Optimism and rehospitalization after coronary artery bypass graft surgery.

OBJECTIVE: To determine whether optimism predicts lower rates of rehospitalization after coronary artery bypass graft surgery for the 6 months after surgery. METHODS: A prospective, inception cohort design was used. The sample consisted of all consenting patients (N=309) from a consecutive series of patients scheduled for elective coronary artery bypass graft surgery at a large, metropolitan hospital in Pittsburgh, Pa. To be eligible, patients could not be scheduled for any other coincidental surgery (eg, valve replacement) and could not be in the cardiac intensive care unit or experiencing angina at the time of the referral. Participants were predominantly men (69.9%) and married (80.3%), and averaged 62.8 years of age. Recruitment occurred between January 1992 and January 1994. RESULTS: Compared with pessimistic persons, optimistic persons were significantly less likely to be rehospitalized for a broad range of aggregated problems (including postsurgical sternal wound infection, angina, myocardial infarction, and the need for another bypass surgery or percutaneous transluminal coronary angioplasty) generally indicative of a poor response to the initial surgery (odds ratio=0.50, 95% confidence interval=0.33- 0.76; P=.001). The effect of optimism was independent of traditional sociodemographic and medical control variables, as well as independent of the effects of self-esteem, depression, and neuroticism. All-cause rehospitalization also tended to be less frequent for optimistic than for pessimistic persons (odds ratio=0.77, 95% confidence interval=0.57-1.05; P=.07). CONCLUSIONS: Optimism predicts a lower rate of rehospitalization after coronary artery bypass graft surgery. Fostering positive expectations may promote better recovery.

Illness representations according to age and effects on health behaviors following coronary artery bypass graft surgery.

OBJECTIVES: To determine if illness representations differ as a function of age and how these representations, in conjunction with age, predict postoperative health behaviors. DESIGN: Prospective study of patients undergoing coronary artery bypass graft (CABG) surgery. SETTING: A large metropolitan hospital providing regional cardiac care for patients in a tri-state area, located in Pittsburgh, Pennsylvania. PARTICIPANTS: All consenting patients (N = 309) from a consecutive series of patients scheduled for CABG surgery between January 1992 and January 1994. To be eligible for participation, patients could not be scheduled for any other coincidental surgery (e.g., valve replacement), and could not be in cardiac intensive care or experiencing angina at the time of the referral. Participants were predominantly male (70%) and married (80%), and averaged 62.8 years of age. MEASUREMENTS: Postoperative self-reported health behaviors. RESULTS: Older participants awaiting CABG surgery were significantly more likely to believe old age to be the cause of their coronary heart disease (CHD) and significantly less likely to believe genetics, health-damaging behaviors, health-protective behaviors, and emotions to be the cause of their CHD than were younger participants awaiting surgery. Furthermore, the older participants were significantly more likely to believe they had no control over the disease and that the disease would be gone after surgery, and reported fewer postoperative health behavior changes than did younger participants. CONCLUSION: These findings demonstrate significant differences in illness representations as a function of age. Furthermore, differences in postoperative health behaviors were consistent with differing illness representations.

Optimism, coping, and health: assessment and implications of generalized outcome expectancies.

This article describes a scale measuring dispositional optimism, defined in terms of generalized outcome expectancies. Two preliminary studies assessed the scale's psychometric properties and its relationships with several other instruments. The scale was then used in a longitudinal study of symptom reporting among a group of undergraduates. Specifically, respondents were asked to complete three questionnaires 4 weeks before the end of a semester. Included in the questionnaire battery was the measure of optimism, a measure of private self-consciousness, and a 39-item physical symptom checklist. Subjects completed the same set of questionnaires again on the last day of class. Consistent with predictions, subjects who initially reported being highly optimistic were subsequently less likely to report being bothered by symptoms (even after correcting for initial symptom-report levels) than were subjects who initially reported being less optimistic. This effect tended to be stronger among persons high in private self-consciousness than among those lower in private self-consciousness. Discussion centers on other health related applications of the optimism scale, and the relationships between our theoretical orientation and several related theories.

Self-focused attention and the experience of emotion: attraction, repulsion, elation, and depression.

