Rob Lowe

A longitudinal analysis of psychological impact and coping strategies following spinal cord injury

Objectives. This study longitudinally examines the relationships between psychological impact and coping in a cohort of 87 traumatic spinal cord injured individuals. Trieschmann (1988) emphasized the need to adopt a more longitudinal method of enquiry, elaborating not only on aspects of psychological impact following spinal cord injury (SCI), but exploring the relationship between psychological well-being coping strategies and adjustment. Within the framework proposed by Folkman and Lazarus (1988), coping is conceptualized as a mediator of emotional reactions, and Leventhal, Nerenz, and Steele (1984) suggest an interaction between coping and emotional outcomes. Design. A prospective longitudinal multiple wave panel design was utilized. Methods. Repeated, standardized measures were collected across nine observational periods from onset of injury to community placement. Forward stepwise variable selection multiple regression analyses were employed to examine concurrent predictive factors and prediction over time. Results. At 6 weeks post-injury, 64% of the variance in depression was predicted by the use or non-use of three coping strategies. The coping measures collected at 6 weeks post-injury predicted 67% of the variance in depression at 1 year post-discharge. This study not only elaborates on the pattern of adjustment post-traumatic SCI, but specifies the relationship between coping and adjustment. Moderating variables did not account for significant variance. Conclusions. This study demonstrates a predictive relationship between coping and adjustment and highlights a number of dispositional factors that require further examination.

Stress in nurses: coping, managerial support and work demand

One hundred and six ward-based nurses of 340 approached completed questionnaires measuring sources of stress within their work, the managerial support available to them, the strategies they used to cope with work stress and levels of anxiety, depression, and work satisfaction. Univariate analysis identified consistent relationships between work stress and each of these outcomes. Lack of managerial support was also associated both with negative mood states and, particularly, with low levels of work satisfaction. Multivariate analyses showed the key predictors of negative affect to be lack of management support, job overspill, having to make decisions under time pressure and lack of recognition by the organisation. These data fit well into existing models of work stress, and their implications for organisational change are discussed. Copyright

Associations between visual attention, implicit and explicit attitude and behaviour for physical activity.

The current study explored associations between previous physical activity and both implicit and explicit attitudes, as well as visual attention and activity motivation (intention). Analyses were performed on participants initially unaware of the physical activity focus of the study (N = 98). Higher levels of physical activity were associated with positive implicit attitudes and an attentional bias towards exercise cues. There was a quadratic (‘U’ shaped) relationship between implicit attitude and attention: the more extreme individuals’ implicit attitudes towards exercise (positive or negative) the greater their attentional bias to exercise cues. Furthermore, explicit attitude moderated the relationship between attentional bias and physical activity: attentional bias to exercise cues was associated with higher levels of physical activity only for those who had a strong positive explicit attitude. Findings suggested that implicit cognitions are linked with previous physical activity. Future research should consider strategies for strengthening positive implicit and explicit attitudes and directing attention to cues signalling healthy behaviour.

Exploring coping reactions to work-stress: Application of an appraisal theory

Previous research has focused on influences of coping on emotional and behavioural outcomes. Less is known about why people cope in the way they do. Drawing on an appraisal theory of emotion, it was expected that secondary appraisal components would be related to coping. Information on appraisal components, emotions, and coping in relation to a recent work stressor was provided by 107 female nurses. Appraisals were associated with coping in theoretically interpretable ways (e.g. active coping and behavioural disengagement with optimistic and pessimistic appraisals of problem-focused coping potential, respectively). The study highlighted emotion theory as useful for exploring possible coping antecedents in a conceptually integrated way.

Coping, emotion and perceived health following myocardial infarction : Concurrent and predictive associations

Objective. This paper examines concurrent and prospective relationships between coping, emotion outcomes and perceived health among first-time myocardial infarction (MI) patients over the first 6 months of adjustment. Method. A longitudinal design was employed. Participants completed questionnaires at three time points; while in-patients (N = 128), at 2 months follow-up (N = 100) and at 6 months follow-up (N = 74). The questionnaires included measures of coping (COPE), positive and negative affect (Global Mood Scale), anxiety (State Anxiety Inventory) and perceived health (Health Complaints Scale). Results. Both coping and outcomes tended to be stable across time. Significant concurrent relationships stressed the role of avoidant-, acceptance- and social/ emotion-focused coping. Prospectively, results emphasized the adaptive influence of problem-focused coping. Conclusions. Coping was both concurrently and predictively associated with outcomes post-MI. A clear distinction between concurrent and predictive associations emerged. Problems associated with relying on cross-sectional data to inform theory and practice are highlighted. The clinical implications of the results for rehabilitation programmes are also outlined.

