The role of illness perceptions in the attachment-related process of affect regulation

Abstract

Based on the predictions of the attachment theory and the Common Sense Model of illness perceptions, the current study focused on the role played by illness perceptions in explaining the path linking attachment orientations to negative affect during recovery from cardiac illness. We predicted two putative mechanisms: (1) illness perceptions would mediate the direct association between attachment-related insecurity (especially attachment anxiety) and levels of distress at follow-up and (2) illness perceptions would interact with attachment orientations (attachment avoidance in particular) in explaining patients' distress. The sample consisted of 111 male patients admitted to the Cardiac Care Unit of the Meir Medical Center, located in the central region of Israel. Patients completed a measure of attachment orientations during hospitalization (baseline). One month later, patients' illness perceptions were measured. Patients' depression and anxiety symptoms were measured at baseline and at the six-month follow-up. The associations between attachment-related anxiety and anxiety symptoms at follow-up were fully mediated by illness perceptions. Attachment-related avoidance was found to interact with illness perceptions in the prediction of depressive symptoms at follow-up. The findings shed light on the possible dynamics among personality, cognitive appraisals, and affect regulation efforts when coping with illness.     

The role of cross-modal associations in statistical learning

Our environment is richly structured, with objects producing correlated information within and across sensory modalities. A prominent challenge faced by our perceptual system is to learn such regularities. Here, we examined statistical learning and addressed learners’ ability to track transitional probabilities between elements in the auditory and visual modalities. Specifically, we investigated whether cross-modal information affects statistical learning within a single modality. Participants were familiarized with a statistically structured modality (e.g., either audition or vision) accompanied by different types of cues in a second modality (e.g., vision or audition). The results revealed that statistical learning within either modality is affected by cross-modal information, with learning being enhanced or reduced according to the type of cue provided in the second modality.     

Flexibility over automaticity: Separable representations for colours and words

This study demonstrates that associations between colour words and the colours they denote are not mandatory. Experiments 1–3 used a go/no-go task in which participants responded to one print colour and one word and withheld response from another print colour and another word. In Experiment 1, the content of the words denoted noncolour entities. In Experiment 2 the two words denoted two colours that were different from the target print colours. In Experiment 3, the words denoted the same colours as the target print colours but each response set included incompatible print colour and word (e.g., one response to the print colour blue and the word “green” and another response to the print colour green and the word “blue”). Participants performed equally well in all the experiments. Experiment 4a used Arabic digits and words denoting numbers, two formats that are known to have shared representations. Here, participants had difficulties separating their responses to the digits and words. These results suggest that representations of words are distinct from the content that they represent, supporting the existence of distinct verbal and colour modules.     

Establishing global and local correspondence between successive stimuli: the holistic nature of backward alignment

Reflection decisions on alphanumeric characters display systemic effects of disorientation, suggesting that subjects mentally rotate the stimulus to the upright (the uprighting process). However, response time also increases with increasing angular disparity between the current and preceding orientations. This occurs only when the current stimulus is brought into congruence with the preceding one (the backward alignment process). In the present study, we examined the hypothesis that the transformation that occurs in backward alignment in holistic even in tasks in which the uprighting process is likely to be piecemeal. Evidence supporting this hypothesis is presented on the basis of tasks requiring either classification of numbers (Experiments 1 and 3) and words (Experiment 2), or mirror image discrimination on letter pairs (Experiment 4). The results indicated that backward alignment establishes global correspondence between successive stimuli and is indifferent to local correspondence at the level of the constituent elements. The establishment of this global correspondence decreases with the number of elements in the stimulus (Experiment 5), but its effects are still observed for four-letter strings (Experiment 6).     

Self‐paced study time as a cue for recall predictions across school age

Recent work on metacognition indicates that monitoring is sometimes based itself on the feedback from control operations. Evidence for this pattern has not only been shown in adults but also in elementary schoolchildren. To explore whether this finding can be generalized to a wide range of age groups, 160 participants from first to eighth grade participated in a study based on a self‐paced study time (ST) allocation paradigm. In contrast to previous studies, picture pairs instead of word pairs were used as stimuli to compensate for reduced reading skills in younger participants. Actual ST and judgments of learning (JOLs) made at the end of each study trial were used as core variables. The results are in line with previous findings, in that children's JOLs decreased with increasing ST, suggesting that JOLs were based on the memorizing effort heuristic that easily learned items are more likely to be remembered. Weaker inverse relationship between JOLs and ST was found for the younger children. Overall, these results underline the importance of mnemonic cues in shaping metacognitive feelings not only in adults but also in older children and expose a developmental trend in their use along childhood.     

