Trajectories of resilience, depression, and anxiety following spinal cord injury

Purpose/Objective: To investigate longitudinal trajectories of depression and anxiety symptoms following spinal cord injury (SCI) as well as the predictors of those trajectories. Research Method/Design: A longitudinal study of 233 participants assessed at 4 time points: within 6 weeks, 3 months, 1 year, and 2 years from the point of injury. Data were analyzed using latent growth mixture modeling to determine the best-fitting model of depression and anxiety trajectories. Covariates assessed during hospitalization were explored as predictors of the trajectories. Results: Analyses for depression and anxiety symptoms revealed 3 similar latent classes: a resilient pattern of stable low symptoms, a pattern of high symptoms followed by improvement (recovery), and delayed symptom elevations. A chronic high depression pattern also emerged but not a chronic high anxiety pattern. Analyses of predictors indicated that compared with other groups, resilient patients had fewer SCI-related quality of life problems, more challenge appraisals and fewer threat appraisals, greater acceptance and fighting spirit, and less coping through social reliance and behavioral disengagement. Conclusion/Implications: Overall, the majority of SCI patients demonstrated considerable psychological resilience. Models for depression and anxiety evidenced a pattern of elevated symptoms followed by improvement and a pattern of delayed symptoms. Chronic high depression was also observed but not chronic high anxiety. Analyses of predictors were consistent with the hypothesis that resilient individuals view major stressors as challenges to be accepted and met with active coping efforts. These results are comparable to other recent studies of major health stressors. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Affordances after spinal cord injury

Spinal cord injury can cause cognitive impairments even when no cerebral lesion is appreciable. As patients are forced to explore the environment in a non-canonical position (i.e., seated on a wheelchair), a modified relation with space can explain motor-related cognitive differences compared to non-injured individuals. Peripersonal space is encoded in motor terms, that is, in relation to the representation of action abilities and is strictly related to the affordance of reachability. In turn, affordances, the action possibilities suggested by relevant properties of the environment, are related to the perceiver's peripersonal space and motor abilities. One might suppose that these motor-related cognitive abilities are compromised when an individual loses the ability to move. We shed light on this issue in 10 patients with paraplegia and 20 matched controls. All have been administered an affordances-related reachability judgement task adapted from Costantini, Ambrosini, Tieri, Sinigaglia, and Committeri (2010, Experimental Brain Research, 207, 95) and neuropsychological tests. Our findings demonstrate that patients and controls show the same level of accuracy in estimating the location of their peripersonal space boundaries, but only controls show the typical overestimation of reaching range. Secondly, patients show a higher variability in their judgements than controls. Importantly, this finding is related to the patients’ ability to perform everyday tasks. Finally, patients are not faster in making their judgements on reachability in peripersonal space, while controls are. Our results suggest that not moving freely or as usual in the environment impact decoding of action-related properties even when the upper limbs are not compromised.     

Assertiveness, social support, and psychological adjustment following spinal cord injury.

Tested predictions that assertiveness and social support would be significantly predictive of psychological adjustment. Furthermore, it was anticipated that assertiveness and certain types of social relationships would differentially interact to predict adjustment, since positive and negative effects of both variables have been noted in prior research. Trained raters interviewed 156 persons receiving either in-patient or out-patient care for cord injuries and administered measures of assertiveness, social support, depression and psychosocial impairment. Persons who reported a keen sense of responsibility for the welfare of another reported more depression and impairment. Persons reporting higher levels of support facilitating social integration and reassuring personal worth were less depressed. Several significant interactions between assertiveness and different social support relationships revealed beneficial and deleterious effects on depressive behavior and impairment secondary to the disability. Results are discussed as they advance theoretical understanding of the effects of assertiveness and social support. Implications for discriminate cue learning in assertion training for persons with physical disability are proposed.     

Difficulties adjusting to post-discharge life following a spinal cord injury: an interpretative phenomenological analysis

Individual semi-structured interviews were conducted with 17 individuals who had experienced a traumatic spinal cord injury (SCI), focusing on the participants' lived experience of SCI. The interviews were transcribed verbatim and were analysed for recurrent themes using interpretative phenomenological analysis (IPA). Here, we present three inter-related recurrent themes all concerning difficulties in adjusting to home life following hospital discharge: "loss of camaraderie", "lack of post-discharge care" and "other people's reactions to spinal cord injury". Participants reported that the camaraderie they formed with fellow patients during their rehabilitative stay in hospital generated feelings of security and community. This was discussed in stark contrast to the isolation and loneliness that they subsequently experienced post-hospital discharge. A perceived lack of physical, practical and psychological support coupled with negative and stigmatising reactions of the wider community served to make adjustment to home life post-SCI particularly difficult for the participants. The findings are discussed in relation to extant SCI literature, and recommendations for future health care of individuals with SCI are made.     

