Appraisal of health threats: Cognition,motivation, and social comparison

Recent experimental research has examined the determinants of illness-related cognitive appraisals. This work is reviewed and discussed within the context of Lazarus and Folkman's (1984) stress and coping model. The data from this research support and extend the model, but are best accounted for by Leventhal, Nerenz, and Steele's (1984) self-regulation theory of illness behavior. Neither model adequately addresses the role of social comparison and influence, which, together with a motivationally biased system of cognitive appraisal, provides individuals with a highly adaptive repertoire of strategies for maintaining emotional equilibrium and a positive view of their own health status.The author would like to acknowledge the support of grants MH 43097 from the National Institute of Mental Health and HS 06660 from the Agency for Health Care Policy and Research.     

Threat appraisal, coping, and emotions across pregnancy subsequent to perinatal loss

BACKGROUND: Pregnancies after perinatal loss are known to be anxiety-filled. Stress in pregnancy and the response to it, often seen as anxiety and depression, have known negative consequences for obstetric outcomes, parenting, and infant behaviors. Women have reported fluctuating emotions in response to events in their subsequent pregnancies, but these pregnancies have not been studied longitudinally. OBJECTIVES: To test Lazarus' theory of stress, coping, and emotions in this population, and to understand the patterns of threat appraisal, coping, and emotional states of women across pregnancy after perinatal loss. METHODS: In this predictive correlational study, 82 women pregnant after loss (PAL) were followed, and the study was guided longitudinally by Lazarus' theory of stress, coping, and emotions. Obstetric and loss history, and assigned fetal personhood were gathered at intake (Time 1). Measures completed at 10-week intervals (one time each trimester) included Moneyham Threat Index (threat appraisal), Ways of Coping Checklist-Revised (relative coping), Pregnancy Anxiety Scale (pregnancy anxiety), Multiple Affect Adjective Checklist-Revised (emotional states), and Stress in Life (stress). Time 3 sample size was 70. RESULTS: Threat appraisal was correlated with assigned fetal personhood and gestational age of past loss. Pregnancy subsequent to loss was perceived as a threat, and threat appraisal strongly predicted pregnancy anxiety. Pregnancy anxiety, reported at moderate levels on average, decreased over time; threat appraisal, coping, and other emotions were stable across pregnancy. Coping did not mediate these effects, but relative coping was correlated with emotional status as theorized, with problem-focused coping used more than emotion-focused coping. DISCUSSION: Women find pregnancy after loss stressful and a threat, and this appraisal remains across pregnancy. Because pregnancy anxiety is common, and highest in early pregnancy, providers should address worries and fears with all women early in PAL. Interventions must be tested in future studies.     

Emotions and Cognitions in Coronary Heart Disease: Risk, Resilience, and Social Context

Until recently, scientists have lacked the technology and data needed to support or refute the centuries-old belief that emotions influence coronary health. The past two decades have witnessed dramatic advances in knowledge concerning the pathophysiology underlying coronary heart disease (CHD) and the contribution of emotions and cognitions to disease processes. This progress, in combination with findings from a growing body of large, methodologically sound epidemiological studies, provides substantial evidence that negative emotions and cognitions, including hostility and related constructs, and sub-facets of negative affectivity (e.g., depression, anxiety) contribute to the initiation and progression of CHD. In contrast, research focused on the potential resilient contribution of positive emotions and cognitions has been notably absent from the literature. Furthermore, studies concerning emotions and health have often neglected important contextual factors and concomitant social processes. In the current review, we examine the evidence regarding the roles of emotions and cognitions in CHD risks and outcomes, and suggest that further attention to positive emotional constructs is warranted. We also suggest that the literature would benefit from a more integrative conceptualization of cognitive/emotional and social factors, to better understand how each variable contributes to coronary disease. We further encourage a focus on broad contextual factors, including socioeconomic status (SES) and ethnicity, which may elucidate the circumstances under which health effects of cognitions and emotions are most likely to emerge. We conclude by noting the implications of the current knowledge base for coronary interventions and the practice of cardiac psychology.     

