Showing papers in "British Journal of Health Psychology in 2003"

Evidence for the independence of positive and negative well-being: implications for quality of life assessment.

Abstract: Objectives: Evidence is accumulating that positive mental states are more than the absence of symptoms, and may play an independent role in health outcomes. The aim of this study is to compare the characteristics and determinants of positive and negative mental states in a population sample. Design: A novel analysis of data was undertaken from the General Health Questionnaire (GHQ-30) which was completed by 6,317 participants in the Health and Lifestyle Survey at Time 1 and 3,778 at Time 2, 7 years later. Methods: We derived a positive well-being scale (POS-GHQ) based on positive responses to the positive items of the GHQ-30, and compared it to a standard symptom measure (CGHQ). Discriminant function analyses were performed to establish which demographic, health and social variables best accounted for scores on each scale. Results: The distributional properties of the two scales, together with the results of the discriminant analyses, demonstrate a degree of independence between positive and negative well-being. Over one third of the sample obtained either low scores on both positive and negative well-being measures or high scores on both measures. Disability and lack of social roles were important determinants of psychological symptoms, but had less influence on positive well-being. Having paid employment was an important determinant of positive well-being but had less influence on psychological symptoms. We also found that 7-year mortality was predicted more strongly by the absence of positive well-being than by the presence of psychological symptoms. Conclusions: These findings point to the need to include measures of positive well-being in studies of health outcomes and quality of life assessment.

Body dissatisfaction, dieting awareness and the impact of parental influence in young children.

Abstract: Objectives: This study aimed to assess the level of body dissatisfaction and dieting awareness in young children. Method: A sample of 135 children aged between 5 and 8 years old were individually interviewed. Body dissatisfaction was assessed by means of figure preference ratings, and dieting awareness by responses to a brief scenario. Results: The difference between boys' ratings of current and ideal figures was not significant at any age; nor was that of 5-year-old girls. However, 6-, 7- and 8-year-old girls rated their ideal figure as significantly thinner than their current figure. For dieting awareness there was no significant gender effect, although level of dieting awareness increased with age. Multiple regression analyses showed that body dissatisfaction was predicted by gender and perception of mothers' body dissatisfaction, while age was the only significant predictor of dieting awareness. Conclusions: A substantial proportion of young children have internalized societal beliefs concerning the ideal body shape and are well aware of dieting as a means for achieving this ideal. In particular, the desire for thinness emerges in girls at around age 6.

Coping and caregivers of people with dementia

Abstract: Purpose: To critically review the research based on Lazarus and Folkman's (1984) stress and coping model, in respect to the coping of those caring for persons with dementia in the community, in an attempt to establish its implications for interventions aimed at improving caregiver adjustment. Method: Published material on the coping of caregivers of persons with dementia was identified through computerized literature searches (Med-line, Psych-Info) to December 1999, employing search terms including Alzheimer's disease, dementia, caregiving, caregiver burden, adaptation, psychological, coping, and stress. Studies were chosen to be considered in detail, based on the reviewer's opinion that they would contribute to an understanding of the current state of the research and its clinical implications. This material was then critically reviewed against the tenets of Lazarus and Folkman's (1984) model. Results: Sixteen studies were selected to be included in the review, 12 cross-sectional and 4 longitudinal. Seven of the studies did not incorporate coping measures specific to caregiving and/or assess coping in respect of specific caregiver problems. Nine of the studies did do this. The research suggests that a general tendency towards problemsolving and acceptance styles of coping is likely to be advantageous to caregivers of people with dementia. Conclusions: Despite this finding, it is concluded that the ability of the research to inform the clinician is severely limited. It is proposed that while longitudinal studies considered specific caregiver problems which incorporate coping measures specific to the caregiving task may improve understanding, a substantial revision of methodology and perspective may be required to produce findings that are likely to influence practice.

Illness perceptions, mood and coping in predicting attendance at cardiac rehabilitation.

Abstract: Objective: The aim of this study was to identify psychological variables in poor/non-attendance at cardiac rehabilitation (CR). We investigated whether attenders and poor/non-attenders differed in relation to components of the self-regulatory model and coping, and which of these variables were the best predictors of attendance behaviour. Design: A cross-sectional, between groups design was employed. In contrast with two previous similar studies, participants completed self-report measures shortly before the start date for the CR programme. Univariate and logistic regression analyses were conducted. Method: In all, 93 individuals who had been invited to attend CR completed the Illness Perceptions Questionnaire (IPQ), the Hospital Anxiety and Depression Scale (HADS) and the Coping Orientation to Problems Experienced (COPE). Subsequently, 32 participants failed to attend, or dropped out early from, the programme. Results: Attenders differed from poor/non-attenders in that they perceived a greater number of symptoms and consequences of their illness, greater distress, less strong beliefs that their illness had been caused by a germ or virus, and used problem-focused and emotion-focused coping more frequently. The best predictors of poor/non-attendance were lower perceptions of symptoms and controllability/curability of illness, and less frequent use of problem-focused and more frequent use of maladaptive coping strategies. Conclusion: Attenders and poor/non-attenders at CR were distinguished by illness representations, distress and usage of coping strategies. The variables found to be the best predictors of attendance could be used to screen those unlikely to attend and to develop interventions for enhancing attendance.

