روابط بین پاسخ های مقابله ای و خوش بینی، بدبینی در پیش بینی پریشانی روانی پیش بینانه در بیماران مبتلا به سرطان پستان جراحی شده
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|38217||2006||11 صفحه PDF||سفارش دهید||محاسبه نشده|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Personality and Individual Differences, Volume 40, Issue 2, January 2006, Pages 203–213
Abstract Individual differences in characteristics such as optimism, pessimism, and coping responses have been shown to contribute to variability in distress during stressful situations. However, the interrelationships among these characteristics are not well established. The purpose of this study was to investigate the interrelations among optimism, pessimism, and coping in predicting distress levels among patients scheduled for surgery related to breast cancer. Sixty surgical patients (mean age = 52; SD = 12.21) completed the Brief Cope and the Life Orientation Test as a part of a presurgery take-home packet. Distress was measured with the Profile of Mood States in the waiting area, just prior to surgery. Results revealed that optimism and pessimism were directly related to distress levels prior to surgery (p < 0.05). Coping responses also were related to distress (p < 0.05); however, these effects appeared to be largely mediated by optimism and pessimism
. Introduction Optimism and pessimism are important psychological constructs, which can predict how individuals react to stressful events. Optimism is typically defined as the degree to which an individual generally expects positive experiences in the future, while pessimism denotes the degree to which an individual generally expects negative experiences (Scheier & Carver, 1985). Existing literature has indicated that individual differences in characteristics such as optimism and pessimism contribute to variability in levels of emotional distress in stressful situations (e.g., Chang, 2001, Scheier and Carver, 1985 and Scheier and Carver, 1992). For example, Scheier, Matthews, and Owens (1989) found that patients’ levels of optimism inversely predicted their levels of distress before surgery, above and beyond the effects of relevant medical variables. In addition to optimistic and pessimistic tendencies, there is also a long-standing view that the ways in which individuals cope make a difference in how strongly they react to various stressors (e.g., Carver, 1997 and Folkman and Lazarus, 1988). Differences in coping responses have been associated with variability in emotional responses to a wide variety of stressful events, with some forms of coping (e.g., planful-problem solving) generally associated with less distress and other forms of coping (e.g., distancing) generally associated with higher levels of distress (Folkman & Lazarus, 1988). Although optimism and pessimism, as well as coping responses, have been found to predict variability in psychological responses (e.g., distress) to stressful situations, less is known about their interrelations (Gilham et al., 2001 and Scheier et al., 2001). One line of research (e.g., Billingsley et al., 1993, Carver et al., 1989 and Scheier et al., 1986) has investigated the possibility that coping responses mediate the effects of optimism and pessimism on distress. Consistent with that possibility, differences in the types of coping responses typically used by “optimists” and “pessimists” have been found in a number of studies (see for review, Taylor & Aspinwall, 1996). Optimism, for example, has been found to be positively related to the use of problem-solving coping, positive reframing, and tendency to accept reality (Carver et al., 1989 and Scheier et al., 1986). Optimism has also been found to be negatively related to the use of denial and the attempt to distance oneself from the problem (Scheier et al., 1986). Pessimism has been reported to be associated with the use of overt denial, substance abuse and coping responses that lessen awareness of the problem (Billingsley et al., 1993). Overall, more optimistic individuals generally seem to be active “copers” while more pessimistic individuals seem to be avoidant copers (Taylor & Aspinwall, 1996). Viewed in this way, coping can be conceptualized as a mediator of the effects of optimism and pessimism on distress levels in stressful situations. However, support for the mediational role of coping is not universal. Recent studies have demonstrated that optimism and pessimism can have associations with outcomes that are independent of coping responses (i.e., not mediated by coping) (Lobel et al., 2002 and Tomakowsky et al., 2001). For example, in a group of healthy women with high-risk pregnancies, Lobel et al. (2002) found that optimism had an independent association with emotional distress beyond relations potentially accounted for by coping responses. Similarly, Tomakowsky et al. (2001) found that optimism was related to better subjective health in HIV-infected men and that this relationship was not mediated by coping responses. These results challenge the idea that the impact of optimism and pessimism on various outcomes is necessarily mediated by coping responses. Indeed there is some support for the reverse possibility. Optimism and pessimism seem to be related to secondary appraisal processes (e.g., Chang, 1998) and thus might mediate the effects of coping on distress, consistent with Appraisal Theory (Lazarus, 1991). The purpose of the present study was to investigate the interrelations among optimism, pessimism, and coping in predicting distress levels among patients scheduled for surgery related to breast cancer. In the United States of America, more than 150,000 women undergo lumpectomy and mastectomy for breast cancer each year, and hundreds of thousands more undergo similar surgical procedures (i.e., excisional biopsy) for definitive diagnosis. Research with patients awaiting breast surgery for treatment or diagnosis of breast cancer consistently support the time before surgery as a period of heightened distress (Carver et al., 1993, Montgomery et al., 2002 and Northhouse et al., 1997). Generally, higher levels of distress have been associated with poorer postoperative outcomes in various surgical patient samples (Scott et al., 1983 and Urrutia, 1975). The presurgical period thus offers a unique opportunity to investigate the impact of relations between optimism, pessimism, and coping in predicting distress. Few studies have investigated the relations between these individual differences variables and distress in patients scheduled for surgery, but in those that have, associations with distress have been generally supported (e.g., Epping-Jordan, Compas, & Osowiecki, 1999). However, a search of the literature revealed only one study that directly tested mediational hypotheses involving optimism, pessimism, coping, and presurgical distress in breast cancer patients. In that study, Carver et al. (1993) using a total score from the Life Orientation Test (LOT) found that several coping responses mediated the effects of optimism on presurgery distress. Specifically, they reported that acceptance and denial mediated the effects of optimism on presurgical distress among these women. However, the implications of this study are limited for at least three reasons: (1) LOT, which includes separate subscales for optimism and pessimism was treated as a unitary scale; although Carver et al., had explored the two subscale their results were not published. More recent studies have supported the view that optimism and pessimism are two distinct psychological constructs (Chang et al., 1994 and Chang et al., 1997); (2) The measure of distress used was based on an abbreviated distress scale rather than on a well-established scale with demonstrated psychometric properties. Thus, the results potentially may be unreliable to the extent that there was measurement error; and (3) Coping responses were evaluated using only two or three selected items for each, and this measure of coping was not validated. Again, such an approach may have introduced additional unreliability into the results. In sum, the interesting findings in the single limited study addressing these relations in breast surgical patients (Carver et al., 1993) suggest the importance of further empirical investigation. The present prospective study had three specific goals: (1) to examine the effects of optimism and pessimism on presurgical distress levels in women scheduled for surgery relating to breast cancer; (2) to examine the effects of specific coping responses on presurgical distress levels in this population; and (3) to investigate the mediational pathways by which optimism, pessimism, and coping as contributers to variability in patients’ presurgical distress levels. That is, based on the literature, coping may account for effects of optimism and pessimism on distress, or optimism and pessimism may account for effects of coping on distress. Results of the present study might have both theoretical and practical implications. From a theoretical perspective, the results may add to the basic understanding of the interrelationships among optimism, pessimism, and coping in accounting for distress levels in stressful situations. From a practical perspective, the present study might provide insight relevant for the development of targeted interventions to reduce distress in patients awaiting surgery.
