Cognitive appraisals of rheumatoid arthritis.
Item
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Title
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Cognitive appraisals of rheumatoid arthritis.
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Identifier
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AAI9009779
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identifier
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9009779
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Creator
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Schiaffino, Kathleen M.
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Contributor
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Advisers: Suzanne Ouellette Kobasa | Tracey A. Revenson
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Date
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1989
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Language
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English
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Publisher
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City University of New York.
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Subject
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Psychology, Social | Psychology, Personality
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Abstract
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This longitudinal study examines cognitive appraisals in adaptation to chronic illness in 101 recently diagnosed rheumatoid arthritis (RA) patients. Three theoretical models were compared, self-efficacy, learned helplessness, and stress and coping. Components of these three models were also considered within the broader framework of the cognitive representation of illness model. Data were collected a two points using a structured format. Primary and secondary appraisals, self-efficacy beliefs, and causal attributions of diagnosis were assessed initially. One year later they were assessed with reference to a symptom flare, as were illness representations. Coping behavior, functional disability, depression and helplessness were assessed, as outcome variables, at both times.;Self-efficacy was consistently related to less helplessness and disability. This was true for diagnosis and flare, concurrently and over time, independent of level of pain. However, at high pain self-efficacy was related to higher depression a year later, suggesting that the benefits of self-efficacy deteriorate in the face of greater pain.;As predicted by the learned helplessness paradigm, internal, global, stable attributions were associated with greater depression, but only at high levels of pain or when the RA was seen as uncontrollable. However, the internal-external component alone was not related to outcomes. The importance of reporting component scores was thus noted.;For the stress and coping model, threat appraisals re: diagnosis were associated with less concurrent disability and reduced helplessness one year later, whereas threat appraisals of flare were related to greater depression. Change and challenge flare appraisals were associated with less helplessness and disability.;Relationships between appraisals of diagnosis and coping were weak. Conversely, flare appraisals were related to problem-solving coping, suggesting that people arrive at a plan of action regardless of appraisals.;The cognitive representations of illness model added two constructs--illness label and illness controllability. Ascribing to a label of RA as serious, painful, and disabling was associated with higher concurrent depression when pain was high. Belief in the controllability of RA was associated with lower helplessness. The implications of these findings for intervention and research are discussed.
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Type
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dissertation
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Source
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PQT Legacy CUNY.xlsx
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degree
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Ph.D.