Social barriers to emotional expression and their relations to distress in male and female cancer patients

Abstract: Objective: Emotional expression is an important means of coping with stressful experiences such as cancer. Social barriers to expression may have adverse effects. Research has suggested that men are less likely to express their emotions and have different patterns of social support compared to women. We examined whether male cancer patients have a lower tendency to express emotions, are less likely to perceive social barriers to expression, and are differentially affected by social barriers from different support sources as compared to women. Design: Questionnaires were administered to 41 women and 41 men using a cross-sectional study design. Method: Patients diagnosed with gynaecological or prostate cancer within the past 5 years completed questionnaires on moods, intrusive thoughts, social constraints and emotional expressivity. Results: There was a trend towards greater emotional expressivity in women as compared to men, but no significant gender differences in perceptions of social constraints from spouse/partner or others. Multiple regression analyses revealed that men experienced significantly greater distress in association with social constraints from their spouse/partner than did women. Conclusion: Men may be more vulnerable to social barriers to expression than previously assumed. Gender differences in emotional expressivity may be less important than the social context in which expression takes place.

Religion and mental health: Towards a cognitive‐behavioural framework

Abstract: Purpose: Religion is frequently ignored within the clinical domain. Yet when examined, empirical evidence indicates that specific aspects of religiosity are correlated with mental health. The established associations between religious dimensions and mental health could be mediated by cognitive-behavioural mechanisms. This paper proposes a preliminary conceptual framework in which two types of cognitive and behavioural mechanisms are described, (1) generic mental models that provide a basis for guiding appraisals of life events and (2) self-regulation of thinking processes (metacognitive control). Method: A critical analysis of extant literature was employed to examine support for each of the mechanisms. Discussion: Evidence supports the idea that a religious framework can serve as a generic mental model that influences appraisals and affects well-being. The benefits derived depend on the salience of the framework, level of certainty with which attributions can be accepted, and the content of the information. Evidence for the self-regulation mechanism is weaker. Although consistent with this supposition, it requires further empirical evaluation. Conclusion: The relationships between religious variables and mental health may depend on cognitive-behavioural mechanisms. Developments in this area might encourage clinicians to consider further the ways in which religious variables might be utilized and assessed in therapy. However, there is a need for further efforts to incorporate religious and spiritual factors in the clinical arena.

Relationships between personality, an extended theory of planned behaviour model and exercise behaviour.

Abstract: Objectives: The purpose of this study was to investigate the theory of planned behaviour's (TPB) mediating hypothesis between the five-factor model of personality and exercise behaviour using an extended TPB model including concepts of affective and instrumental attitude, injunctive and descriptive norm, controllability, and selfefficacy. It was hypothesized that extraversion's activity facet would have a significant direct effect on exercise behaviour while controlling for the TPB, based on the presupposition that activity may represent a disposition that predicts exercise beyond planned behaviour. Design: To test the replicability of these findings, we examined this research question with undergraduate students prospectively and cancer survivors, using a cross-sectional design. Results: Using structural equation modelling, the results indicated that activity had a significant effect (p < .05) on exercise behaviour (study 1 = .20; study 2 = .31) while controlling for the TPB. Conclusions: This study suggests the importance of extraversion's activity facet on exercise behaviour, even when controlling for a TPB model with additional socialcognitive concepts and disparate population samples.

The prevalence and predictors of psychological distress in men with prostate cancer who are seeking support.

Abstract: Objective: The incidence of prostate cancer has risen sharply in the last decade, yet knowledge about the psychological health of men with this disease is still limited. A study was therefore undertaken to identify (1) the prevalence of psychological distress in these males, and (2) factors predicting psychological distress. Design: Retrospective cross-sectional survey design by means of a self-administered questionnaire. Method: A sample of 94 men with various stages of prostate cancer completed the Functional Assessment of Cancer Therapy—Prostate Instrument (FACT-P), the Hospital Anxiety Depression Scale (HADS) and items measuring satisfaction with medical care. Results: We detected a prevalence rate of 38% of participants reporting psychological distress corresponding to a HADS cut-off score at or above 15. A standard multivariate regression analysis revealed social/family well-being, physical well-being and functional well-being as significant inverse predictors of psychological distress. Conclusions: Health professionals should be aware of the potential for psychological distress in patients exhibiting poor physical functioning and those with apparent deficits in social or family support in this under-studied group of patients. Strategies for psychosocial intervention are implied.

