Emotion regulation interventions: A common‐sense model approach

We present an expanded common‐sense model of self‐regulation that delineates emotion regulation strategies for coping with illness‐related distress, and we describe how it can be used to design self‐regulation interventions for promoting adjustment and well‐being. Two therapeutic interventions guided by this model are reviewed: a self‐regulation writing technique for promoting adaptation to stressful experiences and an emotion regulation intervention for women with breast cancer. The implications of these and related studies for designing self‐regulation interventions are discussed. Therapeutic interventions must give appropriate attention to both problem‐focused regulation and emotional regulation processes in order to confer optimal benefits for individuals with physical health conditions. This expanded model can be used to synthesize findings from the growing body of research on emotion regulation, formulate new hypotheses, and identify constructs to manipulate and assess in health intervention research.     

Illness perceptions in depersonalization disorder: Testing an illness attribution model

Depersonalization disorder (DPD) remains poorly understood and controversial in terms of diagnosis and treatment. Little is known about the cognitive representation of this disorder. In this study, 80 participants with DPD were assessed using the Revised Illness Perception Questionnaire to determine the nature of their perceptions, causal attributions and whether these correlate with levels of depersonalization and affect. Illness perceptions were generally negative; the nature of symptoms was described as mainly psychological but causal attributions were equally divided between psychological and physical. Over half of the sample believed that symptoms were due to ‘physical changes in the brain’. A strong illness identity, psychological illness attributions and high levels of depression were associated with greater depersonalization disorder severity. High levels of anxiety were also prevalent but the relationship between anxiety and depersonalization was unclear. The findings offer some support for a cognitive model of understanding depersonalization disorder, namely that attribution processes are linked to perceived symptom severity and a wide range of experiences come to be seen as part of the disorder. Copyright © 2007 John Wiley & Sons, Ltd.     

Patient perceptions of participation in group-based rehabilitation in an inpatient brain injury rehabilitation setting

Objectives

The use of groups is common in healthcare. There is a paucity of research which captures patient experiences of group participation. The aims of this study were to explore the perceptions and experiences of people with traumatic brain injury (TBI) about their participation in inpatient occupational therapy rehabilitation groups.

The impact of illness‐related shame on psychological health and social relationships: Testing a mediational model in students with chronic illness

This study explores the impact of illness‐related shame on the quality of social relationships and psychological health in chronic patients. We aimed to examine the roles of fear of receiving compassion from others and experiential avoidance as potential mediators of this relationship. Although some studies have demonstrated the negative impact of chronic illness‐related shame on psychological functioning, the mechanisms that may underlie this link remain understudied. The sample was comprised by 115 college students, which had been diagnosed with at least 1 chronic illness. Participants completed self‐report measures on an online platform. This study's design was cross‐sectional. A path analysis was conducted using structural equation modelling. Results showed that the impact of illness‐related shame on both psychological health (R² = .45) and the quality of social relationships (R² = .33) was fully accounted by fear of compassion from others and experiential avoidance. This model revealed an excellent fit. Fear of receiving compassion from others was the main mediator of the illness‐related shame link with the quality of social relationships (β = ?.22). The main mediator of the association between shame‐related chronic illness and psychological health was experiential avoidance (β = ?.21).This study shed light on possible psychological mechanisms linking feelings of shame associated with having a chronic condition and impaired social relationships and mental health. On one hand, resisting feelings of compassion and care from others and, on the other hand, avoiding difficult internal experiences and situations that might trigger them seem to underlie the impact of shame on psychological and social functioning in chronic patients.     

Feasibility and effectiveness of a pulmonary rehabilitation programme in a community hospital setting.