Cognitive Specificity in Fear and Sad Affect: An Investigation of Emotional Reactivity and Recovery from Experimental Mood Induction

Beck’s (Cognitive therapy of the emotional disorders. New American Library, New York, 1976) cognitive content specificity hypothesis states that anxiety and depression can be differentiated by their thought content. Although Beck extended the hypothesis to normal emotion states, the generalizability of content specificity has not been demonstrated. In the current study 183 students were randomly assigned to view a fearful or sad movie clip, followed by an expressive writing task to induce mood recovery. Positive and negative cognitions and emotional reactivity were assessed before and after the movie clip, as well as after recovery. Only threat/danger cognitions demonstrated specificity after fear induction. Negative and coping loss/failure thoughts exhibited the same pattern of change with induction and recovery across both emotion conditions, thus showing non-specificity. The findings supported the cognitive specificity hypothesis for fear but not normal sad affect. Discussion of the generalizability of the cognitive content specificity hypothesis and its implication for cognitive theories of emotion are considered.     

Goals and Depressive Symptoms: Cross-lagged Effects of Cognitive versus Emotional Goal Appraisals

Relationships between work goal appraisals and depressive symptoms were investigated in a 2-wave study of health care employees spanning a 2-year period. Cross-lagged models were tested and compared in structural equation modeling analyses. The results suggest that the direction of longitudinal relationships between work goal appraisals and depressive symptoms may depend on the nature of the appraisals. In the best-fitting model, goal self-efficacy cognitions predicted depressive symptoms 2 years later. This finding supports cognitive/self-regulatory theories positing that dysfunctional cognitions form a vulnerability factor in the etiology of depressive symptoms. On the other hand, we found no evidence that depressive symptoms predicted goal cognitions. Instead, depressive symptoms were associated with goal-related emotions two years later, suggesting that depressive symptoms may lead over time to greater negative emotional arousal. Implications for depression theory and goal research are discussed.     

A Longitudinal Investigation of Maternal and Child ‘Anxious Cognitions’

Overestimation of threat and underestimation of coping have been frequently reported amongst anxious adults and children. The current study examines the longitudinal relationship between mothers’ anxious cognitions and expectations about their child, and children's anxious cognitions. 54 children (aged 10–11 years) and their mothers reported on their interpretation of ambiguous scenarios at two time points. Mothers also reported on their expectations about their child's reaction to ambiguous situations. Significant cross-sectional associations were found between mother and child anticipation of distress. Associations were most consistent between mothers’ expectations and children's cognitions. Furthermore, based on regression analyses, mothers’ expectations predicted change in children's anxious cognitions over time. Evidence for a reciprocal relationship, that child cognitions predict change in mothers’ expectations, was found for girls. The results provide empirical support for potential influences on the development of children's ‘anxious cognitive style,’ and suggest targets for preventing and reducing maladaptive cognitions in children.     

Poor psychological health status among patients with inflammatory rheumatic diseases and osteoarthritis in multidisciplinary rehabilitation: Need for a routine psychological assessment

Purpose.?To examine psychological health status among patients with inflammatory rheumatic diseases (i.e. rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis) and osteoarthritis in multidisciplinary rehabilitation, and to describe changes in psychological distress, illness cognitions, and pain coping from pre- to post-treatment.

Method.?Eighty-nine patients referred to multidisciplinary rehabilitation completed a set of questionnaires to assess pain (AIMS2-SF), physical functioning (AIMS2-SF), psychological distress (IRGL), illness cognitions (ICQ) and pain coping (PCI) at pre- and post-treatment. Changes in physical functioning, pain, and psychological health status were determined. On the basis of the cut-off scores of psychological distress, distressed, and non-distressed patients were compared on physical and psychological outcomes.

Results.?Psychological distress was found in 64% of the study sample. In addition, high levels of helplessness and worrying, low levels of acceptance, and moderate levels of physical functioning were found. After treatment, positive changes in pain, psychological distress, and illness cognitions were observed. However, 69% (29/42) of the distressed patients at baseline still experienced elevated levels of psychological distress and maladaptive cognitions.

