Maladaptive schemas of patients with functional neurological symptom disorder

BACKGROUND

The psychological underpinnings of functional neurological symptom disorders (FNSD) remain poorly understood. A disintegration of explicit and implicit information processing in patients with FNSD has previously been suggested; however, this suggestion has so far received little empirical support. Trauma and maladaptive schemas probably reinforce disintegration in FNSD. The present study explored the occurrence of maladaptive schemas and investigated the impact of trauma-related maladaptive schemas in patients with FNSD.

METHODS

Forty-eight FNSD patients were assessed at the start of treatment using the Young Schema Questionnaire (YSQ-2) to explore maladaptive schemas. The Life Event Checklist (LEC-5) and the PTSD Checklist for DSM-5 (PCL-5) were used to explore trauma states, and the Sickness Impact Profile (SIP-68) was used to measure health dysfunction.

RESULTS

The self-sacrifice schema scored within a clinically relevant range where no increased scores were found in other maladaptive schemas. Linear regression models showed a positive association between mistrust/abuse and severity of health dysfunction.

DISCUSSION

Results suggest that maladaptive schemas play a modest role in FNSD at the start of treatment. It is suggested to examine the occurrence of maladaptive schemas in FNS-disordered patients with a longitudinal design.

Coping with amplified emotionality among people with bipolar disorder: A longitudinal study

BACKGROUND

The amplified emotionality characteristics of bipolar disorder (BD) may interfere with goal pursuit in the recovery process. This is the first study to test the coping flexibility model empirically among people with BD. Finding ways to cope with goal-striving life events should shed light on managing elevated mood states.

METHODS

Using a 12-month longitudinal follow-up design, this study examined the stability in coping flexibility with experimentally-devised Behavioral Approach System (BAS) activating life events and mood states at 6- and 12-month time points for individuals with BD (n = 83) and healthy controls (n = 89). Hierarchical linear modeling tested the individual growth model by studying the longitudinal data.

RESULTS

The findings showed fluctuations in different components of coping flexibility and mood states across time. They confirmed the amplified emotionality characteristics of BD. Moreover, coping flexibility took precedence over BAS sensitivity and psychosocial functioning levels in predicting mood states.

LIMITATIONS

Measurements of BAS sensitivity may focus on trait nature only and prone to subjective bias. The assessment of mood or coping flexibility may not accurately capture actual experience in daily life. Lack of respective data on bipolar subtypes and significant differences in some dimensions between the BD and control groups are further limitations of the study.

CONCLUSIONS

The study's findings have implications for coping with amplified emotionality within the personal recovery process for people with BD. Judicious application of coping strategies and adjustment of perceived controllability are crucial for individuals to reach goals pertinent to personal recovery and manage potential manic mood symptoms.

Is the effect of coping styles disease specific? Relationships with emotional distress and quality of life in acquired brain injury and multiple sclerosis

OBJECTIVE

To investigate the use of coping styles and the relationships linking coping to emotional distress and quality of life in patients with acquired brain injury and multiple sclerosis.

METHOD

Cross-sectional cohort study of 143 patients with acquired brain injury and 310 patients with multiple sclerosis in the chronic stage. Quality of life was measured with the Life Satisfaction Questionnaire (LiSat-9), coping styles with the Coping Inventory for Stressful Situations (CISS-T, task-oriented; CISS-E, emotion-oriented; CISS-A, avoidance), emotional distress with the Hospital Anxiety and Depression Scale (HADS).

RESULTS

Coping styles did not differ between types of multiple sclerosis and varied only little with regard to severity of disease. In both patient groups, task-oriented coping was most used followed by avoidance and emotion-oriented coping. Patients with multiple sclerosis used all styles to a greater extent. In acquired brain injury, lower CISS-E and lower HADS scores were associated with higher LiSat-9 scores. CISS-E had a direct effect on LiSat-9 and an indirect effect via HADS. In multiple sclerosis, next to lower CISS-E and lower HADS scores, higher CISS-A scores were also associated with higher LiSat-9 scores. CISS-E had an indirect effect and CISS-A had a direct and indirect effect on LiSat-9.