BACKGROUND: Pulmonary rehabilitation programmes run in secondary care have proved to be one of the most effective interventions for patients with chronic obstructive pulmonary disease (COPD). AIM: To assess whether a pulmonary rehabilitation programme, similar to that run in secondary care, could be established in a primary care-run community hospital and whether it could achieve similar benefits in patents with moderately severe COPD. DESIGN OF STUDY: Uncontrolled prospective intervention study SETTING: A primary care-run community hospital. METHOD: Thirty-four patients with COPD aged between 5 and 80 years of age (mean = 70years) with a forced expiratory volume (FEV1) of 30 to 50% (mean = 40%) predicted were enrolled in a programme established in the activities room at Honiton Community Hospital. Patients were assessed at the start, on completion of the programme, and six months after completion, using spirometry, shuttle-walking distance, and short form-36 (SF-36) and chronic respiratory questionnaire (CRQ) scores. RESULTS: All but one patient completed the programme. There were significant improvements in the walking distance (by a mean of 100 m), in the SF-36, and in all domains of the CRQ. There was no significant change in the FEV1 or forced vital capacity. CONCLUSION: Pulmonary rehabilitation programmes can be run in community hospitals. They appear to be as effective as those run in secondary care and patients may find them easier to access.     

A conceptual care model for individualized care approach in cardiac rehabilitation – combining both illness representation and self‐efficacy

Purpose This paper analyses the two prominent psychological theories of patient response – illness representation and self‐efficacy – and explore the possibilities of the development of a conceptual individualized care model that would make use of both theories. Methods Analysis of the literature established common themes that were used as the basis to form a conceptual framework intended to assist in the joint application of these theories to therapeutic settings. Results Both theories emphasize personal experience, pre‐construction of self, individual response to illness and treatment, and that the patients' beliefs are more influential in their recovery than the severity of the illness. Where the theories are most divergent is their application to therapeutic interventions, which reflects the different sources of influence that each theory emphasizes. Based on their similarities and differences it is possible to integrate the two theories into a conceptual care model. Conclusion The Interactive Care Model combines both theories of patient response and provides an explicit framework for further research into the design of effective therapeutic interventions in rehabilitation care.     

Beyond a sense of safety: a psychologist's tale of serious chronic illness

Based on a narrative account, this paper highlights and reviews the experiences of the author, a psychologist, experiencing a chronic illness. Areas covered include coping with doctors and medical personnel, adjusting to illness, complying, actively coping, and even, at times, resisting unwarranted medical procedures. Experiences such as loss of trust, a sense of isolation, re-working relationships, and generative reaching-out are also covered. Some positive consequences of chronic illness for personal growth are suggested. Suggestions for conducting psychotherapy with clients who are dealing with serious chronic illness are made.     

The self‐regulatory model in women with rheumatoid arthritis: Relationships between illness representations,coping strategies,and illness outcome

Objectives. The self‐regulatory model proposes that an individual's cognitive representations of illness threat (illness representations) influence the selection and performance of strategies to cope with that illness ( Leventhal, Meyer, & Nerenz, 1980 ). Also implicit in the model is the proposal that such coping strategies influence illness outcomes. These relationships represent a mediational model ( Baron & Kenny, 1986 ). The aim of the present study is to test the hypothesis that coping strategies partially mediate the relationship between illness representations and illness outcome in women with rheumatoid arthritis. Design and methods. The study is an observational cross‐sectional design. Self‐report measures of illness representations, coping strategies, and illness outcome were collected from 125 women with rheumatoid arthritis attending rheumatology out‐patient clinics. Clinical measures of disease activity and severity were obtained from hospital records. Results. Avoidant and resigned coping were found to partially mediate the relationship between symptom identity and the illness outcome measures of disability and psychiatric morbidity. As in other studies, strong relationships were found between illness representations and illness outcome. Conclusions. The finding that avoidant and resigned coping partially mediated the relationships between the illness representation dimension of symptom identity and two of the illness outcome measures (disability and psychiatric morbidity) provided some support for the hypothesis. However, the hypothesis was not fully supported, as coping did not partially mediate the relationship between any of the other illness representations and illness outcomes.     