The illness representations of multiple sclerosis and their relations to outcome

Abstract: Objectives: The main aims of the present study were to explore the illness representations of individuals with multiple sclerosis (MS) and investigate the relationship of these beliefs to outcome. Based on Leventhal et al.'s self-regulation model, the commonly accepted generic five-component structure of illness representations including identity, time-line, consequences, cause, and cure/controllability was used. Design: A cross-sectional, correlational design was employed for the study. Interrelationships among the illness representation components and the relationships between the components and outcome were explored using Pearson's r. To determine the contribution of the illness representation components to the explained variance in outcome, a series of stepwise multiple regression analyses was used. Method: A total of 99 participants took part in the study. A series of measures were completed to assess (1) illness representations and (2) five specific areas of outcome. Results: Participants' illness representations of MS were consistent with the medical nature and understanding of this illness indicating that they held the perceptions of a strong illness identity, chronic time-line, no particular cause and no cure. Beliefs in the serious consequences of MS and limited control were also reported. Some important interrelationships among the illness representation components were demonstrated where a strong illness identity, chronic time-line view and perception of low control were related to more serious consequences. Overall, evidence was provided to suggest that illness representations contribute to outcome. The consequences component was associated with, and contributed to, the explained variance for each of the five outcome areas, indicating that the perception that MS has many negative effects on an individual's life was associated with greater levels of difficulty in all of the outcome areas. In addition, for each of the outcome variables, different combinations of illness representation components explained their variance. For example, higher levels of depression were associated with perceptions of a stronger illness identity, more serious consequences, acute time-line, and low control. Conclusion: Overall support is provided for the application of the five-component structure of illness representations to MS and the likely contribution of such beliefs to outcome. The concept of illness representations therefore provides a useful framework for understanding the psychosocial effects of this illness.

Quality of life, distress and self-esteem: a focus group study of people with chronic bronchitis.

Abstract: Chronic bronchitis (a form of chronic obstructive pulmonary disease or COPD) is a common cause of morbidity and mortality resulting in around 5% of deaths in the UK. Over recent years, there has been an increased emphasis on patient-based evaluation of health and social care, which has led to a rapid growth in quality of life measures and an increase in measuring quality of life for COPD patients. However, less attention has been paid to patients' perceptions and experiences of everyday life, specifically their active engagement in the psychological, emotional and social aspects of adjustment and adaptation to living with chronic bronchitis. This study employs a series of four focus groups (N = 20) to identify key experiences of living with chronic bronchitis. The results, obtained through using both thematic and conceptual qualitative analysis, within a broadly symbolic interactionist framework, describe the subjective and sometimes contradictory ways in which the disease leads to psychological distress, dependency on medication, and disruption to social and family relationships, and has a negative impact on self-esteem. The study further argues for greater awareness of qualitative approaches to the broad view of quality of life as complementary to quality of life assessments.

The expectancy-value muddle in the theory of planned behaviour — and some proposed solutions

Abstract: The authors of the Theories of Reasoned Action and Planned Behaviour recommended a method for statistically analysing the relationships between beliefs and the Attitude, Subjective Norm, and Perceived Behavioural Control constructs. This method has been used in the overwhelming majority of studies using these theories. However, there is a growing awareness that this method yields statistically uninterpretable results (Evans, 1991). Despite this, the use of this method is continuing, as is uninformed interpretation of this problematic research literature. This is probably due to the lack of a simple account of where the problem lies, and the large number of alternatives available. This paper therefore summarizes the problem as simply as possible, gives consideration to the conclusions that can be validly drawn from studies that contain this problem, and critically reviews the many alternatives that have been proposed to address this problem. Different techniques are identified as being suitable, according to the purpose of the specific research project.

Self‐management training for people with chronic disease: An exploratory study

Abstract: Objective: To determine the effectiveness of a community-based Chronic Disease Self-management Course (CDC) for UK participants with a range of chronic diseases. Design: The study was a multiple baseline, pre-test post test design with a sample of 185 participants who attended a CDC delivered in community settings by lay tutors, in the UK. Method: Data were collected by self-completed questionnaires before attendance and at four-month follow-up. Results: The sample comprised 72% women (mean age = 53 years, mean disease duration = 16 years). The main chronic diseases included endometriosis, depression, diabetes, myalgic encephalomyelitis, osteoporosis and polio. Adjusting for baseline values and gender, small to moderate increases were found on cognitive symptom management, self-efficacy (disease and symptoms) and communication with physician. A similar sized decrease was found on fatigue, and small decreases were evident on anxious and depressed moods, and health distress. There were no changes in the use of health care resources, or on self-reported exercise behaviour. Conclusion: The results of this exploratory study suggest that self-management training for people with chronic diseases can offer benefits in terms of enhanced self-efficacy, greater use of cognitive behavioural techniques, and improvement in some aspects of physical and psychological well-being.