نتیجه گیری انگلیسی
3. Results No significant differences between excisional biopsy and lumpectomy patients on optimism, pessimism, coping responses and distress (all p’s > 0.05) were revealed. Therefore, these groups were combined in the analyses. Bivariate correlations between optimism, pessimism, coping responses, and distress (POMS-SV) are presented in Table 1. Table 1. The relevant correlations among measures of: (1) coping responses (B-COPE); (2) optimism and pessimism; and (3) psychological distress (POMS-SV) POMS-SV Optimism Pessimism BRIEF COPE Venting 0.52⁎ −0.24 0.40⁎ Self-blame 0.36⁎ −0.17 0.10 Instrumental support 0.34⁎ −0.27⁎ 0.25⁎ Self-distraction 0.31⁎ −0.26⁎ 0.36⁎ Emotional suppression 0.27⁎ −0.14 0.10 Denial 0.27⁎ −0.20 0.50⁎ Planning 0.26⁎ −0.16 0.25⁎ Humor 0.25 −0.15 0.21 Active 0.23 −0.12 0.32⁎ Substance abuse 0.23 −0.21 0.17 Positive reframing 0.20 0.07 0.37⁎ Acceptance −0.14 0.04 0.007 Behavioral disengagement 0.13 −0.14 0.30⁎ Religion 0.10 0.15 0.26⁎ LOT Pessimism 0.35⁎ −0.49⁎ Optimism −0.46⁎ All other results are not statistically significant. N = 60 in all cases. ⁎ p < 0.05. Table options We found that both optimism and pessimism correlated with distress (POMS-SV) (p’s < 0.05). Higher optimism scores were associated with less distress before surgery, while higher pessimism scores were associated with greater distress before surgery. As seen in Table 1, seven of the 14 coping responses assessed with the B-Cope were significantly related to distress (POMS-SV) (p’s < 0.05) in bivariate analyses. Scores on nine of the 14 coping responses were significantly associated with pessimism levels and two were associated with optimism level (see Table 1). Pessimism was related to planning, positive reframing, denial, self-distraction, instrumental support, active coping, religion, venting, and behavioral disengagement, and optimism was related to self-distraction and instrumental support (p’s < 0.05). For variables showing significant bivariate relations consistent with mediation of effects on distress models describing relations between optimism, pessimism, coping, and distress were evaluated (as shown in Fig. 1). Mediational diagrams for models testing the interrelations among optimism, ... Fig. 1. Mediational diagrams for models testing the interrelations among optimism, pessimism, coping mechanism, and distress. Mediational diagrams are presented according to the “best-fit” of the data. Values presented are standardized parameter estimates. Values above lines reflect bivariate relations; values below lines reflect multivariate relations accounting for other predictors in the regression equation. All relations are significant unless indicated otherwise (NS). Figure options Mediational analyses were consistent with the view (see Fig. 1) that optimism and pessimism completely mediated the effects of coping responses (i.e., planning, denial, self-distraction) on distress, with the lone exception of venting. Also, pessimism partially mediated the impact of instrumental support on distress. These results indicating that the impact of coping is generally mediated by optimism and/or pessimism are not consistent with previous findings of Carver et al. (1993). In the previous study of Carver et al., the reverse was found; the impact of optimism was generally mediated by coping responses (i.e., denial, acceptance). However, we found evidence only for venting as a possible mediator of the effects of pessimism on distress. 3.1. Supplementary analyses As the present mediational models were not consistent with those of Carver et al. (1993), we took the opportunity to reanalyze the present data in a form more consistent with the approach used by Carver et al. (1993). Specifically: (1) the LOT score was recalculated according to the unidimensional model of optimism (scores on the negatively worded items were reversed and summed with scores on the positively worded items); (2) distress was recalculated using only those 11 POMS-SV items used by Carver et al. These analyses supported mediational models that were identical to those found with our original assessment strategy. That is, optimism mediated the relations between coping responses and distress (p < 0.05) with the exception of venting, which maintained a direct relation with distress (p < 0.05).