Dimensions of cancer locus of control scale as predictors of psychological adjustment and survival in breast cancer patients

The Cancer Locus of Control Scale, to investigate specific beliefs of control in cancer patients, was validated previously with an English-speaking population. This study tested the construct and concurrent validity of a 17-item French version of the scale and explored its relations with psychological adjustment and with adaptation assessed two years later. In a sample of 157 women diagnosed with a first breast cancer, the French version was administered along with the Body Image Questionnaire, the State-Trait Anxiety Inventory, the Perceived Stress Scale, the Social Support Questionnaire, and the Ways of Coping Checklist. A factor analysis performed on scores identified the three original factors: internal causal attribution, control over the course of the illness, and religious control. Internal causal attribution was associated with high scores for state and trait anxiety, negative body image, emotion-focused coping, and problem-focused coping. Control over the course of the cancer was positively associated with scores on both problem- and emotion-focused coping. Religious control was negatively associated with perceived stress. Emotional adjustment and quality of life were assessed in 59 of the 157 breast cancer patients two years after diagnosis and original testing. Hierarchical regression analyses indicated that internal causal attribution significantly predicted 38.1% of the variance in rated state anxiety. None of the dimensions of the Cancer Locus of Control Scale predicted the duration of survival measured two years later in 75 of the 157 patients.     

Lung function, adherence and denial in asthma patients who exhibit a repressive coping style

Lung function, adherence and denial were explored in asthma patients who possess a repressive coping style (repressors). Repressors (low trait anxiety, high defensiveness) and non-repressors were identified by their trait anxiety and defensiveness scores. Participants completed measures of self-reported adherence, denial, morbidity and demographic data. A lung function measure (FEV(1)) was obtained for a subset of patients. Repressors, who comprised 33% of the sample, had significantly worse lung function but scored significantly higher on self-reported adherence, compared to non-repressors. Age was positively correlated with adherence. Although repressive coping was positively correlated with denial, denial was significantly correlated with defensiveness but not trait anxiety. The study provides evidence that repressors are an important group to identify in future studies of asthma.     

The relationship between dispositional optimism, dispositional pessimism, repressive coping and trait anxiety

The purpose of this study was to investigate the relationship between dispositional optimism, dispositional pessimism, repressive coping and trait anxiety. The Marlowe-Crowne scale (MC) and the Bendig version of the Taylor Manifest Anxiety Scale (MAS) were used to select repressor and control groups (N=143, aged between 18 and 47 years), who subsequently completed a measure of dispositional optimism, the Life Orientation Test (LOT), which consists of two sets of items: optimism and pessimism. Repressors (high MC, low MAS) reported significantly lower pessimism than all other participants. When the pessimism scale was divided into high and low categories, there were significantly more repressors in the low pessimism group than the other low trait anxiety group, low anxious (low MC, low MAS). However, for the optimism scale the opposite pattern of results was found, with significantly more low anxious in the high optimism group than repressors. These results support the assertion that the pessimism and optimism scales of the LOT are not the same construct and should be measured separately.     

Anxiety symptom interpretation in high-anxious, defensive high-anxious, low-anxious and repressor sport performers

For the first time in a sport setting this study examined the intensity and direction of the competitive state anxiety response in collegiate athletes as a function of four different coping styles: high-anxious, defensive high-anxious, low-anxious and repressors. Specifically, the study predicted that repressors would interpret competitive state anxiety symptoms as more facilitative compared to high-anxious, defensive high-anxious, and low-anxious performers. Separate Multivariate Analyses of Variance (MANOVA) were performed on the intensity and direction subscales of the modified Competitive State Anxiety Inventory-2 (CSAI-2). A significant main effect was identified for trait worry revealing that low trait anxious athletes reported lower intensities of cognitive and somatic anxiety and higher self-confidence and interpreted these as more facilitative than high trait anxious athletes. The prediction that performers with a repressive coping style would interpret state anxiety symptoms as more facilitative than performers with non-repressive coping styles was not supported.     

