Patients’ expectations for the functional and psychosocial outcomes of orbital decompression surgery for thyroid eye disease: a qualitative study

Patients with appearance-altering conditions may be dissatisfied with the outcomes of reconstructive surgery due to unmet expectations. This study explored patients’ expectations of orbital decompression surgery for thyroid eye disease (TED) and whether these were met. Semi-structured interviews were conducted at two times: (1) in the weeks after patients were listed for decompression surgery and before surgery; (2) up to 12 months after surgery. Thematic analysis was performed for each time point, to identify themes within the data. Fourteen adults with TED were interviewed prior to surgery and five were followed up after surgery. Thematic analyses found: (1) Prior to surgery, patients had formed expectations through online information about the procedure, consultations with physicians, the impact TED had on their lives, and speaking to relevant others. Patients had specific expectations about the procedure, the recovery, post-operative appearance and post-operative vision. (2) After surgery, patients generally felt their appearance and well-being had improved. However, dissatisfaction was linked to unanticipated specific aspects of surgical care, recovery, or appearance. Dissatisfaction can arise from unmet expectations for the outcomes of reconstructive surgery. Physicians should be aware of the processes by which patients form expectations, for example different types and quality of online information. Ensuring that preoperative expectations are realistic could enhance satisfaction after surgery.     

An analysis of coping profiles and adjustment in persons with rheumatoid arthritis

This study examined dispositional and situative antecedents of vigilant and avoidant coping behavior. Seventy-two subjects were classified in coping style on the basis of their responses to the vigilance and cognitive avoidance scales of the Mainz Coping Inventory (MCI, Krohne, 1989), and alternatively, on their trait anxiety and defensiveness scores (cf. Weinberger, Schwartz, & Davidson, 1979). In a subsequent laboratory task, subjects were exposed to various conditions of predictability of an aversive event. In anticipation of an aversive loud tone, coping behavior was operationally defined as choosing to listen either to a warning channel (i.e., vigilance) or instead to music (i.e., avoidance). Probability of occurrence of a warning signal while listening to the warning channel varied across trials, being either 0%, 33%, 66%, or 100%. Subjects were exposed to each level and were informed about the respective probability in advance. In general, listening to the warning channel increased with an increase in the probability of the warning signal. However, four groups of subjects who differed in their pattern of coping behavior across trials were observed: rigid-avoidant copers (always listening to music), rigid-vigilant copers (always monitoring the warning channel), flexible copers (switching from music to warning channel with increasing probability of warning), and inconsistent copers (vacillating between music and warning channel regardless of probability of warning). Coping style classifications did not show substantial associations with coping behavior. However, subjects demonstrating the inconsistent coping pattern scored high on trait anxiety.     

Physical recovery in Arthroscopic knee surgery: unique contributions of coping behaviors to clinical outcomes and stress reactivity

Few studies have examined whether certain coping behaviors are associated with physical outcomes following surgery. This prospective, longitudinal study investigated the effect of active and avoidant coping behaviors on two physical outcomes over time, pain and knee function, in a group of patients experiencing knee arthroscopic surgery (n = 81). Structured interviews and physician clinical assessments were conducted preoperatively and at 3 and 24 weeks postoperatively. Coping behavior was assessed during the preoperative interview, and patients were divided into high and low avoidant and active coping groups. Using repeated measures MANCOVA/ANCOVA, avoidant coping was significantly associated with knee pain and active coping was associated with knee function. Serum cortisol levels were available for a patient subset (n = 16); higher cortisol was related to both avoidant coping and poorer functioning during early recovery. Results suggest that these divergent coping behaviors are differentially associated with stress reactivity and physical outcomes in healthy patients undergoing minor knee surgery.     

Could Treatment Matching Patients’ Beliefs About Depression Improve Outcomes?