Self-efficacy as an appraisal that moderates the coping-emotion relationship: Associations among people with rheumatoid arthritis

The way a coping strategy is expressed might depend on the nature of underlying efficacy expectations. For example, a cognitive coping strategy may have different content depending on efficacy beliefs underpinning the strategys formulation and application. As such, self-efficacy (SE), as an appraisal, may moderate relationships between coping and outcomes: coping effects may differ depending on SE. This process was examined in 127 rheumatoid arthritis patients attending routine patient education/self-management programmes. Participants completed questionnaire measures of SE, coping, anxiety and depression at baseline and at 8 weeks follow-up. Regression analyses focused on coping and SE change variables, and their concurrent association with measures of change in anxiety and depression. Results highlighted contributions to these emotional variables from interactions between coping and SE. The nature of associations between coping and emotional outcomes was found to differ according to efficacy appraisals. This may have implications for clinical practice in that the adaptive significance of adjustment efforts may differ according to underlying SE.

Affective and social‐cognitive predictors of behavioural change following first myocardial infarction

Objectives. To assess the utility of measures of affect and social-cognitive variables in predicting risk behaviours for coronary heart disease in post-myocardial infarction (MI) patients. Design. A longitudinal design was adopted with predictor variables measured while participants were in hospital and dependent variables (exercise, alcohol consumption, diet and smoking) measured 3 months following discharge. Method. A random sample of 43 patients with a first MI were identified on the wards and given a questionnaire measuring anxiety and depression, and measures of outcome and self-efficacy expectancies and intentions relevant to each risk behaviour. Thirtyseven participants completed further behavioural measures at 3-month follow-up (excluding those who died in the follow-up period), a 90% completion rate. Results. Social cognition measures were predictive of later behaviour, and in particular light exercise. Here, intentions accounted for 51% of the variance in behaviour explained after partialling out pre-MI levels of exercise. Affect was less predictive, explaining only 7% of the variance in light exercise. Conclusions. Beliefs and intentions about future risk behaviour are formulated in the immediate post-infarction period. Future rehabilitation programmes would benefit from some intervention, probably educational, at this early stage.

Sensitivity to change of the Rheumatoid Arthritis Self-Efficacy scale (RASE) and predictors of change in self-efficacy

OBJECTIVES Patient education in rheumatoid arthritis (RA) aims to improve health outcomes by prompting people to adopt self-management behaviours. One precursor for initiating behaviour change is self-efficacy (SE), a belief that you can do a task. This study tested the sensitivity to change of a new scale to measure SE for self-management in people with RA, the Rheumatoid Arthritis Self-Efficacy scale (RASE). Exploratory analysis examined potential predictors of change in SE. METHODS People with RA at 11 rheumatology centres, who had accepted an education programme as part of clinical care, completed questionnaires at baseline, and two and eight weeks after their programme end. Programmes were not standardized, as this was a pragmatic study in clinical practice. RESULTS A total of 128 patients participated. After controlling for baseline scores, the RASE showed small but significant improvements in SE from baseline (RASE 107.57, CI 105.42-109.72) to two weeks after programme end (RASE 110.80, CI 108.60-112.99), and eight weeks (RASE 110.62, CI 108.40-112.85, p<0.001). Standardized response means, calculated both by absolute and percentage change, were 0.339 and 0.371 at two weeks after programme end, and 0.321 and 0.352 at eight weeks. Changes in the RASE were associated with behaviour initiation at two and eight weeks (r=0.419, r=0.342, p<0.001). No substantial predictors of change in SE could be identified. CONCLUSIONS The RASE is sensitive to change in a cohort of people with RA in the UK receiving education programmes as routine clinical care. Exploratory analysis did not identify clinical or psychological factors that predict change in SE, suggesting that programmes should not be restricted to particular patients.

Living with an implantable cardioverter defibrillator: The patients' experience

OBJECTIVES To explore the lived experiences of implantable cardioverter defibrillator (ICD) recipients. BACKGROUND Previous research suggests ICD recipients experience significant psychological distress with a focus on shock anxiety. In response, avoidant behaviors are often used which can lead to reduced quality of life, cardiac fitness and increased risk of arrhythmia. METHODS A qualitative study using semi-structured interviews with a purposive sample of 18 recipients who had either received or not received an ICD shock was conducted. Data were analyzed using a thematic approach. RESULTS Three themes with sub-themes were defined: (i) physical consequences; (ii) emotional consequences (feeling vulnerable and uncertain; anxiety and depression); and (iii) coping with the ICD (avoidance/restrictive behaviors; acceptance; concealment). CONCLUSION ICD recipients might be helped by a psycho-social intervention that corrects false beliefs about exercise and offers some simple stress management techniques. Additional elements might include helping recipients to re-evaluate goals and find a valued sense of self which this study found aided ICD acceptance.

A connectionist implementation of the theory of planned behavior: association of beliefs with exercise intention.

The theory of planned behavior suggests attitudes are a product of salient beliefs. This study examined whether aggregating salient beliefs was plausible within a more biologically centered information-processing environment. A neural network was used to examine associations among beliefs relating to exercise intention. Data on intentions and behavioral, normative, and control beliefs from 114 respondents were used to train (by error backpropagation) a neural network to associate beliefs with intention. The R-sup-2 between the networks estimated and self-reported intention was.66. The networks representation comprised 6 belief profiles associated with high, moderate, or low behavioral intention. The neural network accommodated complex relationships among beliefs and belief-intention associations and indicated how high-level constructs such as attitudes may be viewed as the best fit (compromise state) between aroused beliefs.