Anxiety symptom interpretation in high-anxious,defensive high-anxious,low-anxious and repressor sport performers

Abstract

For the first time in a sport setting this study examined the intensity and direction of the competitive state anxiety response in collegiate athletes as a function of four different coping styles: high-anxious, defensive high-anxious, low-anxious and repressors. Specifically, the study predicted that repressors would interpret competitive state anxiety symptoms as more facilitative compared to high-anxious, defensive high-anxious, and low-anxious performers. Separate Multivariate Analyses of Variance (MANOVA) were performed on the intensity and direction subscales of the modified Competitive State Anxiety Inventory-2 (CSAI-2). A significant main effect was identified for trait worry revealing that low trait anxious athletes reported lower intensities of cognitive and somatic anxiety and higher self-confidence and interpreted these as more facilitative than high trait anxious athletes. The prediction that performers with a repressive coping style would interpret state anxiety symptoms as more facilitative than performers with non-repressive coping styles was not supported.     

Emotional information processing in repressors: The vigilance–avoidance theory

A vigilance–avoidance theory of the repressive coping style (low trait anxiety and high defensiveness) is presented. The new theory attempts to account for several key findings, including the discrepancy between low self-reported anxiety and high behavioural and physiological indicators of anxiety shown by individuals with a repressive coping style. According to the theory, repressors have an initial rapid vigilant response triggering behavioural and physiological responses and involving attentional and interpretive biases to self-relevant threat stimuli. These biases may be based on negative self-relevant schematic information. This initial vigilant stage is followed by an avoidance stage involving avoidant cognitive biases (attentional, interpretive, and memory) that inhibit the conscious experience of anxiety. Future research should examine systematically the time course of repressors’ reactions to threatening and non-threatening stimuli.     

Repression and effective coping styles

This study investigated the relationship between repressive coping style as defined by Weinberger (1990)—low reported anxiety and high reported defensiveness—and several individual difference measures related to general coping styles. Twenty‐nine studies looking at cognitive, behavioural, and individual difference factors associated with repressive coping were tabulated and reviewed. In the current study 116 women and 32 men were administered a questionnaire including measures of personality, ways of coping, self‐monitoring, interpersonal influence, and locus of control to further explore the repressor coping style. Two measures, as opposed to the usual one, were used to categorize repressors: the use of anxiety and social desirability measures of Weinberger, Schwartz and Davidson (1979) and the Gudjonsson (1981) method using Neuroticism and Lie scales from the EPQ(R). Analysis of variance showed that repressors reported using more positive/healthy and less negative/unhealthy coping styles. The results did not change substantially when more extreme scoring groups were used. Factor analysis of the scales revealed six clear factors relating to ways of coping; again, repressors scored highly on the factor denoting positive coping. It was also found that the Lie and Neuroticism scales of the revised EPQ personality questionnaire of Eysenck, Eysenck and Barrett (1985) could be used as a substitute for anxiety and defensiveness to predict repression with considerable success. However results from both one‐ and two‐way analysis of variance indicated that the two different ways of classifying repressors was not totally inter‐changeable as the overlap in results occurred only with highly significant effects. The results are discussed in the light of previous investigations into repression which suggested that repressors report an overly optimistic way of coping in order to avoid negative affect. Copyright © 1999 John Wiley & Sons, Ltd.     

Repressive Coping,Emotional Adjustment,and Cognition in People Who Have Lost Loved Ones to Suicide

Research indicates that a repressive coping style is psychologically protective against the stress of trauma, yet it is unclear whether this finding generalizes to suicide bereavement. Thus, we assessed cognitive ability and mental health among individuals who lost a loved one to suicide. The results indicate that repressive coping may be associated with greater emotional health during suicide bereavement. Interestingly, “repressors” also had lower scores on both cognitive tasks compared to “nonrepressors,” but it is unclear whether their more recent loss accounts for this difference. These results are based on cross‐sectional data, and should be interpreted with caution.     

