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UBC Theses and Dissertations

Beliefs of self-esteem, self-confidence, control, faith in therapy, optimism, will to live, and recovery… Kenworthy, Shirra 1989

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B E L I E F S OF SELF-ESTEEM, SELF-CONFIDENCE, CONTROL,  FAITH IN THERAPY, OPTIMISM,  WILL TO L I V E , AND RECOVERY OF BACK AND NECK PATIENTS  by SHIRRA KENWORTHY B.S.R., U n i v e r s i t y  of British  C o l u m b i a , 1970  A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE  REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS  in THE  FACULTY OF GRADUATE STUDIES  Department o f C o u n s e l l i n g  We a c c e p t t h i s the  The  thesis  required  University  Psychology  as conforming t o standard  of British  Columbia  O c t o b e r , 1989  (c)  SHIRRA KENWORTHY, 1989  In  presenting this  degree at the  thesis  in  University of  partial  fulfilment  of  of  department  this thesis for or  by  his  or  requirements  British Columbia, I agree that the  freely available for reference and study. I further copying  the  representatives.  an advanced  Library shall make it  agree that permission for extensive  scholarly purposes may be her  for  It  is  granted  by the  understood  that  head  of  copying  my or  publication of this thesis for financial gain shall not be allowed without my written permission.  Department  of  Counselling Psychology  The University of British Columbia Vancouver, Canada  Date Qr-.toher 8 t h . 1989  DE-6 (2/88)  ii Abstract T h i s study self-esteem, optimism,  examined t h e d i f f e r e n c e s i n b e l i e f s o f  self-confidence, control,  and t h e w i l l  poor recovery,  to live  how t h e s e b e l i e f s  i n therapy,  between r e c o v e r y  moderate r e c o v e r y ,  back and neck p a t i e n t s .  faith  groups o f  and good r e c o v e r y , i n  In addition, t h i s  study  examined  related t o the rate of recovery  when  p a t i e n t s were d i v i d e d i n t o t h r e e g r o u p s o f s l o w r a t e o f recovery,  moderate r a t e o f r e c o v e r y ,  recovery. with  I t was h y p o t h e s i z e d  and h i g h r a t e o f  t h a t t h e p a t i e n t group  a g r e a t e r degree o f recovery  and a g r e a t e r r a t e o f  r e c o v e r y would be r e l a t e d t o s i g n i f i c a n t l y beliefs faith  of self-esteem,  i n therapy,  self-confidence, locus of control,  optimism,  and w i l l  the groups w i t h moderate r e c o v e r y recovery  rate,  group w i t h  and t h e s e  stronger  to live,  compared t o  degree and moderate  g r o u p s would be f o l l o w e d by t h e  a poor degree o f recovery  and a s l o w e r  rate of  recovery. The  s u b j e c t s were b a c k a n d n e c k p a t i e n t s who were  discharged  from t h e p h y s i o t h e r a p y  department o f  S t . V i n c e n t ' s H o s p i t a l d u r i n g t h e p e r i o d from January, to  December,  letter with 47)  1988.  A package c o n t a i n i n g a c o v e r i n g  o f e x p l a n a t i o n a n d t h e q u e s t i o n n a i r e s was  a response a n d women  1986  r a t e o f 45%.  mailed  R e s p o n d e n t s were men  (n = 103) r a n g i n g  (n  f r o m 20 t o 89 y e a r s  =  o f age  (M = 52.7, SD = 1 6 . 8 9 ) . Two m u l t i v a r i a t e a n a l y s i s o f v a r i a n c e s  (MANOVAS)  were  iii computed w i t h t h e d e p e n d e n t m e a s u r e s o f s e l f - e s t e e m , self-confidence, optimism,  locus of control,  and w i l l  to live,  faith  examining  group d i f f e r e n c e s on  degree o f r e c o v e r y and r a t e o f r e c o v e r y . t h e MANOVA  i n therapy,  The r e s u l t s o f  f o r degree o f recovery demonstrated  differences  for faith  i n therapy,  significant  F(2, 147) = 18.13, jo  <.001, o p t i m i s m , F(2, 147) = 7.24, E <.001, a n d self-esteem,  F(2, 147) = 3.16, jo <.001.  t h e means a n d p o s t h o c S c h e f f e t e s t s  An e x a m i n a t i o n o f  (p_ <.05) r e v e a l e d  t h a t t h o s e w i t h a good d e g r e e o f r e c o v e r y h e l d beliefs  of faith  i n therapy,  degree o f recovery, While  than  those with  stronger  a moderate  f o l l o w e d by those w i t h poor  recovery.  t h o s e w i t h a good d e g r e e o f r e c o v e r y and a moderate  degree o f recovery h e l d stronger b e l i e f s  o f optimism  than  t h e p o o r r e c o v e r y group, and t h o s e w i t h a good d e g r e e o f recovery held stronger b e l i e f s poor r e c o v e r y group.  o f self-esteem than t h e  No g r o u p d i f f e r e n c e s w e r e f o u n d f o r  rate o f recovery. The  importance  limitations, discussed.  o f t h e study  and t h e i m p l i c a t i o n s  as w e l l as i t s f o r future research are  iv Table o f Contents ABSTRACT  i i  TABLE OF CONTENTS  iv  L I S T OF TABLES  v i i  ACKNOWLEDGEMENTS  ix  INTRODUCTION  1  LITERATURE REVIEW  5  General B e l i e f s  and A t t i t u d e s  The  S a l u t o g e n i c Model  The  Placebo  7 8 11  C o g n i t i v e - E m o t i o n a l Model  13  E x p e c t a n c y - A t t r i b u t i o n Theory  13  C o n d i t i o n i n g Theory  14  Secondary The  Suggestibility  Theory  14  H e a l t h B e l i e f Model  A Phenomological  16  Approach  26  Measurement I s s u e s  30  Summary  32  HYPOTHESES  38  Purpose  38  Hypotheses  38  METHOD  42  S u b j e c t s and Procedures  42  Instruments  46  The  Rosenberg Self-Esteem S c a l e  (RSE)  46  The  Interpersonal  Dependency I n v e n t o r y  (IDI)....47  The  H e a l t h R e l a t e d H a r d i n e s s S c a l e (HRHS)  48  V The  C l i e n t Readiness f o r Therapy  Inventory The  Life  The W i l l  (CRTI)  48  Orientation Test t o Live Scale  Demographic  (LOT)  (WLS)  and A n c i l l a r y Measures  Data A n a l y s i s  49 50 50 51  RESULTS  52  Descriptive Recovery  Data  52  Degree  52  Recovery Rate  57  Correlation Matrix  59  Hypotheses Degree  Testing o f Recovery  Rate o f Recovery DISCUSSION  .62 62 67 69  Limitations  75  Recommendations f o r F u t u r e R e s e a r c h  78  Conclusions  79  REFERENCES  81  APPENDIX A  90  Purpose  o f Study L e t t e r  Instruction  Sheet  93  APPENDIX B  94  Rosenberg  Self-Esteem Scale  Lack o f S o c i a l Control Faith  91  Self-Confidence Subscale  Subscale  i n Therapy  95 96 98  Subscale  99  vi Life  Orientation Test  100  Will  to Live Scale  101  Demographic and A n c i l l a r y  Questionnaire  APPENDIX C  104  C o m p a r i n g t h e Means  105  R o s e n b e r g S e l f - E s t e e m Means a n d  Standard  Deviations  106  APPENDIX D Correlation Matrix  102  108 f o r Dependent Measures,  Treatment Measures, A n c i l l a r y  Data,  a n d Age  APPENDIX E T a b l e s w i t h Portuguese  109 I l l  P o p u l a t i o n Removed  112  vii List  o f Tables  1.  H e a l t h B e l i e f Model R e s e a r c h  20  2.  Comparisons o f Models/Theories  34  3.  Descriptive  45  4.  Means a n d S t a n d a r d D e v i a t i o n s o n T r e a t m e n t Variables  Information  f o r Respondents  f o r Perceived  Degree o f R e c o v e r y  Groups 5.  54  C h a r a c t e r i s t i c s o f t h e Poor Degree o f Recovery, M o d e r a t e D e g r e e o f R e c o v e r y , a n d Good of  6.  Degree  R e c o v e r y Groups  55  C h a r a c t e r i s t i c s o f t h e Slow R a t e o f R e c o v e r y , Moderate Rate o f Recovery, and High Rate o f R e c o v e r y Groups  7.  60  Means a n d S t a n d a r d D e v i a t i o n s  f o r Dependent  Measures f o r t h e Degree o f Recovery 8.  Summary  o f MANOVA a n d f o l l o w u p ANOVAS f o r t h e  Degree o f Recovery Groups 9. C r i t i c a l  63  Values  (n = 150)  (Scheffe Tests)  64  of Significance  for  t h e Dependent M e a s u r e s Between  for  t h e Degree o f R e c o v e r y  Groups 66  10. Means a n d S t a n d a r d D e v i a t i o n s o f D e p e n d e n t Measures f o r Rate o f Recovery 11. Means a n d S t a n d a r d D e v i a t i o n s for 12. Summary  68  f o r Self-Esteem  t h e Degree o f Recovery Groups  106  o f MANOVA a n d f o l l o w u p ANOVA f o r t h e  Degree o f Recovery Groups  (n = 150)  107  viii 13. C o r r e l a t i o n M a t r i x  f o r Dependent  Measures,  T r e a t m e n t M e a s u r e s , A n c i l l a r y D a t a , a n d Age...109 14. Means a n d S t a n d a r d D e v i a t i o n s  f o r Dependent  Measures f o r t h e Degree o f Recovery Groups w i t h no P o r t u g u e s e  112  15. Summary o f MANOVA and f o l l o w u p ANOVAS f o r t h e D e g r e e o f R e c o v e r y G r o u p s w i t h no P o r t u g u e s e . . 1 1 3 16. C r i t i c a l  Values  (Scheffe Tests)  of  Significance  f o r t h e D e p e n d e n t M e a s u r e s Between G r o u p s f o r the  D e g r e e o f R e c o v e r y w i t h no P o r t u g u e s e  114  ix Acknowledgments I would l i k e t o f i r s t L o n g , whose u n d e r s t a n d i n g , been a source  t h a n k my  s u p e r v i s o r Dr.  e n c o u r a g e m e n t , and  o f s t r e n g t h and  guidance  motivation throughout  p r e p a r a t i o n of t h i s paper.  I a l s o wish t o thank  Isabel  Dyck f o r h e r  valued  as  Stephen Marks.  Dr.  time  and  In a d d i t i o n I wish t o thank the administration and  Finally special belief  suggestions,  staff  t o my  this  parents  a b i l i t y to  the  as  well  and help  process.  B e t t y and  Sam  Kenworthy, a  thank-you f o r y o u r encouragement, s u p p o r t , i n my  has  Dr.  of St. Vincent's Hospital f o r t h e i r  a s s i s t a n c e throughout  Bonita  succeed.  and  very  1  Introduction In our h e a l t h considered dollars  b a c k and n e c k p r o b l e m s  t o be m a j o r e n t i t i e s  t h r o u g h workdays l o s t  through treatment years  services,  annually  back c l i n i c s  that  cost millions  and s e v e r a l  (Saunders,  h a v e emerged t o  billion  1983).  d e a l more  are of  dollars  In  recent  specifically  w i t h t h e s e problems t h r o u g h a m u l t i d i s c i p l i n a r y team. D o c t o r s and t h e r a p i s t s ,  through the medical model,  t o maximize the  and r e c o v e r y o f p a t i e n t s  the  healing  degree of h e a l i n g that  with which t h i s our knowledge increased  takes place,  healing occurs.  Yet today,  paper then they  are at  and why some do n o t .  is  to  examine  may h a v e w i t h The r o l e  been  of  of  1985).  the  the  beliefs  a loss to  and t h e  with the the  advent  noted that  of  relationship  as  entities  development  it  influences  of  explain pre  of  this  and r e c o v e r y h a s "there  body a p a r t from t h e mind"  interaction  has  relationships  the of  of  the  mind and t h e  the mind,  our h e a l t h  1980).  holistic the is  with  in  recognized.  became  as  More  and t h e  Martus,  in  body  recently  approach i n  body,  long  no  new t e c h n o l o g i e s  (Ferguson, the  is  (cited  d i v i d e d and d i s e a s e and i n j u r y were d e a l t physiological  the  The f o c u s  mind i n h e a l i n g  Socrates  With the  medicine,  though  recovery.  the  recognized.  illness  even  with  speed  a b o u t n e c k and b a c k i n j u r y and r e c o v e r y  d r a m a t i c a l l y , we s t i l l  state  both  and i n t h e  why some i n d i v i d u a l s r e c o v e r by r e t u r n i n g t o injury  strive  medicine  environment  2  O r n s t e i n and S o b e l that  "minds t h e  health body,  is  its  where,  information trouble  body"  it  1987;  the  the  the  to the  little of  Antonovsky  adapt i t s e l f  Frank,  Siegel, relates  1961;  demands and t h e  sense of health  on  a n d how  to  the  the avoid  they  degree  r e c o v e r y and t h e  of  the  maintenance  of  germs and v i r u s e s  injury.  of  and n o t  rate  of  In a d d i t i o n there  is  support  beliefs. (1979,  1987)  positive  conceptualizes  pull  of  system,  believes  self-identity, the  respond to  it  of  address  those  that  a  model  life  control placed  individual  (HBM) ( B e c k e r ,  demands.  strong where  and a towards  continuum.  The h e a l t h b e l i e f  of  the  s h o u l d be p l a c e d ,  push the  pull  as  individual's  he t h e o r i z e s  a locus  health  negative  the  specifically  self-efficacy,  end o f  of  the  i n order to  Much o f  beliefs  which are a v a i l a b l e to  individual  based  e m p i r i c a l d a t a and r e s e a r c h t o  individual's belief  the  maintenance  onslaught  A l t h o u g h he d o e s n o t  sense of  brain  Ornstein & Sobel,  1986).  b a l a n c e d on a c o n t i n u u m between t h e  resources  the  The b r a i n t e l l s  between o u r b e l i e f s  1979;  however,  influence  the  and i n t e r p r e t s ,  from a s p e c i f i c  relatively  is  well.  1964;  health against  recovery  it  b o d y t h r o u g h t h e b r a i n a r e made b y many  Shapiro,  necessarily  and t h a t  function.  receives  (Cousins,  literature  note t h a t  40),  when and how t o  The c o n n e c t i o n s  authors  (p.  primary  and s t a y  influence  (1987)  1974)  strong the  3  identifies a health care, as  perceptions  threat,  the  clinic  this  examine  recovery  beliefs  of  recovery  (1984)  preventive  cost  used t h i s  and danger (i.e.,  model  as  However,  specific  type  to  identified  higher benefits,  lower  representative  because the  i n t o b r o a d subdomains  it  of b e l i e f s  limits  of  the  HBM c l a s s i f i e s our a b i l i t y  w h i c h may i n f l u e n c e  to the  process.  The p l a c e b o different Shapiro,  effect  authors 1964)  treatment  field  is  faith  physician,  experience  a  of  1961;  identifies  effects,  i n the  which has been  (Frank,  pain or recovery. the  al.  and l o w e r r e s e n t m e n t  study the  such as  of  compliance with a medical  lower v u l n e r a b i l i t y ,  beliefs  belief  action  severity  from l a m i n e c t o m y s u r g e r y a n d  more i m p r o v e d g r o u p . the  a specific  vaccination,  Roberts et  barriers,  of  the  an i n d i v i d u a l s h e a l t h b e h a v i o r  utilization,  regimen).  susceptibility,  benefits  and b a r r i e r s t o  influencing  of  the  believing  as  efficacy  specifically it  phenomenological  healing  showed  a dramatic increase  in therapy,  self-esteem,  The p u r p o s e o f significant  this  differences  of of  1987;  positive therapy, the  and  relief  study  optimism, and  examined  influences  (1985)  as  Lundh,  an i m p o r t a n t c o n t r i b u t i o n  Martus'  such c e n t r a l b e l i e f s  1978;  contributory to  Finally  study that  Jospe,  expectation  i n the as  s t u d i e d b y many  to  the  recovery.  of  16 p a t i e n t s  was a b l e being  of  to  whose  identify  i n charge,  faith  self-confidence.  study then  is  to  examine  e x i s t between i n d i v i d u a l s  whether with  4  greater, of  compared t o  self-esteem,  therapy,  self-confidence,  optimism,  return to  the  was e x a m i n e d  less recovery,  and w i l l  pre-injury i n two w a y s .  achieved,  and s e c o n d by t h e  and t h e  healing to This  patients  number o f  faith  back and neck subjectively  of  treatments  the function  by  they  recovery,  beliefs  in  Recovery,  identify  rate  health  the  have the  required for  length this  occur. study  extends Martus  examining whether control,  live.  First  recovery that  time  control,  state of  degree of  of  to  and t h e  faith  significant  to  beliefs  of  i n therapy, the  1  qualitative  self-esteem,  optimism,  healing process  research  by  self-confidence,  and w i l l  to  live  are  f o r b a c k and n e c k  patients. The r e c o g n i t i o n the  healing process  understanding of this the  and s u b s t a n t i a t i o n  c o u l d be a m a j o r s t e p  health  with  t y p e s and i m p o r t a n c e o f b e l i e f s healing  patients.  It  and t h e r a p i s t s counselling therapies.  believing  in  forward i n  our  and h e a l i n g t o d a y .  s t u d y may p r o v i d e c o u n s e l l o r s  with the  of  s h o u l d a l s o be u s e f u l i n h e l p i n g them t o  may b e a u s e f u l  information  that  and r e c o v e r y p r o c e s s  of to  are  of about  associated  back and neck doctors,  identify  adjunct to  Results  nurses,  when  their  prescribed  5 Review o f L i t e r a t u r e The recovery their  issue o f concern i n t h i s of patients with  a s s o c i a t i o n with  attitudes.  This  characteristics the  h e a l t h r e l a t e d b e l i e f s and  study  effect,  (HBM) a r e e x a m i n e d .  which e x p l o r e d  Finally  t h e h e a l i n g and  o f 16 p a t i e n t s i s e x a m i n e d i n d e p t h .  There i s a high  i n c i d e n c e o f back and neck  (1981) e s t i m a t e s  enough s t a t i s t i c s  population While other 30%  review  and a t t i t u d e s t o h e a l t h .  (1979, 1 9 8 7 ) , t h e p l a c e b o  t h e h e a l t h b e l i e f model  a phenomenological  are  describe the  t h e s a l u t o g e n i c model o f h e a l t h a s  d e v e l o p e d by Antonovsky  Grieve  briefly  o f neck and back p a t i e n t s and t h e n  relationship of beliefs  recovery  i s t h e h e a l i n g and  back and neck p r o b l e m s , and  section will  More s p e c i f i c a l l y ,  and  study  will  problems.  t h a t i n a n y 2-week p e r i o d  there  t o i n d i c a t e t h a t 20% o f t h e a d u l t  b e s u f f e r i n g f r o m some f o r m o f b a c k  studies  i n d i c a t e an i n c i d e n c e  t o 50% o f t h e p o p u l a t i o n w i t h  of  approximately  t h i s problem,  these  ranges a r e c o n s i s t e n t throughout t h e i n d u s t r i a l i z e d between t h e s e x e s , between t h e d i f f e r e n t the  different  social  classes.  l o w e r i n t h e u n d e r 35 g r o u p greater 1974; task 1987)  i n t h e o v e r 55 g r o u p  Hult,  1972; N a g i ,  races,  The i n c i d e n c e  and a c r o s s  i s generally  (55%) ( F a i r b a n k ,  R i l e y , & Newby,  t h a t t h e frequency  problems represented  world,  (between 25% a n d 30%) a n d much 1986; Hay,  1973).  f o r c e on s p i n a l d i s o r d e r s i n t h e w o r k e r reported  pain.  (LaRocca,  of work-related  14.3% o f a l l c l a i m s .  