Patients’ beliefs about depression and expectations for treatment can influence outcomes of major depressive disorder (MDD) treatments. We hypothesized that patients with weaker biological beliefs (less endorsement of [a] biochemical causes and [b] need for medication) and more optimistic treatment expectations (greater improvement and shorter time to improvement), have better outcomes in cognitive therapy (CT). Outpatients with recurrent MDD who received acute-phase CT (N = 152), and a subset of partial or unstable responders (N = 51) randomized to 8 months of continuation CT or fluoxetine with clinical management, completed repeated measures of beliefs, expectations, and depression. As hypothesized, patients with weaker biological beliefs about depression, and patients who expected a shorter time to improvement, experienced greater change in depressive symptoms and more frequent response to acute-phase CT. Moreover, responders who received continuation treatment better matched to their biological beliefs (i.e., responders with weaker biological beliefs about depression who received continuation CT, or responders with stronger biological beliefs about depression who received continuation fluoxetine) had fewer depressive symptoms and less relapse/recurrence by 32 months after acute-phase CT than did responders who received mismatched continuation treatment. Specific screening and/or intervention targeting patients’ biological beliefs about depression could increase CT efficacy.     

When Situations Call for Instrumentality and Expressiveness: Resource Appraisal,Coping Strategy Choice,and Adjustment

The coping model of Holahan and Moos (1987) served as a framework for examining associations among resource appraisals, gender-role coping strategy choices, and adjustment in situations having salient social expectations for expressiveness and instrumentality (i.e., dual-expectation situations). Participants were 70 male and 124 female undergraduates. Appraisals of setting-specific social support availability and self-esteem were related to coping strategy choices. Androgynous copers had higher social support appraisals than instrumental or indeterminate copers and higher self-appraisals than indeterminate copers. Androgynous coping was (a) positively related to well-being at all levels of resource appraisals and (b) negatively related to stress at moderate and low levels of social support and all levels of self-esteem.

     

Optimizing preoperative expectations in cardiac surgery patients is moderated by level of disability: the successful development of a brief psychological intervention

Patients’ expectations have shown to be a major psychological predictor of health outcome in cardiac surgery patients. However, it is unclear whether patients’ expectations can be optimized prior to surgery. This study evaluates the development of a brief psychological intervention focusing on the optimization of expectations and its effect on change in patients’ expectations prior to cardiac surgery. Ninety patients scheduled for coronary artery bypass graft were randomly assigned to (1) standard medical care, (2) additional expectation manipulation intervention (EMI), and (3) additional attention control group. Therapists’ fidelity to intervention manuals and patients satisfaction with the intervention were assessed for both active intervention conditions. Patients’ expectations about post-surgical disability, treatment control, personal control, and disease duration were assessed before and after the psychological intervention. Demographical, medical, and psychosocial characteristics and disability were assessed at baseline. Treatment fidelity and patient satisfaction was very high in both intervention conditions. Only patients receiving EMI developed higher personal control expectations and longer (more realistic) expectations of disease duration. The effect of intervention group on patients’ disability expectations and patients’ personal control expectations was moderated by patient’s level of disability. EMI patients with low to moderate disability developed positive expectations whereas patients with high disability did not. This study shows the successful development of a short psychological intervention that was able to modify patients’ expectations, especially in those with low to moderate disability. Given the robust association of expectations and surgery outcome, such an intervention might offer the opportunity to enhance patients’ health following cardiac surgery.     

Older adults' recovery from surgery for osteoarthritis of the knee: psychosocial resources and constraints as predictors of outcomes.

The authors investigated psychosocial resources (positive support, active coping) and psychosocial constraints (negative support, avoidant coping) as predictors of improvement in the health of 63 older adults undergoing surgery for osteoarthritis of the knee. Following surgery, patients and social partners are motivated both to strive for the appetitive goal of recovery (approach), and to protect themselves from pain and impairment (avoidance). The authors assessed resources and constraints 6 weeks after surgery as predictors of outcomes (improvement in knee pain, knee functioning, and psychological well-being) 6 months after surgery. The constraints patients encountered early in recovery were strong predictors of poor recovery. Although resources were associated with some improvement, these effects were largely accounted for by constraints.     