Four experiments were conducted to study the effect of self-focused attention on affective reactions. In addition, the research was also intended to help resolve the controversy over attentional versus arousal explanations of self-awareness research. In Experiment 1, undergraduate men were asked to view and rate slides of nude women in the presence of a mirror or with no mirror. In Experiment 3, subjects were either exposed or not exposed to a mirror and read a set of mood statements which became either increasingly positive or increasingly negative. Experiments 2 and 4 conceptually replicated Experiments 1 and 3 by selecting subjects on the basis of private self-consciousness. In each study, self-focused attention increased the person's responsiveness to his transient affective state. The convergence between mirror-manipulated self-awareness and private self-consciousness was offered as support for an attentional interpretation of the findings. The implications of the research for self-awareness theory are discussed.

Situational coping and coping dispositions in a stressful transaction.

After reporting dispositional coping styles, students reported situational coping and 4 classes of affect (from threat, challenge, harm, and benefit appraisals) 2 days before an exam, after the exam but before grades were posted, and after posting of grades. Coping did not predict lower levels of future distress; indeed, some coping seemed to induce feelings of threat. Feelings of harm before the exam induced several kinds of coping after the exam, mostly dysfunctional. Confidence about one's grade was a better predictor of emotions throughout than was coping. Dispositional coping predicted comparable situational coping at low-moderate levels in most cases. Coping dispositions did not reliably predict emotions, however, with these exceptions: Dispositional denial was related to threat, as was dispositional use of social support; dispositional use of alcohol was related to both threat and harm.

Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test.

Research on dispositional optimism as assessed by the Life Orientation Test (Scheier & Carver, 1985) has been challenged on the grounds that effects attributed to optimism are indistinguishable from those of unmeasured third variables, most notably, neuroticism. Data from 4,309 subjects show that associations between optimism and both depression and aspects of coping remain significant even when the effects of neuroticism, as well as the effects of trait anxiety, self-mastery, and self-esteem, are statistically controlled. Thus, the Life Orientation Test does appear to possess adequate predictive and discriminant validity. Examination of the scale on somewhat different grounds, however, does suggest that future applications can benefit from its revision. Thus, we also describe a minor modification to the Life Orientation Test, along with data bearing on the revised scale's psychometric properties.

Coping with stress: divergent strategies of optimists and pessimists.

Previous research has shown that dispositional optimism is a prospective predictor of successful adaptation to stressful encounters. In this research we attempted to identify possible mechanisms underlying these effects by examining how optimists differ from pessimists in the kinds of coping strategies that they use. The results of two separate studies revealed modest but reliable positive correlations between optimism and problem-focused coping, seeking of social support, and emphasizing positive aspects of the stressful situation. Pessimism was associated with denial and distancing (Study 1), with focusing on stressful feelings, and with disengagement from the goal with which the stressor was interfering (Study 2). Study 1 also found a positive association between optimism and acceptance/resignation, but only when the event was construed as uncontrollable. Discussion centers on the implications of these findings for understanding the meaning of people's coping efforts in stressful circumstances.

Attention, unpredictability, and reports of physical symptoms: eliminating the benefits of predictability.

Sometimes unpredictable aversive events have more adverse consequences than predictable aversive events and sometimes not. Three experiments were conducted to test an attentional explanation of the inconsistent effects of unpredictability. This explanation suggests that unpredictable events exert a deleterious influence because more attention is typically directed to them. If there were no difference in the amount of attention directed to unpredictable and predictable events, however, there should be no difference in their effects. The validity of these notions was assessed by applying them to one previously established finding from the unpredictability literature--the finding that exposure to unpredictable noise leads to reports of more severe physical symptoms than does exposure to predictable noise. In Experiment 1, subjects performed a reaction time task while they listened to loud bursts of either predictable or unpredictable noise. As expected, reaction times were slower when the noise was unpredictable than when it was not. This finding suggests that more attention had been directed to the unpredictable than the predictable noise. In Experiments 2 and 3, subjects were exposed to either predictable or unpredictable noise and were either instructed to attend to the noise or given no special instructions. In both cases, subjects not instructed to attend to the noise reported more severe symptoms when the noise was unpredictable than when it was not, thus replicating the previous finding. Of greater interest, however, was the fact that equating the amount of attention directed to the unpredictable and predictable noise (by asking subjects to attend to the noise) eliminated the apparent benefits of predictability. The discussion of the findings centers on their theoretical and practical significance.

Self-directed attention, awareness of bodily states, and suggestibility.