A Quebec  spinal  T h e s e were  6 f u r t h e r b r o k e n down i n t o a n a t o m i c a l percent  of the  and  F a c t o r s c o n t r i b u t i n g t o and  aging  these  process  etiological  where t h e  physiological an  7%  changes;  a d d i t i o n a l s t r e s s on  Grieve  f a c t o r s as  (b) b e i n g the  injuries.  causing  i n c l u d i n g : (a) supple  contribute to  (d) o c c u p a t i o n a l  f u r t h e r more  s t r e s s such as  (f) the  regular f o r long  unexplainable  t e n d e n c y o f some i n d i v i d u a l s t o e x p e r i e n c e  degenerative  changes such as  than  arthritis  a t an  earlier  age  others;  (g) c o n g e n i t a l d e f e c t s o r a d d i t i o n a l b o n y o r s o f t d e v e l o p m e n t ; and  (h) t h e p r e s e n c e o f d i s e a s e .  a d d i t i o n p s y c h o l o g i c a l f a c t o r s such as depression,  and  contributory  1973;  tissue  In  anxiety,  p e r s o n a l i t y have been i d e n t i f i e d  f a c t o r s (Finneson,  to  joints;  r e p e t i t i v e movements o r a f i x e d p o s t u r a l p o s i t i o n (e) t r a u m a ;  the  places  s p i n a l weight bearing  specific  of time;  due  overweight which  w h i c h may  periods  11%  (1981)  t i s s u e becomes l e s s  (c) p o o r p o s t u r e stress;  were neck  i n some c a s e s  n e c k p r o b l e m s a r e many.  identifies  Seventy  c l a i m s were f o r l u m b a r b a c k i n j u r y ,  were f o r t h o r a c i c b a c k i n j u r i e s  b a c k and  areas.  Grieve,  as  1981;  Nagi  e t a l . , 1973). A review years  (1986  of hospital  to  1988)  records  and  5%  are  largely  from the  patients,  the  r e v e a l s t h a t b a c k and  attending the physiotherapy Hospital  over  last  neck p a t i e n t s  outpatients at St.  from Vancouver  lower mainland area.  (65.5%) were f e m a l e and  (90%), Of  three  5% the  Vincent's from  Burnaby  400  (35.5%) w e r e m a l e w i t h  a  7 mean a g e o f 49 General It related  B e l i e f s and A t t i t u d e s should  the  be n o t e d t h a t  to healing  research disease  years.  i n this  ability  and r e c o v e r y  area  and d i s e a s e  (Ornstein  reveals  a paucity of  & Sobel,  1987).  p r o c e s s has been s t u d i e d  o f t h e body t o m a i n t a i n h e a l t h  T h e r e i s some l i t e r a t u r e connection  a review o f t h e l i t e r a t u r e  that discusses  a n d a few o f t h e s e r e a d i n g s  The  rather  than  and t o h e a l .  t h e mind-body specifically  comment on t h e e f f e c t s o f a t t i t u d e s a n d b e l i e f s .  Siegel  (1986) n o t e s t h a t p o s i t i v e a t t i t u d e s a n d b e l i e f s  increase  the  degree o f h e a l i n g ,  our  personal  prophecy,  belief  system c o n t a i n s  by  step  a  Ornstein  self-fulfilling s y s t e m s we c a n  and S o b e l  that  the potential f o rhealing  m a n i p u l a t i o n o f t h e mind h a s gone What t h e n a r e t h e s e b e l i e f s influence our health?  (1987) t a k e  this  are "opinions  and a t t i t u d e s t h a t  S t e i n and U r d a n g  immediately  susceptible to rigorous  (1966) n o t e  that  o f something not  proof"  (p. 1 3 5 ) .  t h e need t o d i s t i n g u i s h b e t w e e n  s e v e r a l t y p e s o f b e l i e f s which she i d e n t i f i e s a t t i t u d e s and knowledge. "generalized  may  o r c o n v i c t i o n s " w h i c h a r e b a s e d on a  i n the truth or existence  (1976) r e p o r t s  through the  unnoticed.  "confidence  Fleming  that  f u r t h e r when r e f e r r i n g t o a t t i t u d e s a n d b e l i e f s  noting  beliefs  (1986) s t a t e s  and t h a t by c h a n g i n g o u r b e l i e f  influence our health. one  w h i l e Johnson  She d e s c r i b e s  as  values  values,  as  c o n c e p t i o n s o f what i s 'good' o r ' b a d ' " . . .  8 which  "clearly  reflect  " f e e l i n g s about  personal p r e f e r e n c e s " , a t t i t u d e s as  particular  o b j e c t s which  'flow  from'  values".  She f u r t h e r s t a t e s t h a t a t t i t u d e s  "are usually  considered  less  r e a s o n , " and  that  s t a b l e than values f o r t h a t  i t i s " p o s s i b l e t h a t what a p p e a r s  t o be an a t t i t u d e  of c e r t a i n  individuals  i s a v e r y deep s e a t e d v a l u e f o r  others."  Knowledge she d e f i n e s as " v e r i f i a b l e  i n f o r m a t i o n a p e r s o n has about that as  knowledge i n c o r p o r a t e s " b e l i e f s which s o c i e t y  facts"  (p.  are the r e s u l t  and  true  t h e s e a t t i t u d e s and b e l i e f s  o f c o g n i t i v e thought  an " i n t e r a c t i o n care giver"  thought  health  processes which  result  (Genest  & Genest,  the  environment,  1987, p . 3 4 ) .  These  p r o c e s s e s i n f l u e n c e u s i n what we a c c e p t t o b e  i n the world  (Gazzaniga,  about  u s , t h e y a l s o a r e one o f t h e life  t h a t we a r e a b l e t o m e a s u r e  1985).  S a l u t o g e n i c Model Antonovsky  health called that  about  among t h e p a t i e n t ,  p r o p e r t i e s o f our mental  The  accepts  4).  We know t h a t  from  a s u b j e c t , " and she n o t e s  (1979) p r e s e n t s a n i m p o r t a n t  "sense  o f coherence"  i n order t o understand  survival  (SOC).  concept of He  believes  h e a l t h we n e e d t o u n d e r s t a n d  a n d t h a t we c a n do s o b y s t u d y i n g t h o s e  who a r e h e a l t h y a n d w e l l t h r o u g h o u t Antonovsky  their  (1987) m a i n t a i n s t h a t  people  lives.  i n medicine  there i s  a p a t h o g e n i c o r i e n t a t i o n w h i c h s e e k s t o e x p l a i n why become i l l  people  a n d f o c u s e s on t h e o r i g i n s o f d i s e a s e , w h i l e he  9 seeks  t o e x p l a i n the o r i g i n s of h e a l t h with h i s  salutogenic orientation. concepts (p.  3)  a r e l o c a t e d on  and  proposes  that this p u l l  i s offset  h e a l t h - e a s e end  expresses  enduring  structured,  and  investment The  as  "a  from  and  and  of  has  (1987, p.  and  are  by  resources these  Antonovsky second  as m e a n i n g f u l n e s s .  t h e s e t h r e e components t o form h i s o r i e n t a t i o n and  notes  of  19).  component o f t h i s d e f i n i t i o n  the t h i r d  a  confidence  t o meet t h e demands p o s e d  engagement"  m a n a g e a b i l i t y , and  that this  99).  global  (b) t h e  (1987) r e f e r s t o a s c o m p r e h e n s i b i l i t y , t h e  and  can  one's i n t e r n a l  explicable;  of  (c) t h e s e demands a r e c h a l l e n g e s , w o r t h y  first  instrument  resistance  (1979, p.  i n the course of l i v i n g  predictable,  a r e a v a i l a b l e t o one stimuli;  that  though dynamic f e e l i n g  environments  the  t h e e x t e n t t o w h i c h one  deriving  or  He b e l i e v e s  closer to  or the environment  the  defines  characteristic  (1987) d e f i n e s t h e SOC  (a) t h e s t i m u l i  external  and m a i n t a i n e d  of  available  72).  e f f e c t i v e t e n s i o n management"  orientation that  that  (1979, p.  t h e o r i z e s a r e "any  t h e group,  Antonovsky  pervasive,  readily  o f t h e c o n t i n u u m by t h e g e n e r a l  r e s o u r c e s w h i c h he  facilitate  continuum"  g e n e r a l r e s i s t a n c e d e f i c i t s w h i c h he  adaptive resources"  the person,  these  t o t h e d i s e a s e end  "demands t o w h i c h t h e r e a r e no  automatic  that both  a "health ease/dis-ease  that there i s a p u l l  c o n t i n u u m by as  He  as He  to  uses  life  t h a t t h e s e components a r e i n t e r t w i n e d  statement  i s supported  by d a t a  that  10 demonstrate a high components.  He  of these three elements as  SOC  controlled.  a  but  the  breakdown  locus  may  or  whole.  be  with the  What i s i m p o r t a n t  within  head o f  i s that  i t should  necessarily  externally  o f power may  a l s o be  a  various  be,  the  the  family  in their  Antonovsky SOC (b)  emotions,  will will and  control  the  rightfulness  because the  discusses  have:  i s where  individual be  individuals with  sense of  identity  more a b l e  e m o t i o n s ; and He  d e p e n d i n g on  F u r t h e r m o r e he  changes, c u l t u r a l  increases  aware o f and  f a c t o r s t h a t he  resources  are  a strong  self-efficacy.  external  of the  be  for their  circumstances.  relations  (a)  of  interest.  e x p e r i e n c e d i f f e r e n t t y p e s and  sense of  stressors or  best  (1987) b e l i e v e s t h a t  will  responsibility stronger  own  or  the  a s s u r e d t h a t m a t t e r s p e r t a i n i n g t o them w i l l  resolved  strong  the  i n d i v i d u a l i s not  a u t h o r i t y however i s c r i t i c a l  must be  self;  model as  either internally  individual believes  this  part  t o the  concept the  The  leader.  however d e s c r i b e  three  components t h o u g h d o e s d e s c r i b e  being  individual  does not  they apply  In the v i e w e d as  i n t e r c o r r e l a t i o n between t h e  take  (c) w i l l  have  believes their  elements t h a t  require  act  as  a  either  various life  interpersonal  a d a p t a b i l i t y on  i n d i v i d u a l which lowers t h e i r  the  resistance  and  their vulnerability.  A n t o n o v s k y ' s model t h o u g h u s e f u l  of  also  suggests t h a t  changes, or changes i n  and  strengths to  (1979)  a  for c l i n i c a l  and  11 theoretical  purposes  particular beliefs may  does not attempt  and  attitudes of the  i n f l u e n c e h e a l i n g and  examine s t r e s s e s might f a l l response The  and  to identify  recovery.  those  individual  which  Instead i t tends  r e s o u r c e s and where an  to  individual  on t h e h e a l t h e a s e / d i s - e a s e c o n t i n u u m i n  to  these.  Placebo The  1961;  placebo  Shapiro,  physicians Initially  notion originated  1 9 7 1 ) , and  was  as  (Frank,  relegated to psychology  f o r f u r t h e r s t u d y and i n psychology,  i n medicine  research  i n medicine,  (Katz, i t was  by  1969). regarded  as a n u i s a n c e v a r i a b l e but w i t h t h e development  of  c o g n i t i v e b e h a v i o r a l m o d e l s i t became a c k n o w l e d g e d a s cognitive variable  i n i t s own  right  (Critelli  a  & Neumann,  1984) . The shall  word " p l a c e b o "  please"  and M o r r i s  i s d e r i v e d from  (Ornstein & Sobel,  1987,  (1978) d e f i n e t h e p l a c e b o a s  component o f t h e r a p y t h a t  psychological,  that  f o r i t s presumed s p e c i f i c  without (p.  specific  78).  "any  means " I Shapiro  therapy  or  for i t s  psychophysiological effect, effect,  but  f o r the c o n d i t i o n being  well  based. until  be  been suggested the  Shapiro just  that h i s t o r i c a l l y  f o u n d a t i o n on w h i c h m e d i c a l  the  treated"  placebo  practice  (1971) b e l i e v e s t h a t a l l m e d i c a t i o n s  r e c e n t l y were i n f a c t p l a c e b o s .  or  is  371). I t has  may  activity  p.  and  i s d e l i b e r a t e l y used  nonspecific, i s used  Latin  Cousins  is  12 (1971) e x p a n d s on t h i s by d e s c r i b i n g t h e p l a c e b o d o c t o r who  r e s i d e s w i t h i n " (p. 6 9 ) , and  t h a t what i s i m p o r t a n t  i s the  states  individual's  as  further  "will  to  He  a l s o d e s c r i b e s t h e p l a c e b o as a c a t a l y s t w h i c h  us  t o h e a l o u r s e l v e s w h i l e g i v i n g us a t a n g i b l e  explain this healing In  p r e s e n t day  i s seen  medicine  as  the placebo  "trick"  in  and  fake o r imagined  (Frank,  has  Ornstein & Sobel,  The has  h e a l i n g and  degree  of  our  has  1987).  Research that  recovery  1984; on  (Cousins,  the  1968)  (1969) t o be  claims  produced (cited  only provides  f o r e q u a l l y small problems. quantitative  that  however  while Hamilton  b e l i e v e s that the placebo  the d i f f e r e n c e s ,  placebo  1979).  Zimbardo  laboratories,  Cousins,  i t i s the mind  i s t h e most e f f e c t i v e d r u g  the pharmaceutical  small treatments  to  It  (Agras,  prompted c o n s i d e r a b l e debate.  in Rickels,  made some  of e f f e c t i v e n e s s of the placebo  that the placebo by  t h e mind  a l s o h e l p e d t o demonstrate  b r i n g s about  as  t h e c o n n e c t i o n between t h e h e a l i n g  mechanism o f t h e body and 1979;  1980).  their patients  particularly  of the h e a l i n g process. clearly  viewed  1961).  highly valuable contributions,  demonstrated  to  whose  of the placebo  However t h e n o t i o n o f t h e p l a c e b o h a s  understanding  reason  (Ferguson,  o f t e n disapprove of t r i c k i n g  t h i s manner  enables  is still  cure f o r those  A l s o d o c t o r s o f t e n view t h e use deceitful  live".  (1979).  q u i t e n e g a t i v e l y as t h e suffering  "the  r e s e a r c h has  Regardless however  13 shown t h a t a p p r o x i m a t e l y received placebos from t h e i r  have r e p o r t e d a s a t i s f a c t o r y  symptoms  The mechanisms e f f e c t works  one-third of the people  (Ornstein & Sobel,  recovery  1987).  by which t h e p l a c e b o  i s not y e t understood,  who  w o r k s , o r how i t s  however  several  t h e o r i e s have been advanced. Cognitive-emotional  model.  r e c e n t l y proposed a r e l a t i v e l y model w h i c h he b e l i e v e s w i l l experience  of health.  t o them e m o t i o n a l l y .  improvement beliefs  simple  effect  interpret  the individuals  these  that  These s i g n s a r e t a k e n  respond these  beliefs.  their  as proof  s e t t i n g up a p o s i t i v e  He r a i s e s t h e q u e s t i o n o f  i s a psychophysiological placebo  w e l l and s u p p o r t s  this possibility  by c i t i n g  e f f e c t as  A d e r ' s 1981  o f t h e p s y c h o l o g i c a l i n f l u e n c e s on t h e immune  s y s t e m , Imboden's 1972 s t u d y recovery  from  demonstration life  s i g n s and  which i s c o n s i s t e n t w i t h  of the correctness o f t h e i r b e l i e f s ,  study  individual's  more a t t e n t i v e t o s i g n s o f  o f improvement.  whether t h e r e  cognitive-emotional  M o r e o v e r he s u g g e s t s  o r t o evidence  cycle o f placebo  (1987) h a s  Lundh p r o p o s e s t h a t  sense s i g n s o f i l l n e s s ,  e m o t i o n s make p e o p l e  Lundh  on how d e p r e s s i o n  infections,  and G o t t s c h a l k ' s 1974  o f how hope  i s correlated with  slows  the length of  i n cancer. Expectancy-attribution theory.  Ross and O l s e n  (1981) h a v e p r o p o s e d t h e E x p e c t a n c y - A t t r i b u t i o n t h e o r y w h i c h d i f f e r e n t i a t e s b e t w e e n two l e v e l s  of patient  14 assessment.  They i d e n t i f y p r i m a r y  assessment  measures t h e s u b j e c t s e x p e c t a n c i e s o f t h e effects, the  and  secondary  individual  and  b e l i e v e s that the c o n d i t i o n  often the  been e f f e c t e d .  focus of the placebo  the e v a l u a t i o n i s based  w h e t h e r t h e r e i s any The  or the u n d e r l y i n g  be  milieu and  They p o i n t out  i s on t h e  directed  at e i t h e r the  U l l m a n n and  of conditioning  responses  to stimuli  (1985) f o u n d  support  s t u d y o f p a i n i n d u c e d by n o x i o u s a n a l g e s i c cream, however Swalm  Krasner  effects  suggestibility  suggestibility  effect  (Eysenck  Voudouris,  for this  theory  stimulation  (1987) f o u n d  numerous s t u d i e s e x a m i n i n g the placebo  response  relationships patients.  theory.  and  that  and no  1984).  Peck, in their an  support study.  Jospe  induction  i n the  placebo  (1978)  reviewed  the r o l e of s u g g e s t i b i l i t y  concluded  for  Secondary  e m o t i o n s as i n f l u e n t i a l  & Furneaux,  the  are present w i t h i n the  i s a theory t h a t emphasizes the  o f p e r c e p t i o n s and  (1969)  and  t h i s t h e o r y when c o n d u c t i n g a s i m i l a r t y p e o f Secondary  of  symptom  They b e l i e v e  o f the therapy or experiment.  Coleman  symptoms,  on t h e p a t i e n t s ' b e l i e f s  a conditioning theory.  i s the r e s u l t  conditioning  they  cause.  Conditioning theory.  placebo  f o r which  change i n t h e i r u n d e r l y i n g c o n d i t i o n .  p l a c e b o h o w e v e r may  have proposed  treatment  assessment which measures whether  were b e i n g t r e a t e d h a s that  which  that  in  significant  o n l y seemed t o emerge when t h e s u b j e c t s w e r e  15 It the  i s i n t e r e s t i n g t o examine t h e v a r i o u s  placebo e f f e c t .  Frank  (1961) d e s c r i b e s  which he s t a t e s needs t o be i n p l a c e These a r e :  (a) t h e h e a l e r  relationship,  faith  four  f o rhealing  features t o occur.  and p a t i e n t must h a v e a g o o d  one where t h e h e a l e r  p a t i e n t has t o t a l  features of  i s empathic and t h e  i n the healers  ability  o f h e a l i n g must b e s o c i a l l y  to heal;  (b)  the place  the  p a t i e n t must h a v e a r a t i o n a l e t o e x p l a i n t h e i l l n e s s  o r p r o b l e m ; a n d (d) t h e r e  must be a t r e a t m e n t  I n f o r m a t i o n about t h e e f f e c t also  found t o be n e c e s s a r y .  expected  (c)  procedure.  f r o m t h e p l a c e b o was  Dinnerstein  f o u n d t h a t when p a t i e n t s were t o l d energized  sanctioned;  a n d Halm  (1970)  t o expect t o f e e l  or tranquilized following the administration of  a placebo that  there  was a h i g h  correspondence with  this  effect.  The need f o r p h y s i c i a n  enthusiasm has a l s o  confirmed  (Fisher, Cole,  & U h l e n h u t h , 1964;  Rickels, Stuart,  Baum, T a y l o r ,  & Raab, 1964; R i c k e l s ,  1964; U h l e n h u t h e t a l . , 1 9 6 6 ) .  