Adolescence and the diet-dieting disparity: healthy food choice or risky health behaviour?

Abstract: Objectives: Food choice in schoolchildren was examined in relation to dieting and measures of eating psychopathology. It was predicted that dieters would make healthier food choices compared to non-dieters and that measures of eating psychopathology would be associated with food choice. Design: A cross-sectional questionnaire design incorporating an established adapted recall method was used to assess patterns of food consumption. Methods: Questionnaires were administered in 13 state secondary schools. Measures included a food frequency questionnaire, the Children's Eating Attitudes Test (CHEAT), body satisfaction ratings, dietary restraint, and questions about dieting status. The sample consisted of 574 females and 445 males aged 11-16 years. Results: Females made significantly more healthy food choices compared to males. Females reported dieting more than males (35% vs. 18%, respectively), and female dieters made more healthy food choices than female non-dieters. Almost a fifth (19%) of the entire sample reported skipping breakfast, with female dieters being three times more likely to do so than non-dieters. There were small but significant associations between reported food consumption and measures of eating attitudes, body dissatisfaction and restraint. For females who scored in the at-risk range on the CHEAT (8.7%), these associations were more substantial. Conclusions: Female dieters appear to make more healthy food choices than non-dieters and so may be tuning into healthy eating messages more effectively. Vulnerable females may use ‘healthy eating’ to hide risky weight reduction behaviours. Further studies are required to examine the nutritional impact of moderate and extreme dieting in this age group.

Re-appraising HIV testing: an exploration of the psychosocial costs and benefits associated with learning one's HIV status in a purposive sample of Scottish gay men

Abstract: Objective: This study explored contemporary understandings of the psychosocial costs and benefits associated with learning one's HIV status within a purposive sample of Scottish gay men. It seeks to provide insight into the psychosocial factors associated with decision-making processes relating to the HIV antibody test. Method: Transcripts of one-to-one interviews (N = 19) and four focus groups (N = 18) were analysed using Interpretative Phenomenological Analysis. Participants had varied HIV testing histories, and the sample included men who identified their HIV status as positive, men who identified it as negative, and men who did not know. Results: The HIV test could resolve doubt and anxiety for some men, but only when ‘not knowing’ was experienced as less tolerable than an imagined positive result. Many participants were deterred from seeking an HIV test because of their fears of the implications of a positive result. The decision to take an HIV test could be understood as a choice between living with uncertainty and the perceived impact of ascertaining HIV status. Conclusion: For the participants in this study, the decision to test or not involved many complex medical, psychological and social factors. It is argued that the development of HIV testing policy must start with a perspective grounded in an understanding and appreciation of these complexities.

The psychosocial impact of the implantable cardioverter defibrillator: A meta-analytic review

Abstract: Objective:. The implantable cardioverter defibrillator (ICD) has become the treatment of choice for ventricular arrhythmia (VA; abnormal heart rhythms) and the prevention of sudden cardiac death (SCD). Recent clinical trials have shown the ICD to be superior to anti-arrhythmic medication in reducing mortality; however, research has suggested that ICD recipients experience poor psychosocial adjustment following implantation of the device. This aim of this study was to identify the key psychological characteristics associated with ICD implantation and to establish whether poor psychosocial outcome can be attributed directly to the device and its therapy. Method: Studies which reported valid and reliable measures of psychological functioning in ICD patients and appropriate comparison groups were considered for inclusion in a meta-analytic review. A systematic search of electronic databases and reference lists identified 20 studies which fulfilled the inclusion criteria. Results: There were no significant differences in psychosocial outcome between ICD patients and drug-maintained VA patients or between pre- and post-implant ICD patients. However, ICD patients reported significantly worse psychological functioning and physical functioning than other cardiac controls. Conclusion: These findings suggest that poor psychosocial outcome in ICD patients may occur as a result of variables associated with the underlying VA condition, rather than as a direct response to implantation of the device and its therapy. This holds important implications for the development and implementation of psychological interventions for patients experiencing VA, in preference to ICD-specific programmes.

How sleep is related to fatigue.