Understanding the phases of recovery from serious mental illness: the roles of referent and expert power in a mutual‐help setting

This study explored an approach to studying recovery that is sensitive to the multiphase and contextual nature of the recovery process. The authors focused on the experience of recovery in a mutual‐help group, Schizophrenics Anonymous (SA). Prior qualitative research conducted with SA revealed that SA participants experience four phases of recovery: (a) mourning and grief, (b) awareness and recognition, (c) redefinition and transformation, and (d) enhanced well‐being and quality of life. Surveying a national sample of SA participants, they explored whether these four phases were predicted by different change mechanisms (i.e., referent and expert power) within SA and whether these mechanisms varied according to participants' role in the organization. Referent and expert power were found to differentially relate to the phases of recovery for members and leaders. They conclude that our understanding of the processes and contexts that facilitate recovery can be enhanced by using recovery models that are setting‐specific and reflect the multifaceted nature of the recovery process. © 2009 Wiley Periodicals, Inc.     

Multidimensional health locus of control in a rehabilitation setting

In an attempt to replicate a recent report of the factorial structure of the Multidimensional Health Locus of Control Scale, a sample of rehabilitation patients (N = 107) were studied. Analyses in the present study failed to validate the previously reported three-dimensional structure, which indicates a need for careful interpretation of this scale when used with certain populations. An alternative factor structure and possible future directions are proposed.     

Adolescent mental health consumers' self‐stigma: associations with parents' and adolescents' illness perceptions and parental stigma

Currently, little is known about adolescents' self‐stigma experiences as mental health (MH) treatment recipients. Hence, this study addresses the following two questions: (a) what are adolescents' and parents' perceptions of stigma and perceptions of the cause, controllability, and anticipated outcome (illness perceptions) of adolescents' MH problems? (b) to what extent do illness perceptions (adolescents and parents) and parents' own stigma experiences relate to adolescents' self‐stigmatization? The results, based on data from separate interviews with a voluntary sample of 60 adolescent–parent dyads, clients of MH wraparound services, suggest that approximately 20% of adolescents and parents reported significant concerns related to self‐stigmatization. Using multivariate analyses, we found that the three most prominent factors associated with adolescents' self‐stigma ratings included adolescents' perceptions of social skill deficits and trauma as causal factors pertaining to their mental health challenges, as well as parents' inclination to conceal their child's MH problems from others. © 2010 Wiley Periodicals, Inc.     

Testing a conservation of resources model of the dynamics of emotional labor

This study uses S. E. Hobfoll's (1989) conservation of resources theory as a means of examining why emotional labor may or may not result in burnout. A model is developed that proposes that workers attempt to cope with role demands by performing surface or deep acting and that the effect of this expenditure of resources on worker burnout depends on the more immediate rewards of the service encounter and the application of internal and external resources specific to the needs at hand. This model is tested and confirmed using cross-sectional survey responses from 236 working adults. Research and practical implications are discussed.     

The PPVT-R: Validity as a quick screen of intelligence in a postacute rehabilitation setting for brain-injured adults

The utility of the Peabody Picture Vocabulary Test-Revised (PPVT-R) as a surrogate for the Wechsler Adult Intelligence Test-Revised (WAIS-R) was investigated in 61 brain-injured adult participants in a postacute rehabilitation setting. Idiographic comparison revealed substantial disagreement in clinical classification between the two instruments, and it is concluded that the PPVT-R is not a good surrogate for the WAIS-R for this purpose. In contrast, the PPVT-R was judged an adequate surrogate for the WAIS-R for the purpose of group comparison, as is common in biomedical research. Finally, contrary to prior report, the PPVT-R was demonstrated to measure more than simply Vocabulary. As such, in the absence of independent validation research, perhaps the most parsimonious conclusion regarding what the PPVT-R is measuring is that like each of the various subtests of the WAIS-R, the PPVT-R shares some of the variance of the construct termed intelligence, as well as demonstrates some unique variance that is likely comprised of error and, perhaps, a unique or different facet of intelligence. © 1998 John Wiley & Sons, Inc. J Clin Psychol 54: 877–884, 1998.     

The attributional model of depression: a path analysis test in a naturalistic setting

A path analysis test of the attributional model of depression was conducted in a naturalistic achievement setting (N = 77). Relatively depressed and nondepressed students reported their attributions on an academic test, and then their subsequent test performance were measured. In support of the attributional model of depression, the results indicated that for successful outcomes the attribution dimension of stability (i.e., stable vs. unstable across different situational contexts) served to buffer the influence of depression on later test performances. The results thus show that stability attributions for a successful behavior, defined in terms of consistency across different situational contexts, play a mediating role in the behavioral consequences of depression.     