therapists treatment 1973;  Rickels,  Shapiro,  Boren, &  In addition, the  a t t i t u d e towards t h e treatment results strongly  and  the  i n f l u e n c e t h e outcome  t h a t must b e p r e s e n t  Also  f o rthe placebo e f f e c t  (1961) a n d S h a p i r o  anxiety  i s present  (1964) n o t e t h a t  Although they both discuss  or patient  t o occur,  a high  with a successful placebo  n o t e d was t h e i m p o r t a n c e o f f a i t h ,  motivation.  (Frank,  1971).  On e x a m i n i n g t h e a t t i t u d e s o f t h e s u b j e c t  Frank  been  level of  response.  hope and these  elements  16 t h e y do  n o t s u g g e s t what t h e i r  role  Following a review of the placebo noted t h a t  i t c o u l d be  argued  chronic pain p a r t i c u l a r l y neurotically Lundh  anxious  were d e p r e s s e d  of  the  of treatment  and  c o g n i t i v e - e m o t i o n a l model on t h e s u g g e s t i o n on a p e r s o n ' s  b e l i e v e s t h a t what i s t h e r a p e u t i c a b o u t and  faith  i s their  ability  Although  belief  and  w h i c h may  b e l i e f s , he  o n l y e x a m i n e s one  contribute to this  of  the  of  the  attitudes  i t s effect  i s understood  h a v e t h e means t o s t r e n g t h e n and  or values  g i v e s us  we  will  reinforce the  Once  an the  hopefully healing  of our b o d i e s .  Health Belief There  Model  a r e many m o d e l s t h a t h a v e b e e n u s e d  health behavior 1988;  beliefs  type  t h e power o f t h e m i n d .  mechanism o f t h e p l a c e b o  The  o f hope  effect.  s t u d y o f t h e p l a c e b o and into  He  and d e p r e s s i o n .  of other personal b e l i e f s ,  important glimpse  system  beliefs  does not e x p l o r e o r even suggest  possibility  The  anxieties  bases  that  L u n d h ' s model e m p h a s i z e s t h e i m p o r t a n c e  individual's  and  health.  to counteract those  w h i c h w o u l d seem t o p r o d u c e  (1987)  best to placebos.  i n the e f f i c a c y  b e l i e f s have s t r o n g e f f e c t s  be.  that patients experiencing  (1987) d i s c u s s e s t h e i m p o r t a n c e  patient's belief his  l i t e r a t u r e Swalm  t h o s e who  responded  o r f u n c t i o n might  (Allen,  J e n k i n s , 1988;  Miller,  1988;  1988;  Kirscht,  Becker 1974;  to  e t a l . , 1977;  explain Janz,  Maiman & B e c k e r ,  Pender, Walker, S e c h r i s t ,  &  Stromberg,  1974;  17 1988). these  The  most f r e q u e n t l y  i s the  H e a l t h B e l i e f Model  Hochbaum, L e v e n t h a l , 1977;  model  1974;  been d e s c r i b e d  (Janz & Becker,  1984)  HBM  theories  of  developed to  the  behaviors  examination of  HBM  and  (Becker,  benefits  i s b a s e d on  or  threat  or  1974;  behavior  related  (Becker  to  et  investigate  relationships the  Becker e t a l . ,  utilization,  1977;  a response to  1984)  ; and  the  recovery,  improvement f o l l o w i n g  of preventive care.  The  includes  consequences of  four basic  resusceptibility  s e v e r i t y of the  preventive  care  compliance with  (Janz & Becker,  actual  was  medical  ( R o b e r t s e t a l . , 1984).  susceptibility perceived  behavioral  been u s e d t o  examining p o s s i b l e  variables  illness  or problem  i t has  Janz & Becker,1984); c l i n i c  The  and  these actions  disease  More r e c e n t l y  intervention  psychological  i n d i v i d u a l s as  a specific  HBM  model  compliance  health  of  This  both a psychosocial  explain  sick r o l e behaviors,  an  1974).  a sociobehavioral  by  (Langlie,  i n v e s t i g a t e and  threat  symptoms o f  Rosenstock  (1938) and  the  prescribed  formulated  Skinner  c o m p l i a n c e by  between t h e  and  as  (1935) and  and  1977).  (HBM)  a l l of  1975).  i s b a s e d on Lewin  researched of  Rosenstock,  as  and  ( B e c k e r & Maiman, The  al.,  Kegeles,  Maiman & B e c k e r ,  model h a s  u s e d and  the  disease  c a r e and  action.  to disease or threat,  perceived  perceived  evaluations  components;  threat,  perceived  barriers  s e v e r i t y of  o f m e d i c a l and Perceived  or  perceived  the  to  disease  clinical  benefits  of  18 preventive is  care  i s d e p e n d e n t on t h e b e l i e f  feasible, while perceived  health  that  barriers to a particular  a c t i o n would be elements s u c h a s c o s t ,  u n p l e a s a n t n e s s and time  (Becker,  & Becker,  t h e a d d i t i o n a l element  action", action, do  1984).  Also  a stimulus  this  danger,  1974; H i j e c k ,  1984; J a n z "cues t o  t o t r i g g e r the d e c i s i o n t o take  i s identified  not include  the action  a s a component, h o w e v e r many  element  (Janz & Becker,  studies  1984).  The  HBM e m p h a s i z e s t h e n e e d t o a s s e s s a t t i t u d e s a n d b e l i e f s and  focuses  the  individual.  motivation central  on t h e v a l u e  placed  Rosenstock  More r e c e n t l y ,  A f t e r much  and Becker  be i n c o r p o r a t e d  variable.  desired any  i n t o t h e HBM  They d e s c r i b e  behavior  outcome a n d p o i n t  action being  that  psychobiological  risk  as an  self-efficacy  i n order  out that  undertaken.  that  Also  this  t o achieve the occurs p r i o r t o  Feuerstein  and L i n d e n  t o t h e HBM b y  factors identified  mechanisms, w h i c h may  as having i n t e r f e r e with  h e a l t h b e h a v i o r maintenance, need t o be i n c o r p o r a t e d the  model.  as t h e  s/he c a n s u c c e s s f u l l y  (1984) h a v e p r o p o s e d a m o d i f i c a t i o n suggesting  this i s  debate,  (1988) p r o p o s e d  c o n v i c t i o n by t h e i n d i v i d u a l t h a t perform the required  as t h e  t h e HBM h a s b e e n e x p a n d e d t o i n c l u d e  Strecher,  self-efficacy  out that  by  o f t h e HBM.  some a d d i t i o n a l v a r i a b l e s .  explanatory  (1974) r e f e r s t o t h i s  o f t h e i n d i v i d u a l and p o i n t s  t o the functioning  Rosenstock,  on a p a r t i c u l a r g o a l  into  They s u g g e s t t h a t t h e s e mechanisms need t o be  19 differentiated  f r o m t h o s e w h i c h may  health  and  actions  accurate The care the  they b e l i e v e t h i s w i l l  evaluation HBM  has  threat  a disease  of  of the  health  been used t o  b e h a v i o r and  initiate  progression,  behavior  diseases clinic  Becker  ratio"  by  number o f  studies.  dimension, the potential  HBM  will  reduce the  "severity"  belief threat,  of the  prospective  and  d i m e n s i o n was  reported  not  reported  significant  studies  significant  the  o f 89%,  a  findings the  "barriers" a c t i o n such  as  that  on  i n 25,  threat,  a specific  or not i n 30,  with  and  the  majority  i n 31  of the  significant  i n the  the  then action  finally f o r both  "Barriers" is  studies  m e a s u r e d i n 18.  and  this held  of the  significant  81%,  course of  came n e x t w i t h 78%,  not  the  "susceptibility",  retrospective designs.  higher  significant  See  d i v i d i n g i t by  t h r e a t w i t h 65%,  significantly  was  HBM.  similar  of a health  f e e l i n g s of v u l n e r a b i l i t y t o the the  recovery.  s i d e e f f e c t s , u n p l e a s a n t n e s s e t c . , was  most i m p o r t a n t w i t h a r a t i o  "benefits",  the  and  aspect  of  and  They d e t e r m i n e d  They found t h a t  negative  cost,  1984.  a d d i n g up  f o r each dimension of the  threat  studies.  (1984) r e v i e w e d 46  w h i c h were c o n d u c t e d b e f o r e "significance  the  health  relate to  or problems, the  utilization,  1 f o r a summary o f t h e s e J a n z and  a more  outcome.  these actions  Many s t u d i e s h a v e b e e n c o n d u c t e d u s i n g Table  give  investigate patient  c o m p l i a n c e as  specific  positive  i n 3,  studies,  this  reviewed, i t and  either  S u s c e p t i b i l i t y was opposite  direction  20 Table  1  H e a l t h B e l i e f Model  Research  Type  Authors  Health behavior i n the prevention of a Dental preventive care  - Haefner,  Vaccination  - Harris  Dietary  &  1974  & Guten,  - Langlie,  1977  - Montano,  1986  1979  exercise  compliance  - Becker,  Maiman,  Kirscht,  Haefner,  Drachman,  Roberts,  Price,  Jurs,  McKinley, - Tirrell  &  1977.  - O'Connell,  Breast  threat  &  1985.  & Hart,  1980.  self  examination  - Champion, - Rutledge  Smoking  - Janz  Pregnancy  - Eisen  1985,  & Davis,  & Becker,  - Eisen,  1987.  1984.  & Zellman, Zellman,  McAlister,  1986. &  1985.  - Hester & Macrina, Driving behavior &  1988.  1985,  21 seat b e l t  usage  - Beck, 1981. - Langlie,  1977.  Health behavior t o prevent the progression  of a  disease. Medication compliance  - Becker,  Drachman, &  Kirscht,  1972.  - Becker e t a l . , - Fincham  &  1978.  Wertheimer,  1985 - Jones, Jones,  & Katz,  1988. - Kelly,  Mamon, & S c o t t ,  1987. - Kirscht,  Becker,  Eveland, Measuring  1976.  diabetic  beliefs  - Given, Given, G a l l i n , Condon,  1983.  - Harris,  Linn,  Sandifer,  Clinic  &  Skyler,  &  &  1987.  utilization  Mothers services children  obtaining for their - B e c k e r , Maiman  et a l . ,  22 1977. - Kirsent,  Use o f p r e health  Becker,  Eveland,  1976.  - Leavitt,  1979.  &  paid  program  Recovery From b a c k s u r g e r y  - R o b e r t s e t a l . , 1984.  23 in  2,  n o n s i g n i f i c a n t i n 5,  m e a s u r e d i n 9.  and  e i t h e r not  They b e l i e v e the  HBM  both explains  p r e d i c t s h e a l t h - r e l a t e d b e h a v i o r and provide  very  substantial empirical  dimensions of the It the  most s i g n i f i c a n t .  around a r e q u i r e d  time).  activity  (i.e.,  of  that  cost,  l i v i n g may  not  i s assessed.  are  the  beliefs  of these are beliefs, t h a t by  for  i s performed  danger of the  of  w o u l d be  of  action,  level,  O n l y one  value,  not but  leave  and  (1984) e v a l u a t e d  following  their  beliefs  lack  act  or  beliefs  identification  of  available  as  individual  dimensions.  been l o c a t e d t h a t has  as  HBM.  retrospectively patient  do  its  focus  Roberts  et  beliefs  successfully  o f t h o s e p a t i e n t s who  the  categories  i s not  the  Both  on  be  r e s u l t s at the  and  other  "benefits".  them c l u s t e r e d as  of  day  threat w i l l  beliefs within  to  in significance  i n each of these  laminectomy surgery  between t h e  and  however t h i s  report  s t u d y has  recovery  to  i n d i v i d u a l v u l n e r a b i l i t y , and  involved  of great  i n order  s t r o n g l y based  Furthermore, s p e c i f i c  a u t h o r s do  patients  "susceptibility"  is  beliefs  d e c i s i o n of whether t o  a c e r t a i n a c t i o n the  types of b e l i e f s  these  take precedence over the  dimensions that are  taking  and  " b a r r i e r s " dimension  However, a l m o s t a s h i g h  beliefs  reduced.  al.  support  not  studies  This dimension contains  g r o u p s o f b e l i e f s when t h e  belief  these  T h i s w o u l d seem t o s u g g e s t t h a t d a y  difficulties  the  that  or  model.  i s i n t e r e s t i n g t h a t the  reduce a t h r e a t  reported  delineated  well  after  24 surgery  and  those  who  do  not.  The  authors  A i r d a l e S p i n a l Surgery Questionnaire vulnerability,  An  measure p r e pain,  and  which measured  and  general  a d d i t i o n a l s e t o f s c a l e s was and  the  post-operative  levels  of  Subjects  according  i m p r o v e d on  measures. they  had  improved o r not This  g r o u p s was  and  had 42  conducted.  reported  lower b a r r i e r s ,  group a l s o r e p o r t e d illnesses,  more d i s a b i l i t y , It  is interesting  p a i n and not  not  lower v u l n e r a b i l i t y , lower resentment  that the  This  by  p r i o r to surgery,  helps  the  that  higher  improved  operations, more p a i n , illness.  the  those  authors, with  patients with  authors  this  a more  is  may  severe  a milder  were n o t  more  though t h i s  h e a l t h b e l i e f s w h i c h were m e a s u r e d  indices constructed  improved  improved group r e p o r t e d  a d d r e s s e d by  A  post  a b e t t e r knowledge o f t h e i r  p r o b l e m compared t o t h o s e general  reported  d i d not.  the  improved group.  more d i s a b i l i t y  specifically  who  maximally  fewer o u t p a t i e n t v i s i t s ,  indicate that surgery  The  they  i m p r o v e d and  and  and  above  112  p r e o p e r a t i v e l y , fewer  and  surgery  classified  the  subjects,  reported  to  disability,  T h e i r r e s u l t s demonstrated  o p e r a t i v e l y were i n t h e  shorter  154  who  between t h e  p a t i e n t s who  benefits,  included  were  f u n c t i o n a n a l y s i s aimed a t  differentiating  those  study  improved,  discriminant  health  p a t i e n t ' s knowledge about t h e i r  subsequent r e h a b i l i t a t i o n . to  the  b e n e f i t s of action, b a r r i e r s to a c t i o n ,  a t t i t u d e s towards h o s p i t a l stay, beliefs.  developed  one.  through  significant.  25 This  study  i s n o t w e l l documented a n d i s d i f f i c u l t t o  interpret. the  beliefs  scanty  The q u e s t i o n n a i r e s tested  are u n i d e n t i f i a b l e , also the data are  and t h e a n a l y s i s  Clearly  unclear.  the majority  c o m p l i a n c e and h e a l t h for  used a r e n o t a v a i l a b l e so  o f t h e HBM s t u d i e s  b e h a v i o r and n o t r e c o v e r y ,  t h e study by R o b e r t s e t a l . (1984).  majority deal  of these studies  there  but s t r i c t l y  i s considerable  beliefs  that  psychological  literature  constructed  although  a v a i l a b l e o n t h e HBM, t h e a n d how t h e y  might  t o disease,  o r on  and d i s e a s e  a r e s u p p o r t e d by t h e v a r i o u s  theories.  examined w i t h i n  f o r t h e y do n o t  In addition,  emphasis i s n o t on t h e t y p e o f b e l i e f s  the  except  changes o f h e a l i n g and  behavior.  be s i m i l a r , s t u d y t o s t u d y ,  with  As such t h e  are tangential  with the psychobiological  recovery  deal  The b e l i e f s  t h e model a r e many.  contains  those b e l i e f s  and a t t i t u d e s Each  instrument  the designer  views as  r e l e v a n t t o examine o r t o p r e d i c t a p a r t i c u l a r b e h a v i o r a s long  as they  dimensions. for  the four previously  Thus t h e r e  each type o f b e l i e f ,  that by  f i t within  each question  i s no r e c o g n i z e d  described  measurement  n o r a r e a t t e m p t s made t o e n s u r e  i s c l e a r l y understood  different individuals.  i n t h e same way  The HBM i s l i m i t e d i n t h a t i t  does n o t examine t h e spectrum o f d i f f e r e n t b e l i e f s may i n f l u e n c e r e c o v e r y , beliefs  that  b u t f o r c e s a mixed group o f  t o f i t into i t s four categories  susceptibility,  tool  of perceived  severity, effectiveness of the precaution  26 and  barriers  inability beliefs  to action.  to determine  (Rosenstock,  the comparative (Martus, global is  use  1974)  Finally  and  o f an HBM  behavior,  its inability  instrument,  shown by R o b e r t s  and  determine  beliefs very  content requirements  (Jette,  1981).  compliance  to  as t h e c a t e g o r i e s a r e  s i n c e t h e r e a r e no  & Naessens,  model's  the causal r o l e o f the v a r i o u s  a lack of r e p l i c a b i l i t y  Phelps,  weakness i s t h e  strengths of the d i f f e r e n t  1985).  and  Another  Cummings,  Brock,  T h r o u g h t h e c o n s t r u c t i o n and a means o f p r e d i c t i n g  e v e n outcome c a n be  e t a l . (1984).  patient  developed  However, a s  which ones a r e s i g n i f i c a n t i s not  degree  i n depth  r e c o v e r y and  examined b e l i e f s  believing  i n 16  h e a l e d o r who  arthritis,  characterized  as  they  None o f them h a v e  b e l i e f s may  (1985),  influence  utilizing  a  examined t h e e x p e r i e n c e  i n d i v i d u a l s who  had  been  from major p h y s i c a l  their  illnesses  high blood pressure, kidney  identified  n i n e themes t h a t he  experience.  He  of  successfully  e x p e r i e n c e d a marked i m p r o v e m e n t  cancer, He  Martus  approach,  had  condition  health.  which s p e c i f i c  healing.  phenomenological  tumors.  influence  o f t h e h e a l t h t h e o r i e s o r models examined so f a r  i n f l u e n c e h e a l t h b e h a v i o r and  their  t h e y may  Approach  have t o a c e r t a i n  examined  how  beliefs,  clear.  A Phenomenological All  and  as  each  s u b d o m a i n o f t h i s model i n v o l v e s v a r i o u s t y p e s o f  recovery  there  in  of disease,  believed  obtained the  data  or  27 through then  90 m i n u t e i n t e r v i e w s w h i c h were t a p e r e c o r d e d ,  transcribed.  M a r t u s c i t e s K e e n ' s 1975  a n a l y z i n g phenomenological his  analysis.  He  t h e themes t h r o u g h and  "thematic  The  of  identified  acknowledgment o f a r a t i o n a l e , from  are: the  i n charge,  presence  of strong feelings.  are  the v i t a l  of b e l i e v i n g  types  an a c t i v e  self  of being  certain  and  o f theme  compatibility the need  f o c u s o n e ' s a t t e n t i o n on h e a l i n g , s i g n i f i c a n t  the process  He  "imaginative v a r i a t i o n "  of previous experiences,  r e c e i v i n g o f feedback  "epoche"  1985) .  n i n e themes he  incompatibility  identifying  i n the data.  l i n k a g e s " , i n the process (Martus,  for  "horizontalization",  "clustering",  identification  of  e n t e r i n g i n t o the process  "bracketing",  "delimiting",  model f o r  framework used  describes h i s process  immersing h i m s e l f "completely"  f u r t h e r used  or  data as t h e  and  and  optimism,  of support,  Although  Martus  sense  and  of  beliefs,  however,  i n t e r t w i n e d m a k i n g c o m p l e t e s e p a r a t i o n and  division  After  synthesizing Martus  t h r e e domains o f b e l i e f s about the beliefs these,  self,  beliefs  support,  themes,  are  domains  about the h e a l i n g p r o c e s s , and  future.  In a d d i t i o n  themes n o t d e s c r i b e d i n t h e  t h r e e domains a r e a l s o e v i d e n t . social  nine  are evident, these  about the p r e s e n t three different  1  negative  life  These are b e l i e f s  c h a n g e s , and  the  the  examined  the types  are apparent.  