The role of coping, anxiety, and stress in depression post-acute coronary syndrome

Depressive symptoms are common and can affect prognosis following acute coronary syndromes (ACS). This study examined the psychological factors, coping, anxiety, and perceived stress associated with depression following ACS. Psychological variables were assessed in 15 females and 66 males (M = 57 years, SD = 12). Repeated measures at 2, 12, and 24 weeks post-ACS compared depression, anxiety, perceived stress, and coping resources as determined by the Cardiac Depression Scale, Beck Depression Inventory-II, State Trait Anxiety Inventory, Perceived Stress Scale, and Coping Resources Inventory. Depression, anxiety, and perceived stress remained high in the depressed group across time. Coping scores at 2 weeks post-ACS predicted depression scores at 24 weeks post-ACS. It appears that trait anxiety and coping resources are related to depressive symptoms post-ACS.     

Anxiety and Depression in Cancer Patients: The Association with Religiosity and Religious Coping

There is a lack of studies looking into religiosity and religious coping in cancer patient. In this cross-sectional study, we examined the religiosity using Duke University Religion Index, religious coping using Brief Religious Coping Scale, anxiety and depression based on Hospital Anxiety and Depression Scale among 200 cancer patients. The association between religiosity and religious coping with anxiety and depression was studied. The findings showed that subjects with anxiety or depression used more negative religious coping and had lower non-organization religiosity. Hence, measurements in reducing negative religious coping and encouraging religious activities could help to reduce psychological distress in cancer patients.     

Repression and Coping Styles in Asthmatic Patients

The objectives of this study were to (a) determine prevalence of the dispositional repressive coping style as well as other situational coping styles in a sample of asthmatic patients and (b) to analyze the capacity of these styles to predict subsequent morbidity (emergency room visits or hospitalizations due to asthma) during a 12-month follow-up. A sample of 75 adult asthmatic patients was selected and information about sociodemographics, asthma severity, and patient’s perception of illness severity was collected. Repressive coping style was defined by a combination of scores obtained on the Trait Anxiety Inventory and the Marlowe-Crowne Social Desirability Scale. Coping styles were assessed with the dispositional version of the Coping Orientation to Problems Experienced Inventory. Eighteen patients (24%) were classified as repressors. Repressor asthmatics obtained scores significantly lower on Emotion-Focused Coping compared to non-repressors (F _(1,72) = 5.15, p = .026). Patients who perceived their asthma as severe reported to use Emotion-Focused Coping more than those who judged it as mild or moderate (F _(2,71) = 4.83, p = .011). A higher use of Denial (an Emotion-Focused strategy of coping) explained 8% of variance of the frequency of emergency room visits during the 12-month follow-up. The prevalence of repressive coping style in the asthmatic population is similar to that registered in other populations of chronic patients, and it is also associated with the tendency to report a lower use of strategies traditionally considered as maladaptive. The use of Emotion-Focused Coping strategies seems to be related to a worse perception of the physical status, and among this group of strategies, Denial also could favor a poor clinical course in bronchial asthma.     

Parent and Child Agreement for Acute Stress Disorder,Post-Traumatic Stress Disorder and other Psychopathology in a Prospective Study of Children and Adolescents Exposed to Single-Event Trauma

Examining parent-child agreement for Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD) in children and adolescents is essential for informing the assessment of trauma-exposed children, yet no studies have examined this relationship using appropriate statistical techniques. Parent-child agreement for these disorders was examined by structured interview in a prospective study of assault and motor vehicle accident (MVA) child survivors, assessed at 2–4 weeks and 6 months post-trauma. Children were significantly more likely to meet criteria for ASD, as well as other ASD and PTSD symptom clusters, based on their own report than on their parent’s report. Parent-child agreement for ASD was poor (Cohen’s κ = −.04), but fair for PTSD (Cohen’s κ = .21). Agreement ranged widely for other emotional disorders (Cohen’s κ = −.07–.64), with generalised anxiety disorder found to have superior parent-child agreement (when assessed by phi coefficients) relative to ASD and PTSD. The findings support the need to directly interview children and adolescents, particularly for the early screening of posttraumatic stress, and suggest that other anxiety disorders may have a clearer presentation post-trauma.     

