investigated the impact of childhood chronic illness within a family context. We interviewed 30 mothers of 6- to 14-year-old children with asthma or diabetes and 30 mothers of healthy children of the same age and sex. Family functioning, extrafamilial social support available to mothers, and child life stress events were examined in relation to the children's psychological adjustment and illness events. The mothers of asthmatic children reported a greater number of internalizing behavior problems in their children, perceived their own social support as less adequate, and reported a greater number of stressful events. Regression analyses demonstrated that family functioning, maternal social support, and chronic illness were significantly related to the psychological adjustment of the child. The importance of family functioning and resources available to the family, such as social support, are discussed as protective influences in coping with childhood chronic illness.     

Perceived Problem-Solving Ability, Stress, and Coping in Mothers of Children with physical disabilities: Potential cognitive influences on adjustment

Examined the contribution of perceived problem-solving ability to the adjustment of mothers of children with a physical disability, in conjunction with appraised disability-related stress and approach and avoidance coping, as a further evaluation of Wallander and Varni's Disability-Stress-Coping model emphasizing cognitive processes. One hundred sixteen mothers of children, ages 2 to 20, with spina bifida or cerebral palsy completed measures of relevant constructs. Results show that the mother's appraisal of disability-related stress is strongly associated with her reported maladjustment. However, perceptions of competence in problem solving are associated with better overall adjustment. A portion of this relation appears mediated by coping styLe, as confidence in one's problem-solving ability increases so does the likelihood of selecting more adaptive coping strategies when faced with disability-related stress. Overall, consideration of perceived problem-solving ability appears to make a valuable contribution to the Disability-Stress-Coping model and to current understanding of the experience of coping with raising a child with a disability. Perceived problem-solving ability can also be linked to clinical intervention, as discussed.     

A validity and reliability study of the coping self‐efficacy scale

Objectives. Investigate the psychometric characteristics of the coping self‐efficacy (CSE) scale, a 26‐item measure of one's confidence in performing coping behaviors when faced with life challenges. Design. Data came from two randomized clinical trials (N1 = 149, N2 = 199) evaluating a theory‐based Coping Effectiveness Training (CET) intervention in reducing psychological distress and increasing positive mood in persons coping with chronic illness. Methods. The 348 participants were HIV‐seropositive men with depressed mood who have sex with men. Participants were randomly assigned to intervention and comparison conditions and assessed pre‐ and post‐intervention. Outcome variables included the CSE scale, ways of coping, and measures of social support and psychological distress and well‐being. Results. Exploratory (EFA) and confirmatory factor analyses (CFA) revealed a 13‐item reduced form of the CSE scale with three factors: Use problem‐focused coping (6 items, α = .91), stop unpleasant emotions and thoughts (4 items, α = .91), and get support from friends and family (3 items, α = .80). Internal consistency and test–retest reliability are strong for all three factors. Concurrent validity analyses showed these factors assess self‐efficacy for different types of coping. Predictive validity analyses showed that residualized change scores in using problem‐ and emotion‐focused coping skills were predictive of reduced psychological distress and increased psychological well‐being over time. Conclusions. The CSE scale provides a measure of a person's perceived ability to cope effectively with life challenges, as well as a way to assess changes in CSE over time in intervention research.     

Reducing conduct problems among children of battered women.

This study was an experimental evaluation of an intervention designed to reduce conduct problems among children of battered women. Participants were 36 families (mothers and children) in which the mother had sought shelter because of relationship violence and had at least 1 child (4-9 years old) with clinical levels of conduct problems. The intervention consisted of 2 primary components: (a) providing instrumental and emotional support and (b) teaching child management skills to mothers. Families were randomly assigned to either the intervention condition or the existing services comparison condition and were assessed on 5 occasions over 16 months after shelter departure. Compared with families receiving existing services, children in the intervention condition improved at a faster rate, the proportion of children displaying clinical levels of conduct problems was greatly diminished, and mothers displayed greater improvements in child management skills.     

Impact of an educational support group on family participants who take care of their schizophrenic relatives

Using a stress-coping framework, we designed a six-session educational support group offering family caretakers information about schizophrenia, training in problem-solving skills for managing patient behavior, and greater access to social support and community resources. Subjects were recruited though local community mental health centers; 24 subjects participated in one of five identically structured caretakers' groups and another 24 subjects served as matched controls. Results of the multivariate analysis of covariance indicated a significant difference between the experimental and control caretakers following the intervention. Caretakers of the educational support group reported significantly reduced anxiety and personal distress and significantly more active coping behaviors (increased use of community resources and better management of home life with their schizophrenic family member). However, no changes were reported in the frequency of their negative feelings toward their mentally ill family member or in their generalized sense of self-efficacy.