Cognitive Appraisal, Coping and Psychological

349 Pages·2013·15.65 MB·English

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Cognitive Appraisal, Coping and Psychological
- Adjustment of those who Care for People
with Physical Disability
Rukhsana Kausar
Thesis Submitted in fulfilment of the requirement for the award of
Doctor of Philosophy
Department of Psychology
University of Surrey
1994
Abstract
Care giving is an exhausting job, and carers are reported to experience very
significant strain. This research examined burden, cognitive appraisal, coping, and
psychological adjustment of carers of physically disabled people with specific
reference to post-onset personality and physical changes. Two studies were
conducted.
Study one examined subjective burden in carers in relation to post-onset personality
changes, severity of disability, and other objective symptoms in disabled people
(objective burden). The carers rated both the current and pre-morbid personality of
disabled people, and they were interviewed to assess subjective and objective
burden 4-9 months and 12-18 months post-onset. Physically disabled people were
frequently reported as showing personality changes, and these changes were
reported in a negative direction on both occasions. Personality changes and
severity of disability showed a positive relationship with carers' subjective burden
at both assessment times. The carers' subjective burden was also associated with
objective burden categories, and the number of objective symptoms which related
to carers' subjective burden, increased over time. It was concluded that although
carers' burden was related to both personality changes and severity of disability,
their burden was associated more with personality changes, behavioural problems,
emotional disturbances and subjective symptoms.
Study two investigated carers' cognitive appraisal of post-onset personality and
physical changes, coping, and psychological adjustment to these changes. In
addition to examining the relationships between different variables, Lazarus'
cognitive model of coping was also tested. Carers completed a series of self-report
measures 4-18 months post-disability. It was confirmed that carers experienced an
immense amount of subjective burden and psychological distress, and that carers'
subjective burden was determined by both personality and physical changes in
patients. However, compared with physical changes, the personality changes of
patients were perceived as more stressful, more threatening, as of greater centrality
and they elicited more concerns. Physical changes, on the other hand, were
perceived as more manageable compared to personality changes. A variety of
strategies were employed to cope with post-onset changes. However, a greater
number of strategies were used to cope with personality changes as compared to
physical changes. Carers depended more on emotion-focused strategies when
coping with personality changes, whereas more problem-focused strategies were
utilized to cope with physical changes. As far as the relationship between
cognitive appraisal and coping is concerned, findings showed a general consensus
with Lazarus' cognitive model of coping. Cognitive appraisal of threat, centrality,
and levels of concerns showed a positive relationship with carers' subjective
burden and psychological distress. The appraisal of manageability and
controllability had a negative association with subjective burden and psychological
distress. Those carers who used a greater number of coping strategies and those
who employed more emotion-focused strategies were more subjectively burdened
as well as psychologically distressed. Looking at the predictability of subjective
burden and psychological distress by cognitive appraisal and coping, cognitive
appraisal emerged as a strong predictor of subjective burden and distress. Coping,
however was a weak predictor of carers' subjective burden and psychological
distress. It was concluded that cognitive factors, in particular cognitive appraisal
plays an important role in predicting carers' adjustment to post-onset changes in
physically disabled people.
Acknowledgements
A number of people have contributed to the completion of this research work.
Some have helped developing research ideas, others have aided practically, and yet
others have provided emotional support and encouragement.
First of all, I would like to thank my supervisor, Dr. Graham Powell for providing
invaluable supervision throughout the four years of work on this thesis. I would
like to thank Professor Glynis Breakwell for being supportive and considerate.
My thanks are due to the concerned staff at different hospitals and rehabilitation
units from where the subjects were recruited. In particular, I would like to thank
Dr. Michael Gross, Consultant Neurologist at the Royal Surrey Hospital, Mrs.
Penny Vargosen and Mr. Alistair Bradford, directors of the Harrowlands' Young
Persons' Disabled Unit, Mr. Collin Starling, the General Manager of the Unsted
Park Rehabilitation and Medical Centre, Mr. Drew AHcot, Clinical Psychologist at
the Unsted Park Rehabilitation and Medical Centre, Professor C. G. Swift and Dr.
Stephen Jackson at the Kings' College Hospital London. All of them cooperated in
allowing me access to the medical records and contributed to the progress of this
research.