Two studies tested the hypothesis that self-directed attention would cause increased awareness of internal states and would thus reduce suggestibility effects. Experiment 1 applied this reasoning to the experience of an emotion. Males viewed moderately arousing slides of female nudes after being led to expect the slides to be either highly arousing or nonarousing. As predicted, ratings of the slides corresponded less with these experimentally-manipulated anticipations when self-focus was heightened by the presence of a mirror than when it was not. Experiment 2 examined a different internal experience: the perception of taste. Some subjects were led to expect a strong flavor as part of a test series, and other subjects were led to expect a weak flavor. Subjects high in private self-consciousness were less affected by this expectancy manipulation and more accurate in reporting their actual internal state than were subjects low in private self-consciousness. Discussion centers on the theoretical implications of the findings.

Focus of attention, chronic expectancy, and responses to a feared stimulus.

An attentional model of fear-based behavior is proposed and a study that tested the model is reported. It was predicted that among subjects with moderate fear of snakes, heightened self-attention during an approach attempt would cause increased awareness of existing anxiety, followed by one of two courses of events: Subjects who believed that they could do the behavior in spite of their fear were expected to redirect their attention to the behavior--goal comparison and exhibit no behavioral deficit. Subjects who doubted their ability to do the behavior were expected to divert their attention from the behavior--goal comparison and to withdraw behaviorally from the approach attempt. The results of the study support this reasoning. Discussion centers on relationships between the proposed model and previous theory.

Relations between anger expression and cardiovascular reactivity: reconciling inconsistent findings through a matching hypothesis.

Previous psychophysiological research has demonstrated that both anger expression and anger suppression are related to cardiovascular responses, but in an inconsistent fashion. The present study tested the following hypotheses: (a) that the influence of anger expression style on psychophysiological responses would be limited to Ss exposed to an anger instigation, and (b) that the specific pattern of psychophysiological responses would vary as a function of whether Ss were induced to use their preferred vs. nonpreferred mode of anger expression style in response to the instigation. Seventy-eight male college undergraduates were randomly assigned to work on a task with either an annoying or a pleasant confederate and subsequently to write either a negative or a positive evaluation of the confederate. Blood pressure was measured intermittently and heart rate continuously throughout task performance and a subsequent 15-min rest period. Ss' preferred method of anger expression had been previously assessed by a self-report questionnaire. Systolic blood pressure results generally were consistent with the hypotheses. Implications of the findings for the etiology of cardiovascular diseases are discussed.

Assessing coping strategies: a theoretically based approach.

We developed a multidimensional coping inventory to assess the different ways in which people respond to stress. Five scales (of four items each) measure conceptually distinct aspects of problem-focused coping (active coping, planning, suppression of competing activities, restraint coping, seeking of instrumental social support); five scales measure aspects of what might be viewed as emotional-focused coping (seeking of emotional social support, positive reinterpretation, acceptance, denial, turning to religion); and three scales measure coping responses that arguably are less useful (focus on and venting of emotions, behavioral disengagement, mental disengagement). Study 1 reports the development of scale items. Study 2 reports correlations between the various coping scales and several theoretically relevant personality measures in an effort to provide preliminary information about the inventory's convergent and discriminant validity. Study 3 uses the inventory to assess coping responses among a group of undergraduates who were attempting to cope with a specific stressful episode. This study also allowed an initial examination of associations between dispositional and situational coping tendencies.

How coping mediates the effect of optimism on distress: a study of women with early stage breast cancer.

At diagnosis, 59 breast cancer patients reported on their overall optimism about life; 1 day presurgery, 10 days postsurgery, and at 3-, 6-, and 12-month follow-ups, they reported their recent coping responses and distress levels. Optimism related inversely to distress at each point, even controlling for prior distress. Acceptance, positive reframing, and use of religion were the most common coping reactions; denial and behavioral disengagement were the least common reactions. Acceptance and the use of humor prospectively predicted lower distress; denial and disengagement predicted more distress. Path analyses suggested that several coping reactions played mediating roles in the effect of optimism on distress. Discussion centers on the role of various coping reactions in the process of adjustment, the mechanisms by which dispositional optimism versus pessimism appears to operate, third variable issues, and applied implications.

Dispositional optimism and recovery from coronary artery bypass surgery: the beneficial effects on physical and psychological well-being.