The subjective organization of input and output events in memory

In order to study the organization of memory for self-performed actions, 80 participants were presented with 20 action phrases for ten consecutive study-test cycles. Enactment was manipulated both in the input phase and in the output phase by having participants say or enact the phrases during encoding and/or during testing. Enactment at input or output generally enhanced both the quantity and the accuracy of recall and also improved output monitoring. More important, subjective organization, as indexed by the tendency to recall the same two phrases successively across repeated recall tests, was significant for all conditions, even on the first pair of trials, and increased systematically with repeated study-test cycles. Enactment neither impaired nor enhanced the amount of organization, and in all conditions a positive correlation was obtained between recall and subjective organization. Some commonalities in the nature of memory organization were found across all conditions. The results suggest that enactment may lead to more differentiated memory traces, resulting in more accurate recall. Although subjective organization was clearly observed when enactment was involved, its contribution to the enhancement of recall deserves further examination. Received: 12 November 1997 / Accepted: 2 June 1998     

Individual differences in habituation: Some methodological and conceptual issues

The personality correlates of habituation were investigated. A moderate intensity tone was presented 20 times on each of three sessions, and skin conductance and heart rate were recorded. There were no relationships between individual differences in rate of habituation and any of the personality dimensions assessed (which included, among others, manifest anxiety and introversion-extraversion). Some possible reasons are discussed for this lack of results, as well as for conflicting findings which fill the literature. Specifically, various methods of measuring habituation are examined and their interrelationships described. None of the measures derived showed adequate consistency either across sessions or over response modalities.     

Emotion Regulation Strategies in Cognitive Behavioral Therapy for Panic Disorder

Emotion regulation (ER) has been incorporated into many models of psychopathology, but it has not been examined directly in cognitive behavioral therapy (CBT) for panic disorder with agoraphobia (PD/A). In this study, a preliminary model of ER in CBT for PD/A is proposed based on existing theories, and several propositions of the model are tested. We hypothesized that increases in cognitive reappraisal would precede decreases in biased cognitions, decreases in expressive suppression would follow decreases in biased cognitions, and a reduction in symptom severity would follow decreases in expressive suppression. Twenty-nine patients who received CBT for PD/A completed weekly self-report measures of symptom severity, anxiety sensitivity, reappraisal and expressive suppression. In addition, patients were compared to a matched normal sample. Cross-lagged analyses partially supported the hypotheses. Reappraisal did not change until late stages of therapy and was generally not associated with treatment outcome. Suppression decreased significantly and exhibited a reciprocal relationship with biased cognitions. Symptom reduction followed decreases in suppression as hypothesized. However, patients did not differ in ER from matched controls at either pre- or posttreatment. Results suggest the important distinction between reappraisal and appraisal, and stress the role of session-by-session decreases in suppression as a predictor of symptom reduction.     

Children’s Perspectives and Evaluations of Safety in Diverse Settings and Their Subjective Well-Being: A Multi-National Approach

There is a need to explore variations in children’s safety perceptions for different settings (home, school and neighbourhood) and their relationship with subjective well-being (this including satisfaction with safety and satisfaction with life as whole) by comparing a variety of cultural contexts. A further objective is to explore to what extent gender, age group (10 and 12-year-olds) and level of SWB (measured using the SLSS -Student’s Life Satisfaction Scale- and the BMSLSS -Brief Multidimensional Student’s Life Satisfaction Scale) play a role in this prediction. Results obtained through binary logistic models with samples from Spain (n = 2,724), Algeria (n = 2432), South Africa (n = 2192) and Israel (n = 1914), show that children’s perceptions of safety are predicted by their different perceptions and evaluations of school, home and the nearby area. Perceptions of safety in the nearby area and satisfaction with safety (O.R. = 1.080) contribute to predicting higher levels of satisfaction with life as a whole to a greater extent than scores on the SLSS (O.R. = 1.036) and the BMSLSS (O.R. = 1.050) scales. The country participants live in (especially when combined with satisfaction with safety) and, to a lesser extent gender, also make important contributions. The age group they belong to plays a significant role in predicting higher perceptions of safety at home, in the area nearby, at school, and in predicting higher satisfaction with safety. Results open the door to the introduction of specific interventions (e.g. improving parent-child communication, enhancing public spaces for children to play and promoting children’s participation at school), aimed at promoting higher satisfaction with safety and also indirectly at higher satisfaction with life as a whole, on the basis of achieving positive changes of those factors which make the highest contribution.