Shirley A. Morrissey

Illness Representations of Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a chronic illness that usually follows a fluctuating course and, therefore, can be difficult to diagnose. Consequently, individuals with SLE often hold beliefs about the nature and course of the illness that are at odds with medical opinion. Clearly, a shared understanding of the illness would be beneficial to illness management. In this study, the authors used semistructured interviews and interpretative phenomenological analysis to explore the content of the illness representations held by 36 individuals diagnosed with SLE. They also identified the ways in which these illness representations were generated initially and attempted to determine whether changes occurred over time in these illness representations, as predicted by the self-regulatory model.

A field study of stress and fatigue in long-distance bus drivers

Psychophysiological changes during long-distance driving may be associated with driving fatigue and morbidity. Measures of stress and arousal, including heart rate, blood pressure, catecholamines, cortisol, state anxiety, and self-ratings of stress and arousal were collected from 10 long-distance bus drivers during 12-hour driving shifts and at matched times on nondriving rest days. Cardiovascular and catecholamine data were elevated across the entire work day, compared with rest days. Self-reported stress and state anxiety were elevated only at the preshift measure, and these elevations were interpreted as the result of anticipatory anxiety and additional work demands at the beginning of the shift. Decelerating activation from the 9th to the 12th hours of driving were reflected in slower heart rate and lower subjective arousal ratings. Suggested explanations for these findings are that drivers experience a release of tension when they anticipate the end of the shift and therefore deactivation is a signal or precursor to the onset of fatigue in physiological adjustment mechanisms.

Readiness to adopt a self-management approach to pain: evaluation of the pain stages of change model in a non-pain-clinic sample

&NA; The Transtheoretical model of stages of behaviour change has stimulated research interest in relation to chronic pain, yet studies using the Pain Stages of Change Questionnaire (PSOCQ; Pain (72) 1997 227) have reported inconsistent findings and have generally utilized pain‐clinic samples. The aims of the current study were to assess the general validity of the PSOCQ with a non‐pain‐clinic sample of patients with chronic pain, and to examine the utility of the stages of change model as applied to this population. The study employed multi‐stage, cluster‐sampling methodology, with 90 participants recruited from 19 medical and allied health clinics and practices. The findings demonstrated a number of limitations of the PSOCQ in terms of its ability to classify individuals into specific stages of change. The stages of change model requires adaptation in order to be useful for treatment planning in a non‐pain‐clinic sample of patients with chronic pain.

Positive predispositions, quality of life and chronic illness

This study assessed the extent to which being predisposed towards engaging in acts of gratitude and forgiveness is associated with enhanced quality of life (QoL), and whether these associations are mediated by positive and negative affective states. The study sample comprised 327 people with one of three chronic illnesses (arthritis, chronic obstructive pulmonary disease and diabetes). Participants completed self-report measures of two positive predispositions (the tendencies towards gratitude and forgiveness), two affective states (positive and negative) and three indices of QoL (physical, psychological and satisfaction with life). As hypothesised, gratitude, and to a lesser extent forgiveness, predicted enhanced QoL, with most effects mediated via increased positive affect. Findings support the view that predispositions towards interpersonal gratitude, and possibly interpersonal forgiveness, may bolster the QoL of people living with chronic physical illness. Consistent with contemporary theories of positive emotion, gratitude appears to have its effects via enhancing positive affect. The study adds to the emerging evidence that a predisposition towards gratitude benefits QoL and extends past findings by identifying a mechanism that is important in people with chronic illnesses.

The Threat of Climate Change: Psychological Response, Adaptation, and Impacts

This chapter examines the existing social and health science literature addressing the psychological impacts of the threat of climate change. The exercise reflects a convergent environmental, social, and health psychology perspective, informed by those interdisciplinary bodies of work relating to the social construction and representation of environmental threat; psychosocial environmental impact assessment and monitoring; public and mental health; risk communication and perception; and disaster preparedness and response. Attention is also paid to public understandings of the phenomenon and threat of global climate change, and popular culture discourse and reflections about the psychological and mental health responses to and impacts of ‘climate change’. The chapter indirectly addresses the unfolding physical environmental impacts of climate change and corresponding psychological, social, and societal consequences, but the principal focus is on public exposure and response to the phenomenon of climate change through multimedia representations of this phenomenon and limited direct experience. The larger context of this chapter and the present coverage is the post–Intergovernmental Panel on Climate Change [IPCC] focus on climate change adaptation and mitigation, and the continuing neglect of the psychological, social, and cultural in research and policy considerations and initiatives addressing human and environmental quality, sustainability, and health. The chapter concludes with a brief consideration of what psychology has contributed and can contribute in addressing psychological adaptation to the threat of climate change.