Making sense of illness or disability: the nature of sense making in multiple sclerosis (MS)

This study investigated sense making in multiple sclerosis (MS) and relations with illness, religious-spiritual beliefs and adjustment (life satisfaction, positive states of mind, depression, anxiety). Four hundred and eight persons with MS completed a questionnaire. Half the sample generated sense making explanations for their illness. Content analyses revealed 16 sense making themes. Participants who reported having a religious-spiritual belief were more likely to report sense making than those who did not have such a belief. Sense making was related to lower disability and disease severity and evidenced beneficial direct effects on positive adjustment outcomes and depression after controlling for illness and religious-spiritual belief.     

The two‐process model of sleep regulation: a reappraisal

In the last three decades the two‐process model of sleep regulation has served as a major conceptual framework in sleep research. It has been applied widely in studies on fatigue and performance and to dissect individual differences in sleep regulation. The model posits that a homeostatic process (Process S) interacts with a process controlled by the circadian pacemaker (Process C), with time‐courses derived from physiological and behavioural variables. The model simulates successfully the timing and intensity of sleep in diverse experimental protocols. Electrophysiological recordings from the suprachiasmatic nuclei (SCN) suggest that S and C interact continuously. Oscillators outside the SCN that are linked to energy metabolism are evident in SCN‐lesioned arrhythmic animals subjected to restricted feeding or methamphetamine administration, as well as in human subjects during internal desynchronization. In intact animals these peripheral oscillators may dissociate from the central pacemaker rhythm. A sleep/fast and wake/feed phase segregate antagonistic anabolic and catabolic metabolic processes in peripheral tissues. A deficiency of Process S was proposed to account for both depressive sleep disturbances and the antidepressant effect of sleep deprivation. The model supported the development of novel non‐pharmacological treatment paradigms in psychiatry, based on manipulating circadian phase, sleep and light exposure. In conclusion, the model remains conceptually useful for promoting the integration of sleep and circadian rhythm research. Sleep appears to have not only a short‐term, use‐dependent function; it also serves to enforce rest and fasting, thereby supporting the optimization of metabolic processes at the appropriate phase of the 24‐h cycle.     

Classroom relationships,sense of community,perceptions of justice,and collective efficacy for students’ social well‐being

A review of literature suggests a lack of studies analyzing the correlates of school context to social well‐being (SWB). By integrating the perspective of community psychology and social cognition, this study uses structural equation model to examine the effect of classroom climate, classroom sense of community, collective efficacy, and justice beliefs on students SWB. The study involves 390 high school students (58.6% females) between the ages of 13 and 20 years. The results show that classroom relationships as indicator of classroom climate and sense of community are associated with collective efficacy. Furthermore, collective efficacy, sense of community, and relational and procedural justice correlate with SWB. We discuss the implications of this finding for the positive development of adolescents and school‐based intervention programs.     

Adolescents' sense of community on myspace and facebook: a mixed‐methods approach

Communities are foundational to the field of Community Psychology yet they are difficult to define and measure. Once viewed as social groups with ties to geographical locations, online communities interact free of physical or face‐to‐face contact. This cyberexistence makes the study of communities more challenging. Social networking sites (SNS), such as Facebook and MySpace, are referred to as online communities; however, research has yet to explore whether these sites engender a psychological sense of community (PSC) for users. This study reanalyzes focus group and survey data from high school and college students to investigate whether uses of SNS demonstrate key components of PSC (i.e., membership, influence, immersion, shared emotional connection, and an integration and fulfillment of needs). This mixed‐method analysis synthesizes data through a top‐down (confirming PSC categories) and bottom‐up (identifying emergent patterns/themes) analytic procedure. Results suggest that typical adolescent uses of SNS represent networked individualism, rather than online communities. © 2010 Wiley Periodicals, Inc.