Identifying repressors: A methodological issue for health psychology

Abstract

The majority of studies in health psychology use self-report measures. However, there is a growing body of evidence indicating that this methodology may be problematic for a significant minority of the population: individuals who possess a repressive coping style (repressors). Repressors, who fail to report negative affect, answer many self-report measures in a positive fashion. Research has identified an association between repressors, who are identified by low trait anxiety scores and high defensiveness scores, and adverse health outcomes. Therefore, repressors are an important group for health psychologists to investigate. Health psychology research should use more than one method of data collection in an attempt to unravel this difficult methodological problem.     

Early vigilance and late avoidance of threat processing: Repressive coping versus low/high anxiety

The time course of a bias in predicting danger as a function of a repressive coping style was examined. The participants belonged to repressor, low - anxious, or high - anxious groups. They read context sentences predictive of threat or nonthreat event outcomes, followed by target words for rapid naming representing the outcomes. The interval between context and target word was 50 ms (Experiment 1), 550 ms (Experiment 2), or 1050 ms (Experiments 3 and 4). There was bias for naming words confirming threatening outcomes: (a) for repressors in the 550-ms delay condition; and (b) for high - anxiety participants in the 1050-ms delay condition. Repressive coping facilitated early processing of threat, but inhibited late processing, whereas high anxiety was characterised by sustained vigilance for threat. There were clear differences in threat processing by repressors and the low - anxious participants     

Repression and coping with the threat of rape

A study is reported which examined the impact of repressive coping style on processing and recalling information about rape. It was predicted that repressors selectively avoid threatening information about a rape incident and that selective avoidance is reflected in poorer recall for details of the rape account as well as anticipation of fewer coping problems in the event of sexual victimization. A total of N=143 women were presented with an authentic rape scenario taken from police files. The sample was divided into repressors, sensitizers, non‐anxious and defensive high‐anxious individuals on the basis of an anxiety and a social desirability measure. Differential memory by the four groups for the rape scenario was measured in a free‐recall task. In addition, respondents were asked to anticipate potential coping problems they thought they would experience in the event of sexual victimization, and they were asked to indicate their behavioural precautions against a sexual assault. As predicted, repressors showed poorer recall for the described rape than both sensitizers and non‐anxious subjects. Results were less conclusive concerning the proposed interaction of anxiety and defensive avoidance on anticipated coping problems. No effect was found of cognitive coping style on behavioural precautions against rape. The findings are discussed with respect to the construct validity of repression as a cognitive strategy for coping with threat in the domain of sexual violence. Copyright © 1999 John Wiley & Sons, Ltd.     

The distribution of repressive coping styles among non-metastatic and metastatic breast cancer patients as compared to non-cancer patients

Abstract

Recent investigations have shown increased disease progression among breast cancer patients with a “repressive” coping style characterized as: passive, conforming, inclined to deny physical symptoms and emotionally unexpressive. The Millon Behavioral Health Inventory (MBHI) scales which delineate three discrete repressive coping styles include the: Introversive, Cooperative and Respectful. Forty-four women recently diagnosed (within four weeks) with non-metastatic (N=32) or metastatic (N=12) breast carcinoma, responded to the MBHI upon admission for treatment of their disease at a cancer treatment unit. All subjects received mastectomy as well as chemotherapy, radiation and/or endocrine therapy. These 44 Cancer patients were compared to 34 control subjects, comprising women who were seen at a colposcopy clinic for follow-up of a suspicious pap smear which was ultimately shown to be benign or consisted of mild dysplasia. Non-metastatic, metastatic and control subjects were compared with respect to coping style and psychological distress. The breast cancer patients were more likely to employ a repressive coping style as compared to non-cancer patients who utilized a “sensitizing” coping strategy predominantly. Cancer patients with the most severe prognosis (metastasis) were the only group within the study to attain a clinically significant mean base rate score on the respectful scale. Results suggest that the incidence of repressive coping styles may be disproportionately high among breast cancer patients.     