Cross-sectional and prospective associations between cognitive appraisals and posttraumatic stress disorder symptoms following stroke

This study examined cross-sectional and prospective associations between cognitive appraisals and posttraumatic stress disorder (PTSD) symptoms following stroke. While in hospital, stroke patients (n=81) completed questionnaires assessing cognitive appraisals (i.e., negative cognitions about the self, negative cognitions about the world, and self-blame) and PTSD symptoms. PTSD symptoms were assessed again 3 months later when all patients had been discharged from hospital (n=70). Significant correlations were found between the time 1 measures of negative cognitions about the self and the world, but not self-blame, and the severity of PTSD symptoms measured at time 1 and at time 2. Regression analyses revealed that cognitive appraisals explained a significant amount of variance in the severity of PTSD symptoms at time 1, with negative cognitions about the self-emerging as a significant predictor. In contrast, time 1 cognitive appraisals were unable to explain additional variance in time 2 PTSD severity over and above that explained by time 1 PTSD severity. The findings therefore provide only weak support for Ehlers and Clark's cognitive model of PTSD.     

The impact of assuming the primary caregiver role following traumatic spinal cord injury: An interpretative phenomenological analysis of the spouse's experience

This study aimed to explore the lived experience of assuming the primary caregiver role in a group of spouses of individuals living with a traumatic spinal cord injury (SCI) (injuries ranged from paraplegia to quadriplegia). Individual in-depth interviews were conducted with 11 participants who were both the spouse and primary caregiver of an individual with a SCI; of these, 10 were female and 1 was male. All interviews were transcribed verbatim and were subjected to interpretative phenomenological analysis (IPA). Here we present three inter-related master themes: ‘The emotional impact of SCI’; ‘Post-injury shift in relationship dynamics’ and ‘Impact of caregiving on identity’. Regarding the emotional impact of spinal injury, participants reported an almost instantaneous sense of loss, emptiness and grief during the injured person's rehabilitative period and feelings of anxiety were reported in anticipation of their return to the family home. A distinct change in role from spouse and lover to care provider was reported and this ultimately contributed to relationship change and a loss of former identity. The findings are discussed in relation to extant caregiver literature and recommendations for future caregiver support are highlighted.     

An examination of post-traumatic growth in Canadian and American ParaSport athletes with acquired spinal cord injury

ObjectivesThe study was guided by two research questions: (1) Does participation in ParaSport following acquired spinal cord injury (SCI) influence people's perceptions of post traumatic growth (PTG)? (2) What specific dimensions of PTG, if any, do ParaSport athletes report experiencing?DesignA phenomenological approach was adopted to understand ParaSport athletes' perceptions and experiences of PTG and sport participation following acquired SCI.MethodTwelve participants with acquired SCI who integrated, reintegrated, or attempted to integrate into sport completed a survey and participated in a semi-structured interview to assess their perceptions of acquired SCI, involvement in ParaSport, and PTG.ResultsFive general dimensions of growth emerged from the data including: (a) injury relevant processing; (b) appreciation for life; (c) reactive behavior as a result of attempted integration into ParaSport; (d) relating to others and (e) health and well-being. Participants reported increased physical functioning and independence related to their involvement in sport. Emotional and psychological gains were also associated with ParaSport including re-establishment of self-identity, improved clarity and perception of life, changed priorities, greater confidence, and enhanced social relationships.ConclusionsParticipation in ParaSport following acquired SCI may provide physical, emotional, and psychological health benefits, which should be considered in the development and implementation of sport related interventions to encourage PTG. Clinicians and rehabilitation specialists may use information from the present study to help individuals improve their identity, build relationships, and develop an appreciation for life after incurring a SCI.     

Attitude learning through exploration: advice and strategy appraisals

Processes of attitude learning were investigated through a game requiring discrimination between good and bad objects, where feedback about object valence (involving gain or loss) is contingent on approach. Previous research demonstrates a preponderance of false‐negative errors, with some good objects (‘learning asymmetry’) and most novel objects (‘generalization asymmetry’) being judged as bad, but provides no direct evidence concerning how participants appraise alternative strategies and their own performance. To compare alternative strategies, participants received advice, supposedly from a previous participant, that most objects were bad and should be avoided, or good and should be approached. Learning and generalization asymmetries were replicated, especially among participants who followed the former (risk‐averse) advice. Additionally, participants' evaluations of their own game strategy were inversely related to amount of negative feedback (the number of bad objects approached), but unrelated to positive feedback (from good objects approached), pointing to the salience of negative information for self‐appraisals. Copyright © 2007 John Wiley & Sons, Ltd.     

