A protection motivation theory is proposed that postulates the three crucial components of a fear appeal to be (a) the magnitude of noxiousness of a depicted event; (b) the probability of that event's occurrence; and (c) the efficacy of a protective response. Each of these communication variables initiates corresponding cognitive appraisal processes that mediate attitude change. The proposed conceptualization is a special case of a more comprehensive theoretical schema: expectancy-value theories. Several suggestions are offered for reinterpreting existing data, designing new types of empirical research, and making future studies more comparable. Finally, the principal advantages of protection motivation theory over the rival formulations of Janis and Leventhal are discussed.

A Protection Motivation Theory of Fear Appeals and Attitude Change1.

This natural experiment provides substantial evidence for the following major themes, which are based on a cognitively oriented, process-centered theory of stress and coping: First, a stressful encounter should be viewed as a dynamic, unfolding process, not as a static, unitary event. Emotion and coping (including the use of social support) were assessed at three stages of a midterm examination: the anticipation stage before the exam, the waiting stage after the exam and before grades were announced, and after grades were posted. For the group as a whole there were significant changes in emotions and coping (including the use of social support) across the three stages. Second, people experience seemingly contradictory emotions and states of mind during every stage of an encounter. In this study, for example, subjects experienced both threat emotions and challenge emotions. The complexity of emotions and their cognitive appraisals reflects ambiguity regarding the multifaceted nature of the exam and its meanings, especially during the anticipation stage. Third, coping is a complex process. On the average, subjects used combinations of most of the available forms of problem-focused coping and emotion-focused coping at every stage of the exam. Different forms of coping were salient during the anticipation and waiting stages. Problem-focused coping and emphasizing the positive were more prominent during the former, and distancing more prominent during the latter. Finally, despite normatively shared emotional reactions at each stage, substantial individual differences remained. Using selected appraisal and coping variables, and taking grade point averages (GPA) into account, approximately 48% of the variances in threat and challenge emotions at the anticipation stage was explained. Controlling for variance due to the grade received, appraisal, and coping variables accounted for 28% of the variance in positive and negative emotions at the outcome stage. Including grade, 57% of the variance in positive emotions at outcome and 61% of the negative emotions at outcome were explained. The essence of stress, coping, and adapta- changing meaning or significance of what is tion is change. The emotions one experiences happening as the encounter unfolds. Coping, in a stressful encounter, for example, are too, is characterized by change. One might characterized by flux. At first one may feel at first engage in avoidant or denial-like strat

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If it changes it must be a process: Study of emotion and coping during three stages of a college examination.

In this essay in honor of Donald Oken, I emphasize coping as a key concept for theory and research on adaptation and health. My focus will be the contrasts between two approaches to coping, one that emphasizes style—that is, it treats coping as a personality characteristic—and another that emphasizes process—that is, efforts to manage stress that change over time and are shaped by the adaptational context out of which it is generated. I begin with an account of the style and process approaches, discuss their history briefly, set forth the principles of a process approach, describe my own efforts at measurement, and define coping and its functions from a process standpoint. This is followed by a digest of major generalizations that resulted from coping process research. The essay concludes with a discussion of special issues of coping measurement, in particular, the limitations of both coping style and process approaches and how these limitations might be dealt with. There has been a prodigious volume of coping research in the last decade or two, which I can only touch on very selectively. In this essay, I also ignore a host of important developmental issues that have to do with the emergence of coping and its cognitive and motivational bases in infants, as well as a growing literature on whether, how, and why the coping process changes with aging.

https://www.sunswlondon.nhs.uk/wp-content/uploads/2013/01/Coping-Process-Theory.pdf

Coping theory and research : Past, present, and future

The fear appeal literature is diverse and inconsistent Existing fear appeal theories explain the positive linear results occurring in many studies, but are unable to explain the boomerang or curvilinear results occurring in other studies The present work advances a theory integrating previous theoretical perspectives (ie, Janis, 1967; Leventhal, 1970; Rogers, 1975, 1983) that is based on Leventhal's (1970) danger control/fear control framework The proposed fear appeal theory, called the Extended Parallel Process Model (EPPM), expands on previous approaches in three ways: (a) by explaining why fear appeals fail; (b) by re‐incorporating fear as a central variable; and (c) by specifying the relationship between threat and efficacy in propositional forms Specific propositions are given to guide future research

Putting the fear back into fear appeals: The extended parallel process model

This article reviews the research on resilience in order to delineate its significance and potential for understanding normal development. Resilience refers to the process of, capacity for, or outcome of successful adaptation despite challenging or threatening circumstances. Three resilience phenomena are reviewed: (a) good outcomes in high-risk children, (b) sustained competence in children under stress, and (c) recovery from trauma. It is concluded that human psychological development is highly buffered and that long-lasting consequences of adversity usually are associated with either organic damage or severe interference in the normative protective processes embedded in the caregiving system. Children who experience chronic adversity fare better or recover more successfully when they have a positive relationship with a competent adult, they are good learners and problem-solvers, they are engaging to other people, and they have areas of competence and perceived efficacy valued by self or society. Future studies of resilience will need to focus on processes that facilitate adaptation. Such studies have the potential to illuminate the range and self-righting properties of, constraints on, and linkages among different aspects of cognitive, emotional, and social development.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0954579400005812

Resilience and development: Contributions from the study of children who overcome adversity

A measure of the attitudes and feelings that a relative expresses about a mentally ill family member, termed expressed emotion (EE), is derived from an extensive, semistructured interview, the Camberwell Family Interview (CFI). The present article describes a method for the assessment of EE attitudes that uses a variation of the 5-minute speech sample, originally developed by Gottschalk and Gleser (1969). The measure is derived from responses made by a patient's key relative when prompted to give thoughts and feelings about the patient for a 5-minute period. A coding system was developed to score behaviors analogous to those rated on the CFI, such as criticism and emotional overinvolvement. The relationship between blind EE ratings derived from the 5-minute speech samples and those from the CFI was investigated with two separate samples of relatives of schizophrenics. The relationship between the sets of ratings was very close and supports the value of the 5-minute speech sample as a brief EE screening procedure.

