Do behavioural self-blame and stigma predict positive health changes in survivors of lung or head and neck cancers?

Survivors of lung or head and neck cancers often change tobacco and alcohol consumption after diagnosis, but few studies have examined other positive health changes (PHCs) or their determinants in these groups. The present study aims to: (a) document PHCs in survivors of lung (n?=?107) or head and neck cancers (n?=?99) and (b) examine behavioural self-blame and stigma as determinants of PHCs. We hypothesised that: (a) survivors would make a variety of PHCs; (b) behavioural self-blame for the disease would positively predict making PHCs; and (c) stigma would negatively predict making PHCs.

Methods: Respondents self-administered measures of PHC, behavioural self-blame, and stigma. Hierarchical multiple regression analysis tested the hypotheses.

Results: More than 65% of respondents reported making PHCs, the most common being changes in diet (25%), exercise (23%) and tobacco consumption (16.5%). Behavioural self-blame significantly predicted PHCs but stigma did not. However, both behavioural self-blame and stigma significantly predicted changes in tobacco consumption.

Conclusions: Many survivors of lung or head and neck cancers engage in PHCs, but those who do not attribute the disease to their behaviour are less likely to do so. Attention to this problem and additional counselling may help people to adopt PHCs.     

Rape: A Trauma of Paralyzing Dehumanization

This study examines the pathogenic role of rape-induced peritraumatic dehumanization, and subsequent humiliation and “freezing.” A theoretical causal model linking these rape-related peritraumatic responses to symptoms is tested while considering the ways in which rape differs from other types of nonsexual trauma in relation to this particular model. Two hundred and fifty-five participants completed self-report questionnaires. Structural path analyses identified dehumanization and humiliation as highly prevalent and almost invariably predictive of a freeze response in rape; and, in turn, of elevated self-blame and post-traumatic stress disorder in its wake while concurrently showing a poor fit for this model in respect to other traumas. In addition, multivariate analysis of variance results indicated that peritraumatic, as well as post-traumatic distress, was considerably more severe among rape survivors as compared to controls.     

Trauma event autobiographies: An exploratory multiple case study

This multiple case study explored trauma event memories of three individuals to characterise underlying meanings important for their recovery. The three participants were women in the age range of 43 to 54 years old, who shared their own memories of a trauma-laden event four to five years post-occurrence. Thematic analysis of the autobiographical narratives indicated underlying memories across cases of silence imposed on trauma victims by their social environments and communities. Differences in trauma autobiographical memories were in meaning making within the context of the participants’ own culture, society, and community. Autobiographical memory studies appear to have value for understanding likely pathways to recovery from trauma     

Self-blame attributions,control appraisals and distress among cardiac rehabilitation patients

This study examined associations between self-blame attributions, control appraisals and distress among cardiovascular disease patients participating in a cardiac rehabilitation (CR) programme. Questionnaire data were collected from 129 patients at the beginning and end of CR. We found little evidence that characterological self-blame (CSB) affects distress symptoms, but behavioural self-blame at the beginning of CR was positively associated with distress symptoms concurrently, and 12 weeks later. Furthermore, diet- and exercise-focused self-blame was only modestly, positively related to control appraisals concurrently, while CSB was negatively associated with control. Prospectively, we found few significant associations between self-blame and control. Results imply that making any type of self-blame attribution during CR does not aid in adjustment or enhanced control appraisals. Our findings suggest that CR staff should encourage patients to recognise their control over reducing risk for recurrence, but should discourage patients from looking backward and ruminating about factors that may have contributed to disease onset.     

Perceived stigma,self-blame,and adjustment among lung,breast and prostate cancer patients

People who suffer from disease have often been stigmatised. The internalisation of stigma leads to the experience of self-blame. The relationship among stigma, self-blame and adjustment was framed with two theoretical perspectives: the looking-glass self and learned helplessness models. These models were studied in 96 lung, 30 breast and 46 prostate cancer patients. Consistent with the looking-glass-self model, we predicted that perceived stigma and self-blame would be associated with poorer psychological adjustment; the data supported these hypotheses. Consistent with the learned helplessness model, we predicted that self-blame would mediate the link between perceived stigma and psychological adjustment; data supported these hypotheses. The mediation model explained a greater percentage of the variance in adjustment in the lung cancer sample compared to the breast and prostate cancer sample. Participants who reported internal causal attributions reported poorer psychological adjustment. Lung cancer patients were more likely than breast or prostate cancer patients to report internal causal attributions for their cancer. Future research and cancer care are discussed in light of these findings.     