Dr. Sean Hammond, Dr. Chris Fife-Schaw and Dr. Evanthia Lyons helped in
statistical analysis. I would like to thank them for their invaluable advice in data
analysis. Many thanks to Dr. MartYn Barrett for his guidance in handling practical
problems. I would like to thank Dr. Sarah Wilson for reading my thesis and giving
very useful comments.
My family, colleagues and friends were a source of immense support and
motivation for me, particulary my family members, whose unconditional love and
affection enabled me to complete this research work. I would like to offer my
special thanks to my friends at the University of Surrey, who always encouraged
me through all the ups and downs while staying away from my home and never let
me feel lonely. Specifically, I would like to mention Regina Pauli, Glynis Laws,
Mari Ito and Yun Low who, in addition to their support, read my work and
provided critical and helpful suggestions. My friends Lynne Martin, Jorg Huber,
Vickey Eftichiadou, Paul Sowden, Clare Twigger, Eithne Buchanan-Barrow,
Jamila-Al-Bahri, Sophia Muhammad, Yasmin Ejaz, Jawahra Jung, Riaz suddle,
Sarfraz Ahmed, Tariq Mahmood, Yasir Urfat, Mohamed Benbrahim, Bilal Ahmed
and Sadia Bilal, Abdul Qadar were always there for me. My thanks are due to Dr.
Zahid Mehmood for being very supportive.
My special thanks are due to the Government of Pakistan for providing funding for
the project, particulary I would like to thank Dr. Muhammad Latif Virk the
Education Attache for being very kind and understanding.
The people who undoubtedly contributed most significantly to the completion of
this thesis are the participants of the study, who spared their precious time to take
part in this research. I would like to thank all the carers and second informants
who participated in the research.
For my Father, Mother, Sisters and Brother
Table of Contents
Introduction 1
Overview of the thesis 4
Chapter 1 Physical Disability 7
1.1 Definition and Epidemiology of Physical disability
1.1.1 Definition of Physical disability 7
1.1.2 Epidemiology of Physical disability 8
1.2 Neurological causes of Physical disability 9
1.2.1 Stroke 12
1.2.1.1 Epidemiology of stroke 14
1.2.1.2 Post stroke changes 16
Physical changes 16
Psychological sequelae 18
1.2.2 Head injury 21
1.2.2.1 Epidemiology of head injury 23
1.2.2.2 Post-onset changes 25
Physical changes 25
Psychological sequelae 25
1.3 Summary 29
Chapter 2 Caregiving and Psychological Adjustment 31
2.1 Care giving 31
2.1.1 Family caregiving 34
2.2 Psychological impact of caregiving 35
2.2.1 Caring for a disabled child 36
2.2.2 Caring for a demented elderly relative 37
2.2.3 Caring for a head injured person 38
2.2.4 Caring for a stroke patient 39
2.3 Burden and Psychological distress in carers 41
2.4 Factors associated with Burden and Psychological distress
carers 45
In
2.5 Summary 49
Chapter 3 Cognitive Appraisal, Coping, and Psychological Adjustment 51
3.1 Cognitive appraisal 51
52
3.1.1 Primary appraisal
3.1.2 Secondary appraisal 53
3.2 Coping 54
55
3.2.1 Models of coping
3.2.2 Types and functions of coping 58
3.3 Cognitive appraisal and Coping 60
3.3.1 Primary appraisal and coping 61
3.3.2 Secondary appraisal and coping 63
3.4 Relationship between Cognitive appraisal, Coping and
Psychological distress 65
3.4.1 Cognitive appraisal and adjustment 65
3.4.2 Coping and adjustment 69
3.4.3 Relationship between Cognitive appraisal, Coping and
Psychological adjustment 73
3.5 Caregiving, Cognitive appraisal, and Coping 75
3.6 Summary 81
Chapter 4 Study One: Personality Changes in Physically Disabled People
and Burden on Carers 83
4.1 Introduction 83
4.2 Aims of the study 84
4.3 Method 85
4.3.1 Design 85
4.3.2 Patients and carers 85
Inclusion Criteria 86
4.3.3 Technical arrangements for data collection 89
4.3.4 Assessment Measures 89
4.4 Results 93
4.5 Discussion 109
4.6 Summary and Conclusions 117
Chapter 5 Study Two: Carers' Cognitive Appraisal, Coping, and
Psychological Adjustment to Personalty and
Physical changes in Physically Disabled People 118
