Resilience & Behavioral Disengagement: Correlates of a Negative Sense of Control for an HIV sample

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Resilience & Behavioral Disengagement: Correlates of a Negative Sense of Control for an HIV sample

Danielle Vincent, Eliot Lopez, MS, James Miller, MS, Chwee-Lye Chng, PhD & Mark Vosvick, PhD

Center for Psychosocial Health Research

+Background Limited research has been conducted on sense of control within

people living with HIV (PLH) However, many researchers have found a correlation between

negative sense of control and deleterious psychosocial and health outcomes in elderly individuals (Langer & Rodin, 1976) and those with coronary heart disease (Glass, 1977; Shapiro, Friedman and Piaget, 1991)

PLH may experience a loss of control leading to a negative sense of control (Siegel & Schrimshaw, 2000)

Positive sense of control has been associated with positive psychological and physical outcomes (Shapiro, 1994)

Having a positive sense of control can help you reduce stress and improve psychological wellbeing (Shapiro, 1994)


+Background

Negative sense of control -> stress Stress undermines the immune system

Cortisol, the “stress hormone”, is increased Production of “good” prostaglandins (which support

immune function) slows Immune system cells disappear from the blood Lower levels of cortisol will allow immune system cells to

circulate in excess (Sapolsky, 2004)


+Background

Negative sense of control is associated with feelings of a loss of control, lack of control, and too much control from others. Individuals with a negative sense of control may feel helpless and may demonstrate passive ( Seligman, 1975) coping strategies (Shapiro 1994)

Behavioral disengagement (i.e. avoidance) is characteristic of a negative sense of control (Moskowitz et al., 2009)

Resilience can be obtained through a positive sense of control over stressful life events (Emlet, Tozay & Raveis, 2010; Connor & Davidson, 2003; Bonanno, 2004)


+Theoretical ModelBased on the Transactional Model of Stress & Coping(Lazarus & Folkman, 1984)

Diagnosis

Stressor Primary Appraisal

Secondary Appraisal

Stressful

Behavioral Disengagement

Challenging/Positive/Irrelevant

Adaptive Coping

Outcome

Higher chance for resilienceLower chance for resilience

Higher chance for resilience

Reappraisal


+Hypotheses

1. Resilience is negatively correlated with negative sense of control

2. Behavioral disengagement is positively correlated with negative sense of control

3. Resilience and behavioral disengagement account for a significant proportion of variance in negative sense of control


+Participants

Recruitment: Dallas/ Forth Worth metroplex AIDS service organizations and local health centers

Eligibility: 18+, HIV+, fluent in English Incentive: $10 for Phase 1 and $25 for Phase 2


+Methodology

Study received IRB approval Cross-sectional correlational design Computerized survey on QDS Assistance provided by study staff


+Procedures

A gender stratified convenience sample was recruited via word-of-mouth and flyers

Written informed consent obtained from all participants Self-report computerized survey Researchers were present to assist any participants

who had difficulty understanding the questionnaire

+DemographicsVariable N % M (SD) Range

Female 32 50%African American 43 67.3%European American 17 26.7%Latino 2 3.0%Other 2 3.0%Gay 24 37.5%Bisexual 9 14.1%Heterosexual 31 48.4%Age (years) 46.8 (8.87) 23-66Education (years) 11.9 (2.59) 3-18

N = 64


+MeasuresConnor-Davidson Resilience Scale (Connor & Davidson, 2003)α= .89 25 items 5-point likert-type scale 0 (Not at all true) 4 (True nearly all the time)

Ex: “I tend to bound back after illness or hardship” Ex: “Coping with stress strengthens me”

Convergent and divergent validity assessed with similar resilience measuring scales

High scores represent greater resilience


+MeasuresBrief Cope (Carver, 1997) Behavioral Disengagement Subscaleα= .65 2 items 4-point likert-type scale 1 (I haven’t been doing this at all) 4 (I’ve been doing this a lot)

Ex: “I’ve been gibing up trying to deal with it” Ex: “I’ve been giving up the attempt to cope”

Discriminant validity assessed High scores represent increased frequency of the

particular coping mechanism


+MeasuresShapiro Control Inventory (Shapiro, 1994) Negative Sense of Control subscaleα= .89 5 items 6-point likert-type scale 1 (never) 6 (very often)

Ex: “I feel that I am losing control in areas where I once had control”

Ex: “I am too passive and helpless”

Discriminant, divergent and incremental validity assessed High scores indicate more negative sense of control


+Data Analysis

Univariate analysis Bivariate analysis Multivariate analysis


+Data AnalysisUnivariate

Mean (SD)

Possible

Range

Actual Range

Calculated α

Behavioral Disengagement

3.5(1.8)

2 - 8 2 - 8 .73

Resilience 66.0(22.7)

0 - 100 0 - 100 .97

Negative Sense of Control

14.5(5.1)

5 - 30 5 - 28 .70


+Data AnalysisBivariate

1 2 3 4 5 6 71. Gender 12. Ethnicity -.26** 13. Sexual Orient. .67** -.17 14. Age -.09 .02 -.02 15. Education -.29** .07 -.35*

*.18* 1

6. Resilience -.05 -.18 .03 .14 .06 17. Behav. Dis. .14 .09 .01 -.13 -.13 -.35** 18. Neg. S.O.C. .19 .02 .16 -.18 -.23 -.49** .39**

*p < .05; **p < .01


+ResultsMultivariateDependent Variable: Negative Sense of Control

IV β t p Tolerance

Vif

Age -.18 -1.40 .17 .96 1.04

IV β t p Tolerance VifResilience -.39 -3.35 .001 .86 1.16Behavioral Disengagement

.24 2.07 .043 .87 1.15

Block 1

Block 2

F(3, 60) = 8.39), Adjusted R2 = .26R2 change = .27, p < .001

F(1, 62) = 1.96), Adjusted R2 = .02, p < .05


+Discussion Hypothesis 1: As predicted, resilience is negatively correlated

with negative sense of control. This is defended by the finding that negative sense of control is associated with depression and anxiety (Siegel & Schrimshaw, 2000), both of which are commonly found when levels of resiliency are low.

