Non-Pharmacologic Management
Abstract# 2023 - Cognitive Coping and Well-Being in Patients with a Rheumatic Disease
Authors: E. Taal et al.
Background: The ways people cope with disease and its associated stresses is an important topic because coping relates systematically to well-being. Research on coping generally does not distinguish between behavioral coping strategies (the actions taken) and cognitive coping strategies (what people think). In this study, Taal and colleagues assess the cognitive coping strategies used by people with rheumatic disease and their relationship to psychological well being.
Methods: One hundred and seventy-five consecutive rheumatology clinic patients completed the Cognitive Emotion Regulation Questionniare (CERQ). The 36-item CERQ assesses 9 different types of cognitive coping, 4 maladaptive strategies (i.e., self blame, rumination, catastrophizing, other blame) and 5 adaptive strategies (i.e., positive reappraisal, positive refocusing, acceptance, putting things into perspective, and refocus on planning). Scores on each type of coping range from 4 (virtually never used) to 20 (virtually always used). Participants also completed measures of pain (via a visual analog scale) and psychological well-being (via the Mental Component Summary Score of the SF-36, version 2).
Results: The 4 maladaptive cognitive coping strategies were used relatively infrequently by patients (median score ~ 6). The maladaptive strategy “other blame” was excluded from the analysis because of a floor effect (i.e., virtually no one rated using this strategy). The 5 adaptive strategies were used more frequently (median score ~ 11). The only sex difference observed in use of cognitive coping strategies was that women used self-blame more frequently than did men (p<.05). Neither age nor disease duration correlated with the use of these coping strategies. Pain associated with the use of rumination (r = .25), refocus on planning (r = .21), and catastrophizing (r = .19). Psychological well-being was positively associated with positive refocusing (r = .18), and negatively associated with self-blame (r = -.31), rumination (r = -.53), catastrophizing (r = -.43), and acceptance (r = -.16). Multiple regression analysis adjusting for age, disease duration, and pain indicated that, collectively, the 8 cognitive coping strategies accounted for 24% of the variance in psychological well-being. Self blame (r = -.22) and rumination (r = -.33) were the greatest contributors in the model.
Conclusions: Rheumatology patients report using an array of cognitive coping, the majority of which appear to be adaptive. The use of self blame and rumination were salient predictors of poorer psychological well-being.
Editorial Comment: It is important to keep in mind that rheumatic disease, or indeed any chronic illness, requires both physical and psychological adaptations. In this study the focus was on cognitive adaptations to living with a rheumatic disease. In other words, how do people perceive and appraise their illness and how do these cognitive processes influence subsequent functioning and well-being? The results of this study suggest that the majority of cognitive coping responses used by this sample of patients tend to be adaptive in the sense that they promote a positive outlook that might facilitate a propensity toward greater efforts to self-manage aspects of their disease that may be amenable to modification. On the other hand, the results also suggest that the use of maladaptive cognitive coping strategies might lead to poorer psychological well-being which might hamper subsequent efforts to take tangible actions (e.g., exercise, improve diet, reduce weight) that might improve symptoms.
What is unclear is whether the use of particular cognitive coping strategies are linked to stable personality/dispositional characteristics (i.e., general optimism/pessimism) or whether they can be developed and refined via psychological intervention. Many so-called cognitive-behavioral therapies are being developed for use with medical patients to assist them in initiating the use of positive or adaptive coping strategies that might promote enhanced function and emotional well-being. Whether such interventions produce durable changes remains unclear.