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.

This study tested aspects of the Reserve Capacity Model (Gallo & Matthews, 2003; Gallo, Penedo Espinosa de los Monteros, & Arguelles, 2009) as a means of understanding disparities in health-related quality of life appraisals among Hispanic Americans. Questionnaire data were collected from 236 Hispanic participants, including measures of perceived discrimination, optimism, social support, symptoms of trait anxiety, and physical and mental health-related quality of life. Path analysis indicated direct, negative associations between perceived discrimination and both forms of health-related quality of life. Results also showed that these relationships were partially mediated by the reserve capacity variable of optimism and by symptoms of anxiety, though evidence for mediation by anxiety was stronger than for optimism. Findings suggest that perceived discrimination depletes intrapersonal reserves in Hispanic Americans, which, in turn, induces negative emotions. Implications for community-level interventions are discussed.

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Our findings imply that patients show unrealistic optimism surrounding the ease of initiating and maintaining an exercise program and that integrating efficacy-building activities into cardiac rehabilitation, especially for patients who show signs of distress, is advisable.

Creative Commons Non Commercial CC-BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License (http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).The creation of meaning to cope with trauma is seemingly universal. In her influential piece on cognitive adaptation, Shelley Taylor (1983) outlines steps commonly taken in the wake of trauma: the generation of meaning, the bolstering of perceived control, and self-enhancement. The first step in this cognitive process, the creation of meaning, is often accomplished through the generation of a causal attribution. Empirical evidence supports the process of meaning creation via causal attributions among patients diagnosed with various forms of cardiovascular disease (CVD). For example, Cameron et al. (2005) found that the most common causal attributions endorsed by myocardial infarction (MI) patients via a checklist method were stress, high cholesterol, heredity, and eating fatty foods, and that these attributions remained stable over a 6-month followup period. Another study found not only similar types of attributions generated by MI patients at baseline (i.e. smoking, heredity, and stress) but also some volatility in endorsement over time (Reges et al., 2011). Specifically, at 2-year post-hospitalization, more patients endorsed high cholesterol, lack of physical activity, and problems at work as causes than at baseline. Day et al. (2005) found that the most commonly endorsed attributions among CVD patients via a checklist were heredity, hypertension, high cholesterol, physical inactivity, and poor food habits. Furthermore, nearly one-third of the sample endorsed stress/negative emotions as a causal factor in their diagnoses. A more recent study among coronary artery bypass graft (CABG) patients that used an attribution checklist found the most common causes to be stress and genes for both men and women (Dunkel et al., 2011). Results also pointed to a gender difference: whereas men were more likely than women to make an attribution to past behavior, women were more likely than men to attribute their diagnosis to destiny.The above-mentioned studies examined attributions generated via a checklist, but other researchers have collected patients' open-ended causal explanations. For example, Martin et al. (2005) qualitatively analyzed MI patients' attributions, collapsing them into the following commonly AbstractThis study examined attributions generated by cardiac rehabilitation patients shortly after experiencing a cardiovascular event, exploring whether attribution type was associated with health appraisals and outcomes concurrently and 21 months later. Attributions fell into three categories: controllable behavioral ones, uncontrollable biological ones, and stressrelated causes....