the  the  Both,  impossible.  of b e l i e f s  changes,  others, a strong  presence  r a t h e r than  to  and to above about  location  of  28 the  individuals  f o c u s on t h e i n j u r y t o f u l l  health  continuum. First, self.  are those b e l i e f s  The " s e n s e  category,  here  This decision  of being  related  i n charge"  the individual i s based  social  behaviors,  processes.  t h e theme o f " s i g n i f i c a n t  (p. 89) a s one where b e l i e f s  this  and  support,  knowledge o f t h e h e a l i n g and b e l i e v i n g  changed.  into  on p r e v i o u s e x p e r i e n c e ,  Also, Martus i d e n t i f i e s  an  falls  d e c i d e s t o be i n c o n t r o l .  promoted by t h e f a m i l y through and  t o and about t h e  are either  strengthened  H e r e h e d e s c r i b e s how t h i s p r o c e s s  increase of the individual's  changes" or  results i n  s e l f - e s t e e m and  self-confidence. Second, a r e those b e l i e f s healing process. one's a t t e n t i o n process belief  believing friends  that  away  from  the i l l n e s s  substitute,  and  by f o c u s i n g  on t o t h e h e a l i n g  a n d power i s g i v e n t o t h e  t h e r e g u l a r and c o n s i s t e n t p r a c t i c e o f  i n t h i s process.  Also support  a n d t h e r e a d i n g o f l i t e r a t u r e may  process. (i.e.,  Healing i s experienced  or another through  about t h e i n j u r y  R e c e i v i n g feedback  doctors, medical  tests)  from  from  family,  assist  the s e l f  i n this  and o t h e r s  i s an a d d i t i o n a l  element  a f f i r m s t h e h e a l i n g p r o c e s s and h e l p s t o f o c u s  attention.  One c a n assume t h a t b e l i e f  therapy  i s one d i m e n s i o n  healing  process.  Third,  i n the e f f i c a c y of  of these b e l i e f s  are those b e l i e f s  about t h e  about t h e p r e s e n t  and t h e  29 future. is  A c c o r d i n g t o M a r t u s t h e theme o f a c t i v e  essential.  literature,  He  states i t "originates  friends,  and  o n e s own  as w e l l as a c o n s c i o u s e f f o r t this  domain a r e b e l i e f s  develops  into the  (p. 8 1 ) .  T h i s may  life  be  they are l i v i n g  on t h e  domains o f  Martus are the presence  on h e a l i n g .  individuals'  their  f o r the  church,  or the  I t may  and  continual  individuals  attention  Martus  notes  emotional support  for  family, friends,  of  the  "significant  individual  h a p p e n i n g a b o u t them and  changed.  An  b e c o m i n g aware o f what what was  This  self-esteem  I n some c a s e s b e l i e f s w e r e  i n o t h e r s t h e y were a c t u a l l y the  by  p r e s e n t when h e a l i n g o c c u r r e d .  increased the  self-confidence.  t h i s was  the  significant  intellectual  come f r o m  and  doctor.  c h a n g e " t h a t was  and  noted  support  There i s a l s o the c h a r a c t e r i s t i c  experience  This i s  need t o f o c u s t h e i r  s h o u l d be  individual  rationale.  becoming  others.  support,  When d i s c u s s i n g s o c i a l  the s t r u c t u r e of t h i s support  personal  or simply  importance  of s o c i a l  the  themselves  influence of previous b e l i e f s  Three a d d i t i o n a l  the  a  80),  the  or t h e i r bodies.  input of t h e i r doctor or s i g n i f i c a n t  c h a n g e , and  and  Here  spiritual,  (p.  Also i n  a b o u t what i s h a p p e n i n g ,  more i n t o u c h w i t h t h e m s e l v e s u s u a l l y based  it.  a rationale explaining to  what i s h a p p e n i n g . insight  positive  o f humor"  to maintain  "acknowledgment o f a r a t i o n a l e " individual  sense  from  optimism  and  strengthened example was  happening w i t h i n  of  30 t h e m s e l v e s , o r a n o t h e r example w o u l d be t h e g a i n i n g knowledge. that it  Martus s t a t e s t h i s  i t may  may  c h a n g e must b e w a n t e d  b e an i n t e r n a l o r e x t e r n a l  only  of  change and  o c c u r on t h e p h y s i c a l l e v e l  i n v o l v e the emotions, the s p i r i t ,  i t may  and t h e  new and  although  also  behavioral  patterns. Further, healing  process,  focusing instead  t h e need t o focus characterized  o n e ' s a t t e n t i o n on t h e by t h e n e e d t o  avoid  o n e ' s a t t e n t i o n on t h e p r o b l e m o r d i s e a s e , t o focus  on o n e ' s h e a l i n g  i s also  but  identified  by  Martus. Martus a l s o notes t h a t the "presence of feelings" negative  (p. 94)  are important.  p r i o r to the s t a r t  T h e s e f e e l i n g s a r e more  of the healing  t h e y become more p o s i t i v e a s h e a l i n g reports of  scared  frightened".  stiff,  Later  thankful,  as b e i n g  totally  and  Martus  express  feelings  f r u s t r a t e d and  on a s t h e h e a l i n g was  f e e l i n g s were d e s c r i b e d energized,  ashamed,  experience  occurs.  that p a t i e n t s , p r i o r t o recovery,  "being  strong  "full  i n process the  o f hope,  satisfied,  confident,  and b l e s s e d "  (p.  94) . Measurement  Issues  The v a l i d i t y is  a concern.  of health numerous  o f s e l f - r e p o r t measures o f h e a l t h  Tissue  (1975) n o t e s t h a t  i s d e p e n d e n t on t h e i n d i v i d u a l health  objectively  the  self-rating  evaluating  a r e a s both s u b j e c t i v e l y as w e l l  and t h e n  i n t e r p r e t i n g these data  status  as  through  31 h i s / h e r own Boyer  perceptual  framework.  Goldstein,  (1984) f o u n d t h a t n e i t h e r p o s i t i v e o r  changes i n p e r c e i v e d associated with status.  health  physical health beliefs  They measured t h i s w i t h  categorized  as  medical care, seriousness Therefore  covering  of  the  illness,  physical  status.  This  specific  beliefs.  The  the  are  areas.  not  b r o a d and  s t u d y however, majority  self-rated  health  the  On  status  and  associated  those i n the  psychic  years  r a n g e by  examine  of health  possible  m e a s u r e d by  a  for h a n d Maddox the  predominantly Jylha,  Leskinen,  (1986) when e x a m i n i n g f a c t o r s i n men 31  to  35  of age  range  symptoms and  an  51  range  by  i n the  71  well-being, chronic  like  o f h e a l t h by  status.  Heikkinen  symptoms and  to  other  t h e i r h e a l t h more by fitness,  failed  self-assessment  and  or  actual  the  explained  self-assessment  health  tested  ages found t h a t t h o s e i n the  o f age  motivation.  and  different  physical  and  b e l i e f s were n o t  o r i e n t a t i o n to health  Leskinen,  with  encompass a l a r g e r a n g e o f  noted that they expressed a  realistic  they  of these categories,  specific belief.  (1964) when s t u d y i n g  Alanen,  of perceived  health  services,  of care,  instrument constructed  measuring t h a t  or p h y s i c a l  always dependably r e l a t e d t o  Furthermore, the  standardized  significantly  questions  to medical  and  negative  areas of s a t i s f a c t i o n  efficacy  self-ratings  are  HBM,  the  accessibility  recovery  elderly  s t a t u s were  Siegel,  t o 55 and  those  illness.  s t a t u s may  age  index  Therefore  measure  of  to  the  different  75  32 elements of h e a l t h s t a t u s f o r the d i f f e r e n t  age  groups.  Summary The  review of  literature  span s e v e r a l t h e o r e t i c a l developed  areas.  and  the medical  (1979) s a l u t o g e n i c model was  the  The  seem t o be HBM,  to  i n the  literature.  self  and  He  are  the  of the  and  as  of  Martus' areas,  frequently models  The  perceived  tell  However none  i n f l u e n c e of the  of  various  process.  a strong to r e s i s t  sense the  sense  of  of effects  locus of c o n t r o l  of construct  or e x t e r n a l does  not  i s s u e i s w h e t h e r i t i s where i t i s  according  t h r e a t , and  behavior  are  recovery.  recovery  necessary  critical  interpretation. of b e l i e f s ,  and  A l l of these  a l s o discusses the  s u p p o s e d t o be  dimensions  placebo,  placebo  n o t i n g t h a t whether i t i s i n t e r n a l matter, the  sociological,  (1979) i d e n t i f i e s t h a t a s t r o n g  self-identity,  self-efficacy stress.  explore  t h e h e a l i n g and  Antonovsky  was  t h e most c o m p r e h e n s i v e m o d e l s a v a i l a b l e .  them s p e c i f i c a l l y on  HBM  Antonovsky's  cross theoretical  s o m e t h i n g a b o u t h e a l i n g and  beliefs  from  Because the  s a l u t o g e n i c m o d e l , and  referred us  study  the  and  disciplines;  s a l u t o g e n i c model, t h e  (1985) p h e n o m e n o l o g i c a l they  example,  developed  p s y c h o l o g i c a l approaches.  t h e HBM,  For  approaches which  from p s y c h o l o g i c a l , h e a l t h c a r e ,  epidemiological,  and  revealed  HBM  t o the i n d i v i d u a l ' s which i d e n t i f i e s  susceptibility,  b e n e f i t s and  a response to these  the  perceived  four  areas  severity  b a r r i e r s t o a c t i o n examine beliefs  and  perceptions.  33 The  HBM d o e s n o t however, i d e n t i f y  beliefs  t h a t might  Research  individual  i n f l u e n c e h e a l i n g and r e c o v e r y .  and l i t e r a t u r e  on t h e p l a c e b o  t h a t many p a t i e n t - b e l i e f v a r i a b l e s faith,  specific  effect  such  identifies  as s e l f - e f f i c a c y ,  hope, i n a d d i t i o n t o s e v e r a l o t h e r v a r i a b l e s a l l  must b e p r e s e n t  f o r this  effect  t o occur.  Attempts a r e  made t o d e s c r i b e t h e s e v a r i a b l e s b u t n o t n e c e s s a r i l y t o specifically  substantiate the types o f b e l i e f s  Further the placebo  e f f e c t has been p r e d o m i n a n t l y  i n terms o f t h e i n d i v i d u a l s response unpleasant  stimuli  participating  i n the recovery process.  Martus'  a n d t h e r e f o r e a r e more  2 summarizes t h e b e l i e f s  self-esteem  i s only i d e n t i f i e d  phenomenological identified  An e x a m i n a t i o n  approach,  by M a r t u s ,  (1985)  do d e s c r i b e  t o the individuals personal b e l i e f  t h r e e approaches.  pain or  and n o t n e c e s s a r i l y t o a group  components o f b e l i e v i n g  Table  examined  t o s h o r t term  n i n e themes t h o u g h n o t s p e c i f i c t o b e l i e f s  aligned  involved.  closely  system.  inherent i n these of Table  i n Martus  2 reveals that  (1985)  1  while self-confidence, also  i s a core element  (1979) s a l u t o g e n i c m o d e l .  i n Antonovsky's  The l o c u s o f c o n t r o l  belief,  identified  a s a c o r e theme b y M a r t u s ,  a critical  v a r i a b l e by Antonovsky because he p o s t u l a t e s  that Faith  internality i n therapy  or externality  i s not considered  of control  i s described indirectly  however i t i s a c o r e element b o t h Martus and t h e p l a c e b o  by Martus,  i n the placebo effect  can vary.  identify  effect, optimism  while as  Table  2  Comparisons  of M o d e l s / T h e o r i e s  Beliefs  Phenomenological  Salutogenic  Self  Experience  of  Not  Esteem  ing  healing  i n the  process  increased  esteem in  the  believ-  ified, self  (identified theme  ificant  of  specifically  sign-  change).  as  the  sense  strong  identity essary  Self  Experience  of  Confidence  ing  healing  process  increased  confidence in  the  theme  ificant  Locus  of  control.  Core of  believ-  and  for a of  Core  Not  Not  identified  be  part of  in  charge".  of  vulnerabil-  strong  of  Anton-  of  Not  identified  coher-  Not  specifically  ified  though  ition  of  would  appear  self  Identified  as  important  however  control  need  be  self  control  and  be  placed  with  this  individual be.  Not  not may  another  i s where  believes i t  as the  identified.  Not  ident-  the  "self  defin-  efficacy"  to  include  c o n f i d e n c e as  primary  should  component  coherence.  element  as  a  though  nec-  ence .  long  Model  ity".  sign-  "Sense  be  "perceived  (identified of  Belief  identified,  could  of  self,  o v s k y 's s e n s e self  Health  change).  theme.  being  may  considered  sense  i n the  though  indent-  Placebo  element.  identified.  a  Beliefs  Phenomenological  Faith i n  Not  Therapy  tified,  specifically  ing",  Placebo  Health  Not  Core  Not  identified.  element  but a general  assumption themes  iden-  Salutogenic  " f o c u s on and  feedback  Model  identified,  could  i nthe  Belief  though  be a component o f  "perceived  benefits".  heal-  "receiving  from  self  and  others  Optimism  Core  theme.  Optimism.  Not i d e n t i f i e d .  Core  element  lated ing  to the h e a l -  process  belief ing  re-  that  will  (the heal-  Not i d e n t i f i e d , possibly  a component o f  "perceived an  though  benifits  of  action".  be a c h i e v -  ed) .  Will Live  to  General made  assumption  throughout the  9 themes  though n o t  specifically ified.  ident-  Core  element  Orientation which  and  to  life  h a s a s i t s comp-  onents, ility,  i n the  comprehensibmanageability,  meaningfulness.  General made as ing  assumption  through out  patient therapy  work.  i s hopwill  General made to  assumption  as p e o p l e  and seek  faced  with  respond  h e l p when a  threat.  36 core elements.  The w i l l t o l i v e i s a g e n e r a l  made b y a l l f o u r o f t h e m o d e l s , a l t h o u g h i d e n t i f i e d by A n t o n o v s k y  assumption  i t i s only  i n his orientation to  life.  In o r d e r t o be c l o s e t o t h e p a t i e n t p e r s p e c t i v e , study  focused  on b e l i e f s  identified  f r o m M a r t u s ' work  which u t i l i z e d a phenomenological approach. beliefs  a r e : (a) t h e b e l i e f s  beliefs  about s e l f - e s t e e m ,  (b) t h e b e l i e f s is  focused  beliefs  i n therapy"  of  and t h e " w i l l t o l i v e "  i n the placebo  Therefore  this  study  of self-esteem,  therapy,  will to live,  social  include  where a t t e n t i o n  and t h e f u t u r e , s u c h  In a d d i t i o n t o these b e l i e f s ,  identified  these  s e l f - c o n f i d e n c e and c o n t r o l ;  about t h e h e a l i n g p r o c e s s  about t h e present  beliefs  about t h e s e l f ,  These  on h e a l i n g a n d away f r o m i l l n e s s ; a n d ( c )  optimism. "faith  this  support,  effect  as a c t i v e  the individuals as b r o a d l y  are included.  emphasizes s i x t y p e s  of beliefs;  self-confidence, control, and optimism.  significant  The t h r e e  faith in domains  change, and t h e i n d i v i d u a l s  f o c u s on h e a l i n g w h i c h M a r t u s a l s o i d e n t i f i e s a r e n o t specific  attitudes or b e l i e f s ,  b u t a r e more t a n g i b l e a n d  t h e r e f o r e a s t e p removed f r o m t h e more i n t r a p s y c h i c h e a l t h beliefs  discussed  T h i s study beliefs  above.  then,  examines t h e i n f l u e n c e s o f s p e c i f i c  on t h e r e c o v e r y  o f b a c k and n e c k p a t i e n t s .  r e s u l t s may p r o v i d e c o u n s e l l o r s , t h e r a p i s t s , doctors with beliefs  i n f o r m a t i o n about t h e type  nurses  The and  and i m p o r t a n c e o f  t h a t may be a s s o c i a t e d w i t h t h e h e a l i n g a n d  37 recovery process  o f b a c k and n e c k  patients.  38 Hypotheses Purpose The  purpose of t h i s study  significant differences r e c o v e r y and of  the  self-esteem,  therapy, t o the  rate  pre-injury  e x a m i n e d i n two  s e c o n d , by  and  the  of  r e c o v e r y and  will  state  to  the  number o f  patient rate  the  control,  live.  health faith  s u b j e c t i v e l y by  recovery,  the  treatments required  of  beliefs in  neck f u n c t i o n the  i d e n t i f i e s they have  of  degree  Recovery, the  o f b a c k and  ways: f i r s t ,  the  and  e x i s t between b o t h t h e  self-confidence,  o p t i m i s m and  recovery that  i s t o examine whether  return was  degree  of  achieved;  length  of  time  for this healing  to  occur. This six  study  b e l i e f s of  faith  self-esteem,  i n therapy,  whereas t h e  attention  on  included;  (b)  nor  following  will  to  elements of  c h a n g e , and  being healthy  i n the  self-confidence,  o p t i m i s m and  more t a n g i b l e  s i g n i f i c a n c e of  not  i s constrained  the  live social  were e x a m i n e d , support, focus  response  were  more  l i v e s which  a l s o a f f e c t t h e i r a t t i t u d e s , b e l i e f s and  the of  (1985) s t u d y  does t h i s s t u d y examine t h e  i n t e r p s y c h i c aspects of peoples s o c i a l  (a)  control,  individuals  from M a r t u s '  ways:  may to  treatment. Hypotheses This 1.  The will  study t e s t e d  patient  the  following  group e x h i b i t i n g a  have s i g n i f i c a n t l y  greater  hypotheses:  full  degree of  self-esteem,  recovery compared  39 w i t h t h e group w i t h moderate  recovery,  f o l l o w e d by t h e  g r o u p w i t h no r e c o v e r y , when s e l f - e s t e e m i s m e a s u r e d the Rosenberg  Self-Esteem  Scale  by  (RSE).  2. T h e p a t i e n t g r o u p e x h i b i t i n g t h e g r e a t e s t r a t e o f recovery w i l l compared recovery,  have  significantly  greater self-esteem,  w i t h t h e group w i t h a moderate  f o l l o w e d by t h e group w i t h t h e l e a s t  r e c o v e r y , when s e l f - e s t e e m i s m e a s u r e d Self-Esteem 3.  Scale  have  compared  rate of  by t h e Rosenberg  (RSE).  The p a t i e n t g r o u p e x h i b i t i n g will  rate of  significantly  a full  degree o f recovery  greater self-confidence,  w i t h t h e group w i t h moderate  recovery,  f o l l o w e d b y t h e g r o u p w i t h no r e c o v e r y when self-confidence Social  i s measured  by t h e s u b s c a l e o f L a c k o f  S e l f - C o n f i d e n c e i n t h e I n t e r p e r s o n a l Dependency  Inventory  (IDI).  