A profile approach to impulsivity in bipolar disorder: the key role of strong emotions.

OBJECTIVE: Bipolar disorder has been associated with elevated impulsivity - a complex construct subsuming multiple facets. We aimed to compare specific facets of impulsivity in bipolar disorder, including those related to key psychological correlates of the illness: reward sensitivity and strong emotion. METHOD: Ninety-one individuals diagnosed with bipolar I disorder (inter-episode period) and 80 controls completed several well-validated impulsivity measures, including those relevant to reward (Fun-seeking subscale of the Behavioral Activation System scale) and emotion (Positive Urgency and Negative Urgency scales). RESULTS: Bipolar participants reported higher impulsivity scores than did controls on all of the impulsivity measures, except the Fun-seeking subscale of the Behavioral Activation System scale. Positive Urgency - a measure assessing the tendency to act impulsively when experiencing strong positive emotion - yielded the largest group differences: F(1,170) = 78.69, P < 0.001, partial η(2)  = 0.316. Positive Urgency was also associated with poorer psychosocial functioning in the bipolar group: ΔR(2)  = 0.24, b = -0.45, P < 0.001. CONCLUSION: Individuals with bipolar I disorder appear to be at particular risk of behaving impulsively when experiencing strong positive emotions. Findings provide an important first step toward developing a more refined understanding of impulsivity in bipolar disorder with the potential to inform targeted interventions.

Effects of mastectomy versus lumpectomy on emotional adjustment to breast cancer: a prospective study of the first year postsurgery.

PURPOSE: Procedure (mastectomy v lumpectomy) and choice of procedure were examined as predictors of adjustment to breast cancer in a prospective study of the experiences of the first year after surgery. PATIENTS AND METHODS: Breast cancer patients were interviewed the day before surgery, 10 days after surgery, and at the 3-month, 6-month, and 12-month follow-ups. Patients included 24 women who received mastectomy on strong recommendation, 24 who chose mastectomy for other reasons, and 15 who chose lumpectomy. Subjective well-being was assessed in terms of mood disturbance, perceived quality of life, life satisfaction, marital satisfaction, perceptions of social support, and self-rated adjustment. RESULTS: Surgical groups differed in well-being in only one respect: lumpectomy patients reported a higher-quality sex life at 6 and 12 months postsurgery than mastectomy patients. Choice of surgical procedure predicted higher levels of life satisfaction at 3 months. CONCLUSION: The lack of difference between surgical groups in areas other than sexual adjustment replicates previous findings, but extends them by (1) using a fully prospective design, (2) providing data on the period surrounding the surgery (as well as later periods), and (3) examining a broader range of indices of well-being than usual.

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.

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.

An exploratory study of social support, distress, and life disruption among low-income Hispanic women under treatment for early stage breast cancer.

Relationships between distress and perceived availability of social support were examined in 51 Hispanic women being treated for early stage breast cancer. Distress and different types (emotional, instrumental) and sources (spouse, women family members, other family members, friends) of support were measured at presurgery, postsurgery, and at 3-, 6-, and 12-month follow-ups. Emotional support from friends and instrumental support from spouse at presurgery predicted lower distress postsurgery. No other prospective benefits of perceived support emerged. Distress at several time points predicted erosion of subsequent support, particularly instrumental support from women in the family. In contrast to the adverse effects of distress (and independent of them), illness-related disruption of recreational and social activities at 6 months elicited greater support at 12 months.

Associations of blood pressure with self-report measures of anger and hostility among black and white men and women.