A revaluation of the adaptiveness of avoidant and vigilant coping with surgery

Abstract

It has been assumed that an avoidant coping style is less adaptive in patients coping with surgery than a vigilant coping style. Empirical evidence, however, has indicated the contrary. This article, therefore, revaluated the adaptiveness of these coping styles. A review of the literature yielded three conditions of the situation that determine the adaptiveness of coping: controllability of the situation, time-reference and interpretational set. Problem-focused coping, vigilance, active coping and monitoring seem to be more adaptive in controllable situations; emotion-focused coping, avoidance, blunting and passive coping more adaptive when little control is possible. For short-term adaptation, avoidance seems the more adaptive strategy, whereas in the long run vigilance is a better strategy. Regarding interpretational set, avoidance seems more adaptive when patients have to cope with the emotional value of the event; vigilance seems more adaptive when coping with sensory elements of the event. Implications of the situational conditions for the adaptiveness of coping with surgical stress and consequences for future research are discussed.     

“What support would you find helpful?” The relationship between treatment expectations,therapeutic engagement,and clinical outcomes in parent–infant psychotherapy

The aim of this study was to investigate the impact of pretreatment expectations on clinical outcomes and engagement in Parent–Infant Psychotherapy (PIP). Sixty-one mothers who were experiencing mental health difficulties and who were receiving PIP with their young infants participated in the study. A mixed-methodology was used to examine participants’ expectations through transformation content analysis of pretreatment interviews; recurring themes were classified and quantified. Further statistical analyses explored relationships between the quantified themes of parental expectations and clinical outcomes and engagement in treatment. No significant correlation was found between expectations and engagement. One of the six clinical outcomes significantly correlated with parental expectations. Improved reflective functioning (RF) was predicted by participants describing expectations of wanting to improve their parent–infant relationship through the treatment, and expressing concerns about discussing their past experiences. These two expectations predicted improvements in RF independently and when combined. These results indicate that PIP may be more effective for some mothers than others and that assessing future clients’ expectations before beginning PIP may be beneficial.     

Emerging Adults’ Behavior Problems and Coping Following Hurricanes

When experiencing natural disasters, coping is important. Individuals who have behavior problems may use less effective coping, however. This study sought to better understand the relationship between emerging adults’ behavior problems and coping following hurricanes. Using a sample of 193 emerging adults, correlations suggested that emerging adults who reported more behavior problems also endorsed higher levels of avoidant coping. More specifically, multivariate analyses of variance and subsequent post hoc analyses indicated that emerging adults who were experiencing relatively low levels of both internalizing and externalizing behavior problems endorsed avoidant coping significantly less often relative to those emerging adults who were experiencing relatively high levels of internalizing behavior problems only and those who were experiencing relatively high levels of both types of behavior problems. These results suggested that those who experience behavior problems following hurricanes may benefit from interventions that could improve the coping that they utilize.     

Testing a dual-process model of avoidant defenses

Research suggests that the defensive strategy used by people who score high on attachment-related avoidance when they encounter interpersonal threats involves two stages: automatic vigilance followed by effortful avoidance. In two studies we varied stimulus exposure times and cognitive load to determine how attention is regulated by avoidant individuals. Results indicate that avoidant individuals were vigilant toward contempt faces when the faces were presented for 100 ms but quickly disengaged from them when the faces were presented for 750 ms. Moreover, avoidant participants could disengage from contempt faces presented for 750 ms while rehearsing a simple 1-digit number, but not when rehearsing a 7-digit number, suggesting that avoidant disengagement is a cognitively effortful process. Theoretical and practical implications are discussed.     

