Coping strategies and causal attributions have been shown to be related to recovery and adjustment following illness. Certain coping strategies and causal attributions, such as avoidant coping and other blame have been found to be related to higher levels of distress while others, like behavioural self blame and attention coping have been shown to be related to lower distress. There have however, been few longitudinal studies of the process. The study described here examined coping strategies, causal attributions and levels of distress over a period of 1 year in 91 patients following a first myocardial infarction (MI). Coping strategies (measured by the COPE), causal attributions (measured by open ended questions and a check-list) and distress (measured by the HAD a measure of anxiety and depression with minimal somatic symptoms), were measured within 2 weeks of discharge and at 2, 6 and 12 months post MI. The main findings of the study showed that both coping strategies and causal attributions changed over time. Patients were most likely to use attention coping strategies early following the illness onset but more avoidant and religious coping later on. Patients made fewer attributions as time passed and the most commonly reported causal attributions were stress and smoking. Results further revealed that both coping strategies and causal attributions were either concurrently related to and/or predictive of levels of distress. Avoidant coping was related to higher distress at all assessment times. Furthermore, both characterological self blame and other blame were found to be concurrently related to higher distress, with characterological self blame also being predictive of subsequent higher distress. These findings have implications for care and rehabilitation of cardiac patients as they imply that certain causal attributions and coping strategies might be problematic as regards post MI distress. This points towards the importance of examining and if necessary, altering certain causal attributions and coping strategies in order for the patient to gain the best possible recovery.

No description available.

Ph.D. / It has become an accepted fact that Coronary Heart Disease is an epidemic of modern civilisation. Coronary Heart Disease is responsible for approximately a third of all deaths in the Western world (Fullard, 1990) and South Africa is no exception. Several risk factors contributing to the development of heart disease have been identified but the extent and exact nature of their contribution is not fully understood. Traditionally accepted risk factors that play a role in the development of Coronary Heart Disease include diet, hypertension, hypercholestrolaemia, smoking, physical inactivity, age, sex and genetic disposition. However the strongest combination of these factors has been unable to predict the majority of heart disease cases. In this regard psychological factors are steadily gaining acceptance as risk factors, one of the most important of these being the Type A behaviour pattern. The far reaching consequences of Coronary Heart Disease have necessitated investigations into methods of decreasing contact with risk factors, particularly psychological ones. The substantial success of the Recurrent Coronary Prevention Project (Friedman et al), coupled with the promising results from other intervention studies, suggests that behaviour change is a viable goal in the prevention of heart disease. Following on from the Recurrent Coronary Prevention Project, Venter (1993) and Viljoen (1993) adapted it for the South African population. Although relatively successful, it did have its flaws. Thus the motivation for redesigning this intervention addressing its shortcomings The revised intervention was administered to a group of 25 Coronary Heart Disease patients. A second group of 22 patients were subjected to the intervention utilised in the original South African Recurrent Coronary Prevention Project. A third group of 18 patients served as a waiting list control group. The results indicated that although the revised intervention produced larger changes in Type A behaviour than the original South African Recurrent Prevention Project intervention, these differences were not significant. Possible reasons for this were the measures utilised, the sample sizes and the nature of the groups themselves. However, the revised version of the SARCPP was found to be more effective in the reduction of the hostility and anger components of the behaviour pattern than the original version. In conclusion it was found that before any further research in this area be conducted, the measures utilised should be modified and the mechanisms of treatment effect be examined.

The direct effect of spouse presence during graded exercise testing on anxiety and performance has not been previously delineated. Therefore, the purposes of this study were to (a) ascertain if spouse presence during graded exercise testing affects state anxiety or physiological performance variables, and (b) determine differences in psychological status between cardiac patients and healthy adults.