This study examined associations between blood pressure (BP) and dispositional variables pertaining to anger and hostility. Black and White 25- to 44-year old male and female normotensives and unmedicated mild to moderate hypertensives completed four reliable self-report scales--the Cook-Medley Hostility (Ho) Scale, the Trait Anger subscale of the State-Trait Anger Scale (STAS-T), and the Cognitive Anger and Somatic Anger subscales of the Cognitive-Somatic Anger Scale--plus the Framingham Anger Scale and the Harburg Anger Scale. They also engaged in three laboratory tasks--Type A Structured Interview (SI), a video game, and a cold pressor task--that elicit cardiovascular reactivity. Ambulatory BP readings at home and at work were also obtained from most subjects. Blacks had significantly higher Ho and lower STAS-T scores than did Whites. Women reported higher levels of somatic anger than did men. White women showed significant positive correlations between STAS-T and systolic BP (SBP) and diastolic BP (DBP) both at rest in the laboratory and during the SI. Black women revealed significant positive relationships between STAS-T and SBP and DBP at rest in the laboratory and at work as well as with DBP during the cold pressor test. For Black men, cognitive anger and DBP at rest were positively related. In contrast, White men revealed significant negative correlations between Ho scores and SBP at rest and during the video game; these men also showed significant negative relationships between somatic anger and SBP and DBP reactivity during the cold pressor test. Women, but not men, showed significant positive relationships between all four anger measures and ambulatory BP at work. Whereas main effects relating anger and cardiovascular measures were not apparent as a function of race, Blacks demonstrated significantly greater SBP and DBP reactivity than Whites during the cold pressor test, with the converse occurring during the SI. Men demonstrated significantly greater DBP reactivity than women during the video game. The present findings indicate that self-reports on anger/hostility measures and cardiovascular responses to behavioral tasks differ as a function of race but that relationships between anger and BP regulation need to take into account possible race-sex interactions and selection of anger/hostility measures.

Concerns about breast cancer and relations to psychosocial well-being in a multiethnic sample of early-stage patients.

Much work on psychosocial sequelae of breast cancer has been guided by the assumption that body image and partner reaction issues are focal. In a tri-ethnic sample of 223 women treated for early-stage breast cancer within the prior year, the authors assessed a wider range of concerns and relations to well-being. Strongest concerns were recurrence, pain, death, harm from adjuvant treatment, and bills. Body-image concerns were moderate; concern about rejection was minimal. Younger women had stronger sexual and partner-related concerns than older women. Hispanic women had many stronger concerns and more disruption than other women. Life and pain concerns and sexuality concerns contributed uniquely to predicting emotional and psychosexual disruption; life and pain concerns and rejection concerns contributed to predicting social disruption. In sum, adaptation to breast cancer is a process bearing on several aspects of the patient's life space.

Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer.

The authors tested effects of a 10-week group cognitive-behavioral stress management intervention among 100 women newly treated for Stage 0-II breast cancer. The intervention reduced prevalence of moderate depression (which remained relatively stable in the control condition) but did not affect other measures of emotional distress. The intervention also increased participants' reports that having breast cancer had made positive contributions to their lives, and it increased generalized optimism. Both remained significantly elevated at a 3-month follow-up of the intervention. Further analysis revealed that the intervention had its greatest impact on these 2 variables among women who were lowest in optimism at baseline. Discussion centers on the importance of examining positive responses to traumatic events--growth, appreciation of life, shift in priorities, and positive affect-as well as negative responses.

Responsiveness to threats and incentives, expectancy of recurrence, and distress and disengagement: moderator effects in women with early stage breast cancer.

Models of neurobiological systems linking personality, motivation, and emotion can be integrated with the expectancy construct to suggest hypotheses about distress and giving up in response to adversity. In 220 women with breast cancer, threat responsiveness-sensitivity of the behavioral inhibition system (BIS)-and incentive responsiveness-sensitivity of the behavioral activation system (BAS)-and expectancies about cancer recurrence were measured. It was predicted and found that high BIS sensitivity interacted with recurrence expectancy to predict elevated distress and disengagement. Low BAS sensitivity (reward responsiveness) also interacted with expectancy of recurrence to predict elevated disengagement. In contrast, high BAS sensitivity (fun seeking) interacted with recurrence expectancy to predict elevated distress. Discussion centers on theoretical implications and possible applications.

How should multifaceted personality constructs be tested? Issues illustrated by self-monitoring, attributional style, and hardiness.

Two or more dimensions unintentionally varied simultaneously are said to be confounded, but several theories in personality intentionally combine 3 or more distinct qualities. Researchers using these theories sum the qualities before testing predictions. How wise is this practice? The practice appears to derive from 2 distinct lines of reasoning. One of them assumes that the component dimensions converge on a single underlying quality (latent variable) that each reflects imperfectly. The other assumes a synergy among dimensions. Issues arising from each line of reasoning are illustrated by examining self-monitoring, attributional style, and hardiness. Conclusions are that (a) information is lost whenever a latent variable theory is tested solely by a composite and (b) a synergistic theory can be tested only through a statistical interaction.