The psychology of injured workers: Health and cost of vocational rehabilitation

Background: In the vocational rehabilitation of injured workers the influence of the workers personality has been neglected. This is despite there being substantial evidence that in chronic pain certain personality factors are significantly related to poorer outcomes. This is a preliminary study that has examined the relationship between personality factors, personality psychopathology and rehabilitation outcomes in injured workers. Method: Data from structured clinical interviews, self report and rehabilitation outcome (cost) were gathered from 36 injured workers with recognized compensation claims for physical and/or psychological workplace injury. Results: Personality factors were associated with poorer outcome, particularly cost and health. Individuals with extreme personality traits experienced poorer health and vocational rehabilitation outcomes. The combination of high Neuroticism and low Extraversion which is a pattern often characterized as anxious and socially avoidant was found to be consistently related to poor health outcomes. Conclusions: The results indicate that considering the type of personality characteristics of injured workers may have important theoretical and practical implications.

Dignity Therapy and Life Review for Palliative Care Patients: A Randomized Controlled Trial

CONTEXT Dignity therapy (DT) is a psychotherapeutic intervention with increasing evidence of acceptability and utility in palliative care settings. OBJECTIVES The aim of this study was to evaluate the legacy creation component of DT by comparing this intervention with life review (LR) and waitlist control (WC) groups. METHODS Seventy adults with advanced terminal disease were randomly allocated to DT, LR, or WC followed by DT, of which 56 completed the study protocol. LR followed an identical protocol to DT except that no legacy document was created in LR. Primary outcome measures were the Brief Generativity and Ego-Integrity Questionnaire, Patient Dignity Inventory, Functional Assessment of Cancer Therapy-General, version 4, and treatment evaluation questionnaires. RESULTS Unlike LR and WC groups, DT recipients demonstrated significantly increased generativity and ego-integrity scores at study completion. There were no significant changes for dignity-related distress or physical, social, emotional, and functional well-being among the three groups. There were also no significant changes in primary outcomes after the provision of DT after the waiting period in the WC group. High acceptability and satisfaction with interventions were noted for recipients of both DT and LR and family/carers of DT participants. CONCLUSION This study provides initial evidence that the specific process of legacy creation is able to positively affect sense of generativity, meaning, and acceptance near end of life. High acceptability and satisfaction rates for both DT and LR and positive impacts on families/carers of DT participants provide additional support for clinical utility of these interventions. Further evaluation of specific mechanisms of change post-intervention is required given DTs uncertain efficacy on other primary outcomes.

Understanding Women's Mammography Intentions: A Theory-Based Investigation

The present study compared the utility of two models (the Theory of Planned Behavior and Protection Motivation Theory) in identifying factors associated with intentions to undertake screening mammography, before and after an intervention. The comparison was made between the unique components of the two models. The effect of including implementation intentions was also investigated. Two hundred and fifty-one women aged 37 to 69 years completed questionnaires at baseline and following the delivery of a standard (control) or a protection motivation theory-based informational intervention. Hierarchical multiple regressions indicated that theory of planned behavior variables were associated with mammography intentions. Results also showed that inclusion of implementation intention in the model significantly increased the association with mammography intentions. The findings suggest that future interventions aiming to increase screening mammography participation should focus on the theory of planned behavior variables and that implementation intention should also be targeted.

Developing interprofessional education: putting theory into practice

Editor s’ note: The lead author of this toolbox article was the recipient of The Clinical Teacher travelling fellowship award, which he undertook on the Gold Coast in Australia with Griffi th University School of Medicine. Despite its now long history, interprofessional education (IPE) is still not a routine component of health professional education. Although there are challenges when introducing IPE, as noted here, these may be overcome with careful planning and consideration of the learning outcomes for all of the students involved. Using Griffi th ’ s three-phase interprofessional curriculum as an example, the authors offer a practical guide to implementation as well as the rationale for IPE. The concept of ‘CAIPE compliance’ is an interesting one, where CAIPE is the Centre for the Advancement of Interprofessional Education and compliance relates to the threepreposition defi nition of IPE: with, from and about. Students move from knowledge building to simulation, and then to working in clinical situations, although the authors do admit that clinical experience is diffi cult given the logistics .

Measuring situational avoidance in older drivers: An application of Rasch analysis

Situational avoidance is a form of driving self-regulation at the strategic level of driving behaviour. It has typically been defined as the purposeful avoidance of driving situations perceived as challenging or potentially hazardous. To date, assessment of the psychometric properties of existing scales that measure situational avoidance has been sparse. This study examined the contribution of Rasch analysis to the situational avoidance construct. Three hundred and ninety-nine Australian drivers (M=66.75, SD=10.14, range: 48-91 years) completed the Situational Avoidance Questionnaire (SAQ). Following removal of the item Parallel Parking, the scale conformed to a Rasch model, showing good person separation, sufficient reliability, little disordering of thresholds, and no evidence of differential item functioning by age or gender. The residuals were independent supporting the assumption of unidimensionality and in conforming to a Rasch model, SAQ items were found to be hierarchical or cumulative. Increased avoidance was associated with factors known to be related to driving self-regulation more broadly, including older age, female gender, reduced driving space and frequency, reporting a change in driving in the past five years and poorer indices of health (i.e., self-rated mood, vision and cognitive function). Overall, these results support the use of the SAQ as a psychometrically sound measure of situational avoidance. Application of Rasch analysis to this area of research advances understanding of the driving self-regulation construct and its practice by drivers in baby boomer and older adult generations.