CONCLUSION

In both patient groups, coping patterns are similar, and emotion-oriented coping negatively influences quality of life. Additionally, in multiple sclerosis, seeking emotional support and distraction (CISS-A) was positively associated with quality of life. Interventions to improve adaptive coping could be organized within a neurorehabilitation setting for both patient groups together.

Physical and mental health 10 years after multiple trauma: A prospective cohort study

BACKGROUND

People who have sustained severe multiple injuries have reduced health and functioning years after the injury. For people who have sustained severe injuries, an optimal degree of predictability in future functioning and health-related quality of life is important. The main aim was to study the impacts of demographic- and injury-related factors as well as functioning at 1 year and 2 years after injury on physical and mental health 10 years after injury.

METHODS

Fifty-eight participants completed a 10-year follow-up (55.2% of all included patients). Demographic and injury severity characteristics were collected, and assessments at 1, 2, 5, and 10 years after injury were performed. Patient-reported outcome measures were the Short Form 36 (SF-36), the Brief Approach/Avoidance Coping Questionnaire, and the cognitive function scale (COG). The SF-36 Physical and Mental Component Summaries (PCS and MCS, respectively) were the main outcome variables. We performed hierarchical multiple regression analyses to assess functioning on the PCS and MCS.

RESULTS

Mean (SD) age at injury was 37.8 (14.7) years, 74% were male. Mean (SD) New Injury Severity Score (NISS) was 33.7 (13.0). Mean (SD) PCS score was 41.8 (11.7). Mean (SD) MCS was 48.8 (10.7). Predictors of the PCS were change in coping from 2 years to 10 years (p = 0.032), physical functioning (p < 0.001) and cognitive functioning at 1 year (p = 0.011), as well as bodily pain at 2 years (p = 0.005). Adjusted R was 0.57. Predictors of the MCS were change in coping (p = 0.031), vitality (p = 0.008) at 1 year, as well as social functioning (p = 0.034) and mental health (p = 0.043) at 2 years. Adjusted R was 0.64.

CONCLUSION

Physical health was reduced compared with the adjusted general population at 10 years after injury. The mental health did not differ from that of the general population. In addition to physical functioning, coping strategies, vitality, social functioning, and mental health should be considered in the long-term rehabilitation perspective. A more comprehensive approach should be used for rehabilitation after multiple injuries.

Stress and coping in parents of children with Prader-Willi syndrome: Assessment of the impact of a structured plan of care

Hyperphagia, developmental delays, and maladaptive behaviors are common in Prader-Willi syndrome (PWS) likely resulting in heightened parental stress. Objectives were to evaluate stress, describe usefulness of coping behaviors, and assess the impact of a structured Plan of Care (PC) on parents with children with PWS. Parents answered Perceived Stress Scale (PSS-14), Coping Health Inventory for Parents (CHIP), and narrative/demographic surveys. The PC was introduced to a cohort of parents after completion of the PSS-14 and CHIP and re-administered 4-6 month after the introduction of the PC. Higher parental stress (n = 57) was observed compared to the general population, and associated with parent's age, number of children living at home, and child's age and residential setting. "Maintaining family integration, cooperation, and an optimistic definition of the situation" was the most useful coping pattern. Thirty-eight parents answered the PSS-14 and CHIP after the PC. Parental stress decreased after the PC (P = 0.035). Coping behaviors related to "maintaining family integration" increased after the PC (P = 0.042). Women and men preferred different coping patterns before and after the PC. In conclusion, parental stress is increased in PWS, and a PC decreased stress and increased coping behaviors related to family stability for parents with children with PWS.

Assessments of coping after acquired brain injury: a systematic review of instrument conceptualization, feasibility, and psychometric properties

OBJECTIVE

To identify measures of coping styles used by patients with acquired brain injury; to evaluate the conceptualization, feasibility, and psychometric properties of the instruments; and to provide guidance for researchers and clinicians in the choice of a suitable instrument.

