Coping with threat: some aspects of psychological functioning in male cardiac patients

Abstract

The general aim of the study was to provide an analysis of certain psychological characteristics and processes exhibited by male coronary patients during their recovery from a heart attack in a Coronary Care Unit. This analysis was conducted within the theoretical framework provided by Richard Lazarus' psychological stress model. The central construct of the model is that of threat, defined as the anticipation of future harm. This definition leads to a concern with: the appraisal of threat stimuli, threat reactions, coping processes, and the multiple determinants of these various phenomena. Using these theoretical categories, a review of the psychological literature on the recovering coronary patient was carried out.
A pilot study of 40 patients' appraisals of and reactions to their Coronary Care Unit was first conducted. The qualitative data obtained indicated that social contact was of prime importance to patients.
Adverse reactions to various aspects of the Unit, such as the monitoring equipment, witnessing cardiac arrests and transfer from the Unit, were strikingly infrequent.
In the main investigation, variables from each of the theoretical categories listed above were assessed in a group of 50 male patients who had suffered a heart attack four to eight days previously. The particular variables measured were: appraisals of the Coronary Care Unit, the future, the patient's job and a heart attack; • the threat reactions of anxiety, depression and hostility; the coping processes of denial, inaction and anxiety; and possible determinants including: the Type A Behaviour Pattern, trait denial, recent life changes, medical history and psychosocial characteristics. To obtain comparable data from a group of
healthy subjects, a stratified random sample of 50 miners was also assessed on most of the above variables.
The data obtained allowed the investigation of three types of question or hypothesis: questions as to the prevalence of the study variables in the two groups; hypotheses concerning expected differences between the groups; and hypotheses concerning the relationships between the variables measured in the coronary group, derived from the theoretical model.
-¦The coronary patients saw both the Unit and their future in a very positive light, but displayed a very negative appraisal of a heart attack. In comparison to the miners, they found their jobs significantly more boring, and generally less attractive. The patients were significantly more anxious and depressed than either the miners or US normative groups, exhibiting levels of affect of psychiatric significance. Hostility scores in the coronary group were also significantly higher than in US samples, again approaching psychiatric significance.
Type A behaviour was significantly less prevalent and intense in both groups, compared to US data. No difference was found between the coronary and miners groups. Trait denial was significantly more intense in the coronary sample than in a US normative group.
On the psychosocial variables the coronary and miners groups differed in only two respects. The coronary patients were significantly older and included significantly more affiliates of the Church of England. Patients reported significantly more recent.life changes than did comparison subjects, especially concerning their work.
There was some very limited evidence of a positive correlation between patients' view of their CCU and that of the future and a heart attack. The coping processes of denial, inaction and anxiety were all detected. With the exception of the cognitive repudiation component of denial, which was strikingly rare, the prevalence rates of the coping processes were similar to those found in other studies. Anxiety was less prevalent than denial, but occurred as frequently as inaction.
Anxiety levels did not appear to vary significantly between the fourth and eighth days after admission, but depression scores declined significantly over time.
Type A behaviour was not a determinant of threat behaviour, nor did trait denial or a psychiatric history correlate with the use of state denial. With the exception of a positive association between social class and being reassured by the Coronary Care Unit, no psychosocial variables appeared to influence threat behaviour. There was a slight tendency for patients with a coronary history to be more depressed and hostile than were patients without such a history, but no clear conclusion could be drawn. Recent life changes and depression were not significantly associated, but there was some indication of a negative correlation between life changes and appraisal of the future, and a positive correlation between life changes and appraisal of a heart attack.
These results were compared with those from other studies, and discussed in the context of the Lazarus model. In general the data were found to be either supportive of Lazarus' theoretical principles, or insufficiently precise to warrant a conclusion. Finally, doubts were expressed as to whether the analytic power and precision which the model seems to promise, are in fact realisable.