The generality of cognitive bias in acute stress disorder

Cognitive bias was investigated in acutely traumatised civilians with either acute stress disorder (ASD; n = 26) or no ASD (n = 24). Participants completed the Acute Stress Disorder Interview, the Beck Depression Inventory, the Beck Anxiety Inventory (BAI), the Impact of Event Scale (IES), and an Event Probability Questionnaire and an Event Cost Questionnaire that comprised items pertaining to (a) external harm, (b) somatic sensations and (c) social events. ASD participants exaggerated both the probability of negative external harm, somatic and social events occurring, and the adverse cost of those events more than non-ASD participants. Elevated probability and cost estimates were predicted by BAI and IES-Avoidance scores, respectively. These findings are discussed in the context of different patterns observed in other anxiety disorders, and interpreted in terms of network theories of posttraumatic stress.     

Ropressive Coping Style and the Experience and Recall of Emotion: A Naturalistic Study of Daily Affect

ABSTRACT Research shows that people characterized as repressors display inhibited recall for unpleasant memories. In this study, the relationship between repressive coping style and the recall of affect near the time of the experience was compared to delayed recall. An experience sampling technique was used to collect affect data twice daily for 4 weeks. Repressive coping style was found to be related to low levels of average daily unpleasant affect and lowered delayed recall of unpleasant affect. Unlike repressors, high anxious individuals overestimated unpleasant affect during delayed recall. Repressors did not exhibit isolation of the dominant unpleasant affect from nondominant unpleasant affect in daily reporting. The overall pattern of results suggests that the effect of repressive coping style is to diminish the encoding of all unpleasant affect, whereas trait anxiety appears to promote overestimation in the recall of unpleasant affect.     

Is the concept of "repression" useful for the understanding chronic PTSD?

Theories concerning the value of avoiding versus attending to trauma-related thoughts provide mixed support for specific coping strategies such as repression. The goal of this study is to examine the usefulness of the concept of repression in understanding chronic Posttraumatic Stress Disorder (PTSD). One hundred and fifty individuals who had been in a motor vehicle accident were included. Participants were classified into four groups (repressors, low anxious, high anxious, and defensively high anxious) based on methodology introduced by Weinberger et al. [J. Abnormal Psychol. 88 (1979) 369]. These four groups were compared on measures of PTSD symptomatology, anxiety, depression, and where appropriate, perceived pain and disability. Results revealed a fairly consistent pattern of group differences such that repressors reported fewer PTSD symptoms, fewer additional anxiety disorders, less depression, and less physical disability due to pain relative to the high anxious and defensively high anxious groups. Regression analyses examining the separate and interactive effects of anxiety and social desirability to predict PTSD symptomatology showed that the majority of the variance was explained by anxiety. In many respects, these data suggest that repression may not be a useful concept for understanding chronic PTSD.     

Trait anxiety reduces affective fading for both positive and negative autobiographical memories

The affect associated with negative events fades faster than the affect associated with positive events (the Fading Affect Bias; the FAB). The research that we report examined the relation between trait anxiety and the FAB. Study 1 assessed anxiety using the Depression, Anxiety, and Stress Scale; Studies 2 and 3 used the Beck Anxiety Inventory. Studies 1 and 2 used retrospective procedures to probe positive event memories and negative event memories while Study 3 used a diary procedure. The results of all 3 studies showed that increased anxiety was associated with both a lowered FAB and lower overall affect fading for both positive events and negative events. These results suggest that for people free of trait anxiety, the FAB reflects the operation of a healthy coping mechanism in autobiographical memory that is disrupted by trait anxiety.