4. The p a t i e n t g r o u p e x h i b i t i n g t h e g r e a t e s t r a t e o f recovery w i l l  have  self-confidence, moderate the  least  measured  compared  rate of recovery,  with t h e group w i t h a f o l l o w e d by t h e group  have  compared  with  by t h e s u b s c a l e o f Lack o f S o c i a l i n t h e I n t e r p e r s o n a l Dependency  (IDI).  5. T h e p a t i e n t g r o u p e x h i b i t i n g will  greater  r a t e o f r e c o v e r y , when s e l f - c o n f i d e n c e i s  Self-Confidence Inventory  significantly  significantly  a full  greater  degree o f recovery  control,  w i t h t h e group w i t h moderate  recovery,  40 f o l l o w e d by t h e group w i t h t h e l e a s t control  when  i s measured by t h e s u b s c a l e o f C o n t r o l i n t h e  Health Related Hardiness 6.  recovery,  Scale  The p a t i e n t g r o u p e x h i b i t i n g recovery  will  the greatest rate of  have s i g n i f i c a n t l y  compared w i t h t h e g r o u p w i t h recovery,  (HRHS).  greater  a moderate r a t e o f  f o l l o w e d by t h e group w i t h when c o n t r o l  control,  the least  of  recovery,  of  Control i n the Health Related Hardiness  rate  i s measured by t h e s u b s c a l e Scale  (HRHS). 7. The p a t i e n t g r o u p e x h i b i t i n g will  have s i g n i f i c a n t l y  compared w i t h  a full  degree o f recovery  greater f a i t h  t h e group w i t h moderate  i n therapy, recovery,  f o l l o w e d by group o f t h e l e a s t d e g r e e o f r e c o v e r y , faith in  i n therapy  Therapy  Inventory  i s measured by t h e s u b s c a l e  (CRTI).  recovery w i l l  the greatest rate of  have g r e a t e r f a i t h  w i t h t h e group w i t h  i n therapy,  when f a i t h  9.  i n therapy  Therapy,  rate of recovery,  i s measured by t h e s u b s c a l e  Faith  i n t h e C l i e n t Readiness f o r Therapy  (CRTI).  The p a t i e n t g r o u p e x h i b i t i n g will  compared  a moderate r a t e o f r e c o v e r y ,  f o l l o w e d by t h e group w i t h t h e l e a s t  Inventory  of Faith  i n the C l i e n t Readiness f o r Therapy  8. T h e p a t i e n t g r o u p e x h i b i t i n g  in  when  have s i g n i f i c a n t l y  the group w i t h  a full  degree o f recovery  g r e a t e r optimism,  compared  a moderate degree o f r e c o v e r y ,  with  followed  41 by t h e g r o u p w i t h optimism  t h e l e a s t degree o f recovery,  i s measured by t h e L i f e  when  Orientation Test  (LOT). 10. The p a t i e n t g r o u p e x h i b i t i n g  the greatest rate of  recovery w i l l  have s i g n i f i c a n t l y  greater  compared w i t h  t h e group w i t h a moderate r a t e o f  recovery,  f o l l o w e d by t h e group w i t h  recovery,  when o p t i m i s m  Orientation Test  recovery, of  will the  a full  degree o f recovery  greater w i l l  t h e group w i t h  when t h e w i l l  to live  scale  to live  the least  degree  i s measured by a  (WLS) w h i c h h a s b e e n d e v e l o p e d  by  author.  12. The p a t i e n t g r o u p e x h i b i t i n g recovery w i l l live,  the greatest rate of  have a s i g n i f i c a n t l y  compared w i t h t h e g r o u p w i t h  greater w i l l to a moderate r a t e o f  recovery,  f o l l o w e d by t h e group w i t h  recovery,  when t h e w i l l  to  to live,  a moderate degree o f  f o l l o w e d by t h e group w i t h  recovery,  rate of  (LOT).  have a s i g n i f i c a n t l y  compared w i t h  the least  i s measured by t h e L i f e  11. The p a t i e n t g r o u p e x h i b i t i n g will  optimism,  live  author.  scale  to live  the least  rate of  i s measured by a  (WLS) w h i c h h a s b e e n d e v e l o p e d  will  by t h e  42 Method S u b j e c t s and P r o c e d u r e s The 103)  respondents  r a n g i n g from  17.14).  were m a l e s  (n = 47) a n d f e m a l e s  (n =  (20 t o 8 9 ) y e a r s o f a g e (M = 52.9; SD =  R e s p o n s e s were s o l i c i t e d  back and neck p a t i e n t s  from t h e p o p u l a t i o n o f  of St. Vincent's physiotherapy  o u t p a t i e n t a r e a o v e r t h e y e a r s 1986, 1987, a n d 1988 (N = 400) . The visit  outpatients received  an assessment  t o t h e h o s p i t a l which c o n s i s t e d  history  on t h e i r  first  of a detailed  i n c l u d i n g t h e i r p a s t and p r e s e n t m e d i c a l  situation,  the history  treatments  attempted  of t h e i r p r e s e n t i n g problem  t o date, as w e l l  orthopedic examination  determined therapist  as a p h y s i c a l  o f t h e problem  frequency of the treatments  that  by t h e t h e r a p i s t , and t h e p a t i e n t .  and t h e  area.  f o l l o w e d were  The then  o r a r r a n g e d between t h e T h e s e may h a v e b e e n  daily,  t h r e e t i m e s w e e k l y , two t i m e s w e e k l y , a n d o c c a s i o n a l l y o n c e a week. was t o s t a r t  T h e most f r e q u e n t l y u s e d p a t t e r n o f t h e r a p y the patient  either daily,  o r three times a  week a n d t h e n d e c r e a s e t h e f r e q u e n c y o f t r e a t m e n t a s required.  Some o f t h e s e t r e a t m e n t s  required  one s e s s i o n  o n l y , w h i l e o t h e r p a t i e n t s came i n f o r o n e t r e a t m e n t a n d for  r e a s o n s known o n l y t o them d i d n o t r e t u r n  More g e n e r a l l y , a  patients  6 t o 8 week p e r i o d  receive  of time.  v a r i e s due t o t h e a c u i t y  f o r more.  15 t o 20 t r e a t m e n t s The need  or chronicity  over  f o r treatments  o f t h e problem  as  43 well  as t h e i n d i v i d u a l ' s l i f e  following  Sometimes  a s e r i e s o f treatments t h e p a t i e n t w i l l  l a t e r time experience  a recurrence  r e - r e f e r r e d by t h e i r d o c t o r The  demands.  o f t h e p r o b l e m and be  f o r more  therapy.  e n t i r e s e t of outpatient physiotherapy  from January identify  1986 t o December  a l l those  1988 were s c r u t i n i z e d t o  An a l p h a b e t i c a l l i s t i n g  p a t i e n t s were made n o t i n g b i r t h d a t e , a d d r e s s , type  o f problem  treatments received, discharge.  The i n i t i a l  coming and t o c o n f i r m  The  questionnaire  instruction patients.  sheet  patients  them t h a t a q u e s t i o n n a i r e  would be  their  address.  t h a t they  was t h e n s e n t  t o the remaining  below as w e l l  questions.  A  370  were c o n t a c t e d  t h e package and asked  as t h e  self-addressed  r e t u r n p o s t a g e was a l s o i n c l u d e d .  weeks a f t e r t h e m a i l i n g , t h o s e  received  l e t t e r and  i n c l u d e d t h e independent and  demographics and a n c i l l a r y  questionnaires  c o u l d b e made a n d  a covering  dependent v a r i a b l e s as d e s c r i b e d  envelope with  O f t h e 400  d i d not wish t o p a r t i c i p a t e .  package with  This mailing  and  t h e former  23 w e r e d e l e t e d a s no c o n t a c t  7 stated e x p l i c i t l y  number o f  o f admission  contact with  o f these  phone  (back o r neck o r b o t h ) ,  and t h e d a t e s  was by p h o n e t o i n f o r m  patients,  records  p a t i e n t s who h a d r e c e i v e d t h e r a p y f o r  back and neck problems.  number,  at a  Three  who h a d n o t r e t u r n e d  their  t o check t h a t they had i fthey  had any q u e s t i o n s .  Seventeen i n d i v i d u a l s had n o t r e c e i v e d t h e package and were m a i l e d  a s e c o n d one.  One h u n d r e d  eighty  44 q u e s t i o n n a i r e s were r e t u r n e d Of the of  these  f o r a response  30 c o u l d n o t be u s e d ,  rate of recovery, recovery,  addition  15 were r e t u r n e d ,  were m a r r i e d , widowed  In  and 3 by p a r t i c i p a n t s  who  3).  T h e r e were 4 6% who  work p a r t t i m e ,  150 p a r t i c i p a n t s  Twenty-two p e r c e n t  61%  a n d 13% w e r e  work f u l l  time,  6% who were u n e m p l o y e d , 13.3%  a n d 27.3% who were r e t i r e d .  b a c k g r o u n d was c l a s s i f i e d  into  who  Ethnic  five basic categories.  138 r e s p o n d e d t o t h i s  were P o r t u g u e s e  included i n t h i s grouping), Canadian,  17% w e r e s i n g l e ,  10% were d i v o r c e d o r s e p a r a t e d ,  were homemakers,  as  out i n c o r r e c t l y .  o f the respondents,  (See T a b l e  6.6% who  was  f o r t h e degree  not wish t o p a r t i c i p a t e . In general  the  data  12 n o t i n g t h a t t h e p a r t i c i p a n t s  were no l o n g e r a t t h a t a d d r e s s , did  13 d i d n o t h a v e d a t a f o r  8 d i d not have  a n d 9 were f i l l e d  r a t e o f 48.7%.  Of  question.  (1 S p a n i s h  respondent  14% i d e n t i f i e d  themselves  22% were f r o m t h e U n i t e d Kingdom, 24% were  E u r o p e a n , a n d 18% were f r o m v a r i o u s d i f f e r e n t  parts of the  world. Independent and Dependent V a r i a b l e s The  independent v a r i a b l e s i n t h i s  degree o f recovery, variable,  study  were: t h e  and t h e r a t e o f r e c o v e r y .  the degree o f recovery,  The  was m e a s u r e d b y p a t i e n t  self-assessment.  The p a t i e n t s were a s k e d  to rate  degree of recovery  on a 5 - p o i n t  the  "no r e c o v e r y " recovery"  scale with  ( 1 ) , "moderate r e c o v e r y "  (5).  first  The t h e r a p i s t ' s r a t i n g  their  anchors;  ( 3 ) , a n d "good a t the time  of  45 Table 3 Descriptive  Information  f o r B a c k and N e c k P a t i e n t s  (n =  150)  % Ethnic  group:  Portuguese  21.7%  United  21.7%  Kingdom  Canadian  14.6%  European  23.8%  Other  18.2%  Work S t a t u s : Full  time  46.3%  Part time/casual  6.7%  Unemp1oyed  6.1%  Homemaker  13.4%  Retired  27.5%  Marital  Status:  Single  16.6%  Married  60.7%  Divorced/Seperated  10.0%  Widowed  12.7%  46 d i s c h a r g e was  recorded i n order to substantiate  patient's  self-evaluation.  following  descriptors  "good"  "full  improvement".  The  of  recovery" or "pain  second  "improved",  improvement", and  However, t h e p a t i e n t ' s  used as t h e independent  was  t h e r a p i s t s used  o r "marked improvement",  improvement" o r " s l i g h t "no  The  the  free",  "some  "no  recovery" or  self-rating  the rate  m e a s u r e d by t h e t i m e s p a n i n v o l v e d days between t h e f i r s t  of recovery  (i.e.,  t h e number  t r e a t m e n t and t h e l a s t  T h e s e d a t a were f u r t h e r  at St.  qualified  by d i v i d i n g  i t by t h e number o f t r e a t m e n t s r e c e i v e d  this period  of time.  The of  dependent  self-esteem,  therapy,  variables  i n v e s t i g a t e d were t h e  self-confidence,  optimism,  was  variable.  independent v a r i a b l e ,  Vincent's Hospital).  the  and t h e w i l l  control, to  faith  over  beliefs  in  live.  Instruments The Shaver,  Rosenberg 1973).  self-esteem.  Self-Esteem Scale  The RSE  measures t h e  c a t e g o r i e s range  from  "strongly disagree". RSE,  the i n t e r v a l  s e c o n d method was s c a l e range  (Robinson &  individual's  I t i s a 10-item q u e s t i o n n a i r e w i t h  r e s p o n s e s b a s e d on a 4 - p o i n t L i k e r t  the  (RSE)  scale.  The  (1) " s t r o n g l y a g r e e " , t o T h e r e a r e two  methods f o r s c o r i n g  s c a l e method was  a l s o computed  i s f r o m 10 t o 40.  greater the self-esteem.  The  used, however t h e  (See A p p e n d i x The  (4)  C).  The  lower the score  reliability  the  coefficient  of  47 .92  was  obtained  through the  use  of the  a t e s t - r e t e s t c o r r e l a t i o n o v e r two .85  (n=28).  discriminant  for  The  s t u d y was  The  ranged  v a l i d i t y was  1973).  this  was  the  subscales  d e v e l o p e d by  self-confidence,  self-confidence  (1977) n o t e t h a t  the  of t h i s  of  to  the  greater  for  cross  well  as  l a c k of  cross  stable  consistency, =  (IDI).  another  the  lack  (1)  The  strong  the  subscale  of  subscale  dependency subscale  in  contains The  "very  lower the  corrected  evidence  of the  i n d i c a t i n g that the  includes  person,  self-confidence.  v a l i d a t i o n of the  The  c h a r a c t e r i s t i c of  subscale  and  .79.  a 4-point scale.  60.  social  confidence i s .78  "not  to  sample c o n s i s t e n c y  relationship is  b a s e d on  (4)  &  autonomy.  This  s c a l e range from  o f me"  half reliability  (Robinson  Hirschfeld et a l .  (p. 6 1 7 ) .  s c a l e r a n g e i s f r o m 15  social  adequate  a s s e r t i o n of  a t t a c h m e n t and  The  l a c k of  and  used.  i t e m s whose a n s w e r s a r e  the  well  l a c k of s e l f - c o n f i d e n c e  "notions  characteristic  and  internal  study only  was  equal portions"  categories  as  o f e m o t i o n a l r e l i a n c e on  purposes of t h i s  15  established  .83  be  several  H i r s c h f e l d e t a l . (1977) and  For  nearly  to  Dependency I n v e n t o r y  social  r e f l e c t s the  .56  and  found t o  c a l c u l a t e d at Cronbach's alpha  lack of  social  from  reliability,  Interpersonal  IDI  the  weeks was  C o r r e l a t i o n s were c a l c u l a t e d w i t h  s i m i l a r m e a s u r e s and  Shaver,  Guttman s c a l e  is  For  The  the  split provided as  scale  composition  ( H i r s c h f e l d e t a l . , 1977).  score  factor structure  factor to  me".  of the  scale  reliability,  48 internal  consistency,  Cronbach's alpha =  for this  s t u d y was  .81.  The H e a l t h R e l a t e d H a r d i n e s s developed  by P o l l o c k  For the purposes o f t h i s used.  individuals high can  study  i n control  14 i t e m s  The HRHS  contains  commitment,  three  and  challenge  to Pollock  (1987)  " b e l i e v e and a c t a s i f t h e y  they  experience".  on a 6 - p o i n t  c a t e g o r i e s range from  (HRHS).  only the subscale of  According  i n f l u e n c e the events  contains  Scale  (1985, 1988, 1989)  s u b s c a l e s which measure c o n t r o l ,  " c o n t r o l " was  calculated at  Likert  This scale  scale.  The  (1) " s t r o n g l y d i s a g r e e " , t o (6)  "strongly  agree".  The s c a l e r a n g e i s f r o m  14 t o 84.  The lower  the score the higher the control.  Pollock  determined alpha, for  the internal  the alpha  the s c a l e  supported  f o r " c o n t r o l " was  (37 i t e m s  loaded  by a p r i n c i p a l  reliability, calculated  consistency using  internal  component  consistency,  measure t h e c l i e n t ' s  analysis.  for this  study  hope a s i m p o r t a n t  by B e r i s h  f o r therapy  This instrument  responsibility,  determinants.  The  was  .73.  designed  readiness  setting.  c l i e n t ' s motivation,  T h e r a p y " was  factor  validity  f a c t o r s ) was  Readiness f o r Therapy Inventory  T h e CRTI i s a n i n s t r u m e n t  psychological  Content  on t h e t h r e e  a t Cronbach's alpha =  The C l i e n t  .82.  Cronbach's  (CRTI).  (1987) t o  i n the  considers a  expectations,  The s u b s c a l e  a p p l i c a b l e t o the physiotherapy  and  "Faith i n  setting.  The s u b s c a l e c o n s i s t s o f a 2 4 - i t e m q u e s t i o n n a i r e u s e d  with  49 a 7-point L i k e r t agree", five  to  (7)  scale,  the anchors  were  "strongly disagree"  i t e m s were u s e d  (1)  Only  "strongly  the strongest  as t h e s e items b e s t measure  c o n c e p t t o be t e s t e d ,  also  f o r pragmatic  the  reasons  there i s  a n e e d t o k e e p t h e number o f q u e s t i o n s s h o r t . identified attitude person The  this  o f optimism,  range  of the scale  t h e 24  faith  w i t h one  calculated The  internal  Life  that  things w i l l  h a p p e n t o them.  individual's  life  specific  trait  t o therapy.  The  factor  from  .74  to  The  study  The  LOT  was  is a  (1985) t o m e a s u r e S c h e i e r , Weintraub, as t h e o u t l o o k  that  "expectancy go t h e i r way  is their judgment" and  that  tool  optimism. and  people  approach (1986,  to p.  good n o t  T h i s instrument examines  approach,  i n Therapy"  alpha  .55.  (LOT).  (1986) d e s c r i b e o p t i m i s m  I t i s the  Cronbach's  l o a d e d s c o r e o f -.55.  (1985) and  have, t h e d i s p o s i t i o n a l  (p. 7 3 ) . score  items ranges  Carver  the  lower the  s u b s c a l e i s .85.  Orientation Test  Carver  the world.  The The  a t Cronbach's alpha =  S c h e i e r and  "Faith  of  consistency, for t h i s  S c h e i e r and  will  and hope on t h e p a r t  individual  d e s i g n e d by  1257)  or  i n therapy.  negatively  reliability,  Carver  "feeling  i s 5 t o 35.  i t e m s on t h i s  l o a d i n g on t h e f i v e .51  trust,  a  i n regard t o the t h e r a p e u t i c e n t e r p r i s e "  the greater the for  s u b s c a l e as r e f l e c t i n g  Berish  an  whereas B e r i s h ' s s u b s c a l e  examines t h e i n d i v i d u a l s This tool  q u e s t i o n n a i r e used w i t h a 5-item  consists Likert  approach  of a  scale.  12-item The  bad  50 categories to  (0)  of t h i s  "strongly disagree".  omitted thus the greater Carver  the  score  f o r the  LOT  LOT.  As  consistency,  The  Will  literature construct  To  =  and  therefore  i s from 0 t o  optimism.  validity  scales.  for this  The  An  of the  the  author developed  as w e l l  the  consistency, alpha  =  will  to  study.  (4)  It is a  typical  the  The  The  s t u d y was  this  of  pilot those  7-item individuals desire range from  "strongly disagree".  live.  for this  lower the  reliability, calculated at  (1)  The  range  score  the  internal Cronbach's  .71.  D e m o g r a p h i c and  A n c i l l a r y Measures.  d e m o g r a p h i c s and  some a n c i l l a r y  age,  work s t a t u s ,  m a r i t a l and  injury  at  a s c a l e and  as p a t i e n t s  s c a l e i s f r o m 7 t o 28.  greater  calculated  Response c a t e g o r i e s  agree" to  of  evaluating  examination of  d e v e l o p e d t o examine an  "strongly  a  adequate  available operationalization of  experts  live.  with  .79.  questionnaire to  and  reliability,  s t u d y was  in this  will  The  Scheier  through  participating  and  32.  a test-retest reliability  Live Scale.  