The motivation to stay abstinent in ex-smokers: comparing the present with the past.

Little is known about the motivation of ex-smokers to stay abstinent. In the present study we argue that ex-smokers compare their present to their past when they still smoked to conclude whether they make good progress towards a satisfactory state of continued abstinence. These temporal comparisons are thought to be central in the motivation to stay abstinent in ex-smokers. The power of temporal comparisons to predict relapse was tested in two related samples of ex-smokers (N=152 and N=197), together with two other relevant psychological factors; positive outcome expectations of smoking and self-efficacy expectations. In the first sample of ex-smokers, only temporal comparisons predicted relapse after 2 months. In the second sample of ex-smokers, temporal comparisons mediated the relation between perceived positive outcomes of smoking and relapse after 6 months. In addition, in predicting relapse after 6 months, temporal comparisons interacted with self-efficacy. The present study suggests that temporal comparisons comprise the cognitive aspect of the motivation of ex-smokers to stay abstinent. This conceptualization of the motivation in ex-smokers can be used in practice to prevent relapse.

The effectiveness of a bibliotherapy in increasing the self-management ability of slightly to moderately frail older people.

OBJECTIVE: Self-management ability (SMA) is the ability to obtain those resources necessary for the production of well-being. With age, SMA becomes increasingly important, if one has a large variety of resources, physical and psychosocial losses due to the aging process can be substituted or compensated for. This study examined whether an increase in SMA would ensure sustainable levels of positive well-being among slightly to moderately frail older people. METHODS: A bibliotherapy was developed to increase the SMA of slightly to moderately frail older people, and to help these persons to sustain a certain level of well-being. The effectiveness of this bibliotherapy was examined by comparing the SMA, mastery, and subjective well-being of 97 older people participating in the bibliotherapy to those of 96 older people in a delayed-treatment control condition. RESULTS: The bibliotherapy resulted in a significant increase in SMA and mastery compared to the delayed-treatment control condition, and for SMA, this effect still existed 6 months after the intervention. The increase in SMA among older people who received the bibliotherapy prevented a decline in well-being as expected, but only in the short-term. CONCLUSION: The current findings show that it is possible to counteract an age-related decline in well-being, even with only slight to moderate levels of frailty. PRACTICE IMPLICATIONS: Cheap and easily accessible interventions, like the self-management bibliotherapy described in this article, may provide a useful addition to more traditional gerontological interventions.

How to measure self-management abilities in older people by self-report. The development of the SMAS-30.

This paper presents the results of two studies carried out in order to design and test a self-report instrument to measure Self-Management Ability (the SMAS-30) in aging individuals. SMA refers to the core behavioral and cognitive abilities which presumably contribute to sustainable well-being in later life. Robust findings of the studies (n = 275 and n = 1338) showed that SMA could be measured reliably as a composite concept of abilities systematically linked to dimensions of well-being in adults aged 65 and over, with the different sub-scales revealing a profile of inter-related abilities. A sub-sample of participants in Study 2 (n = 86) showed that the SMAS-30 had high reproducibility over a period of 16 weeks. The validity of the SMAS-30 was supported by meaningful associations with other constructs in both studies. As expected, the older and frailer the people, and the poorer their perceived health, the lower their SMA. Moreover, SMA was positively related to several dimensions of subjective well-being and the related concepts of general self-efficacy and mastery.

When it is better to give than to receive: long-term health effects of perceived reciprocity in support exchange.

The authors examined esteem enhancement theory and equity theory in explaining the long-term health status of men (n = 178) and women (n = 575). Baseline characteristics were measured in 1990-1993, intimate reciprocity in 1993, and recorded sickness absences for a 9-year period during 1993-2001. Among women, giving more support than receiving in intimate relationships positively affected subsequent health status, as indicated by fewer sickness absences. Among men, receiving more support than giving predicted fewer absences. These effects remained even after significant covariates were included in the model. Thus, women seem to benefit from giving support in intimate relationships, and men seem to benefit from receiving support in intimate relationships. The findings on women are in line with the esteem enhancement theory. No support was obtained for the equity theory.

The interpretation of social comparison and its relation to life satisfaction among elderly people: does frailty make a difference?

We examined the interpretation of upward and downward social comparison and its effect on life satisfaction in a questionnaire study among 444 community-dwelling elderly persons with different levels of frailty. As we expected, elderly persons with higher levels of frailty were less inclined to contrast and more inclined to identify themselves with a downward comparison target. Furthermore, they were more inclined to contrast themselves with an upward comparison target, but contrary to our expectations, they were also more inclined to identify with this target. Upward identification and downward contrast related positively, whereas upward contrast and downward identification related negatively to life satisfaction. These effects existed independently of the negative effect of frailty on life satisfaction.

Effects of a brief intervention program for patients with cancer and their partners on feelings of inequity, relationship quality and psychological distress.