The effect of dispositional optimism on recovery from coronary artery bypass surgery was examined in a group of 51 middle-aged men. Patients provided information at three points in time--(a) on the day before surgery, (b) 6-8 days postoperatively, and (c) 6 months postoperatively. Information was obtained relating to the patient's rate of physical recovery, mood, and postsurgical quality of life. Information was also gathered regarding the manner in which the patients attempted to cope with the stress of the surgery and its aftermath. As expected, dispositional optimism proved to be an important predictor of coping efforts and of surgical outcomes. More specifically, dispositional optimism (as assessed prior to surgery) correlated positively with manifestations of problem-focused coping and negatively with the use of denial. Dispositional optimism was also associated with a faster rate of physical recovery during the period of hospitalization and with a faster rate of return to normal life activities subsequent to discharge. Finally, there was a strong positive association between level of optimism and postsurgical quality of life at 6 months.

Scaling back goals and recalibration of the affect system are processes in normal adaptive self-regulation: understanding 'response shift' phenomena.

This comment addresses a set of phenomena that have been labeled 'response shift'. We argue that many of these phenomena reflect recalibration of a goal-seeking system and an affect-management system, both of which are involved in normal adaptive self-regulation. In brief, we hold that these systems act as feedback control mechanisms. The reference values for both systems continuously undergo gradual recalibration. Because in most circumstances the adjustments tend to occur with equivalent frequency in both directions, their cumulative effect is minimal. In situations of either unusually prolonged goal attainment (and overattainment) or unusually prolonged adversity (as occurs, e.g., with deteriorating health), the cumulative effect can be substantial. We believe that these latter recalibrations of reference value account for many response shift phenomena. Other such phenomena are accounted for by the principle of hierarchical organization among the self-regulatory goals that comprise the self.

Spousal caregivers' activity restriction and depression: a model for changes over time.

In this paper we examine the effects of increasing as well as decreasing caregiving demands on depressive symptomatology. In addition, we focus on spousal caregivers' activity restriction as an explanatory mechanism for changes in depressive symptomatology in the caregiving context. Two databases are used to answer our research questions. An increase of caregiving demands is assessed in study 1, which includes prospective data on 127 spousal caregivers of stroke, hip fracture, congestive heart failure and myocardial infarction patients. A decrease of caregiving demands is examined in study 2, which includes prospective data on 110 spousal caregivers of bypass operation patients. The results generally support the hypothesis that an increase in caregiving demands results in increased depressive symptomatology, while a decrease in caregiving demands reduces depressive symptomatology. The results also support the notion of activity restriction as a critical mediator of changes in depressive symptoms. Cross-sectionally it mediates the association between caregiving and depressive symptomatology, and longitudinally it contributes to changes in depressive symptomatology in both samples.

Dispositional optimism and physical well-being: the influence of generalized outcome expectancies on health.

This article explores the implications that dispositional optimism holds for physical well-being. Research is reviewed that links optimism to a number of different positive health-relevant outcomes, ranging from the development of physical symptoms to recovery from coronary artery bypass surgery. Additional findings are described which suggest that these beneficial effects are partly due to differences between optimists and pessimists in the strategies that they use to cope with stress. A number of other potential mediators are also discussed, including some that are physiologic in nature. The article closes with a discussion of the relationships between our own theoretical account of the effects of optimism and several other conceptual approaches.

Person variables and health: personality predispositions and acute psychological states as shared determinants for disease.

This article reviews prospective evidence linking certain classes of person variables to multiple disease end points. Included in the review is a consideration of the effects of hostility and anger, emotional suppression, depression, fatalism, and pessimism on coronary heart disease, cancer, and acquired immunodeficiency syndrome. A model is presented that integrates several of these variables into an overall conceptual scheme. In addition, several variables are identified that appear to moderate the strength of the relationships that are found between person variables and health. The article concludes with some suggested directions for future research.

Correlates of self-consciousness.

Examined the relationship between the three subscales of the Self-Consciousness Scale and a variety of other personality dimensions, including measures of reflectivity, self-regulation, and social desirability. Data from six geographically diverse samples (total N = 1395) were presented. In general, both the construct validity and discriminant validity of the subscales were supported. First, private self-consciousness significantly correlated with the Guilford-Zimmerman Thoughtfulness Scale and the Paivio Imagery Scale. Second, all of the self-consciousness subscales were shown to be relatively independent of the social desirability response set. Third, less than 6% of the variance in each self-consciousness subscale was shared with scores on the Self-Monitoring Scale. Finally, the minimal relationships between the self-consciousness subscales and measures of emotionality and test anxiety reported by Carver and Glass (1976) were in general replicated. The low magnitude of the correlations obtained was interpreted as supporting the distinctive contribution of the Self-Consciousness Scale to personality assessment.