f o u n d no  i t on  the  agree",  i t e m s were  w e l l they e s t a b l i s h e d  9 other  Cronbach's alpha  tested  .76,  "strongly  internal consistency  discriminant  against  internal  of  scale  greater  (1985) d e m o n s t r a t e d  c o n v e r g e n t and the  the  (4)  Four f i l l e r  range of the  Cronbach's alpha .79  s c a l e range from:  (back o r n e c k ) ,  any  questions  Information included:  sex,  e t h n i c background, type  additional therapy  on  received  of  51 following to  discharge  a home e x e r c i s e  negative l i f e self-health injured health Data  from S t . V i n c e n t ' s H o s p i t a l , program, e m o t i o n a l  change e x p e r i e n c e d o v e r t h e  assessment,  focus of  or being healed), and  support,  and  last  attention  (on  maintenance of  of variances  differences  five  years,  being  physical  on  health  two  multivariate  (one-way) t o t e s t b e t w e e n beliefs  control,  will  S i g n i f i c a n t o v e r a l l MANOVA was  to  live).  faith  i n therapy,  c a l c u l a t i o n o f u n i v a r i a t e F t e s t s and  p o s t hoc  comparisons  (cited  a n a l y s i s was  classified second,  recovery. deviations  as on  c o n d u c t e d on  good, m o d e r a t e and the  greatest,  Descriptive and  optimism,  followup  o f p_ <.05 the  was  Scheffe 1976).  used.  The  participants  poor degree of  m o d e r a t e , and  statistics  and  followed  i n Spatz & Johnston,  acceptable significance level  first  group  (self-esteem,  self-confidence,  The  major  fitness.  h y p o t h e s e s were t e s t e d by  analysis  An  any  Analysis The  by  adherence  (mean,  c o r r e l a t i o n s ) were a l s o  recovery.  slowest standard  calculated.  rate  of  52 Results Descriptive The 103)  Data  respondents  ranging  17.1).  from  were m a l e s  (20 t o 89)  years  p r o b l e m s , and  12.7%  28.7%  with both  with  a v e r a g e number o f p h y s i o t h e r a p y  neck  (SVH)  ranged  These treatments  v a r y i n g p e r i o d s of time 57.0;  SD  = 56.2  ranging  (SD =  The  s c a l e s were c o l l a p s e d , and  being  and  f o u r b e c o m i n g two,  named t h e  and  occurred  over  days  (M  and  the data.  The  becoming  one,  two  and  being c a l l e d  the  "moderate  anchor f i v e becoming t h r e e ,  "good r e c o v e r y " g r o u p .  group c o n t a i n e d  22.0%  group c o n t a i n e d  30.6%.  The  and  "poor  of respondents, 47.3%, a n d The  three  the the  mean age  "good  was  49.5  =17.49) i n the  " p o o r r e c o v e r y " g r o u p , a mean o f  (SD  = 17.79) on  "moderate r e c o v e r y " g r o u p , and  54.2  the  (SD = 18.45) i n t h e  s e x e s were d i s t r i b u t e d w i t h the  females  =  divided  (SD  of  neck  received at  d e g r e e o f r e c o v e r y was  a n c h o r s one  i n the  "good r e c o v e r y " 17%  a  problems.  f r o m 1 t o 352  "moderate r e c o v e r y " group c o n t a i n e d recovery"  =  with  "poor r e c o v e r y " group, anchors  r e c o v e r y " g r o u p , and  recovery"  58.7%  14.7)  i n t o three categories i n order to analyze  as the  SD  days).  Recovery Degree.  staying  (M = 52.9;  treatments  15.3  (n =  a diagnosis of  St. Vincent's Hospital f r o m 1 t o 93.  females  contained  b a c k and  was  and  o f age  T h i s sample o f respondents  d i a g n o s i s o f back problems,  The  (n = 47)  a mean  group.  o f t h e m a l e s and  " p o o r r e c o v e r y " g r o u p ; 48.9%  50.5  The  24.3% of  the  of  53 m a l e s a n d 46.6% o f t h e f e m a l e s  i n t h e "moderate  recovery"  g r o u p ; a n d 34.0% o f t h e m a l e s a n d 29.1% o f t h e f e m a l e s i n the  "good r e c o v e r y " On e x a m i n i n g  group.  the treatment  characteristics  i n Table  4, o f t h e t h r e e r e c o v e r y d e g r e e g r o u p s " m o d e r a t e had  consistently  h i g h e r means a n d s t a n d a r d  recovery"  d e v i a t i o n s when  compared t o t h e o t h e r g r o u p s f o r t h e number o f SVH treatments  r e c e i v e d and t h e t o t a l number o f d a y s  w h i c h t h e SVH t r e a t m e n t s  occurred.  The i n t e n s i t y ,  number o f d a y s o v e r w h i c h t h e SVH t r e a t m e n t s divided value  b y t h e number o f SVH t r e a t m e n t s  the  and  had a lower  t o determine  treatment  t-tests  whether t h e "poor r e c o v e r y "  than was  group  i n treatment  were computed; t h e i n t e n s i t y o f  was s i g n i f i c a n t , t ( 7 7 ) = 2.62, p. <.05;  indicating  that  treatments  p e r number o f d a y s t h a n  group.  t h e y had  A preliminary analysis  t h e "good r e c o v e r y " g r o u p d i f f e r e d  intensity,  mean  i n a s h o r t e r p e r i o d o f time  "poor r e c o v e r y " group.  conducted  the  occurred  f o r t h e "good r e c o v e r y " g r o u p i n d i c a t i n g  r e c e i v e d more t r e a t m e n t s  over  t h e "good r e c o v e r y " g r o u p h a d more  The number o f t r e a t m e n t s ,  over which the treatments  t h e "poor  recovery"  a n d t h e number o f d a y s  o c c u r r e d a t SVH were n o t  s i g n i f i c a n t when t h e "good r e c o v e r y " a n d t h e " p o o r r e c o v e r y " g r o u p s were  analyzed.  Examining t h e a n c i l l a r y c h a r a c t e r i s t i c s f o r the degree o f recovery,  i n Table  60.9% o f t h e "good  5,  recovery"  54 Table 4 Means a n d S t a n d a r d D e v i a t i o n s on T r e a t m e n t V a r i a b l e s f o r Perceived  Degree o f Recovery Groups  PR g r o u p  MR g r o u p  GR g r o u p  (n = 33)  (n = 71)  (n = 46)  M  SD  M  SD  M  SD  Number o f t r e a t m e n t s at  SVH  13.5(13.1)  16.8(15.9)  14.4(13.7)  20.9(21.7)  23.5(23.5)  16.2(16.2)  53.1(44.4)  62.1(60.4)  52.1(57.4)  Number o f t r e a t m e n t s a t SVH & e l s e w h e r e Total  d a y s o f SVH  Treatments Total  days between a l l  treatments Intensity  of treat-  ment a t SVH Intensity  155.2(263.9) 137.0(200.3) 103.4(210.6)  4.2(1.9)  3.7(1.4)  3.2(1.3)  10.6(29.7)  12.4(49.6)  of total  treatments  8.8(10.5)  N o t e . PR = p o o r r e c o v e r y ; MR = m o d e r a t e r e c o v e r y ; GR = g o o d recovery;  a n d SVH = S t . V i n c e n t ' s H o s p i t a l ;  Intensity  number o f d a y s o v e r w h i c h t r e a t m e n t o c c u r r e d d i v i d e d number o f t r e a t m e n t s .  = by t h e  55 Table 5 Characteristics  o f t h e Poor Degree o f R e c o v e r y . Moderate  Degree  o f R e c o v e r y , a n d Good D e g r e e o f R e c o v e r y G r o u p s  PR g r o u p  MR g r o u p  GR g r o u p  (n = 33)  (n = 71)  (n = 46)  % P r e s c r i b e d home  %  %  exercises:  1.4(0.5)  Yes  39.4%  67.6%  48.9%  No  60.6%  32.4%  51.1%  C o m p l i e d w i t h home  exercises•  1. n o t a t a l l  3.3(1.0) 15.4%  2.1%  13.6%  —%  6.3%  9.1%  3. m o d e r a t e l y  46.1%  56.3%  54.6%  4.  23 .1%  20.8%  13.6%  15.4%  14.5%  9.1%  2.  5. v e r y Emotional  regularly support:  1. no s u p p o r t 2. 3. m o d e r a t e  support  4. 5. g r e a t  support  Negative L i f e  4.0(1.1)  —%  4.2%  4.3%  15.2%  7.0%  4.3%  45.4%  21.2%  8.8%  12.1%  26.8%  21.7%  27.3%  40.8%  60.9%  Impact:  1. somewhat -  M(SD)  2.8(1.4) 11.1%  20.5%  57.1!  2.  11.1%  15.9%  9.5%  3. m o d e r a t e l y -  33.4%  38.6%  4.9%  56 4. 5. e x t r e m e l y Self  Health  -  healthy  2. 3. m o d e r a t e  health  4.  Focus of  13.6%  9.5%  11.1%  11.4%  19.0%  21.2%  8.6%  —%  9.1%  4.3%  2.2%  45.4%  37.1%  30.4%  9.1%  25.7%  26.1%  15.2%  24.3%  41.3%  Appraisal:  1. n o t v e r y  5. v e r y  33.3%  healthy  thinking:  1. b e i n g  3.9(1.3)  injured  2. 3. somewhat  improved  4. 5. b e i n g  healed  Maintenance  of  15.6%  8.7%  2.2%  6.3%  4.3%  4.3%  37.5%  26.1%  6.6%  15.6%  29.0%  13.0%  25.0%  31.9%  73 .9%  fitness:  3.1(0.9)  1. n o t a t a l l  21.2%  1.4%  6.5%  2.  15.2%  8.6%  8.7%  39.3%  65.7%  58.7%  18.2%  18.6%  15.2%  6.1%  5.7%  10.9%  3. m o d e r a t e  fitness  4. 5.  Note.  full  fitness  PR = p o o r d e g r e e o f r e c o v e r y ; MR  recovery;  GR  = good  degree of  recovery.  = moderate  degree  of  57 group had the  "great emotional  s u p p o r t " w h i l e o n l y 27.3%  "poor r e c o v e r y " group r e p o r t e d they had  support".  I n e v a l u a t i n g t h e i r own  appraisal),  when compared t o o t h e r s t h e i r  the  health  i n the  (self-health age,  their  f o c u s o f t h i n k i n g was  73.9%  i n the  healed", was  on  25.0%  i n the  "being healed".  above v a r i a b l e s between t h e  i n regard to t h e i r  4.80,  p_ <.001; and  healed  placing  experienced  the  physiotherapy,  the  additional  A  as h a v i n g  last  few  being  a s w e l l a s any  first  additional  naturopathic, accupuncture  SVH  variable was  on  number o f d a y s b e t w e e n t h e  a t SVH  jo  themselves  recovery.  The  =  better  the p a t i e n t received f o r t h e i r  therapy  respondents.  rated  a g r e a t e r degree of  last  independent  = 4.75,  attention  back f o l l o w i n g t h e i r as the  support,  support,  of h e a l t h , t(77)  i n d i v i d u a l s who  chiropractic,  other treatments  for  focus of t h e i r  Recovery Rate.  "being  "good  f o r focus of t h i n k i n g , t(76)  g r e a t e r emotional  and  determined  for self-rating  Therefore, those  treatment  on  " p o o r r e c o v e r y " and  .002;  and  i t was  f o r the  = 3.20,  health,  injury,  t - t e s t s were c o m p u t e d  t(77)  as h a v i n g  where  reported  s i g n i f i c a n c e was  <.001.  group  "poor r e c o v e r y " group  r e c o v e r y " groups, p_ <  in  "very  When a s k e d  "good r e c o v e r y " g r o u p n o t e d  while  41.3%  "poor r e c o v e r y "  r e p o r t e d t h e y were " v e r y h e a l t h y " .  it  "great  "good r e c o v e r y " g r o u p r e p o r t e d t h e y w e r e  h e a l t h y " w h i l e o n l y 15.2%  of  treatment,  recovery rate.  r e c o r d e d by  o f them t r i e d  was  neck  or  or  calculated However  only a t o t a l  of  36  several different  types  58 of treatment,  20 h a d a d d i t i o n a l p h y s i o t h e r a p y ,  c h i r o p r a c t i c treatments, variety  of different  i n missing  were o f t e n v e r y v a g u e ,  several years")  treatment  time  treatment  time.  Therefore  the data,  group.  a n d 62nd  t h r e e groups t o  32.7% i n t h e " m o d e r a t e r a t e o f  between t h e f i r s t  and second  group  days, and t h e d i v i s i o n  group o c c u r r e d between t h e  days.  mean a g e was 55.9 i n t h e " s l o w r a t e o f r e c o v e r y "  53.2 i n t h e "moderate r a t e o f r e c o v e r y "  were d i s t r i b u t e d females  The sexes  were i n t h e " s l o w r a t e o f r e c o v e r y "  o f t h e m a l e s and 19.3% o f t h e f e m a l e s  23.3% o f t h e f e m a l e s  recovery"  group.  group, and  s o t h a t 8.0% o f t h e m a l e s a n d 26.0% o f  "moderate r a t e o f r e c o v e r y " and  data  were i n t h e " s l o w  i n t h e "high r a t e o f recovery group".  13.3%  over  T h i s v a r i a b l e was m e a s u r e d b y t h e number o f d a y s  The  the  "many" t r e a t m e n t s  34.0% o f r e s p o n d e n t s  b e t w e e n t h e s e c o n d and t h i r d  48.9  (i.e.,  the St. Vincent's Hospital  o c c u r r e d b e t w e e n t h e 22nd and 2 3 r d  group,  resulted  g r o u p , a n d 33.3% i n t h e " h i g h r a t e o f r e c o v e r y "  the d i v i s i o n  61st  analysis  r a t e o f r e c o v e r y was d i v i d e d i n t o  recovery"  data  a  was e x a m i n e d i n p l a c e o f t h e t o t a l  r a t e o f r e c o v e r y " group,  and  As t h e s e  and 6 t r i e d  i t was i n a p p r o p r i a t e t o i n c l u d e t h e s e  in the analysis.  analyze  treatments.  i n f o r m a t i o n which p r e c l u d e d  respondents  The  2 had accupuncture,  17 h a d  group,  were i n t h e  g r o u p , a n d 10.0% o f t h e m a l e s  were i n t h e " h i g h r a t e o f  59 Reviewing the c h a r a c t e r i s t i c s  of the ancillary  w i t h t h e t h r e e r a t e o f recovery groups i n T a b l e no m a j o r d i f f e r e n c e s  i n the data  C o r r e l a t i o n matrix.  6 showed  distribution.  A correlation matrix  t h e dependent measures, treatment  for a l l  measures, and a n c i l l a r y  d a t a were u s e d t o e x a m i n e t h e r e l a t i o n s h i p s variables  data  among  these  (See A p p e n d i x D ) .  G r e a t e r d e g r e e o f r e c o v e r y showed m o d e r a t e t o l o w correlations with greater f a i t h g r e a t e r optimism the respondents  i n therapy  ( r = .29), b e t t e r h e a l t h focus of attention  (r =  -.44),  ( r = . 3 6 ) , and  on b e i n g h e a l e d  (r =  .37) . Low t o m o d e r a t e c o r r e l a t i o n s were f o u n d dependent v a r i a b l e s , relating  the highest being greater  t o greater self-esteem,  c o r r e l a t i o n s were n o t e d control,  The  ( r = -.52).  i n therapy  ancillary  optimism No  between s e l f - e s t e e m a n d l o c u s o f  between s e l f - c o n f i d e n c e and f a i t h  between f a i t h  among t h e  and w i l l  to live.  d a t a have s i g n i f i c a n t  t h e dependent measures as w e l l .  i n therapy, and  Greater  correlations self-health  a p p r a i s a l h a s a m o d e r a t e t o low c o r r e l a t i o n w i t h optimism and  ( r = .35), g r e a t e r f a i t h  i n therapy  greater  ( r = .27),  g r e a t e r s e l f - e s t e e m , and h i g h l o c u s o f c o n t r o l  .28).  The f o c u s o f a t t e n t i o n  c o r r e l a t i o n with greater f a i t h greater physical  with  (r =  on b e i n g h e a l e d h a s a l o w i n therapy  ( r = .31), while  f i t n e s s h a s a low c o r r e l a t i o n  with  60 Table 6 Characteristics  o f t h e Slow R a t e o f R e c o v e r y , M o d e r a t e  Recovery, and High Rate o f Recovery  Groups  SR g r o u p  MR g r o u p  HR  (n = 51)  (n = 49)  (n = 50)  % P r e s c r i b e d home  %  group  %  Yes  64.7%  64. 6%  39. 0%  No  35.3%  35.4%  61. 0% 3.3(1.0)  exercises  1. n o t a t a l l  6.1%  6.5%  10. 5%  2.  3.0%  9.7%  5. 3%  3. m o d e r a t e l y  54.5%  48. 3%  63. 1%  4.  18.2%  22.6%  15. 8%  18.2%  12.9%  5. 3%  5. v e r y  regularly  4.0(1.1)  Emotional support: 1. no s u p p o r t  7.8% 7.8%  2.  2.0% 12.2%  — -% 4. 0  21.7%  26.6%  20. 0%  4.  23.5%  18.4%  24. 0%  5. g r e a t s u p p o r t  39.2%  40.8%  52 . 0%  3. m o d e r a t e  Negative L i f e  support  2.8(1.4)  Impact:  1. somewhat 2. 3. m o d e r a t e l y -  M(SD) 1.4(0.5)  exercises:  C o m p l i e d w i t h home  Rate o f  32.0%  25.0%  26. 5%  8.0%  12.5%  17. 6%  36.0%  20.8%  29. 4%  61 4. 5. e x t r e m e l y Self  -  12. 0%  29. 2%  11. 8%  12. 0%  12. 5%  14. 7%  Health Appraisal:  1. n o t v e r y  healthy  2. 3 . moderate  health  4. 5. v e r y  healthy  3.6(1.2) 6. 0%  8. 2%  12. 0%  2. 0%  8. 2%  4. 0%  48. 0%  34. 6%  28. 0%  22. 0%  16. 3%  28. 0%  22. 0%  32. 7%  28. 0%  Focus of t h i n k i n g : 1. b e i n g  3.9(1.3)  injured  2. 3. somewhat  improved  4. 5. b e i n g Maintenance 1. n o t  healed of  2. fitness  4. 5.  Note. HR  full  6. 1%  6. 1%  4. 1%  4. 1%  6. 1%  26. 5%  20. 4%  20. 0%  18. 4%  26. 5%  18. 4%  38. 8%  42 . 9%  49. 0%  fitness:  at a l l  3. m o d e r a t e  12. 2%  fitness  3.1(0.9) 4. 0%  12. 2%  6. 0%  14. 0%  4. 1%  12. 0%  64. 0%  57. 1%  52 . 0%  12. 0%  18. 4%  22 . 0%  6. 0%  8. 2%  8. 0%  SR = s l o w r a t e o f r e c o v e r y ; MR  = high rate of  recovery.  = moderate  rate of  recovery;  62 greater w i l l support (r =  by  to live  (r =  important  .27).  people  Also greater  as a b o v e w i t h  emotional  greater  optimism  .27). Some h i g h c o r r e l a t i o n s were n o t e d  treatment therapy  p a r a m e t e r s and  as d e s c r i b e d  these  (i.e.,  over which the treatments treatments,  r =  among t h e  support  different  the pattern  between t h e number o f  occurred  and  the  number  of days of  .95).  Hypotheses T e s t i n g Degree o f Recovery. h y p o t h e s e s 1,  3,  self-confidence, o p t i m i s m , and  5,  7,  The  9,  and  11.  locus of control,  will  The  found  D i f f e r e n c e s were e x a m i n e d b e t w e e n t h e "moderate r e c o v e r y "  3.89,  revealed  and  the  An  significant  (2,147) = 3.16,  in  therapy,  i n Table  of the u n i v a r i a t e F  the The  = tests  group d i f f e r e n c e s f o r s e l f - e s t e e m , faith  optimism,  i n therapy, F  F  (2,147)  (2,147) = 7.24,  live  (See  groups of  7.  F(12,284)  and  Followup  deviations  groups.  Lack of s e l f - c o n f i d e n c e , locus of c o n t r o l , s c a l e s were n o t  by  "poor r e c o v e r y " ,  significant,  examination  p_ <.05;  18.13, p_ <.001; and  standard  "good r e c o v e r y "  g r o u p e f f e c t was  p_ <.001.  self-esteem,  faith  Means and  the dependent v a r i a b l e s are  multivariate  tests  t o l i v e v a r i a b l e s were e x a m i n e d  c o m p u t i n g a one-way MANOVA. for  degree of r e c o v e r y  significant,  S c h e f f e p o s t hoc  "poor recovery",  F < 1.0  =  p_ <.001. will  to  Table  comparisons between  "moderate r e c o v e r y " ,  F  and  8).  the "good  63 Table  7  Means a n d S t a n d a r d the  D e v i a t i o n s f o r Dependent Measures f o r  Degree o f R e c o v e r y Groups.  Variables  PR g r o u p  MR g r o u p  GR g r o u p  (n  (n = 71)  (n = 46)  M  = 33)  SD  M  SD  M  SD  18. 0 ( 4 . 7)  16 .4(3.9)  15 . 7 ( 4 . 0)  32. 0 ( 8 . 3)  28 .8 (7.2)  29 . 5 ( 6 . 9)  locus of control  45. 1 ( 8 . 9)  42 .6(10.1)  40 .2 (12 .0)  faith  17. 5 ( 3 . 2)  14 .5(4.1)  12 .2 (4. 0)  optimism  18. 1 ( 6 . 6)  21 .0(4.8)  22 . 5 ( 4 . 4)  will  15. 5 ( 3 . 5)  14 .4(3.0)  14 . 4 ( 3 . 7)  self  esteem  lack of social self  confidence  i n therapy  to live  N o t e . PR = p o o r r e c o v e r y ; MR = m o d e r a t e r e c o v e r y ; good r e c o v e r y .  Low s c o r e s on s e l f - e s t e e m ,  self-confidence, optimism,  locus of control,  and w i l l  to live  less  lack of social i n therapy,  i n d i c a t e ; more  more s e l f - c o n f i d e n c e , more i n t e r n a l therapy,  faith  GR =  self-esteem,  control,  o p t i m i s m , and a g r e a t e r w i l l  more f a i t h i n  to live.  64 Table  8  Summary o f MANOVA and f o l l o w u p Recovery Groups  ANOVAS f o r t h e D e g r e e o f  (n - 150) .  