When one member of a couple develops a serious illness, the lives of both partners are likely to be affected. Interventions directed at both partners are generally lacking, however. In the present study, a brief counseling program directed at couples confronted with cancer was evaluated. The intervention focused mainly on the exchange of social support and help between both partners and was aimed at restoring perceptions of equity. Couples were randomly assigned to an experimental group or a waiting-list group. After the intervention, both patients and their partners reported lower levels of perceptions of underinvestment and overbenefit, and higher levels of relationship quality. Moreover, among patients psychological distress decreased after the intervention. These effects were generally maintained until follow-up three months later. Associations between perceptions of equity and relationship quality and psychological distress were also examined.

The impact of an informational self-management intervention on the association between control and illness uncertainty before and psychological distress after radiotherapy.

Many studies have reported that cancer patients who show difficulties maintaining perceptions of control report more psychological distress than patients who are higher in control. Besides perceptions of control, feelings of illness uncertainty have also been regarded as a predictor of psychological distress. Given these strong relationships between perceptions of low control and high illness uncertainty and psychological distress, the present study examined whether an informational self-management intervention (booklet) could moderate this relationship. The booklet contained general and specific information about cancer and cancer treatment, information about possible coping strategies, and social comparison information, which consisted of short stories of other patients. Prior to radiotherapy, 209 patients with cancer completed baseline measures, including control and illness uncertainty. After completing radiotherapy, patients were randomly allocated to receive either a booklet (experimental group; N=103) or no booklet (control group; N=106). Three months after the intervention, aspects of psychological distress were assessed, including tension, anger, depression, fatigue and vigour. The results supported our hypotheses and suggested that a self-management intervention is relevant in reducing the relationship between control and illness uncertainty before radiotherapy and psychological distress after radiotherapy. This seems important, especially for high-risk patients who perceive little control and much illness uncertainty.

The effect of social comparison information on the life satisfaction of frail older persons.

In this study, the authors examined the effects of social comparison on the life satisfaction of 455 community-dwelling older persons. These older persons were confronted with a fictitious interview with either an upward or a downward target. After downward comparison, older persons felt more satisfied with their lives than after upward comparison, especially those who had higher levels of frailty. These effects were only found with lower levels of identification. Apparently, downward comparison only serves its self-enhancing function on life satisfaction among frail older persons when they perceive the comparison target as different from themselves.

Maintenance of subjective health during a merger: the role of experienced change and pre-merger social support at work in white- and blue-collar workers.

Prospective research on psychosocial effects on employees' health associated with organizational mergers has been scarce. The first aim of this study was to explore the subjective health effects (exhaustion and functional incapacity) of an organizational merger among employees who had experienced a change in their own job position differently (improved, unaltered, and declined). Secondly, the effects of pre-merger social support (organizational, supervisor, and coworkers) at work on the experienced change in job position and on subjective health were examined. The merger took place in 1999 between two multinational firms of equal size. The study is based on two surveys (n=2,225) carried out in 1996 and in 2000 in the Finnish part of the company. The data on age, sex, pre-merger sickness absence (1996-98) and subjective health status (1996) were used as covariates. The results indicate that all sources of social support had a significant effect on the experience of change in one's job position. A decline in job position strongly increased the risk of poor subjective health after the merger. Weak organizational support was associated with impaired subjective health, especially in blue-collar workers, while weak supervisor support impaired functional capacity in white-collar workers. In turn, strong co-workers' support increased the risk of poor subjective health among blue-collar workers when their job position declined. We conclude that negative changes experienced in one's job position and lack of upper-level social support at work create a potential risk for health impairment in different employee groups in merging enterprises.

Cognitive adaptation: a comparison of cancer patients and healthy references.

OBJECTIVES: Taylor's theory of cognitive adaptation proposes that adjustment depends on the ability to sustain and modify illusions (i.e. unrealistic optimism, exaggerated perceptions of control, and self-aggrandizement) that buffer against threats but also against possible future setbacks. Because the question of whether cancer patients show these illusions has received little attention, the present study compared patients' perceptions of optimism, control, and self-esteem at different stages of the cancer process with that of healthy references. The effects of these perceptions on psychological distress were also assessed. DESIGN: The present study has a longitudinal design. Including a group of healthy references enabled us to draw more firm conclusions about the effect of cancer upon cognitive perceptions. METHODS: The participants were 67 cancer patients and 50 healthy references. Patients filled out questionnaires prior to their first radiotherapy (T1), at 2 weeks (T2), and at 3 months (T3) after completing radiotherapy. Healthy references were assessed at similar intervals. RESULTS: T tests revealed that patients experienced significantly higher levels of optimism and self-esteem than the healthy reference group. Concerning control, no group differences were found. Importantly, regression analyses showed that lower levels of optimism and control at T1 were predictive of feelings of anxiety at T3. Lower perceived control also predicted depressive symptoms. CONCLUSION: Results support the theory of cognitive adaptation in that patients are indeed able to respond to cancer with high levels of optimism and self-esteem and that lower levels of optimism and control are predictive of psychological distress.