Abstract: Objectives: It is evident that sleep patterns have direct effects on fatigue. However, the multidimensionality of fatigue may imply that complex patterns of relationships exist between fatigue and sleep characteristics. We aimed to study the correlations between fatigue and quantitative and qualitative sleep measurements, while taking into consideration depression and somatization which are known to affect both sleep and fatigue. We predicted that sleep quality, unattained by the effects of somatization and depression, would affect perceived fatigue more than the quantitative characteristics of sleep. Design: Employing a cross-sectional design, hypotheses were addressed using multiple hierarchical regression analyses according to established methods. Methods: Data were gathered from a targeted, randomly selected adult sample (N = 278) by means of subjective sleep reports, a mental health inventory, somatization inventory, several fatigue questionnaires and a demographic questionnaire. Results: Fatigue was significantly predicted by depression scores, somatization levels and subjective sleep quality, but not quantitative sleep characteristics such as sleep latency, nocturnal awakenings and early morning arousals. Depression levels were positively and significantly related to all aspects of fatigue except physical fatigue and fatigue that responds to rest and sleep. Physical fatigue was correlated with somatization, but not depression. Conclusions: The data further our understanding of the multifaceted nature of human fatigue and underline the greater importance of perceived sleep quality, compared to other sleep characteristics, in predicting fatigue.

Cognitive adaptation : A comparison of cancer patients and healthy references

Abstract: Objectives. Taylor's theory of cognitive adaptation proposes that adjustment depends on the ability to sustain and modify illusions (i.e. unrealistic optimism, exaggerated perceptions of control, and self-aggrandizement) that buffer against threats but also against possible future setbacks. Because the question of whether cancer patients show these illusions has received little attention, the present study compared patients' perceptions of optimism, control, and self-esteem at different stages of the cancer process with that of healthy references. The effects of these perceptions on psychological distress were also assessed. Design. The present study has a longitudinal design. Including a group of healthy references enabled us to draw more firm conclusions about the effect of cancer upon cognitive perceptions. Methods. The participants were 67 cancer patients and 50 healthy references. Patients filled out questionnaires prior to their first radiotherapy (T1), at 2 weeks (T2), and at 3 months (T3) after completing radiotherapy. Healthy references were assessed at similar intervals. Results. T tests revealed that patients experienced significantly higher levels of optimism and self-esteem than the healthy reference group. Concerning control, no group differences were found. Importantly, regression analyses showed that lower levels of optimism and control at T1 were predictive of feelings of anxiety at T3. Lower perceived control also predicted depressive symptoms. Conclusion. Results support the theory of cognitive adaptation in that patients are indeed able to respond to cancer with high levels of optimism and self-esteem and that lower levels of optimism and control are predictive of psychological distress.

Help-seeking intentions for breast-cancer symptoms: A comparison of the self-regulation model and the theory of planned behaviour

Abstract: Purpose: Delays in seeking help for symptoms have been found to be associated with poorer outcome in breast-cancer patients. This study explores symptom perceptions and health beliefs as predictors of intentions to seek medical help in a general female population. The utility of the self-regulation model of illness cognition and the theory of planned behaviour were examined in predicting help-seeking intentions for potential symptoms of breast cancer in a general population sample. Methods: A general population sample of 546 women completed a postal questionnaire comprising items examining components of the self-regulation model and the theory of planned behaviour. Help-seeking intention was determined by asking participants to rate the likelihood of visiting their GP for a range of breast symptoms. Results: Hierarchical multiple regression analysis revealed that the cognitive component of the self-regulation model accounted for approximately 22% of the variance in help-seeking intention. Identity (β = 0.45, p < .001) emerged as a significant predictor of intention to seek help. Inclusion of the components of the theory of planned behaviour accounted for an additional 7% of the variance; the significant predictors were attitude to help-seeking (β = 0.19, p <.001) and perceived behavioural control (β = 0.12, p <.01). Conclusions: Intention to seek medical help for a potential breast-cancer symptom may be mediated, partly, by cognitive representations of the identity and consequences of breast cancer and by attitudes towards help-seeking and perceived behavioural control. Although less than one-third of the variance was accounted for, these results have important implications for future research (in terms of identifying which variables should be examined) and for the development of a model of help-seeking behaviour in women with breast-cancer symptoms.

Measuring Sense of Coherence with only three items: A useful tool for population surveys

Abstract: Objectives: Sense of Coherence is the core construct of Antonovsky's salutogenetic model. To measure Sense of Coherence, a 29-item-questionnaire (SOC-29), a shortened 13-item version, and a simplified measure of only three items (SOC-3) are available. In our study, the last was tested in terms of the psychometric properties and compared with an alternative short form derived from the SOC-29. Methods: Data with respect to the original SOC-29-scale, the SOC-3, and additional other health measures were collected in a representative general population survey, the German study ‘Transitions in Alcohol Consumption and Smoking’ (TACOS). Analyses of the factor structures, reliability and validity correlations are reported. Results: The reliability and validity results of the SOC-3 were not encouraging. Subsequent item analyses revealed that three items taken out of the SOC-29 outperformed the SOC-3 in measuring Sense of Coherence in a simplified way. This newly developed instrument is presented as the Brief Assessment of Sense of Coherence (BASOC). Conclusion: The BASOC is a superior short form compared with the SOC-3 and is recommended for large surveys with limited space for questions.