Conclusions.?Psychological distress and maladaptive illness cognitions are important characteristics of this study sample, and psychological distress remains high after rehabilitation. More attention should be given to the appropriate assessment and treatment of psychological distress within multidisciplinary rehabilitation.     

Relationships among selected antecedent variables and coping effectiveness in postmyocardial infarction patients

Selected theoretical relationships from Lazarus' (1966) model of stress were tested in a convenience sample of 81 postmyocardial infarction clients. Two hypothesized causal models were analyzed. Results from regression analyses indicated 63% of the variance in coping effectiveness was explained by marital status, length of time since hospitalization, perceived availability of social support, uncertainty, degree of threat, coping strategies, and emotions. A revised model that fit the data was proposed. Findings indicated that emotions were an outcome of threat, not coping; threat did not directly affect coping strategies; and coping strategies did not directly influence coping effectiveness. © 1993 John Wiley & Sons, Inc.     

Coping with pediatric cancer: strategies employed by children and their parents to manage cancer-related stressors during treatment

Pediatric cancer patients and their families face significant physical, emotional, and psychosocial challenges. Few studies have investigated how children manage these challenges and how parents may help in the process. This qualitative study aimed to explore common cancer-related stressors for children and to examine child coping and parental assistance in coping with these stressors during treatment. Fifteen children undergoing cancer treatment and their parents participated in semistructured interviews. Four themes emerged capturing cancer-related stressors: cancer treatment/side effects, distressing emotions, disruption in daily routines, and social challenges. Six themes emerged regarding child coping strategies that were classified within an approach/avoidance coping framework. Approach coping strategies included the following: cognitive restructuring, relaxation, practical strategies, seeking social support, and emotional expression. Distraction was the only avoidant coping strategy. Parents tended to encourage approach coping strategies (eg, cognitive restructuring, social support). Within families, few coping strategies were reported (child: M = 1.47, SD = 0.99; parent: M = 3.33, SD = 1.18), suggesting that early family-based interventions teaching coping techniques for cancer-related stressors may be beneficial.     

ABC情绪管理在预期性呕吐患者中应用

目的探讨发生预期性恶心、呕吐的患者在化疗期间的应对方式,通过ABC情绪管理,改善患者情绪状态及应对方式,为今后的心理护理给予指导。方法以30名发生预期性恶心、呕吐患者为研究对象,运用焦虑、抑郁自评量表及简易应对问卷测量患者的情绪及应对方式,运用ABC情绪管理对预期性恶心、呕吐的患者进行干预,形式为集体培训与沙龙交流,内容包括化疗与情绪的关系、ABC情绪机制、有关疾病及化疗相关知识、应对不良情绪的技巧及不良情绪自我分析。结果预期性恶心、呕吐的患者在情绪管理后焦虑、抑郁得分显著下降,恶心呕吐程度显著下降,应对方式在干预后,积极应对方式评分明显提高,差异有显著意义(P<0.05)。结论 ABC情绪管理有助于改良预期性呕吐患者的应对方式,改善患者的不良情绪,提高生活质量。     

Emotional Nonacceptance,Distraction Coping and PTSD Symptoms in a Trauma-Exposed Adolescent Inpatient Sample

Emotional nonacceptance is associated with greater posttraumatic stress disorder (PTSD) symptoms among trauma-exposed youth. Similarly, the use of distraction as a coping strategy is associated with greater PTSD symptoms, yet synergistic relations between emotional nonacceptance and distraction coping among trauma-exposed youth have not been examined. The present study examined associations and interactive effects of emotional nonacceptance and distraction coping in relation to PTSD symptoms among trauma-exposed inpatient adolescents. Participants included 50 adolescents (52.0% female; Mage = 15.1 years, SD = .51; 44% White) receiving acute psychiatric care at an inpatient hospital. All participants reported experiencing at least one traumatic event and completed measures of emotion dysregulation, coping strategies, and PTSD symptoms. Analyses revealed a significant interaction between emotional nonacceptance and distraction coping in relation to PTSD symptoms (∆R2 = 0.05; B = 0.60, SE = 0.29; t = 2.06, p = 0.045; 95% CI [0.12, 1.18]). PTSD symptoms were most severe among youth who reported higher levels of emotional nonacceptance and greater use of distraction as a coping strategy. Difficulties accepting negative emotions, coupled with greater use of distraction as a coping mechanism, were associated with more severe PTSD symptoms. The importance of teaching adaptive coping mechanisms to trauma-exposed youth who experience difficulties accepting negative emotions is discussed.     