Psychosocial adaptation to spinal cord injury: a dimensional perspective

From 313 individuals who sustained spinal cord injuries self-reported responses were examined on their psychosocial adaptation to disability and perceived quality of life. A multidimensional scaling analysis yielded a 2-dimensional structure of adaptation. The first dimension indicated adaptive versus nonadaptive reactions. The second dimension was suggestive of denial versus realization of the affect related to the medical impairment.     

Passion and emotions: The mediating role of cognitive appraisals

Research reveals that harmonious passion leads to more positive emotions than obsessive passion, whereas the opposite result is true with respect to negative emotions. The purpose of this research was to evaluate the role of cognitive appraisals as mediators of the passion-emotion relationships. In Study 1, 227 participants engaged in different sports completed an online questionnaire about their passion for their specific sport, as well as cognitive appraisals and emotions generally experienced during an important game of their sport. Results of a structural equation modeling analysis and an indirect effect test showed that harmonious passion was linked to positive emotions through the mediating role of challenge appraisals, and that obsessive passion was linked to negative emotions through the mediating role of threat appraisals. In Study 2, 194 athletes completed questionnaires before and after a competitive game and focused on cognitive appraisals and emotions experienced during the game. Results of analyses conducted separately in the victory and defeat conditions based on game outcomes supported the model found in Study 1 in the case of defeat for both types of passion, and in the case of victory for harmonious passion only. Obsessive passion was not linked to threat appraisals among victorious athletes. These results suggest that both types of passion trigger different cognitive appraisals that lead to corresponding emotions. Future research is needed to replicate these findings and to better understand the role of passion and cognitive appraisals in emotions experienced in the realm of sports.     

Regional cortical volume and cognitive functioning following traumatic brain injury

There has been limited examination of the effect of brain pathology on subsequent function. The current study examined the relationships between regional variation in grey matter volume, age and cognitive impairment using a semi-automated image analysis tool. This study included 69 individuals with mild-to-severe TBI, 41 of whom also completed neuropsychological tests of attention, working memory, processing speed, memory and executive functions. A widespread reduction in grey matter volume was associated with increasing age. Regional volumes that were affected also related to the severity of injury, whereby the most severe TBI participants displayed the most significant pathology. Poorer retention of newly learned material was associated with reduced cortical volume in frontal, parietal, and occipital brain regions. In addition, poorer working memory and executive control performance was found for individuals with lower cortical volume in temporal, parietal, and occipital regions. These findings are largely in line with previous literature, which suggests that frontal, temporal, and parietal regions are integral for the encoding of memories into long-term storage, memory retrieval, and working memory. The present study suggests that automated image analysis methods may be used to explore the relationships between regional variation in grey matter volume and cognitive function following TBI.     

Decision-specific reinvestment scale: An exploration of its construct validity,and association with stress and coping appraisals

ObjectiveThis research project aimed to explore the construct validity of the Decision-Specific Reinvestment Scale (DSRS); more specifically, its links with stress and coping appraisals.DesignStudy 1 validated the DSRS and the Movement-Specific Reinvestment Scale (MSRS) to the French language, in order to examine the construct validity of the DSRS using the MSRS, the Preference for Intuition and Deliberation (PID) inventory and the Melbourne Decision-Making Questionnaire (MDMQ). In addition, sex differences in reinvestment were investigated. Study 2 examined stress and coping appraisals of high and low reinvesters.MethodIn study 1, 379 athletes completed the DSRS, MSRS, PID, and MDMQ. In study 2, 100 handball players, classified as low and high reinvesters, completed surveys aimed to assess stressor intensity, stressor perceived controllability, coping effectiveness, subjective performance and coping strategies with the Coping Inventory for Competitive Sport over three games.ResultsIn study 1, we found that intuitive athletes scored lower on the DSRS in comparison to deliberative athletes, whilst no difference was found for the MSRS. Convergent and discriminant validity was illustrated with the subscales of the MDMQ. No sex differences were found regarding reinvestment. In study 2, findings showed that low reinvesters scored higher than high reinvesters in terms of stressor perceived controllability, coping effectiveness and subjective performance.DiscussionIn addition to confirmation of construct validity, these findings strengthen our understanding of how high decision reinvesters perceive a pressured situation. Key applications are derived from our findings informing coaches and athletes in offsetting the negative effects of reinvestment on sport performance.     