A brief method for assessing expressed emotion in relatives of psychiatric patients.

• Measures of family attitudes (expressed emotion [EE]) and interactional behaviors (affective style [AS]), both of which have been found to predict relapse in schizophrenia, were obtained from key relatives of 23 hospitalized recently manic bipolar patients. Patients were then followed up for a period of nine months after hospital discharge and rated on measures of clinical course, social adjustment, and medication compliance. Levels of intrafamilial EE and AS were found to predict likelihood of patient relapse at follow-up, especially when used as conjoint predictors of patient outcome status. Levels of AS also predicted degree of social adjustment at follow-up. The predictive relationships observed were independent of patient medication compliance, treatment regimen, baseline symptoms, demographics, and illness history. Results suggest that the emotional atmosphere of the family during the postdischarge period may be an important predictor of the clinical course of bipolar disorder.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=psych&articleId=494246&pdfFileName=archpsyc_45_3_004.pdf

Family factors and the course of bipolar affective disorder.

After a brief inpatient hospitalization, 104 acute, young schizophrenics, stratified by premorbid adjustment, were randomly assigned to one of four aftercare conditions for a six-week controlled trial. Conditions involved one of two dose levels of fluphenazine enanthate (1 ml or 0.25 ml) and presence or absence of crisis-oriented family therapy. Relapses during the six-week period and at six-month follow-up were least in patients who received both high-dose and family therapy (0%) and greatest (48%) in the low-dose-no therapy group. Brief Psychiatric Rating Scale symptom ratings disclosed a significant family therapy effect at six weeks that was sustained at six months only for therapy patients originally receiving the high drug dose. Numerous interactions were found between premorbid adjustment status and response to the two treatment conditions.

Drug and Family Therapy in the Aftercare of Acute Schizophrenics

The Developmental Processes in Schizophrenic Disorders project is a longitudinal study of schizophrenic patients who have recently had a first episode of psychosis. The project focuses on discriminating characteristics of schizophrenic patients that are "stable vulnerability indicators," "mediating vulnerability factors," and "episode indicators" by comparing normal subjects to schizophrenic patients assessed in clinically remitted and psychotic states. A parallel project goal is to identify predictors of relapse, social and work impairment, and illness course among potential psychobiological vulnerability factors and environmental potentiating factors. Hypothesized vulnerability factors and potential environmental stressors are examined first under standardized maintenance antipsychotic medication conditions for at least 1 year. Patients showing stable remission of psychosis after 1 year of maintenance antipsychotic medication are invited to enter drug crossover and withdrawal protocols to determine the need for continuous antipsychotic medication. Vulnerability and stress factors are again assessed. A summary of results to date is presented. Deficits in early components of processing visual arrays and in sustained discrimination of successive ambiguous perceptual inputs are relatively stable across psychotic and clinically remitted states in the schizophrenic patients. Performance on a vigilance task demanding active, working memory also remains abnormal during clinical remission but covaries significantly with psychotic state and is a candidate for a mediating vulnerability factor. Autonomic activation level does not appear to be an enduring vulnerability factor, but it predicts the extent of short-term symptomatic recovery and may mediate the impact of stressors. Under conditions of standardized, injectable antipsychotic medication, independent stressful life events and highly critical attitudes toward the patient in the social environment predict relapse risk. Prospective data suggest that signs and symptoms prodromal to psychotic relapse may be present in about 60 percent of patients.

Developmental Processes in Schizophrenic Disorders: Longitudinal Studies of Vulnerability and Stress

Wynne, Foreword. Part I: Bipolar Disorder and Families: Clinical and Research Background. Bipolar Disorder: Why Family Treatment? The Nature of Bipolar Disorder and Its Impact on the Family. Family and Social Factors in the Course of Bipolar Disorder. Part II: Conducting the Family-Focused Treatment. Planning the First Encounter. The Functional Assessment. Family Psychoeducation: The Initial Sessions. Family Psychoeducation: Etiology, Treatment, and Self-Management. Family Psychoeducation: Dealing with Resistances. Communication Enhancement Training: Rationale and Mechanics. Communication Enhancement Training: Clinical Issues. Dealing with Family Problems. Managing Crises in Family-Focused Treatment. Termination.

Michael J. Goldstein

Papers

A brief method for assessing expressed emotion in relatives of psychiatric patients.

Family factors and the course of bipolar affective disorder.

Drug and Family Therapy in the Aftercare of Acute Schizophrenics

Developmental Processes in Schizophrenic Disorders: Longitudinal Studies of Vulnerability and Stress

Bipolar Disorder: A Family-Focused Treatment Approach