DESIGN

Systematic review.

RESULTS

The search identified 47 instruments, of which 14 were selected. The instruments focused on dispositional coping, situation-specific coping, or domain-specific coping. Psychometric properties were scarcely investigated. The COPE stood out in terms of psychometric properties but had low feasibility. The brief COPE, Coping Scale for Adults-short form, and Utrecht Coping List stood out in terms of feasibility, and the available psychometric properties of these instruments were good. Only the Coping With Health Injuries and Problems was used as other report.

CONCLUSION

Information on psychometric properties of coping instruments in acquired brain injury is scarcely available and limits the strength of our recommendations. For patients with mild injuries, we cautiously recommend the COPE and for patients with more severe injuries the brief COPE, Coping Scale for Adults-short form, Utrecht Coping List, and Coping With Health Injuries and Problems-other-report. Other instruments may be used to address particular issues such as coping with a specific stressful situation or illness.

The Influence of Mood on the Relation between Proactive Coping and Rehabilitation Outcomes

Cette étude a examiné un échantillon de 228 personnes âgées en réhabilitation après chirurgie pour remplacement d’une articulation; elle a porté sur la relation entre une adaptation proactive, l’humeur et les résultats psychologiques et fonctionnels. Faire face proactivement c’est une façon de réagir qui est axée sur les objectifs et nécessite qu’on affront les facteurs qui incitent le stress comme un défi plutôt qu’une menace. Selon notre hypothèse, les personnes âgées qui adoptent des stratégies proactives d’adaptation subiraient une amélioration du fonctionnement physique et psychologique apres la réadaptation et connaîtraient une humeur positive. Le modèle proposé a trouvé du support, par lequel une expérience de vigueur a été trouvé à la médiation de l’effet d’une adaptation proactive sur les résultats. Les implications théoriques et pratiques des résultats de recherche sont discutées dans le contexte des interventions qui encourageraient les personnes âgées à faire face proactivement.

Attachment Style, Social Support, and Coping as Psychosocial Correlates of Happiness in Persons With Spinal Cord Injuries

Objective: To examine the roles of attachment, social support, and coping as psychosocial correlates in predicting happiness in people with spinal cord injuries.

Design: Quantitative descriptive research design using multiple regression and correlation techniques.

Participants: 274 individuals with spinal cord injuries.

Outcome Measures: Happiness as measured by the Subjective Happiness Scale.

Results: Functional disability and psychosocial correlates including coping, attachment styles, and social support were found to be associated with happiness scores. Functional disability was found to have a large negative effect on happiness and the effect was significantly reduced after taking into consideration the effect of positive psychology factors.

Conclusion: Positive psychology variables are important for happiness and subjective well-being, and happiness in turn is related to better quality of life. The negative relationship between functional disability and happiness can be mediated by attachment, social support, and coping. Rehabilitation professionals should deemphasize negative characteristics related to poor psychological adjustment and focus on positive human traits and positive psychology interventions for people with disabilities.

Mental health and posttraumatic stress symptoms 2 years after severe multiple trauma: self-reported disability and psychosocial functioning

OBJECTIVES

To describe mental health and posttraumatic stress symptoms (PTSS) for patients with severe multiple trauma at 2 years postinjury. Further, objectives were to examine relationships between PTSS and factors related to the person, injury, and postinjury physical and psychosocial functioning from the time of return home to 2 years after injury. The final aim was to identify predictors of PTSS and mental health at 2 years.

DESIGN

Prospective cohort study with a 2-year follow-up.

SETTING

Hospital and community setting.

PARTICIPANTS

Patients (N=99) age 18 to 67 years with multiple trauma and a New Injury Severity Score (NISS) greater than 15 treated at a regional trauma referral center. Mean age +/- SD was 35.3+/-14.2 years; 83% were men. Mean NISS +/- SD was 34.9+/-12.7.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Postinjury psychologic distress associated with depression on the Medical Outcomes Study 36-Item Short-Form Health Survey Mental Health scale and PTSS on the Post-Traumatic Symptom Scale 10 (PTSS-10) at 2 years post injury. Self-reported physical, mental, and cognitive functioning at the return home and 1 and 2 years, and coping strategies.