Effect of adults' self-regulation of diabetes on quality-of-life outcomes

OBJECTIVE: To examine the relationships among cognitive representations of diabetes, diabetes-specific health behaviors, and quality of life using Leventhal and Diefenbach's self-regulation model of illness (Leventhal H, Diefenbach M: The active side of illness cognition. In Mental Representation in Health and Illness. SkeltonJA, Croyle RT, Eds. New York, Springer-Verlag, 1991, p. 247-272). RESEARCH DESIGN AND METHODS: This research involved secondary analysis of a mailed survey completed by 296 adults (ages 20-90 years). Structural equation modeling was conducted to investigate relationships among cognitive representations, diabetes-specific health behaviors, and quality of life. Model differences by diabetes type were also investigated. RESULTS: Findings indicated that certain cognitive representation constructs were related to increased diabetes-specific health behaviors, decreased sense of burden, and positive quality-of-life outcomes. Individuals levels of understanding of diabetes and their perceptions of control over diabetes were the most significant predictors of outcomes. However, diabetes-specific health behaviors were related to an increased sense of burden that was negatively associated with quality of life. Multigroup analyses indicated that this self-regulatory model provided a good fit for individuals with type 1 diabetes, those with type 2 diabetes who take insulin, and those with type 2 diabetes who do not take insulin. CONCLUSIONS: These findings advance what is known about cognitive representations of illness and the self-regulation of diabetes as well as the relationships between cognitive representations of illness, quality of life, and behavioral factors. In particular, results from this study suggest the need for further study to address ways of reducing the burden of diabetes associated with health behaviors and decreased quality of life.     

Pour un nouveau paradigme de l’obésité

What we now know about obesity means we can put forward a new obesity paradigm and relevant management strategies. Regulated sizes such as fat mass or certain micronutrients are the motivational factors behind dietary behaviour patterns and lead the eater to seek out foods that will ensure homeostasis. Dietary behaviour is also predetermined. Decisions made by the eater, whether consciously or unconsciously, determine his or her relationship with food, creating feelings that affect satiation. Such concepts enable us to define normal dietary behaviour, which is mainly controlled by dietary emotions and feelings. On the other hand, dietary behaviour, controlled principally by cognitions or emotions, defines respectively either a rational eater, whose behaviour is characterised by either cognitive restrictions or orthorexia, or an emotional eater, whose behaviour is characterised by dietary impulsivity and emotional intolerance. Management of overweight or obese patients consists of restoring normal dietary behaviour, without prior judgement as to the targeted weight loss. The treatment has three branches: management of cognitive restrictions, self-acceptance and dealing with emotions.     

Perceived stressors and coping strategies among individuals with rheumatoid arthritis

The purpose of this study was to identify the stressors perceived by individuals with rheumatoid arthritis (RA) and to describe coping strategies used to cope with illness-related stressors and their perceived effectiveness. Data were collected from 53 patients attending a rheumatology clinic. Results revealed that pain was the predominantly perceived stressor followed by limitation in mobility, difficulties in carrying out activities of daily living, helplessness, dependency on others, threat to self-esteem, interference in social activity, interference in family relationships, difficulties performing at work, and discomfort of the treatment. Subjects used optimistic and confrontive coping strategies more frequently than other coping strategies and optimistic coping strategies were perceived to be most effective. Point biserial correlation revealed a number of significant relationships between specific stressors and use of coping strategies: interference in family relationships and use of evasive coping strategies ( r =0.27, P <0.05), and threat to self-esteem and use of both evasive ( r =0.45, P <0.01) and emotive ( r =0.28, P <0.01) coping strategies. Similarly, a number of significant relationships were found between specific stressors and the effectiveness of the coping strategies: interference in family relationships and the effectiveness of both evasive ( r =0.31, P <0.05) and emotive ( r =0.38, P <0.01) coping strategies, and threat to self-esteem and the effectiveness of emotive coping ( r =0.29, P <0.05).     