Adult Attachment Styles, the Desire to Have Children, and Working Models of Parenthood

ABSTRACT College students who had yet to marry and begin a family were asked about their desire to have children and their beliefs and expectations about themselves as parents (Study 1) and the characteristics of their prospective children (Study 2). Persons with more avoidant and anxious-ambivalent models of close adult relationships harbored more negative models of parent-hood and parent-child relationships. These findings indicate that working models of parenting and parent-child relationships form well before marriage and the birth of children and that these models are systematically associated with attachment styles in adult relationships. The findings also suggest ways in which insecure attachments between child and parent may be influenced by the caregiver's models of parenting and parent-child relationships.     

The Relationship of Attributional Style to Learned Helplessness in an Interpersonal Context

The construct validity of the Attributionai Style Questionnaire (ASQ), developed from Seligrnan's reformulated model of learned helplessness and depression, was evaluated in an interpersonal context rather than in the typical research context of an impersonal academic task. Forty college women who had completed the ASQ 1 to 2 months earlier interacted with potential male dates. The subjects reported their causal attributions for dating outcomes as well as their outcome expectations and depressive affect before and after in-, teraction that resulted in their rejection. Several attributional indices on the ASQ did predict subjects' causal attributions for dating failure and expectations of outcomes with a different potential date. While expectations and affect were related, neither dispositional nor situational attributions predicted affective responses to rejection. Subjects, ages and physical attractiveness were also found to influence cognitive aspects of subjects' interpersonal experience. The results were discussed in terms of the utility of the ASQ and the reformulated learned helplessness model.     

A friend is a present you give to your “Self”: Avoidance of intimacy moderates the effects of friends on self-liking

The current research proposes that thinking about friends improves feelings about the self and does so differentially depending on avoidance of intimacy. Based on previous findings that individuals who avoid intimacy in relationships (avoidant individuals) contrast their self-concepts with primed friends whereas those who pursue intimacy in relationships (non-avoidant individuals) assimilate their self-concepts to primed friends [Gabriel, S., Carvallo, M., Dean, K., Tippin, B. D., & Renaud, J. (2005). How I see “Me” depends on how I see “We”: The role of avoidance of intimacy in social comparison. Personality and Social Psychology Bulletin, 31, 156-157], we predicted that friends who embody negative aspects of self would lead avoidant individuals to like themselves more, whereas friends who embody positive aspects of self would lead non-avoidant individuals to like themselves more. A pretest determined that good friends were seen as more similar to positive and ideal aspects of the self, whereas friends about whom participants had more mixed feelings (ambivalent friends) were seen as more similar to disliked and feared aspects of the self. Four experiments supported the main hypotheses. In Experiment 1, non-avoidant individuals like themselves more when good friends were primed. In Experiment 2, avoidant individuals like themselves more when ambivalent friends were primed. In Experiment 3, non-avoidant individuals liked themselves better after thinking about a friend’s positive traits, whereas avoidant individuals liked themselves better after thinking about a friend’s negative traits. In Experiment 4, all individuals under self-esteem threat strategically brought friends to mind who would help them like themselves more.     

Prevalence of anxiety among patients undergoing colorectal surgery

To assess prevalence of anxiety 36 consecutive patients undergoing colorectal surgery with general anesthesia were interviewed on the day of surgery and completed the State-Trait Anxiety Inventory. Postsurgical ratings of pain and anxiety were obtained within 24 hours after surgery. Analysis indicated that 29 scored moderate or higher on the State Anxiety scale prior to surgery. The correlations for scores on presurgical Trait Anxiety with postsurgical pain and Trait Anxiety scores were significant (p<.01) but not that for pre- and postsurgical State Anxiety     

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.     

