Cognitive appraisals, distress and disability among persons in low vision rehabilitation

Autor: M. W. Swanson, John W. Berry, J. McNeal Christopher, Donald C. Fletcher, Timothy R. Elliott, Laura E. Dreer
Rok vydání: 2008
Předmět:
Zdroj: British Journal of Health Psychology. 13:449-461
ISSN: 1359-107X
DOI: 10.1348/135910707x209835
Popis: Accumulating evidence indicates that there is considerable variation in the ways persons with visual impairments react and adapt in the wake of vision loss (e.g., Brennan, 2002; Dreer, Elliott, Fletcher, & Swanson, 2005; Schilling & Wahl, 2006; Teitelbaum & Copolillo, 2005). For example, it has been argued that a major loss does not necessarily lead to depression or distress for some (Kleinschmidt, 1999) and yet for others, persistent depression may continue for longer than normally expected (Ciechanowski, Katon, & Russo, 2000). Additional support for the influential role of intrapersonal factors underlying depression associated with vision impairment has also been demonstrated (Tolman, Hill, Kleinschmidt, & Gregg, 2005). In an effort to find explanations for the wide variations in reactions related to adjustment to disability, contemporary models of adjustment and coping have been informative (Dodds, Ferguson, Ng, Flannigan, Hawes, & Yates, 1994; Hayeems, Gellar, Finkelstein, & Faden, 2005). One of the most widely accepted models, the transactional model of stress appraisal and coping, posits that cognitive appraisals of a stressor and coping strategies are important factors that can have an influence on adaptation outcomes (Lazarus & DeLongis, 1983). Individuals presumably appraise a stressful situation for threats to their well-being (primary appraisal) and to assess if their behavior can have an impact on the stressor (secondary appraisal). Thus, the central feature of this model is the subjective, cognitive appraisal of the situation-specific event (rather than an objectively defined stressor, i.e. severity of vision loss) and one’s coping ability; both of which are considered critical to successfully managing a stressful situation (Folkman & Lazarus, 1985; Oliver & Brough, 2002). Thus, from this viewpoint, stress is the culmination of the dynamic interplay between the individual and the environment. Converging evidence indicates that phenomenological appraisals of stress, personal resources, and subjective meaning are predictive of personal adjustment following chronic disease and disability (Elliott & Harkins, 1991; Elliott & Harkins, 1992; Elliott, Kurylo, & Rivera, 2002; Harkins, Elliott, & Wan, 2006). Generally, this work has examined appraisal processes relevant to various health conditions that yield considerable information beyond the concepts of primary and secondary appraisals (Ptacek & Pierce, 2003). Chronic health conditions can disrupt self-regulatory behavior and outcome expectancies, and these disruptions can trigger a variety of affective responses (Orbell, Hagger, Val Brown, & Tidy, 2004; Williamson, 1998). These key findings are consistent with investigations into goal-directed routine behavior that is interrupted or nonrewarded for overlearned responses (Averill, 1982, 1983; Berkowitz, 1989) based on the notion that individuals utilize cognitive schema comprised of expected behaviors, goals, rewards, and reinforcers in ongoing interactions with the environment. Therefore, when events occur that are incongruent with these expectations, a person will automatically appraise the degree to which the event interferes with goal-directed behaviors and previously anticipated outcomes. Individuals appraise the extent to which specific health conditions may interfere with their expected behaviors and goal-directed pursuits. They then appraise the degree to which they may be able to tolerate disruption to expected behaviors and goal-directed pursuits (Elliott & Harkins, 1992; Harkins et al., 2006). Individuals differ, however, in their perceived ability to tolerate disruptions to expected behaviors and goal-directed pursuits imposed by the stress between their personal needs and environmental reinforcers (Dawis & Lofquist, 1984). This may involve efforts to exert control over internal emotional states upon realizing that behavioral control over specific events or symptoms may not be possible (Heckenhausen & Schulz, 1995). Cognitive appraisals have substantial effects on emotional distress associated with a chronic disease, and this association can be stronger than the effects on distress attributable to disease symptom severity (Harkins et al., 2006). However, we do not know the degree to which these cognitive appraisals predict functional disability, as assessed on self-report measures frequently used in clinical research protocols. It is possible that these reports may be directly influenced by the degree to which sight loss interferes with goal-directed pursuits (i.e., interference appraisals), as one’s appraisals may be based in part on the disruptions in daily activities that an individual experiences from the condition. We do not know if the relation of interference to vision related self-reported disability would remain significant once objective-indicators of symptom severity are taken into account. It is also possible that the degree to which an individual can tolerant these disruptions may contribute to the prediction of vision related disability, independent of the variance attributable to perceived interference (e.g., Harkins et al., 2006). The application of these concepts related to the transactional model of adjustment have recently gained increasing attention in the vision literature (Boerner, Reinhardt, & Horowitz, 2000; Jackson & Taylor, 2000; Ringering & Amaral, 2000). However, in comparison to studies examining coping responses (i.e., Boerner, 2004; Brennan, Horowitz, Reinhardt, Cimarolli, Benn, & Leonard, 2001; Ryan, Anas, Beamer, & Bajorek, 2003), only a few empirical investigations of a person’s appraisal of the condition of vision loss or its concomitants have been documented in the vision literature. For instance, Rovner and Casten (2002) found that the relationship between visual acuity and depression is mediated by the loss of valued, discretionary activities. From our perspective, personal reactions are directly determined by the degree to which vision loss interferes with desired pursuits, and with the degree to which an individual can tolerate these disruptions (Harkins et al., 2006). In the current study, we were interested in further examining the relation of appraisal processes and an objective indicator of symptom severity (i.e., visual acuity) to both vision related self-reported disability and emotional distress reported by persons presenting to low vision rehabilitation services. A significant minority of persons with vision loss experience problems with depression and distress (Casten, Rovner, & Edmonds, 2002; Horowitz & Reinhardt, 2000; Scott, Schein, Feuer, Folstein, & Bandeen-Roche, 2001), and distress is associated with impaired activities of daily living (Heyl & Wahl, 2001; Ryan et al., 2003). We argue that emotional distress associated with vision loss is directly influenced by cognitive appraisals of the loss. In contrast to other studies that have relied upon self-reported measures of the stress, we used an objective index to quantify actual dysfunction (e.g., visual acuity). We hypothesized that reports of greater interference from changes in vision on expected behavior would be significantly predictive of greater emotional distress and vision related self-reported disability, above and beyond objective indicators of vision impairment (e.g., visual acuity). We predicted that distress associated with vision loss would be determined more by subjective, cognitive appraisals than by objective visual impairment severity. Based on previous research (Harkins et al., 2006), we expected that greater tolerance would contribute to the prediction of lower distress; however, we were uncertain if tolerance would be associated with self-reported disability.
Databáze: OpenAIRE
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