Source  SS  df  F  p_<  Between G r o u p s multivariate  12,284  3.65  .001  Univariate self-esteem  106. 07  2, 147  3 .16  . 045  self-confidence  232 . 61  2, 147  2. 14  . 121  locus  of control  455. 71  2, 147  2. 06  . 131  faith  i n therapy  554. 51  2, 147  18. 13  .001  378. 62  2, 147  7. 24  .001  28. 61  2, 147  1. 31  .273  optimism will  to  live  65 r e c o v e r y " were c o n d u c t e d for to  self-esteem,  faith  on s i g n i f i c a n t u n i v a r i a t e  i n therapy,  determine group d i f f e r e n c e s  self-esteem,  recovery"  group.  g r o u p , p_ <.05.  self-esteem than  T h e "moderate r e c o v e r y "  significantly  For  For  t h e "good group d i d n o t  from t h e "poor r e c o v e r y "  o r "good  groups. faith  i n therapy,  t h e "poor r e c o v e r y " significantly,  a n d "good  recovery"  groups d i f f e r e d  recovery"  and "moderate r e c o v e r y " g r o u p s d i f f e r e d ,  and  t h e "moderate r e c o v e r y "  differed,  p_ <.05.  than  "good r e c o v e r y "  group poorer  group,  faith  p. <.05;  groups  o f t h e means i t  group had p o o r e r  t h e "moderate r e c o v e r y "  "moderate r e c o v e r y "  p_ <.05, t h e " p o o r  and "good r e c o v e r y "  From an e x a m i n a t i o n  appears t h e "poor r e c o v e r y " therapy  An  o f t h e means i n d i c a t e s t h a t t h e " p o o r  group had l e s s  recovery"  9).  i n order  differed  f r o m t h e "good r e c o v e r y "  recovery"  differ  (See T a b l e  t h e "poor r e c o v e r y " group  significantly examination  and o p t i m i s m ,  F tests  faith i n and t h e  i n therapy  than t h e  group.  With r e g a r d t o optimism, t h e "moderate r e c o v e r y " and "good r e c o v e r y "  groups d i f f e r e d  "poor r e c o v e r y "  a n d "moderate r e c o v e r y "  significantly,  significantly,  An e x a m i n a t i o n  means i n d i c a t e s t h a t t h e " p o o r r e c o v e r y "  groups.  differed  p_ <.05, b u t t h e " m o d e r a t e r e c o v e r y " a n d  "good r e c o v e r y " g r o u p d i d n o t .  optimism than  group  p_ <.05, t h e  t h e "moderate r e c o v e r y "  of the  g r o u p showed  a n d "good  less  recovery"  66 Table 9 Critical  Values  (Scheffe Tests) of S i g n i f i c a n c e  Dependent Measures  Between G r o u p s  f o r the  f o r t h e Degree  of  Recovery  PR  self  esteem  faith  i n therapy  optimism  Note. group;  & GR  PR  = good  .&  group  6.21*  3.43  0.91  36.39*  13.97*  9.66*  14.36*  7.00*  r e c o v e r y group;  groups s i g n i f i c a n t l y  MR  group  PR = p o o r r e c o v e r y g r o u p ; MR GR  & MR  = moderate  (*)  GR  group  2.36  recovery  denotes p a i r s  d i f f e r e n t a t t h e p_ <.05  level.  of  67 Therefore, supported  number 1 was  partially  a s t h e d i f f e r e n c e s b e t w e e n one  significant.  Hypotheses  supported. study  hypothesis  Hypothesis  numbers 3, a n d  number 7 was  o f the groups 5, w e r e n o t  supported  While hypothesis  partially  a s two  supported  significantly,  this  number 9  was  out o f the t h r e e groups  and h y p o t h e s i s  Rate of Recovery.  number 11 was  Hypotheses  2,  4,  6,  not 8,  12, were t e s t e d  u s i n g a MANOVA on t h e r a t e o f  T h i s r e v e a l e d no  significant  moderate,  and h i g h  f o r means and dependent  faith  differ  supported. 10,  and  recovery.  d i f f e r e n c e s among t h e s l o w ,  rates of recovery  standard  measures  control,  groups  (see T a b l e  d e v i a t i o n s ) , when e x a m i n e d  of self-esteem, i n therapy,  The m u l t i v a r i a t e g r o u p e f f e c t 1.0.  by  a s t h e d i f f e r e n c e s between a l l t h r e e o f t h e g r o u p s  were s i g n i f i c a n t .  of  was  with  the  self-confidence, locus  optimism, and w i l l t o was  10  not s i g n i f i c a n t ,  live. F <  68 Table  10  Means and S t a n d a r d  D e v i a t i o n s o f Dependent Measures f o r  Rate of Recovery  Variables  self  esteem  Lack o f  social  SR g r o u p  MR  (n = 51)  (n = 49)  (n =  M  M  M  SD  group  HR  SD  group 50)  SD  17. 1(4.1)  15 .9(4.4)  16. 6 ( 4 . 0 )  30. 0(7.2)  29 .5(7.4)  29. 8 ( 7 . 2 )  43 . 2 (10.1)  41 .4(10.3)  42. 6(11.5)  14. 8(4.5)  14 .6(4.3)  14. 0 ( 4 . 3 )  20. 7(5.7)  20 .6(5.3)  21. 2 ( 5 . 1 )  14. 9(2.8)  14 .2(3.5)  14. 8 ( 3 . 6 )  self-confidence locus of faith  control  i n therapy  optimism will  to  live  N o t e . SR = s l o w r a t e o f r e c o v e r y ; MR recovery;  HR  = high  rate of  recovery.  = moderate  rate  69 Discussion The  hypotheses t h a t the p a t i e n t group e x h i b i t i n g  "good d e g r e e o f r e c o v e r y " w o u l d h a v e stronger self-esteem, compared w i t h by  The  of control,  significantly  i n therapy,  no  r e c o v e r y was  f i n d i n g s suggest and  will  supported  t o l i v e were n o t  t o the degree of recovery,  beliefs  significantly  related  n o r were any  to the  t h e r e were s i g n i f i c a n t  t h r e e groups f o r f a i t h  the  and  rate of  and  recovery"  group f o r s e l f - e s t e e m . faith  between t h e  i n therapy  between t h e  "poor r e c o v e r y "  belief  the  (self-rating  "moderate r e c o v e r y "  optimism,  of  of  d i f f e r e n c e s among a l l  i n therapy,  and  this  recovery.  "poor  "good r e c o v e r y " g r o u p s a s w e l l a s  "poor r e c o v e r y "  The  by  followed  significantly  With r e g a r d t o degree of r e c o v e r y  recovery"  optimism  that self-confidence, locus  related  recovery),  and  t h e groups w i t h moderate r e c o v e r y ,  the groups with  study.  faith  a  groups f o r  and  indicated  between  "good  that  the  s t r o n g e r t h e b e l i e f s were t h a t t h e t h e r a p i s t w o u l d be  able  h e l p them and  the  g r e a t e r was supports  the degree of recovery  Frank's  in that faith Lundh's efficacy The  t h a t t h e y would have a p o s i t i v e  (1961) d e s c r i p t i o n  i n the t h e r a p i s t  achieved.  outcome This  of the placebo  i s a core  element,  effect and  (1987) c o n t e n t i o n t h a t t h e p a t i e n t s b e l i e f s of therapy  are  tantamount.  optimism v a r i a b l e i n d i c a t e d t h a t the  optimistic  an  individual  i n the  was  the greater the  more degree  of  70 recovery attained.  T h i s supports Martus'  phenomenological r e s u l t s in  active  optimism  i s essential  the h e a l i n g process. The  self-esteem variable  these b e l i e f s finding  indicated  that the  stronger  the better the recovery attained.  concurs with that  d e s c r i b e d how an  that  (1987)  of Martus  This  (1985) w h e r e  the process of " s i g n i f i c a n t  he  change"  lead  increase of self-esteem through the strengthening  the  individuals These  Faith  findings  for faith  i n therapy, optimism,  support f o r Martus' phenomenological  Martus'  no o t h e r s p e c i f i c  study the locus of c o n t r o l  c o r e themes w h i l e s e l f - e s t e e m was identified s u p p o r t was model, live,  found f o r Antonovsky's  w h i l e i n t h e HBM  may  were  identified.  optimism  of the  were  elements  change.  (1979)  i n the  No  salutogenic  no s p e c i f i c  belief  elements  four t o f i v e broad headings are used  to  are into  a l l t h e b e l i e f s must f i t . e t h n i c groups  from P o r t u g a l ,  to  and  and  t h e c o r e e l e m e n t s a r e s e l f - c o n f i d e n c e and w i l l  The  rest  one  i n h i s theme o f s i g n i f i c a n t  a d d r e s s e d and which  beliefs  and  results.  i n t h e r a p y and o p t i m i s m a r e c o r e e l e m e n t s  placebo e f f e c t , In  of  beliefs.  self-esteem provide support f o r the placebo e f f e c t moderate  to  represented i n t h i s  sample,  t h e U n i t e d Kingdom, E u r o p e ,  C a n a d a , and  of the world, provided a unique m u l t i c u l t u r a l  the research.  T h e r e was  have had E n g l i s h  concern that  people  the  language d i f f i c u l t i e s ,  the  nature  Portuguese  and  a MANOVA  71 for rate of recovery  a n d d e g r e e o f r e c o v e r y was  w i t h t h i s g r o u p removed  (See A p p e n d i x E ) .  marked c h a n g e s i n t h e a n a l y s i s , v a l u e s d i d drop s l i g h t l y .  although  these d i f f e r e n t of  cultural  the self-esteem that f o r  seem t o go  across  groups f o r s e l f - p e r c e i v e d degree  recovery. The  their  c o r r e l a t i o n between t h e p a t i e n t s s e l f - r a t i n g o f  recovery  degree a t t h e present  the p h y s i o t h e r a p i s t a t t h e time and  significant  time  time  a n d t h a t done b y  of discharge  ( r = .35, p_ <.001).  however, r e l a t i v e l y  i s positive  The c o r r e l a t i o n i s  l o w and may r e f l e c t  the discrepancy i n  b e t w e e n t h e two e v a l u a t i o n s , i n some c a s e s  discrepancy  i s up t o t h r e e y e a r s ,  may h a v e s u f f e r e d f u r t h e r i n j u r y , additional The  difficult  this  during which t h e p a t i e n t o r may h a v e r e c e i v e d  treatments.  c o m p a r i s o n o f t h e means i n t h i s  means o f t h e same i n s t r u m e n t s because  4.9) f o r e a r l y  Self-Esteem  populations.  (1988) r e p o r t e d a mean o f 30.13  a d o l e s c e n t s , boys and g i r l s  years  (SD = 4.67)  i n g r a d e s 7, 9, a n d 11 o n t h e R o s e n b e r g  Scale.  t h e y were s c o r e d  12 t o 14  (SD =  S c a l e , a l s o Mechanic  (1987) r e p o r t e d a mean o f 3 0.07  for adolescents  with the  reported elsewhere i s  o f age on t h e R o s e n b e r g S e l f - E s t e e m Hansell  study  few s t u d i e s h a d s i m i l a r  Mahon a n d Y a r c h e s k i  and  T h e r e were no  I t i s interesting  b a c k and neck p a t i e n t s s i m i l a r b e l i e f s  computed  After  a d j u s t i n g t h e means s o t h a t  i n t h e same d i r e c t i o n  g r e a t e r s e l f - e s t e e m ) , t h e means i n t h i s  (greater score = study  were  similar  72 to  those o f the adolescents  lack  of s o c i a l self-confidence,  reported  With regard t o  Hirschfeld  et al.  (1977)  means o f 29.8 (SD = 6.4) a n d 34.3 (SD = 7.5) f o r  college This  (M = 3 3 . 4 7 ) .  s t u d e n t s and p s y c h i a t r i c p a t i e n t s  respectively.  s t u d y h a d a mean o f 29.8, s i m i l a r t o t h e c o l l e g e  students.  Sangster  rheumatoid a r t h r i t i s years,  and r e p o r t s  reported  (1988) u s e d t h e LOT t o e x a m i n e patients  w i t h a mean a g e o f 56.2  a mean o f 20.5 (SD = 5 . 7 ) .  a mean o f 20.8 w h i c h i s c o n s i s t e n t  This  with  study  similar  studies. The  i n s t r u m e n t s u s e d were s e l e c t e d  primarily  because  t h e y c o v e r e d most o f t h e b e l i e f s i d e n t i f i e d b y M a r t u s a n d also  f o r t h e i r s i m p l i c i t y and e a s e o f u s e .  how t h e s e d i f f e r e n t s c a l e s  correlated  On e x a m i n i n g  w i t h one a n o t h e r ,  some m o d e r a t e c o r r e l a t i o n s were f o u n d .  The h i g h e s t  t h e s e were s e l f - e s t e e m c o r r e l a t i n g w i t h o p t i m i s m -.52,  (r =  p_ <.001), a n d s e l f - e s t e e m c o r r e l a t i n g w i t h  self-confidence The  ( r = .51, p_ <.001).  findings  o f S m i t h , Pope, R h o d e w a l t , a n d P o u l t o n ,  (1989) i n d i c a t e t h a t neuroticism. and  of  stable  relation  They d e s c r i b e  to the Life  Orientation  Test  elements o f neuroticism  as both a broad  i tparticularly i n (LOT).  as w e l l  as c o g n i t i v e  affect  which c o n s i s t s o f  n e g a t i v e emotions " i n c l u d i n g  and anger,  They  and n e g a t i v e  t o a dimension o f p e r s o n a l i t y  chronically guilt,  neuroticism  d i m e n s i o n and have s t u d i e d  suggest that pertain  optimism r e f l e c t s t h e i n f l u e n c e o f  sadness,  and  anxiety,  behavioral  73 characteristics and  s u c h a s low  insecurity".  distinguish  T h e y c o n c l u d e t h a t t h e LOT  optimism  and  discriminant validity. noted  anxiety,  and  by  (1973) and  Frank  that  t h e r e f o r e has  not  limited  It i s interesting i n the d e f i n i t i o n  a high level  the placebo e f f e c t  does  from measures o f n e u r o t i c i s m o r  negative a f f e c t i v i t y ,  of the elements  self-esteem, pre-occupation,  Shapiro  though  that  one  of neuroticism i s  o f a n x i e t y was  also  noted  (1971) a s b e i n g n e c e s s a r y f o r e t a l . (1989)  further  s u g g e s t t h a t t h e LOT's c o r r e l a t i o n w i t h c o p i n g a n d  symptom  r e p o r t i n g may  be  to occur.  caused  under the d e f i n i t i o n presence  Smith  by n e u r o t i c i s m , h o w e v e r ,  of neuroticism they noted  of the b e h a v i o r a l c h a r a c t e r i s t i c ,  self-esteem.  For t h i s  study optimism  a l s o c o r r e l a t e but only moderately  only negative a f f e c t As argued  this that  study those  the  low  and s e l f - e s t e e m  (r =  t h e r e i s evidence t h a t the optimism  .52), t h e r e f o r e  scale  i s not  i s retrospective i n d i v i d u a l s who  a s b e i n g e f f e c t i v e and  have d e v e l o p e d  measuring  or neuroticism. i n d e s i g n i t can  post treatment,  be  p e r c e i v e themselves  h a v i n g a good r e c o v e r y , a l s o p e r c e i v e t h e t h e r a p y treatment  also  thus  faith  as  or  i n therapy  rather than p r i o r  may  to  treatment. The control,  findings and  distinguish  from t h e s e l f - c o n f i d e n c e ,  the w i l l  to live  among t h e d e g r e e  According t o Martus  i n s t r u m e n t s do of recovery  locus of not  groups.  (1985) i n c r e a s e d s e l f - c o n f i d e n c e  was  74 developed internal one  i n the  same manner a s  locus of control  s e l f - e s t e e m and  or sense of b e i n g  o f h i s n i n e themes, however t h i s  support  the a s s o c i a t i o n of e i t h e r  the degree of recovery. will  to l i v e  to  life  by  these  of  control  expressed  concept  and  results.  study  the  not  v a r i a b l e s with  (1979)  s a l u t o g e n i c model  orientation  i s not  a s t h e n e e d t o h a v e t h e power o f t h e s h o u l d be,  and  this  may  l e a d e r , and  n e c e s s a r i l y be  He  t h i s may  obtained may  e x p l a i n the v a r i e t y  theory  an and  HBM  The  do  literatures related  do  to  among any  not  faith  i n therapy,  optimism, or w i l l  recovery, length  such  of time  individuals  address  tap d i f f e r e n t  as d i f f e r e n t a treatment  life  are  studies.  identify  It The these  further qualify  The  f i n d i n g s here  rate of  recovery  to l i v e .  this.  control,  There  First  elements than  the  program s h o u l d t a k e , interfere with  are  the rate  t h e r a p i s t s p r a c t i c e s on  demands t h a t may  not  suggests  self-confidence, locus of  e x p l a n a t i o n s t h a t may  m e a s u r e u s e d may  need  recovery.  examined t o  of the  with  r e s u l t s here.  d e s c r i b e the degree of recovery.  groups f o r self-esteem,  two  locus of c o n t r o l  r a t e o f r e c o v e r y was  not d i s t i n g u i s h  further  be  of r e s u l t s t h a t  explanation f o r the  t h r e e v a r i a b l e s as b e i n g  and  located.  i n the d i f f e r e n t  also offer  placebo  internally  locus  control  t h e husband, t h e mother, o r a c h u r c h  that  supported  However A n t o n o v s k y d e f i n e s t h e  p l a c e d where i t r i g h t f u l l y  was  s e l f - c o n f i d e n c e and  i n Antonovsky's  the  strong  i n charge does  of these  Likewise  a  or  of  the the  treatment  75 continuation. recover beliefs, us  Second, perhaps t h e  f r o m b a c k and t h a t i s , our  to recover The  neck i n j u r i e s  rate that i s not  e x p e c t a t i o n s and  people  related  beliefs  do  correlate with (r = -.02).  Therefore  found  a s s o c i a t i o n b e t w e e n t h e d e g r e e and  the  r a t e of  Ancillary  d a t a was  Martus  "good" and  significantly group having with  on  examined  i n an  some s u p p o r t  a greater focus.  an  recovery.  "focus  for this  "poor r e c o v e r y "  for  exploratory  the  on h e a l i n g "  notion  groups  focus of h e a l i n g ; the  was  differed  "good  recovery"  This i s also consistent  L u n d h * s c o g n i t i v e - e m o t i o n a l model w h e r e b e l i e f s  improvement s e t up  a positive  Another a n c i l l a r y physical health. found  as t h e  the  t h e m s e l v e s t o be achieve  c y c l e of placebo  measure was  Some s u p p o r t  "good" and  significantly,  not  no  (1985) i d e n t i f i e d  a c o r e theme, and as  not  t h e d e g r e e o r amount o f r e c o v e r y a t t a i n e d was  found  help  r e c o v e r does  support  as  not  faster.  r a t e o r speed w i t h which people  fashion.  to  the  beliefs.  self-rating  for this  also  differed  group c o n s i d e r i n g  g e n e r a l l y h e a l t h i e r than  a good degree o f  of  n o t i o n was  "poor r e c o v e r y " g r o u p s  "good r e c o v e r y "  of  those  who  did  recovery.  Limitations The  most s e r i o u s l i m i t a t i o n  i s t h e measurement o f  rate of recovery.  T h i s measure c o n s i s t e d o f t h e  of  first  days between t h e  t h e SVH  physiotherapy.  and As  l a s t treatments  i t was  important  number  provided to  the  explore  by  76 whether s e l f - e s t e e m , therapy, as w e l l  self-confidence,  optimism, and w i l l  to live  as t h e degree o f recovery,  which t h e treatments occurred an  a s s u m p t i o n was made t h a t  period  control, faith i n  related with the rate the length  o f time  were e x a m i n e d .  