A contemporary validation of the Reeder Stress Inventory.

Abstract: Objectives: To examine the construct validity of the RSI in a contemporary cohort. Design. A cross-sectional investigation of 1,717 employed individuals who responded to the second stage of a study of occupational stress. Methods: Scores on the RSI are compared to smoking and drinking habits, social class, and two measures of health (number of days sick leave, and number of visits to a GP during the previous year). The RSI was compared to three questionnaires measuring concepts related to stress: the 12-item General Health Questionnaire (GHQ-12), the Hospital Anxiety and Depression Scale (HADS), and the Karasek Job Strain Questionnaire. Results: Higher levels of stress, as measured by the RSI, were associated with smoking a greater number of cigarettes, and, if the respondent drank alcohol, greater consumption of alcoholic drinks. High levels of stress were also associated with having taken more days sick leave, having made more frequent visits to a GP, and, somewhat unexpectedly, with being a teetotaller, and with holding a non-manual occupation. Of the questionnaire measures, the strongest association was between the RSI and HADS anxiety subscale, consistent with an overlap between the concepts of stress and anxiety. Conclusions: This study supports the construct validity of the RSI in a sample of employed individuals.

Repressive coping style and positive self-presentation.

Abstract: Objective - This paper reviews 59 studies looking at cognitive, individual differences and physiological correlates of the repressive coping style, as defined by Weinberger,Schwartz, and Davidson (1979). A central aim is to evaluate the relative importance of the anxiety and social desirability components of repression. Thus, the empirical studyinvestigates the relationships between repression and a number of relevant, but hitherto unexamined, constructs, including trait emotional intelligence (trait EI), self-estimated intelligence, functional and dysfunctional impulsivity, and stoicism. It was hypothesized that repressors would score higher than the other three groups on trait EI, self-estimated IQ and functional impulsivity, but lower on dysfunctional impulsivity. Method - In total, 259 (174 females) participants from three British universities completed questionnaires measuring the dependent and independent variables. Participants were divided into four groups (truly low anxious, non-defensive/high anxious, defensive/high anxious and repressors) based on their scores on anxiety and social desirability. Analyses -moderated multiple regressions (and ANOVAs) were conducted both on the total sample as well as on ‘extreme-scoring’ individuals. Results - Where there were significant differences, the hypotheses were supported,particularly with respect to trait EI, self-estimated IQ and impulsivity. Using ‘extreme-scoring’ groups did not effectively change the results. The regressions revealed an absence of signicant interactions between anxiety and social desirability. Conclusion - Results are discussed in terms of the now replicated effect that repressors present a highly positive and optimistic self-image, despite cognitive and behavioural data suggesting that their coping style is psychologically unhealthy. In addition, it is argued that many findings in the repressive coping style literature can be parsimoniously explained through main effects of anxiety or social desirability alone (i.e., without invoking a construct that combines the two).

Stage-specific psychological determinants of stage transition.

Abstract: Objectives. The stages of change construct refers to the different psychological states people move through when they change their behaviour. However, the prediction that people in different stages of change need different sorts of interventions to stimulate the change process has scarcely been tested prospectively. An indirect test of this hypothesis would need to assess whether there are stage-specific psychological determinants of forward stage transition. Method. Smoking and quitting history, demographics, three potential psychological determinants of stage transition and stage of change were assessed in over 700 smokers and ex-smokers (T I). After eight months (T2), stage of change was reassessed. Results. The cross-sectional relationships between two of the three psychological measures and stage of change were largely non-linear. In the main prospective analyses on forward stage transition, stage-specific determinants were identified for three of the four possible forward stage transitions. Furthermore, for three of the four possible backward stage transitions, stage-specific determinants of backward stage transition approached significance. For the contemplation stage, none of the determinants under investigation were found to be related to either forward or backward stage transition. Conclusions. The present data indirectly support the notion that stage-specific interventions should target stage-specific determinants of stage transition in smoking behaviour. However, with regard to smokers in the contemplation stage-who comprise a large proportion of smokers in Western countries-no conclusions can be drawn.

Social problem-solving abilities and distress among family members assuming a caregiving role.