Motor imagery in spinal cord injury patients: Moving makes the difference

Both real action control and execution and motor imagery abilities require knowledge of the spatial location of body parts, in other words efference copy information and feedbacks from the sensory system (Frith et al., 2000, Philos. Trans. R. Soc. Lond. B. Biol. Sci., 355, 1771). Spinal cord injuries induce severe motor disability, due to a damage of the descending motor pathways (Cramer et al., 2007, Exp. Brain. Res., 177, 233). Patients' motor imagery competences are variably reported as either normal or defective (Decety & Boisson, 1990, Eur. Arch. Psychiatry Clin. Neurosci., 240, 39; Lacourse et al., 1999, Behav. Brain Sci., 104, 73). We explored biomechanical constraint effects in Spinal Cord Injury (SCI) patients, as they are considered the most reliable indexes of motor imagery abilities (Parsons, 1987b, Cogn. Psychol., 19, 178). Sixteen spinal cord injuries patients and 16 neurologically unimpaired subjects have been administered with (1) the Hand Laterality Task (HLT), in which subjects were asked to judge the laterality of a rotated hand; and (2) the Mirror Letter Discrimination Task (MLD), in which subjects were asked to judge if a rotated character was in its correct upright position or mirror‐reversed form. Our patients did not present the effect of stimulus orientation, neither did they show any effect related to biomechanical constraints. Based on these data, the hypothesis is that SCI patients' performance may be ascribed to the use of a different strategy to solve the tasks, based on memory rather than on mental rotation.     

Social comparison,coping and depression in people with spinal cord injury

The present study among 70 people with spinal cord injury examined the prevalence and correlates of identification (seeing others as a potential future) and contrast (seeing others in competitive terms) in social comparison as related to coping and depression. The most prevalent social comparison strategy was downward contrast (a positive response to seeing others who were worse-off), followed by upward identification (a positive response to perceiving better-off others as a potential future), downward identification (a negative response to perceiving worse-off others as a potential future), and upward contrast (a negative response to seeing others who were better-off). Those with less severe lesions reported the highest levels of upward contrast, coping through blaming others, and depression. Downward contrast was particularly related to constructive coping, and upward identification to wishful thinking. The less adaptive social comparison strategies, i.e., upward contrast and downward identification, were quite strongly related to wishful thinking and blaming others. Particularly upward contrast, i.e., feeling bad as response to seeing that others are better-off, was related to depression.     

An exploration of the therapeutic process while using computerised cognitive behaviour therapy

Background: Modern technologies that offer an alternative to face‐to‐face therapy have gained ground in the NHS. Critics have argued that some of the important elements of the therapeutic change process necessarily require a human therapist. Yet, the traditional understanding of the change process in psychotherapy is challenged by evidence that some computerised cognitive behaviour therapy (cCBT) programs may be as effective as face‐to‐face therapy, suggesting that in certain cases the interaction between user and a cCBT product satisfies sufficient criteria for personal change without the need for actual human contact. Aim: This study used the cCBT package Blues Begone as a means of investigating the process by which a computer‐mediated program helped adults with mild depression help themselves. Method: Seven qualitative interviews were conducted with mildly depressed users who had completed Blues Begone in their own homes without any additional human help or support. Findings: Interpretive phenomenological analysis (IPA) was performed with four main themes emerging. These were: the meaningful relationship; shape from confusion; stimulation and empowerment. This study illustrates some of the ways that some depressed users make use of cCBT self help.     

Rasch analysis of the Hospital Anxiety and Depression Scale in spinal cord injury

Purpose: The purpose of this study was to evaluate the psychometric properties of the Hospital Anxiety and Depression Scale (HADS), applied among persons with spinal cord injury (SCI), using Rasch analysis. Methods: A cross-sectional multicenter study was conducted and the data of 102 people with SCI were analyzed. Rasch analyses were performed to assess dimensionality, overall and individual item fit, response scale structure, targeting, and differential item functioning. Results: The anxiety and depression subscales showed unidimensionality, that is, model and item fit. The two subscales are reliable (r = .72, 0.82) in SCI. No disordered structure of the response scales or differential item functioning in age, gender, education, relationship status, level of spinal lesion were found. Stepwise deletion of the misfitting items did not produce a total score that fulfilled the statistical criteria for unidimensionality. Conclusions: The results of the Rasch analyses support the use of the anxiety and depression subscales among people with SCI. However, further research is needed to confirm these findings and examine sensitivity to change of the HADS in SCI, which would support its use in longitudinal observational and intervention studies. (PsycINFO Database Record (c) 2012 APA, all rights reserved).