Social Anxiety's Impact on Affect,Curiosity, and Social Self-Efficacy During a High Self-Focus Social Threat Situation

Upon being exposed to a high self-focus, potentially socially threatening situation, excessively socially anxious (SA) individuals were posited to experience amplified negative emotional states, as well as diminished positive emotional, cognitive, and intimacy-related outcomes. Ninety-one college students engaged in a reciprocal self-disclosure task with a trained confederate. Participants and confederates took turns answering (while a camera was directed at them) and asking questions that gradually increased in personal content. The results indicated that high SA individuals experienced more intense negative affect, less intense positive affect, and poorer social self-efficacy compared to low SA individuals in both conditions. However, differences between high and low SA individuals were larger in the social threat/self-focus condition, and self-focused attention partially accounted for these effects. In terms of specificity, nearly all findings remained after statistically controlling for depressive symptoms. In contrast, social anxiety effects were generally absent on measures of observed behavior and intimacy outcomes. These findings implicate the role of social threat and self-focused attention in contributing to affective and cognitive disturbances among SA individuals.     

Cognitive and Behavioral Mediators of Combined Pharmacotherapy and Psychotherapy of Chronic Depression

This study examined coping styles and attributions for negative events among chronically depressed outpatients to determine whether these variables mediated differences in depression treatment outcome between combined nefazodone and cognitive behavioral analysis system of psychotherapy (CBASP), versus nefazodone and CBASP alone. Chronically depressed outpatients (N = 517) who completed the initial 12-week treatment phase were included in the analyses. Attributional style and coping met criteria for partial mediation of the combination treatment effect over nefazodone, accounting for 60% of the difference in treatment outcome. Escape-avoidant coping met criteria for partial mediation of the combination treatment effect over CBASP, accounting for 37% of the treatment differential. Among all of the cognitive and coping variables evaluated, escape-avoidance coping emerged as the dominant mediating variable. These findings suggest that nefazodone and CBASP each produced changes in maladaptive cognitions and coping, and that the superiority of combined treatment was partially accounted for by the additive effects of both forms of treatment on these variables.     

Relationships of Positive and Negative Affect to Coping and Functional Outcomes in Systemic Sclerosis

This study examined the role of two distinct factors of emotion, positive (PA) and negative affect (NA), in adjustment to a chronic rheumatic disease, systemic sclerosis (SSc). Ninety-two patients with a confirmed diagnosis of SSc completed self-report measures assessing PA and NA (Positive and Negative Affect Schedule), coping (Revised Ways of Coping Checklist), and functional outcomes (pain and disability measured with the Health Assessment Questionnaire). Confirmatory factor analysis indicated that PA and NA constituted separate, negatively correlated factors. PA and NA showed differential relationships to coping and functional outcomes. Affect mediated the association between coping and functional outcomes after controlling for disease severity. The results suggest the importance of both PA and NA as factors influencing adjustment to chronic illness.     

The hierarchical arrangement of internalizing cognitions

This investigation examined whether a hierarchical arrangement existed in internalizing cognitions in a sample of 162 outpatient adults. Results demonstrated that Watson and Clark's (1992) hierarchical model of emotional states could be extended to cognitions and clinical patients. Significant convergent and discriminant correlations among anxiety and depressive cognition measures demonstrated that specific and nonspecific relationships existed within the primarily cognition data. Hierarchical multiple-regression analyses and principal-factors analysis demonstrated that a general (nonspecific) cognitive component had more explanatory power than specific cognitive components within the data. Results support a cognition model in which a broad-band valence factor (e.g., negative affectivity) comprises specific discrete content factors (e.g., depressive cognitions, anxious cognitions). Results are discussed in light of Beck's (1976) cognitive content-specificity hypothesis.