RESULTS

Mean PTSS-10 score +/- SD at 2 years was 25.6+/-12.2. Twenty percent had a PTSS-High score, indicating posttraumatic stress disorder (PTSD). Twenty-seven percent had Mental Health scores indicating depression. Predictors of PTSS were sex (female), younger age, avoidant coping, pain, mental health, and cognitive functioning on the return home, which explained 70% of the variance in PTSS-10 score.

CONCLUSIONS

Twenty percent had a PTSS-High score indicating PTSD at 2 years postinjury. The personal factors sex (female), younger age, and avoidant coping and the functional factors pain, mental health, and cognitive functioning predicted PTSS at 2 years.

Adaptation after facial surgery: using the diary as a research tool

We conducted a small-scale qualitative diary study to gather accounts from five facial cancer surgery patients. Participants were asked to record their experiences, thoughts, and feelings for up to 1 year, as they underwent and recovered from their surgery and adapted to living with alterations in their appearance. In this article, we consider evidence relating to the diary as a research tool and discuss our experiences of issues arising with the qualitative diary method employed in this study.These include comparability with interview data, factors affecting the quantity and quality of data (novelty, personal significance, and individual writing styles), chronological storytelling, and barriers to writing (visual difficulties and depression).

Ways of Coping and Perceived Stress in Women with Spinal Cord Injury

Using a cross-sectional design, this research aimed to assess whether a three-factor model of Positive Reappraisal, Escape-Avoidance, and Seeking Social Support based on the Ways of Coping Questionnaire (WOCQ) appropriately depicts coping within a sample of women with spinal cord injury (SCI). Forty-four community-dwelling women with spinal cord injury were interviewed from two urban rehabilitation facilities in the Midwestern United States. The main outcome measures used were the Perceived Stress Scale (PSS) and the WOCQ. The Positive Reappraisal, Escape-Avoidance, and Seeking Social Support scales of the WOCQ significantly accounted for variance in perceived stress. These three scales appear to be most relevant to perceived stress in women with SCI. Implications for coping research in this population are discussed.

Role of psychological factors in studying recovery from a transactional stress-coping approach: implications for mental health nursing practices

Over the last decade, the experience of recovering from psychiatric disabilities has received increased attention in mental health nursing. Recovery is a complex experience that can be understood in terms of construct, process, and outcomes. New theoretical frameworks are needed to better understand antecedents, process variables, and outcomes related to recovery. Considering that recovery is a stressful and challenging experience, the transactional stress-coping theory appears relevant to explore the appraisal and coping processes involved in recovery. Based on this theory, a new framework has been built to better understand the phenomenon of stress in recovery. More specifically, a review of the recovery literature had led to the identification of several key recovery concepts, which were then linked to major stress-coping concepts, namely contextual factors, potential stressors, primary and secondary appraisals, coping strategies, and short-term and long-term outcomes. This paper focuses on specific types of personal characteristics that are included in the broad category of contextual factors, namely psychological factors. These factors may act as coping resources, helping people to deal successfully with events interfering with the achievement of recovery goals. The main purpose of this paper is to offer a detailed discussion about how mental health nursing practices may promote the role of psychological factors within the stress-coping process. Three categories of psychological factors are discussed: views about oneself, psychological empowerment, and personal/philosophical orientations in life. A brief summary of the new framework is first offered to introduce its major concepts and basic mechanisms.

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

OBJECTIVE

Examined cognitive appraisals of interference and tolerance in the prediction of distress and self-reported disability among persons presenting for low vision rehabilitation.

DESIGN

Cross-sectional; correlational and path analyses.

METHODS

One-hundred and thirteen patients (mean age, 71 years; 52 men and 61 women) presenting for low vision rehabilitation at a university-based centre for low vision rehabilitation participated in an initial clinical vision examination and completed several questionnaires to evaluate cognitive appraisals, emotional distress and self-reported disability.