5.1 Introduction 118
5.2 Aims and Hypotheses 119
5.2.1 Aims of the study 119
5.2.2 Hypotheses 119
5.2.2.1 Subjective burden in carers 119
5.2.2.2 Cognitive appraisal of Personality and
Physical changes 120
5.2.2.3 Carers' ways of Coping with Personality
and Physical changes 122
5.2.2.4 Cognitive appraisal and Coping 125
5.2.2.5 Cognitive appraisal and Psychological
adjustment 126
5.2.2.6 Carers' Coping and Psychological
adjustment 129
Chapter 6 Method 131
6.1 Design of study two 131
6.2 Participants 131
6.2.1 Inclusion Criteria 131
6.2.2 Description of the Participants 132
6.3 Assessment Measures 137
6.3.1 Assessment of Physical changes 137
6.3.2 Assessment of Personality changes 138
6.3.3 Assessment of Cognitive appraisal 138
6.3.3.1 Primary appraisal 139
6.3.3.2 Secondary appraisal 142
6.3.4 Assessment of Coping 143
6.3.5 Assessment of Burden and Psychological distress 145
6.4 Procedure 146
Chapter 7 Results: Post-onset Changes in Physically Disabled People,
and Subjective burden and Psychological distress
in Carers 149
7.1 Introduction 149
7.2 Results 150
7.2.1 Subjective burden and Psychological distress in carers
In
relation to their demographic characteristics and other
vaiables 150
7.2.2 Subjective burden and distress in carers 151
7.2.3 Subjective burden in carers in relation to personality
changes opposed to physical changes 152
7.2.4 Post-onset changes as predictors of carers' subjective
burden and psychological distress 154
7.2.5 Carers' vs second informants' assessment of the patients'
personality and physical changes 156
7.3 Summary of the findings 159
Chapter 8 Results: Cognitive Appraisal of Personality and Physical
Changes in Physically Disabled People 160
8.1 Introduction 160
8.2 Results 161
8.2.1 Description and interpretation of Principal Component
analysis on the PAQ 162
8.2.2 Carers' cognitive appraisal of the post-onset changes
in relation to their demographic characteristics 164
8.2.3 Primary appraisal of personality changes as opposed to
physical changes 171
8.2.4 Secondary appraisal of personality changes compared
with that of physical changes 172
8.3 Summary of the findings 173
Chapter 9 Results: Carers' Coping with Personality and Physical
174
Changes in Physically Disabled People
174
9.1 Introduction
174
9.2 Results
9.2.1 Carers' coping in relation to their demographic
characteristics 175
9.2.2 Carers' coping with personality and physical changes 179
9.2.3 Carers' coping with personality changes as opposed to
physical changes 182
9.3 Summary of the findings 183
Chapter 10 Results Carers' Cognitive Appraisal and Coping 184
10.1 Introduction 184
10.2 Results 185
10.2.1 Primary appraisal and coping 185
10.2.2 Secondary appraisal and coping 193
10.3 Summary of the findings 200
Chapter 11 Results: Cognitive appraisal, Coping, and Psychological
distress 202
11.1 Introduction 202
11.2 Results 204
11.2.1 Primary appraisal, burden and distress in carers 204
11.2.2 Secondary appraisal, burden and distress in carers 209
11.2.3 Coping, Burden and distress in carers 213
11.3 Summary of the findings 217
Chapter 12 Results: The Model Testing 218
12.1 Cognitive appraisal and coping 220
12.2 Cognitive appraisal, Coping, Burden and Psychological distress 221
12.3 The Resultant Model 225
12.4 Summary and Conclusions 227
Chapter 13 Discussion and Implications of the Findings 229
13.1 Discussion 229
13.1.1 Subjective burden and distress in carers 229
13.1.2 Subjective burden in carers in relation to
personality and physical changes 231
13.1.3 Carers' Cognitive appraisal of personality
and physical changes 234
13.1.4 Carers' Coping with Personality and physical
changes 237
13.1.5 Cognitive appraisal and coping 238
13.1.6 Cognitive appraisal and Psychological distress 240
13.1.7 Coping and Psychological distress 243
13.1.8 Usefulness of the Cognitive model of Coping 246
13.2 General discussion 247
13.3 Limitations of the study 249
13.4 Implications of the findings, and suggestions for further
research 250
13.5 Conclusions 252
References 254