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

Abstract

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.

Keywords:

• self-blame attributions
• control appraisals
• symptoms of distress
• cardiac rehabilitation

Acknowledgements

This research was supported by an Indiana State University Promising Scholars grant and the University of Missouri – Kansas City, Department of Psychology.

Notes

Notes

1. These authors use the term ‘responsibility attribution’ to capture behavioural-focused attributions.

2. To test for possible differences between participants who completed both Time 1 and Time 2 questionnaires versus those who only completed questionnaires at Time 1 (n = 55), we conducted a series of independent samples t-tests on all demographic and study variables. Results showed that the groups differed significantly in age, baseline symptoms of anxiety and baseline symptoms of depression. That is, participants who completed both questionnaires were significantly older (M = 64.1) and reported experiencing fewer symptoms of anxiety (M = 7.5) and depression (M = 9.1) than their counterparts who completed only the baseline questionnaire (M's = 58.1, 10.0 and 13.2, respectively). Chi-square analyses also showed the group that participated at Time 1 was more likely to be working outside the home than the group that completed questionnaires at both Times 1 and 2. These differences warrant some caution in generalising findings to all patients in CR programmes.

3. For normality purposes, the following transformations were used in data analyses: a log transformation for Time 1 and Time 2 BAI scores, and a square root transformation for Time 1 and Time 2 BDI scores.