Effects of attachment styles on the experience of equity in heterosexual couples relationships

Employing one correlational and two experimental studies, this paper examines the influence of attachment styles (secure, anxious, avoidant) on a person's experience of equity in intimate relationships. While one experimental study employed a priming technique to stimulate the different attachment styles, the other involved vignettes describing fictitious characters with typical attachment styles. As the specific hypotheses about the single equity components have been developed on the basis of the attachment theory, the equity ratio itself and the four equity components (own outcome, own input, partner's outcome, partner's input) are analyzed as dependent variables. While partners with a secure attachment style tend to describe their relationship as equitable (i.e., they give and take extensively), partners who feel anxious about their relationship generally see themselves as being in an inequitable, disadvantaged position (i.e., they receive little from their partner). The hypothesis that avoidant partners would feel advantaged as they were less committed was only supported by the correlational study. Against expectations, the results of both experiments indicate that avoidant partners generally see themselves (or see avoidant vignettes) as being treated equitably, but that there is less emotional exchange than is the case with secure partners. Avoidant partners give and take less than secure ones.     

Trajectories of religious coping from adolescence into early adulthood: their form and relations to externalizing problems and prosocial behavior

Little is known about changes in religious coping and their relations to adolescents' and young adults' functioning. In 686 Italian youths, trajectories of religious coping were identified from age 16-17 years to age 22-23 years; cohorts of youths reported at 3 of the 4 assessments. Four trajectories of religious coping were identified: decreasing, low stable, high stable, and increasing. A decline in religious coping was associated with high levels of externalizing problems at age 16-17, whereas an increase in religious coping was associated with higher externalizing problems at ages 18-19 and 20-21 years and with relatively high involvement with deviant peers. High stable religious copers were high in prosocial behavior at three ages; low stable religious copers were higher than people undergoing change in their religious coping from mid-adolescence into early adulthood. These results can expand our current thinking about religious coping and adolescent adjustment.     

Maternal Avoidant Coping Mediates the Effect of Parenting Stress on Depressive Symptoms during Early Adolescence

We examined maternal avoidant coping as a mediator between maternal parenting stress and maternal depressive symptoms during early adolescence. Three years of self-report data were collected from 173 mothers, beginning when mothers’ adolescents were in 6th grade and aged 11–13 years. Utilizing longitudinal path analysis, results indicated that avoidant coping at time two mediated the association between parenting stress at time one and depressive symptoms at time three. Additionally, the reverse direction of effects was examined, revealing that the relation between parenting stress and avoidant coping was unidirectional, while the relation between avoidant coping and depressive symptoms was bidirectional. Our results suggest that during early adolescence, mothers who experience more stress in the parenting role are more likely to engage in higher levels of avoidant coping when faced with parenting problems. In turn, a mother’s long-term avoidant reactions to parenting problems may predict increases in depressive symptoms. Moreover, our findings of a bidirectional relation between avoidant coping and depressive symptoms suggest that prior levels of depression might serve as a barrier to efficient and effective coping. The present study may inform preventive intervention efforts aimed at decreasing the use of avoidance in response to parenting stressors by increasing adaptive parental coping with stressors, and providing appropriate support and resources for parents.     

Psychosocial vulnerability from adolescence to adulthood: a prospective study of attachment style differences in relationship functioning and partner choice

Using a prospective research design, this study explored whether attachment style during adolescence forecasts the nature and quality of romantic relationships in early adulthood and investigated two general pathways for explaining these effects. Black and White community residents were first interviewed in adolescence at which time they completed a self-report measure of attachment style. Approximately 6 years later, they participated in a follow-up interview along with their current romantic partners (N = 224 couples). Results revealed that insecure attachment in adolescence was a risk factor for adverse relationship outcomes in adulthood, although the effects were most consistent for avoidant attachment. Avoidant adolescents were involved in relationships that they (and their partners) rated as less satisfying overall; they also engaged in fewer pro-relationship behaviors, and perceived that their partners engaged in fewer pro-relationship behaviors. In addition, avoidant adolescents were involved with partners who had less healthy personality profiles. Results for anxious-ambivalent and secure attachment were weaker, more complex, and moderated by gender. This study provides the first prospective evidence that avoidant attachment places individuals at risk for adverse relationship outcomes and highlights potential pathways through which this occurs.