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.

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.

Type A behavior pattern, sex role orientation, and psychological adjustment.

It was argued that the Type A "coronary-prone" behavior pattern is adaptive within the context of a highly masculine sex role orientation, but that it interferes with successful functioning among persons for whom such an orientation is lacking. This interference was expected to predominate in areas of behavior that are interpersonal in nature. Based on this reasoning, it was predicted that the combination of a Type A behavioral style and a sex role orientation low in masculinity would be associated with low social self-esteem, high social anxiety, and depression. Furthermore, because our culture expects women to be more socially adept than men, it was expected that these tendencies toward maladjustment would be more pronounced among women than men. A study of 213 college students yielded results that were consistent with these predictions.

Self-focusing effects of heartbeat feedback.

Two studies tested the hypothesis that auditory heartbeat feedback leads to an increase in self-directed attention. In Experiment 1, subjects exposed to a sound representing their heartbeat made greater self-attributions for hypothetical outcomes than did subjects exposed to the same sound identified as an extraneous noise. Furthermore, subjects in the heartbeat condition showed a pattern of color-naming latencies (on a color-word test) that was consistent with the hypothesis that self-related information was being activated in memory. In contrast, no such pattern was observed among subjects in the noise condition. In Experiment 2, comparisons with appropriate control groups indicated that neither an extraneous noise nor the attachment of a heartbeat-recording device influenced self-attribution, but that the presence of either a constant or an accelerating heartbeat increased self-attribution. The latter two conditions did not differ from each other. Discussion centers on the findings' methodological and theoretical implications.

Predicting successful completion of an aftercare program following treatment for alcoholism: the role of dispositional optimism.

In this study we investigated several variables as potential predictors of success in completing a transition program after treatment for alcoholism. Subjects were 54 men who had completed a 30-day treatment program and who were subsequently admitted to a 90-day inpatient aftercare program. The outcome measure was successful completion of this latter program. Predictor variables were dispositional optimism, hassles, uplifts, and several demographic variables. Optimism was positively associated with successful outcome. The simple association between uplifts and outcome also approached significance, but in the opposite to expected direction. Discriminant analyses used both of these variables, as well as age and education level, as predictors of successful outcome. There was no evidence of a role for hassles. Discussion centers on the importance of dispositional optimism as a predictor of successful adaptation in a variety of behavioral domains.

Cognitive characteristics of the type A coronary-prone behavior pattern.

Recent findings indicate that Type As attend more to tasks defined as central, and less to tasks defined as peripheral, than do Type Bs. If this A-B difference in allocation of attention occurs naturally, as well as in response to experimental instructions, it would have implications for other phenomena, such as the process of creating a category from a series of perceptual events. It was reasoned that across a series of acquisition stimuli, Type As, compared to Type Bs, would be more responsive to the development of central tendencies in the frequency of appearance of the attributes that comprise the stimuli. That is, Type As should be more attentive to frequently occurring attributes (by virtue of their centrality in the evolving category definition) and less attentive to rarely occurring attributes. This difference in attention should lead to a difference in encoding. On a subsequent recognition-memory task, then, Type As should report with greater certainty than Type Bs that they had seen stimuli composed of frequently observed attributes and should report with greater certainty that they had not seen stimuli composed of rarely observed attributes. In a test of this reasoning, students classified as As and Bs completed a concept-formation and recognition-memory task under one of four levels of situational challenge. The predicted patterns occurred among subjects in whom moderate and high levels of challenge had been induced. The findings thus support the arguments that As and Bs process information differently and that this processing difference must be elicited by situational challenge.

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.

Depression and cognitive style: comparisons between measures.

Several instruments have been developed recently to measure cognitive styles associated with depression. At least four of them appear to have an underlying similarity. Each appears to reflect a tendency for respondents to infer a general lack of self-worth (or a continued likelihood of bad events) on the basis of a single discrete failure. The present research was a comparative test of one of these scales against the other three in terms of associations with Beck Depression Inventory (BDI) scores. Though all instruments were significantly correlated with BDI, partial correlations revealed that our generalization scale was a more robust predictor of BDI than were (a) a measure of characterological self-blame, (b) a measure of cognitive bias, and (c) a measure of attributional style.

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.