Audiotaped social comparison information for cancer patients undergoing radiotherapy: differential effects of procedural, emotional and coping information.

The present study focused on the effects of social comparison information on subjective understanding of radiation therapy, validation of emotions, and self-efficacy of cancer patients undergoing radiation therapy. The effects of three different audiotapes, containing different kinds of social comparison information, were examined. On the procedural tape a man and woman discussed their illness and radiation treatment, on the emotion tape they focused on the emotional aspects of these issues, and on the coping tape they focused on the way they had been coping. The effects of these tapes were measured on subjective understanding about radiation therapy, validation and recognition of emotions, self-efficacy, and mood. The results indicate positive effects of the tapes, especially of the procedural and the coping tape. These audiotapes increased understanding of radiation therapy, self-efficacy and the feeling of validation of emotions. Therefore, these tapes may be an important supplement to existing patient education information. Possible explanations and practical implications are discussed.

Feeling bad, but satisfied: the effects of upward and downward comparison upon mood and marital satisfaction.

This study in a sample of 135 women from rural areas examined the effects of social comparison with the marriage of another woman upon mood, identification and relationship evaluation. The comparison target constituted either an upward or a downward comparison, characterized by either high or low effort. Upward targets evoked a more positive mood, and a less negative mood than downward targets, while, in contrast, the evaluation of one's own relationship was more positive after being exposed to a downward target than after being exposed to an upward target. Upward targets and high-effort targets instilled more identification than downward and low-effort targets. A higher level of marital quality led to less identification with the downward targets and to more identification with the upward targets, particularly with targets who put a high degree of effort in the relationship. Identification mediated the association between marital quality and positive mood following upward comparison. The present study suggests that upward and downward comparison may have effects upon mood that are opposite to those upon self-evaluation, and demonstrates that happily married individuals may through identification with upward targets derive positive affective consequences from exposure to such targets.

Social comparison and patient information: what do cancer patients want?

The present study focuses on social comparison processes among cancer patients. The sample consisted of 60 (ex-) cancer patients who participated in a course "coping with cancer". This study examined several aspects of social comparison: the need for comparison, the preferred direction of comparison and the influence of mode (information or contact seeking) and dimension (illness severity or coping) of social comparison as well as indicators of low well-being. The results show that the need for comparison is particularly enhanced among those who evaluate their own health negatively. In addition, the results show that patients prefer to receive information about others who are better off, but also want contact with others who are better off. In addition, they are specifically interested in receiving information about others who are coping better. Practical implications are discussed.

The relation between perceived inequity, marital satisfaction and emotions among couples facing cancer.

The central aim of the present study was to examine if equity theory still applies to intimate relationships when couples are confronted with a serious illness. Equity concerns were examined among 68 cancer patients and their partners. Contrary to our expectations, only male patients on average felt overbenefited in their relationship, whereas female patients on average felt equitably treated. Moreover, it was found that the partners of these patients did not, as was expected, feel underbenefited in their relationship. The main focus of the present study was on the association between perceived equity on the one hand and relationship satisfaction and emotions on the other. It was found that in general patients seemed most sensitive to underbenefit (i.e. they felt least satisfied), and experienced on average least positive and most negative affect when they felt underbenefited. Particularly, patients who were physically impaired felt dissatisfied and angry when underbenefited. The partners of these patients were in general equally sensitive to inequity in both directions, regardless of their ill partner's physical condition.

Failing in spousal caregiving: The 'identity-relevant stress' hypothesis to explain sex differences in caregiver distress.

OBJECTIVES: This study examined a possible explanation for the frequently reported finding that female caregivers perceive more psychological distress than do male caregivers. Our 'identity-relevant stress' hypothesis asserts that feelings of incompetence with respect to caregiving are more strongly associated with psychological distress in women than in men. Women who feel competent with respect to caregiving may report levels of distress as low as that of male caregivers. DESIGN: This study has a cross-sectional design. METHODS: Psychological distress (CES-D) was measured in 32 female and 36 male partners of patients suffering from various types of cancer. Furthermore, partners' perceptions of caregiving performance and patients' perceptions of partners' supportive and unsupportive behaviour were assessed. RESULTS: Only among female partners were self-efficacy and personal accomplishment regarding caregiving found to be positively linked to distress. Also, in contrast to male partners, female partners reported more distress when they acted less supportively. CONCLUSION: The difference in psychological distress between female and male caregivers seems to be carried by a subgroup of partners who feel that they are not doing a very good job at caregiving.