Abstract: We examined the relation of social problem-solving abilities to distress experienced by family members assuming a caregiving role for a loved one who had recently incurred a severe physical disability. Family members completed measures of problem-solving, depression and health, while their loved one participated in an inpatient rehabilitation programme. Correlational analyses indicated that a negative problem orientation was significantly predictive of caregiver distress, regardless of the degree of physical impairment of the care recipient. Women reported more distress on several measures than men, and disability severity was also associated with depression and impaired social functioning. Family members with a greater negative orientation may be at risk to develop psychological and health problems upon assuming a caregiver role. These results are discussed in light of theoretical models of social problem-solving, and implications are presented for psychological interventions and for health policy concerning family caregivers and their care recipients.

Experimental evidence for interpretive but not attention biases towards somatic information in patients with chronic fatigue syndrome

Abstract: Objective: this study tested whether CFS patients have an attentional information processing bias for illness-related information and a tendency to interpret ambiguous information in a somatic fashion. Design: 25 patients meeting research criteria for a diagnosis of CFS were compared to 24 healthy matched controls on a modified Stroop task and an ambiguous cues task. Method: in the modified Stroop task, participants colour named a series of somatic, depressed and neutral words in order to ascertain whether the somatic words were more distracting to the CFS patients than the depressed and neutral words when compared to controls. In the ambiguous cues task, participants were presented with a tape-recorded list of 30 words including 15 ambiguous illness words (e.g., vein/vain) and 15 unambiguous words. For each word, they were asked to write down the first word that came into their head. A somatic bias score was obtained for each subject by summing the number of somatic responses to the ambiguous word cues. Results: although CFS patients were significantly slower in colour naming all of the Stroop word categories than controls, there was no evidence for illness or depressed words creating greater interference than neutral words. However, on the ambiguous cues task, CFS patients made significantly more somatic interpretations than controls and this bias was significantly associated with the extent to which they currently reported symptoms. Conclusion: CFS patients have an interpretive bias for somatic information which may play a part in the maintenance of the disorder by heightening patients' experience of physical symptoms and helping to maintain their negative illness schemas. Although patients did not show an attentional bias in this study, this may be related to the methodology employed.

Nutritional supplementation in older adults: Pleasantness, preference and selection of sip‐feeds

Abstract: Objectives: Malnourishment is common in older adults, and nutritional supplementation is used to improve body weight and well-being. Clinical reports suggest, however, that patients routinely reject sip-feeds. The present study examined the following questions: whether sip-feeds are less preferred and less likely to be selected than other energy-dense foods in healthy elders; and whether eating alone further reduces intake relative to eating in a social setting. Methods: Twenty-one healthy older adults (aged 60-79 years) attended the laboratory on three occasions. Subjects rated six different flavours of sip-feed and then rated the pleasantness of the taste of the favoured flavour against five other energy-dense familiar foods/drinks. Intake of these foods was measured when subjects ate alone or in a group of familiar others. Results: Favourite flavour of sip-feed compared well with other more familiar foods and was selected as part of a snack. Snack intake increased by 60% when consumed in a group setting compared with eating alone. Conclusions: The study suggests that sip-feeds are rated as pleasant and selected by free-living elders. Rejection of sip-feeds in hospitalized elders may relate more to loss of appetite than to the taste preference for sip-feeds, and that eating alone rather than in groups of familiar others is likely to compound eating problems.

Predicting adherence to eye patching in children with amblyopia: an application of protection motivation theory.

Abstract: Objectives: This study reports an application of protection motivation theory (PMT) to the prediction of parental adherence to eye patching recommendations for children with amblyopia over a 2-month period. The study also considered the role of past behaviour in PMT. Design and methods: A total of 151 parents of children with amblyopia who were attending follow-up appointments for orthoptic treatment participated. They completed questionnaires based on PMT to assess their beliefs about amblyopia and eye patching. Of the parents, 105 were contacted again at 2-month follow-up to obtain a measure of adherence to the recommended treatment for their child. Results: PMT was found to be predictive of adherence intentions and behaviour at 2-month follow-up. Regression analyses revealed perceived vulnerability, response efficacy and self-efficacy to be significant predictors of protection motivation, whereas perceived vulnerability and response costs were significant predictors of adherence behaviour. Past adherence behaviour was found to have a direct effect on future adherence behaviour over and above the influence of PMT. Conclusions: The results are discussed in relation to the sufficiency of PMTas a model of adherence behaviour. The practical implications for attempts to increase adherence to eye patching among children with amblyopia are outlined.

Selective processing of threat-related cues in day surgery patients and prediction of post-operative pain.