Peer Victimization, Aggression, and Their Co-Occurrence in Middle School: Pathways to Adjustment Problems

An ethnically diverse sample of 6th-grade students completed peer nomination procedures that were used to create subgroups of students with reputations as victims, aggressors, aggressive victims, and socially adjusted (neither aggressive nor victimized). Self-report data on psychological adjustment, attributions for peer harassment, and perceived school climate were gathered. In addition, homeroom teachers rated participating students on academic engagement and students' grades were collected from school records. Victims reported the most negative self-views, aggressors enjoyed the most positive self-views, and aggressive victims fell between these two groups, although their psychological profile more closely resembled that of victims. However, all three subgroups encountered more school adjustment problems when compared to their socially adjusted classmates. Different pathways to school adjustment problems for aggressors and victims were examined. For victims, characterological self-blame for victimization and psychological maladjustment were the key mediators, whereas for aggressors, the significant pathway was mainly through perceived unfairness of school rules. Analyses by ethnicity revealed that African American boys were most likely to be perceived as aggressive and as aggressive victims and they were doing most poorly in school. Implications for intervention with subgroups of problem behavior youth and the particular vulnerabilities of African American adolescents were discussed.     

Is Rape-Related Self Blame Distinct From Other Post Traumatic Attributions of Blame? A Comparison of Severity and Implications for Treatment

Rape treatment generally takes the form of standard trauma intervention, which may limit its ability to resolve rape-specific symptoms. For the sake of optimizing such treatment, the present study seeks to distinguish specific post-rape symptoms from those observed following other forms of trauma, particularly in respect to self-blame and related PTSD. Given typical societal victim-blaming following rape, self-blame is expected to be considerably more extreme among survivors of rape than in other victims, and predictive of relatively elevated post-trauma symptoms. Three hundred and four participants completed measures of blame attribution and PTSD, substantiating the hypotheses. Implications for rape treatment and social change are discussed.     

Barriers to Reporting Sexual Victimization: Prevalence and Correlates among Undergraduate Women

This study examined the frequency and correlates of barriers to reporting sexual victimization to law enforcement. Participants were 127 female undergraduate sexual assault victims who completed self-report surveys. The most frequently reported barriers were “I handled it myself” and “I didn't think it was serious enough.” Factor analysis of the reported barriers items revealed two factors: shame/not wanting others involved and did not acknowledge the event as a crime?/handled it myself. Shame/not wanting others involved was positively associated with physical injury, being victimized by a relative, and self-blame. Acknowledgment/handled it myself was negatively associated with being victimized by a relative. Findings suggest that intervention efforts should focus on increasing acknowledgment, decreasing negative reactions to disclosure, and decreasing victims' self-blame.     

Gaining Control Over Traumatic Experiences: The Role of Guilt in Posttraumatic Stress Disorder

The present study explores the relationship between guilt, sense of control, and posttraumatic stress disorder. Seventy-eight participants who had experienced a traumatic event completed the following self-report measures online: the Posttraumatic Stress Diagnostic Scale, the Guilt Cognitions subscale of the Trauma-Related Guilt Inventory, the Posttraumatic Cognitions Inventory, and Sense of Control During the Trauma. Results revealed that “behavioral self-blame” that refers to functioning during the trauma, positively correlated with posttraumatic stress symptoms. However, when Sense of Control During the Trauma was introduced into the analysis, this correlation appeared only for participants who had experienced lack of control during the traumatic event. Among the participants who had experienced a sense of control, no such link was found. Results suggest that guilt may be produced to avoid feelings of helplessness following the trauma, because guilt conveys a sense of control.     

Interpersonal Trauma and Physical Health Symptoms in College Students: Mediating Effects of Substance Use and Self-Blame

The present study examined the mediating effect of two coping mechanisms (substance use and self-blame) on the relationship between interpersonal trauma (IPT) exposure and self-reported physical health symptoms in college students. Participants included 365 trauma-exposed college students. We used multigroup structural equation modeling to test our hypothesized model and to determine whether the hypothesized relationships were moderated by gender. Results indicated that IPT exposure was associated with increased substance-use coping and self-blame. These two coping mechanisms, in turn, predicted increased physical health symptoms. The results of the moderation analysis indicated no significant gender differences in the hypothesized relationships.