RESULTS

Path analyses indicated that greater tolerance was associated with less interference imposed by vision loss. Greater tolerance was also associated with less emotional distress and symptom severity (visual acuity) was associated with self-reported disability. Cognitive appraisals (tolerance and interference) indirectly influenced self-reported disability through emotional distress.

CONCLUSIONS

The data indicate that appraisals of personal ability to tolerate vision loss and the perceived interference of vision loss on goal-directed behaviour and expected activities have greater influence on distress and are subsequently predictive of disability in comparison with objective symptoms (visual acuity). Implications for clinical interventions and further research are discussed.

Coping and Emotional Adjustment Following Traumatic Brain Injury

OBJECTIVES

To examine the association between coping style and emotional adjustment following traumatic brain injury.

PARTICIPANTS

Thirty three individuals who had sustained a traumatic brain injury (mean duration of posttraumatic amnesia = 32 days) between 1(1/2) months and almost 7 years previously.

MEASURES

Coping Scale for Adults, Hospital Anxiety and Depression Scale, Rosenberg Self-Esteem Scale, State-Trait Anger Expression Inventory, and the Sickness Impact Profile.

RESULTS

Approximately 50% of the sample reported clinically significant levels of anxiety and depression. Coping characterized by avoidance, worry, wishful thinking, self-blame, and using drugs and alcohol was associated with higher levels of anxiety, depression, and psychosocial dysfunction and lower levels of self-esteem. Coping characterized by actively working on the problem and using humor and enjoyable activities to manage stress was associated with higher self-esteem. Lower premorbid intelligence (measured via the National Adult Reading Test) and greater self-awareness (measured via the Self-Awareness of Deficits Interview) were associated with an increased rate of maladaptive coping.

CONCLUSIONS

The strong association between the style of coping used to manage stress and emotional adjustment suggests the possibility that emotional adjustment might be improved by the facilitation of more adaptive coping styles. It is also possible that improving emotional adjustment may increase adaptive coping. The development and evaluation of interventions aimed at facilitating adaptive coping and decreasing emotional distress represent important and potentially fruitful contributions to enhancing long-term outcome following brain injury.

Positive coping and mastery in a rehabilitation setting

The objective of this study was to examine the predictive value of positive coping in relation to behavioral outcomes. Positive coping focuses on goal setting and preparative behavior in response to distress. The participants were 228 in-patients in a rehabilitation hospital following joint replacement. The average age of participants was 67.3 years old, 71% were women and two-thirds were married. Sixty percent had a hip replacement and 40% had a knee replacement. The study was designed so that at Time 1, two scales were used: the proactive coping subscale of the Proactive Coping Inventory and the Getting on with Life scale. Proactive coping measures future-oriented planning and goal-setting strategies that an individual develops when confronting stress. Getting on with Life assesses feelings about resuming activities and social relationships that give one day-to-day pleasure. At Time 2, behavioral outcomes were assessed using the 2-Minute Walk (2 MW) Test and a functional independence measure. In the 2 MW Test, participants were instructed to walk at a comfortable pace and the distance walked in 2 min was measured in meters. The functional independence measure was based on average ratings of participants' independence behavior by trained hospital personnel in different areas. Results indicated that proactive coping and Getting on with Life were significantly related to behavioral outcomes. In conclusion, the results illustrate the value of positive coping in a rehabilitation setting.

Internet Breast Health Information Use and Coping among Women with Breast Cancer

The objective of this work was to study, among breast cancer patients, if Internet health information use is associated with coping. Questionnaires were completed (n = 178) regarding Internet use and also coping as measured by the Brief Cope. MANOVA analyses were conducted for the 14 coping subscales. Following a significant MANOVA omnibus test, univariate ANOVA and multivariate ANCOVA analyses adjusting for covariates were performed. Univariate ANOVA showed acceptance, active coping, self-blame, and denial coping associated with Internet use but these results were not maintained in the multivariate ANCOVA models. Internet health information use is not associated with psychological coping in breast cancer patients.