Abstract: Objective: To investigate the use of a measure of selective processing bias associated with anxiety as a predictor of post-operative pain independently of self-report measures of anxiety. Methods: Forty-seven women admitted for minor gynaecological surgical procedures completed a selective processing task (modified Stroop) and the State-Trait Anxiety Inventory immediately prior to surgery. Following surgery they completed the McGill Short-Form Pain Questionnaire. Intraoperative analgesia consumption was also recorded. Results: Participants demonstrated significantly slower colour-naming times for physical threat cues than control cues. This was not due to an emotionality effect, as colour-naming times for neutral and positive cues were not significantly different. This bias was congruent with the participants’ current concerns, as colour-naming times were significantly slower for physical threat words than for social threat words. This index of selective processing bias significantly predicted post-operative pain independently of self-reported state and trait anxiety. Conclusions: The advantages of measures of psychological constructs that are not reliant on self-reporting are discussed.

Exercise behaviour change in 40 to 65-year-old women: The SWEAT Study (Sedentary Women Exercise Adherence Trial)

Abstract: Objective: The purpose of this study was to examine the relation between self-reported psychological processes and changes in exercise behaviour in an 18-month longitudinal stage-based intervention trial in 115 initially sedentary women aged 40-65 years. Design: A two-way factorial design was used. Methods: Participants were assigned randomly to either moderate or vigorous and either home or centre-based exercise. After six months, all participants exercised at home. Participants completed questionnaires at baseline, six, 12 and 18 months which assessed stage of exercise behaviour, self-efficacy, decisional balance and processes of change. Results: 28 patterns of stage change were identified across the 18 months with 6.1% remaining sedentary and 45% demonstrating linear movement from contemplation to action to maintenance to continued maintenance. Two interpretable clusters were identified within both the contemplation (at baseline) and action (at six months) stages. Cluster membership, however, did not influence behaviour change. For participants demonstrating a linear pattern of change, self-efficacy for overcoming barriers and behavioural processes increased from contemplation to action. Self-efficacy for exercise competence increased from contemplation to action but was more pronounced for the vigorous exercise groups. Decisional balance showed a three-way interaction and there was no change for experimental processes. There was no change in any variable from action to maintenance. Conclusions: The intervention was seen to be effective regardless of location or intensity of exercise. The relevance of substages is questionable in stage-based interventions as women with a profile suggesting less readiness to change or sustain change were just as likely to adopt or maintain exercise.

Abnormal illness behaviour and locus of control in patients with functional bowel disorders.

Abstract: Objectives: Psychosocial factors have been examined in functional bowel disorders (FBD), including irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC). Abnormal illness behaviour (AIB) has been investigated in IBS patients as evidence of underlying psychological distress and as influencing health-care-seeking behaviour. Health locus of control may also contribute to health-care-seeking behaviour, as possession of an external locus of control places responsibility for health status onto professionals. Thus, external locus of control may also be more prominent in FBD patients. This study examined whether FBD patients displayed more AIB and an external health locus of control compared with organic disease and non-patient controls. Design: A cross-sectional comparison group design was employed. Method: Fifty-three CIC patients were compared with matched control groups of 50 IBS patients, 51 Crohn's disease patients and 53 non-patient participants. Questionnaire measures included the Illness Behaviour Questionnaire, the Multi-dimensional Health Locus of Control, the GHQ, and the SCL-90R. Results: FBD patients did not differ from Crohn's disease patients on measures of AIB, but all three patient groups differed from non-patient participants. Crohn's disease patients possessed a higher external locus of control compared with FBD patients and non-patient controls. There was a general association between AIB and psychopathology. Conclusions: FBD patients did not report more AIB or a higher external locus of control regarding their health status, compared with organic disease controls, but did differ from non-patients. The presentation of AIB was related to increased psychopathology, suggesting that AIB may be related to psychological distress, irrespective of patient status.

Emotion-related primary and secondary appraisals, adjustment and coping: associations in women awaiting breast disease diagnosis

Abstract: Objective: Different emotions are to some extent associated with different ways of coping. Cognitive processes involved in determining emotional reactions may influence coping (perhaps through directing attention or generating salient information). This study explored possible appraisal-coping associations by examining whether a set of appraisal components identified in emotion theory were also associated with coping. Design: The study examined concurrent associations between appraisal components, emotional adjustment, and coping in 148 women with suspected breast disease. Method: Questionnaire measures of primary and secondary appraisal components identified in emotion theory, anxiety, depression, and coping were sent to women during the waiting period between GP referral and attendance at a ‘one-stop’ breast-disease diagnosis clinic. Results: Consistent with expectations, appraisal components were associated with both emotions and coping. Elevated anxiety was associated with appraisals of low emotion-focused coping potential; avoidance coping was associated with motivational incongruence, self-accountability, and pessimistic appraisal of emotion-focused coping potential; acceptance/resignation coping was associated with self-accountability and pessimistic appraisals of both future expectancy and emotion-focused coping potential. Conclusion: This study presents a theoretically driven approach to exploring associations between emotions and adjustment efforts. In keeping with expectations, a number of appraisal components identified in emotion theory were found to be associated with both emotion and coping.