Hypothesis 2: As predicted, behavioral disengagement is positively correlated with negative sense of control. This is supported by Lazarus and Folkman’s finding that efforts to exude control are concurrent with coping(1984, p. 179) (i.e., negative coping is synonymous with negative sense of control)

Hypothesis 3: As predicted, resilience and behavioral disengagement comprise a significant proportion of variance in negative sense of control.


+Discussion Our findings suggest that PLH who report low resilience and

maladaptive coping strategies (such as behavioral disengagement) may experience a negative sense of control, which is characterized by relinquishment in active coping strategies (Langer & Rodin, 1976) as well as feelings of helplessness and passivity.

Researchers have associated maladaptive coping strategies and psychological distress in PLH with reduced functioning of CD4+ T-helper lymphocytes and natural killer (NK) cells, both of which are integral to defending the body from opportunistic infections and cancers (Antoni, 2003; Kiecolt-Glaser, McGuire, Robles, & Glaser, 2002).

Lazarus and Folkman (1984) posit that choice of coping responses (problem-focused vs. emotion-focused) is typically influenced by the degree to which the individual appraises that event as controllable. When individuals attempt to use problem-focused coping to deal with situations beyond their control, feelings of frustration and helplessness can arise.


+Treatment Implications

Public health interventions promoting positive sense of control and resilience Stress management Reduce behavioral disengagement Provide advantageous coping mechanisms

Acceptance

Coping Effectiveness Training (CET) is a theory-based intervention that promotes appropriate coping responses to different situations.

CET is based on the idea that the use of problem-focused coping in response to circumstances that are beyond an individual’s control can result in increased symptoms of frustration, helplessness, and anxiety (Riolli & Savicki, 2010; Chesney, et al., 2003)


+Future Research

The impact of resiliency promoting interventions on negative sense of control

The correlation between other maladaptive coping mechanisms and negative sense of control

The impact of CET interventions on negative sense of control

Public health researchers should further explore interventions enhancing coping abilities and promoting a positive sense of control


+Limitations

Negligible research over the combined constructs in the model could be found

Dated and limited research Self report bias Limited generalizability due to geographic location of

sample Correlation does not equal causation


+Acknowledgements

Center for Psychosocial Health Research HIV community Dallas Resource Center


+Q & A


+References-Bonanno, G. A. (2004). Loss, trauma, and human resilience. American Psychologist, 59(1), 20-28. -Carver, C. S. (1997). You want to measure coping but your protocol's too long: Consider the brief cope. International Journal of Behavioral Medicine, 4(1), 92-100. -Chesney, M. A., Chambers, D. B., Taylor, J. M., Johnson, L. M., & Folkman, S. (2003). Coping effectiveness training for men living with hiv: results from a randomized clinical trial testing a group-based intervention. Psychosomatic Medicine, 65, 1038-1046. -Connor, K. M., & Davidson, J. R. T. (2003). Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depression and Anxiety, 18, 76-82. -Emlet, C. A., Tozay, S., & Raveis, V. H. (2010). “I'm not going to die from the AIDS": Resilience in aging with HIV disease. The Gerontologist, 51(1), 101-111. -Glass, D. C. (1977). Stress, behavior patterns, and coronary disease: The interaction between psychological and physiological variables indicates that attempts by type a individuals to master uncontrollable stressful events may be associated with coronary heart disease. American Scientist, 65(2), 177-187.-Kiecolt-Glaser, J. K., McGuire, L., Robles, T. F., & Glaser, R. (2002). Emotions, morbidity, and mortality: New perspectives from psychoneuroimmunology. Annu. Rev. Psychol., 53, 83-107. -Langer, E. J., & Rodin, J. (1976). The effects of choice and enhanced personal responsibility for the aged: A field experiment in an institutional setting. Journal of Personality and Social Psychology, 34(2), 191-198. -Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. (pp. 1-445). New York, NY: Springer Publishing Company, Inc.-Moskowitz, J. T., Hult, J. R., Bussolari, C., & Acree, M. (2009). What works in coping with HIV? A meta-analysis with implications for coping with serious illness. Psychological Bulletin, 135(1), 121-141. -Riolli, R., & Savicki, V. (2010). Coping effectiveness and coping diversity under traumatic stress. International Journal of Stress Management, 17(2), 97-113.-Sapolsky, R. M. (2004). Why zebras don't get ulcers. (3 ed., pp. 1-539). New York, N.Y.: St. Martin's Press.-Seligman, M. E. P. (1975). Helplessness: On depression, development, and death. (pp. 1-250). San Francisco, CA: W.H. Freeman and Company.-Shapiro, Jr., D. H. (1994). Manual for the Shapiro Control Inventory. (1 ed., pp. 1-230). Test scoring and interpretation service.-Shapiro, D. H., Friedman, M., & Piaget, G. (1991). Changes in mode of control and self-control for post myocardial infarction patients evidencing type a behavior: The effects of a cognitive/behavioral intervention and/or cardiac counseling. International Journal of Psychosomatics, 38, 4-12. -Siegel, K., & Schrimshaw, E. W. (2000). Coping with negative emotions: The cognitive strategies of HIV-infected gay/bisexual men. Journal of Health Psychology, 5(4), 517-530. Center for Psychosocial Health Research

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Resilience & Behavioral Disengagement: Correlates of a Negative Sense of Control for an HIV sample