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.

The Relationship Between Self‐Blame for the Onset of a Chronic Physical Health Condition and Emotional Distress: A Systematic Literature Review

“…For participants with cardiovascular disease (Bennett et al ., ), greater BSB was significantly associated with greater concurrent anxiety and depression. Greater BSB also significantly predicted increases in anxiety and depression over time when controlling for baseline levels of distress.…”

“…() also reported that 76% of those who did see themselves as blameworthy reported ‘mild–moderate’ self‐blame and 24% reported ‘high’ self‐blame. In other studies involving people with lung cancer, HIV/AIDS and cardiac disease, moderate levels were reported, with mean ratings corresponding to ‘agree – strongly agree’ (Mak et al ., ) and ‘somewhat – very much’ (Bennett et al ., ; Milbury et al ., ). Milbury et al .…”

“…The majority of studies included participants with cancer, although two recruited participants with HIV and/or AIDS and one involved people with cardiovascular disease. Mean time since diagnosis at baseline assessment varied widely between two weeks and nine years, although two studies did not report this information (Bennett, Howarter, & Clark, ; Hill et al ., ). Six of the studies involving people with cancer reported the majority (between 62% and 96%) to have been diagnosed with stage I or II cancer (Bennett et al ., ; Glinder & Compas, ; Houldin, Jacobsen, & Lowery, ; Milbury et al ., ; Moulton et al ., ; Phelan et al ., ).…”

“…No clear themes can be seen across studies regarding differences in the prevalence and degree of general, behavioural and characterological types of self‐blame. Within studies measuring both BSB and CSB, although no explicit comparisons were made of prevalence and strength, there was a trend for ratings of BSB to be slightly higher than those for CSB (Bennett et al ., , ; Glinder & Compas, ; Malcarne et al ., ) and for BSB to be the most prevalent of the two types (Bennett et al ., ; Glinder & Compas, ).…”

“…As the interaction between BSB and CSB did not reach significance in this study, the suggestion that BSB might only be influential when CSB is also present (Malcarne et al ., ) is also not supported for this participant population. The findings discussed in the subsequent paragraph may even indicate that BSB is the stronger predictor of distress, although this could be, in part, because of noticeably higher levels of BSB ( M = 2.58, SD = 0.98) being reported in this study compared to CSB ( M = 1.72, SD = 0.80) (Bennett et al ., ).…”