recovery  over  However,  happened o v e r  this  o f t i m e when i t d i d n o t f o r 22% o f t h e r e s p o n d e n t s  who f e l l  i n t o t h e "poor r e c o v e r y "  assumption t h a t  the recovery  group, and second t h e  s t o p p e d on t h e l a s t  day o f  treatment. Another l i m i t a t i o n described  as being  t h i s very  broad  classification,  a r e many d i f f e r e n t t y p e s o f i n j u r i e s  In a d d i t i o n , these in  although the population i s  made up o f p a t i e n t s w i t h b a c k a n d o r  neck problems, w i t h i n there  i s that  their  s e v e r i t y , as w e l l  chronicity. involved therapies  injuries  Also  as w e l l  there  o r problems vary as t h e i r  considerably  acuteness o r  were d i f f e r e n t t h e r a p i s t s  as a considerable  provided.  and problems.  array  of different  A s a r e s u l t i t was n o t p o s s i b l e t o  q u a l i f y t h e s p e c i f i c medical problems i n v o l v e d treatments provided.  The t r e a t m e n t l e n g t h  orthe  and f r e q u e n c y  a l s o v a r i e d d e p e n d i n g on t h e s e v e r i t y a n d a c u t e n e s s o f t h e problems i n a d d i t i o n t o t h e i n d i v i d u a l s l i f e life  commitments.  quantify  Therefore  i t was a l s o n o t p o s s i b l e t o  the treatments accurately  l i m i t a t i o n s may w e l l  s t y l e and  t o some e x t e n t  either. account  These f o r the  findings. A  further limitation  i s with the f a i t h  i n therapy  77 subscale This  of the Client  inventory  indicating  had a low Cronbach's a l p h a  a low r e l i a b i l i t y  In a d d i t i o n t h i s effect,  only  recovery  Readiness f o r Therapy  study  (internal  Inventory,  o f .54  consistency).  d o e s n o t show c a u s e a n d  r e l a t i o n s h i p s among t h e b e l i e f s  degree and r a t e as o n l y  cross  and t h e  s e c t i o n a l data  were  used. Self-report  a n d age b i a s were f u r t h e r  t h a t must b e c o n s i d e r e d of s e l f - r e p o r t  data  o f men  more l i k e l y physical  only,  study  was m o s t l y  From J y l h a e t a l . (1986) i n t h e i r  we know t h a t t h e y o u n g e r p a t i e n t s a r e  t h e m i d d l e age g r o u p b y symptoms a n d  psychic well being  a n d t h e more e l d e r l y g r o u p b e  illness.  study  In t h i s  to  age g r o u p s ,  o f age (n = 5 1 ) , t h o s e  o f a g e , (n = 3 9 ) .  may b e e x p r e s s e d  t h e young  adult  i n m i d d l e a g e 46 t o  Therefore  i n this  chronic  i s well  o f a g e , (n = 6 0 ) , and t h e more e l d e r l y  92 y e a r s  values  the population  over the d i f f e r e n t  20 t o 45 y e a r s 65 y e a r s  was  t o e x p l a i n t h e i r h e a l t h by symptoms a n d  fitness,  distributed  comprised  and t h e age r a n g e o f t h e s u b j e c t s  f r o m 20 t o 89 y e a r s . study  as t h i s  limitations  those  different  66  health  study.  A n o t h e r l i m i t a t i o n may be t h a t t h e s c a l e o f s o c i a l s e l f - c o n f i d e n c e o n l y examines t h e s o c i a l  aspect  of  s e l f - c o n f i d e n c e where t h i s v a r i a b l e may n e e d t o be assessed  more  Finally,  comprehensively. this  study  was r e t r o s p e c t i v e i n d e s i g n  some r e s p o n d e n t s were f i l l i n g  out the questionnaire  and two o r  78 even t h r e e y e a r s  a f t e r the  experience.  Recommendations f o r F u t u r e Future present  r e s e a r c h i s needed t o f u r t h e r e x p l o r e  findings with  retrospective recovery  a concurrent  study.  actual recovery  increasing As  well,  and  the other  i n therapy,  p r i o r t o treatment discharge.  the  in this  specific  o n l y t o b a c k and  study  self-efficacy  to  present  used both  T h i s study  and  symptoms both of done  i f the f i n d i n g s  There are  examined as  are also  well  a good h e a l t h m o t i v a t i o n . established that explains  does not p r o v i d e  a model b u t  to  effect,  neck p a t i e n t s .  a s s o c i a t i o n s of s p e c i f i c b e l i e f s  process.  self-esteem.  g e n e r a l i z e to other groups or  F u r t h e r a m o d e l n e e d s t o be the  at  s t u d i e s n e e d t o be  o t h e r b e l i e f v a r i a b l e s t h a t need t o be as  standard  as w e l l as a t t h e t i m e  c o n d i t i o n s t o determine  observed  such  recovery  g r o u p work a i m e d  o p t i m i s m and  In a d d i t i o n , s i m i l a r  different  and  receiving  influence of t h i s  starting  for  t o see i f  a s s o c i a t i o n of neuroticism with  as w e l l t o r u l e out  a  occurring.  compare  a n e u r o t i c i s m s c a l e s h o u l d be  s u b s t a n t i a t e the  with  prophecy e f f e c t  p l u s c o u n s e l l i n g and  faith  evaluated  group r e c e i v i n g t h e  of physiotherapy,  physiotherapy  r a t h e r than  degree o b t a i n e d  s t u d i e s a r e needed t h a t w i l l  g r o u p s o f p a t i e n t s , one course  the  Also therapists expectations  is a self-fulfilling  Further,  study  f o l l o w i n g a s s e s s m e n t n e e d t o be  compared t o t h e there  Research  i n the enough  does l e n d credence  recovery information  to the  placebo  79 theory  and p a r t i a l l y  support  the f i n d i n g s o f Martus.  Conclusions In c o n c l u s i o n then, that  t h i s was a n e x p l o r a t o r y s t u d y i n  i t attempted t o i d e n t i f y  beliefs  of self-esteem,  therapy,  optimism,  those  hypothesis  individual  self-confidence, control,  and w i l l  to live  the p e r c e i v e d degree o f recovery The  specific  for faith  t h a t were r e l a t e d t o  and t h e r a t e o f r e c o v e r y .  i n therapy  was s u p p o r t e d ,  h y p o t h e s e s f o r o p t i m i s m and s e l f - e s t e e m were supported, The  study  i n the self-reported found  three recovery  significant  groups f o r f a i t h  i n therapy,  significant  a n d "good  "moderate r e c o v e r y " groups f o r o p t i m i s m ,  the  "poor r e c o v e r y "  suggest  1  recovery" and between  and "good r e c o v e r y " g r o u p s f o r  These f i n d i n g s support  r e s e a r c h on t h e p l a c e b o  of Martus  findings.  effect,  the theory  fostering  advanced  as w e l l as support  The i m p l i c a t i o n s o f t h e s e  t h a t p h y s i c a l t h e r a p i s t s when t r e a t i n g  n e c k p a t i e n t s may  groups.  g r o u p d i f f e r e n c e s among a l l  and  by  partially  g r o u p s a s w e l l a s between t h e " p o o r  self-esteem.  and t h e  degree o f recovery  d i f f e r e n c e s between t h e "poor r e c o v e r y " recovery"  faith i n  improve r e c o v e r y  degree  an awareness and c o n f i d e n c e  t h e t h e r a p i s t s knowledge, s k i l l s ,  back and  by t h e p a t i e n t i n  and a b i l i t i e s , provided.  Furthermore the r e s u l t s  a general  that  results  through  as t h e e f f e c t i v e n e s s o f t h e treatment suggest  some  as w e l l  optimistic  outlook  a s w e l l a s g o o d s e l f - e s t e e m on t h e p a r t o f t h e  patient  s h o u l d be encouraged and  supported.  80 S t u d i e s such creating  an  a s t h i s p r o v i d e an  initial  step  towards  e m p i r i c a l base of i n f o r m a t i o n , necessary  i n c r e a s i n g t h e t h e r a p i s t s knowledge so she  i s able  f o s t e r t h e maximum r e c o v e r y d e g r e e p o s s i b l e t h r o u g h informed  approach.  for  to an  81 References A g r a s , W. S. ( 1 9 8 4 ) . The b e h a v i o r a l t r e a t m e n t o f s o m a t i c d i s o r d e r s . I n W. D. G e n t r y ( E d . ) , Handbook o f b e h a v i o r a l m e d i c i n e (pp. 4 9 1 - 5 0 3 ) . New Y o r k : G u i l f o r d Press. A l l e n , J . K. ( 1 9 8 8 ) . S e l f - e f f i c a c y i n h e a l t h b e h a v i o r r e s e a r c h and p r a c t i c e . C a r d i o v a s c u l a r N u r s i n g . 2 4 ( 6 ) , 37-38. A n t o n o v s k y , A. ( 1 9 7 9 ) . H e a l t h , s t r e s s , F r a n c i s c o , Ca.: J o s s e y - B a s s .  and  coping.  San  A n t o n o v s k y , A. ( 1 9 8 7 ) . U n r a v e l i n g t h e m y s t e r y o f h e a l t h : How p e o p l e manage s t r e s s and s t a y w e l l . S a n F r a n c i s c o , Ca.: J o s s e y - B a s s . Beck, K. H. ( 1 9 8 1 ) . D r i v i n g w h i l e u n d e r t h e i n f l u e n c e o f a l c o h o l : R e l a t i o n s h i p t o a t t i t u d e s and b e l i e f s i n a c o l l e g e p o p u l a t i o n . A m e r i c a n J o u r n a l o f D r u g and A l c o h o l A b u s e . 8, 377-388. B e c k e r , M. H. ( 1 9 7 4 ) . The h e a l t h b e l i e f m o d e l and s i c k r o l e b e h a v i o r . H e a l t h E d u c a t i o n M o n o g r a p h s , 2.(4) , 409-419. B e c k e r , M. H., Drachman, R. H., & K i r s c h t , J . P. (1972, O c t o b e r ) . P r e d i c t i n g mother's compliance w i t h p e d i a t r i c m e d i c a l r e g i m e n s . The J o u r n a l o f P e d i a t r i c s . 843-854. B e c k e r , M. H., H a e f n e r , D. P., K a s l , S. V., K i r s c h t , J . P., Maiman, L. A., & R o s e n s t o c k , I . M. ( 1 9 7 7 ) . S e l e c t e d p s y c h s o c i a l m o d e l s and c o r r e l a t e s o f i n d i v i d u a l h e a l t h - r e l a t e d b e h a v i o r s . Medical Care, 15(Suppl. 5), 27-46. B e c k e r , M. H., & Maiman, L. A. ( 1 9 7 5 ) . S o c i o b e h a v i o r a l d e t e r m i n a n t s o f c o m p l i a n c e w i t h h e a l t h and m e d i c a l c a r e r e c o m m e n d a t i o n s . M e d i c a l C a r e . 1 3 ( 1 ) , 10-24. B e c k e r , M. H., Maiman, L. A., K i r s c h t , J . P., H a e f n e r , D. P., & Drachman, R. H. ( 1 9 7 7 ) . The h e a l t h b e l i e f model and p r e d i c t i o n o f d i e t a r y c o m p l i a n c e : A f i e l d e x p e r i m e n t . The J o u r n a l o f H e a l t h and S o c i a l B e h a v i o r , 18, 348-366. B e c k e r , M. H., R a d i u s , S. M., R o s e n s t o c k , I . M., Dachman, R. H., S c h u b e r t h , K. C., & T e e t s , K. C. ( 1 9 7 8 ) . Compliance w i t h a m e d i c a l regimen f o r asthma: A t e s t o f t h e h e a l t h b e l i e f model, P u b l i c H e a l t h R e p o r t s . 9 3 ( 3 ) . 268-277. Berish,  CM.  ( 1 9 8 7 ) . The  multidimensionality  of  client  82 r e a d i n e s s f o r t h e r a p y : A f a c t o r a n a l y t i c s t u d y o f a new s e l f r e p o r t measure. P r e s e n t e d a t t h e Annual Canadian Psychology A s s o c i a t i o n Convention. Vancouver. Champion, V. L. ( 1 9 8 5 ) . Use o f t h e h e a l t h b e l i e f m o d e l i n determining frequency of breast s e l f - e x a m i n a t i o n . R e s e a r c h i n N u r s i n g and H e a l t h , 8, 373-379. Champion, V. L. ( 1 9 8 7 ) . The r e l a t i o n s h i p o f b r e a s t s e l f e x a m i n a t i o n t o h e a l t h b e l i e f model v a r i a b l e s . R e s e a r c h i n N u r s i n g and H e a l t h . 10, 375-382. C o u s i n s , N. ( 1 9 7 9 ) . Anatomy o f an i l l n e s s a s p e r c e i v e d b y t h e p a t i e n t : R e f l e c t i o n s on h e a l i n g and r e g e n e r a t i o n . New Y o r k : Bantum. C r i t e l l i , J . W., & Neumann, K. F. ( 1 9 8 4 ) . The p l a c e b o : Conceptual A n a l y s i s of a construct i n t r a n s i t i o n . A m e r i c a n P s y c h o l o g i s t , 3 9 ( 1 ) , 32-39. D i n n e r s t e i n , A. J . , & Halm, J . ( 1 9 7 0 ) . M o d i f i c a t i o n o f p l a c e b o e f f e c t s by means o f d r u g s : E f f e c t s o f a s p i r i n and p l a c e b o on s e l f r a t e d moods. J o u r n a l o f A b n o r m a l P s y c h o l o g y . 75, 308-314. E i s e n , M., & Z e l l m a n , G. L. ( 1 9 8 6 ) . The r o l e o f h e a l t h b e l i e f a t t i t u d e s , s e x e d u c a t i o n , and d e m o g r a p h i c s i n p r e d i c t i n g a d o l e s c e n t s * s e x u a l knowledge. H e a l t h Education Q u a r t e r l y . 13(1), 9-22. E i s e n , M., Z e l l m a n , G. L., & M c A l i s t e r , A. L. ( 1 9 8 5 ) . A h e a l t h b e l i e f model a p p r o a c h t o a d o l e s c e n t s ' f e r t i l i t y c o n t r o l : Some p i l o t p r o g r a m f i n d i n g s . H e a l t h E d u c a t i o n Q u a r t e r l y . 1 2 ( 2 ) , 185-210. E y s e n c k , H. G., & F u r n e a u x , W. D. ( 1 9 8 4 ) . P r i m a r y a n d s e c o n d a r y s u g g e s t i b i l i t y : An e x p e r i m e n t a l and s t a t i s t i c a l s t u d y . A m e r i c a n P s y c h o l o g i s t . 3 9 ( 1 ) , 32-39. F a i r b a n k , J . C. T. ( 1 9 8 6 ) . The i n c i d e n c e o f low b a c k p a i n i n B r i t a i n . I n D. W. L. H u k i n s & R. C. M u l h o l l a n d ( E d s . ) , Back p a i n : Methods f o r C l i n i c a l i n v e s t i g a t i o n and A s s e s s m e n t (pp. 1-12). M a n c h e s t e r , UK: M a n c h e s t e r University Press. F e r g u s o n , M. ( 1 9 8 0 ) . The a q u a r i a n c o n s p i r a c y . L o s CA.: J . P. T a r c h e r I n c .  Angelos,  F e u e r s t e i n , M., & L i n d e n , W. ( 1 9 8 4 ) . P s y c h o b i o l o g i c a l a s p e c t s o f h e a l t h and d i s e a s e . I n P. B. S u t k e r & H. E . Adams ( E d s . ) , C o m p r e h e n s i v e Handbook o f P s y c h o p a t h o l o g y (pp. 8 0 9 - 8 3 9 ) . New Y o r k : Plenum P r e s s . Fincham, J . E.,  & W e r t h e i m e r , A.  I.  (1985).  Using  the  83 h e a l t h b e l i e f model t o p r e d i c t i n i t i a l d r u g therapyd e f a u l t i n g . S o c i a l S c i e n c e & M e d i c i n e . 20.(1) , 101-105. F i n n e s o n , B. E . Lippincott.  ( 1 9 7 3 ) . Low  back p a i n .  Philadelphia:  J.  B.  F i s h e r , S., C o l e J . O., R i c k e l s , K., & U h l e n h u t h , E . H. ( 1 9 6 4 ) . D r u g s e t I n t e r a c t i o n : The e f f e c t s o f e x p e c t a t i o n s on d r u g r e s p o n s e i n o u t p a t i e n t s . I n P. B. B r a d d l e y , F. F l u g e l , & P. Hoch ( E d s . ) , I n t e r n a t i o n a l Congress of Neuropsychopharmacology (pp. 1 4 9 - 1 5 6 ) . New Y o r k : E l s e v i e r . F l e m i n g , G.V. (1976). H e a l t h b e l i e f s o f t h e U. S. population, implications f o r s e l f care. Chicago: U n i v e r s i t y of Chicago. F r a n k , J . D. ( 1 9 6 1 ) . P e r s u a s i o n and h e a l i n g . A c o m p a r a t i v e study o f psychotherapy. Baltimore: John Hopkins P r e s s . F r a n k , J . D. ( 1 9 7 3 ) . P e r s u a s i o n and h e a l i n g . A c o m p a r a t i v e study of psychotherapy (rev. ed.). B a l t i m o r e : John Hopkins U n i v e r s i t y P r e s s . G a z z a n i g a , M.S. (1985). The n e t w o r k s o f t h e m i n d . New G e n e s t , M., & G e n e s t , Champaign: R e s e a c h  social brain: Discovering York: B a s i c Books.  S. ( 1 9 8 7 ) . P s y c h o l o g y and Press.  the  health.  G i v e n , C. W., G i v e n , B. A., G a l l i n , R. S., & Condon, J . W. (1983). Development o f s c a l e s t o measure b e l i e f s o f d i a b e t i c p a t i e n t s . R e s e a r c h i n N u r s i n g a n d H e a l t h . 6, 127-141. G o l d s t e i n , M. S., S i e g e l , J . M., & B o y e r , R. ( 1 9 8 4 ) . P r e d i c t i n g changes i n p e r c e i v e d h e a l t h s t a t u s . American J o u r n a l o f P u b l i c H e a l t h . 7 4 ( 6 ) , 611-614. G r i e v e , G. P. ( 1 9 8 1 ) . Common v e r t e b r a l York: C h u r c h i l l L i v i n g s t o n e .  joint  problems.  New  H a e f n e r , D. P. ( 1 9 7 4 ) . The h e a l t h b e l i e f m o d e l a n d preventive dental behavior. Health Education M o n o g r a p h s, 2 (4) , 420-431. H a r r i s , D. M., & G u t e n , S. ( 1 9 7 9 ) . H e a l t h - p r o t e c t i v e b e h a v i o r : An e x p l o r a t o r y s t u d y . J o u r n a l o f H e a l t h S o c i a l B e h a v i o r . 20. 17-29.  and  H a r r i s , R., L i n n , M. W., S k y l e r , J . S., & S a n d i f e r , R. (1987). Development o f t h e d i a b e t i s h e a l t h b e l i e f s c a l e . The D i a b e t i s E d u c a t o r . 13.(3), 292-297.  84 Hay, M. C. ( 1 9 7 4 ) . The i n c i d e n c e o f low b a c k p a i n i n B u s s e l t o n . I n L. T. Twomeny ( E d . ) , Symposium; Low b a c k p a i n (pp. 5 - 2 9 ) . W e s t e r n A u s t r a l i a n I n s t . T e c h . : P e r t h . H e s t e r , N. R., & M a c r i n a , D. M. ( 1 9 8 5 ) . The h e a l t h b e l i e f model and t h e c o n t r a c e p t i v e b e h a v i o r o f c o l l e g e women: I m p l i c a t i o n s f o r h e a l t h e d u c a t i o n . C o l l e g e H e a l t h . 33, 245-252. H i j e c k , W.T. ( 1 9 8 4 ) . The h e a l t h b e l i e f m o d e l and c a r d i a c r e h a b i l i t a t i o n . Nursing C l i n i c s of North America. 1 9 ( 3 ) , 449-457. H i r s c h f e l d , R. M., K l e r m a n , G. L., Gough, H. G., Barrett, J . , K o r c h i n , S. J . , & C h o d o f f , P. ( 1 9 7 7 ) . A m e a s u r e o f i n t e r p e r s o n a l dependency. J o u r n a l o f P e r s o n a l i t y A s s e s s m e n t . 1 1 ( 6 ) , 610-618. H u l t , L. ( 1 9 7 2 ) . F r e q u e n c y o f symptoms f o r d i f f e r e n t age g r o u p s and p r o f e s s i o n s . I n C. H i r s c h & Y. Z o t t e r m a n ( E d s . ) , C e r v i c a l p a i n (pp. 1 7 - 2 0 ) . O x f o r d : Pergamon Press. J a n z , N. K. (1988) . The h e a l t h b e l i e f m o d e l i n understanding cardiovascular r i s k f a c t o r reduction b e h a v i o r s . C a r d i o v a s c u l a r N u r s i n g . 24.(6) , 39-41. J a n z , N. K., & B e c k e r , M. H. ( 1 9 8 4 ) . H e a l t h b e l i e f m o d e l : a decade l a t e r . H e a l t h E d u c a t i o n Q u a r t e r l y . 2 ( 1 ) , 1-47. J e n k i n s , L. S. ( 1 9 8 8 ) . S e l f - e f f i c a c y t h e o r y : O v e r v i e w and measurement o f key components. C a r d i o v a s c u l a r N u r s i n g . 2 4 ( 6 ) , 36-37. J e t t e , A.M., Cummings, K.M., B r o c k , B.M., P h e l p s , M.C., & N a e s s e n s , J . ( 1 9 8 1 ) . The s t r u c t u r e and r e l i a b i l i t y o f health b e l i e f i n d i c e s . Health S e r v i c e s Research. 16(1), 81-98. J o h n s o n , J . A. ( 1 9 8 6 ) . W e l l n e s s : Thorofare: S l a c k Inc.  A context  for  living.  J o n e s , S. L., J o n e s , P. K., & K a t z , J . ( 1 9 8 8 ) . H e a l t h b e l i e f model i n t e r v e n t i o n t o i n c r e a s e c o m p l i a n c e w i t h e m e r g e n c y d e p a r t m e n t p a t i e n t s . M e d i c a l C a r e . 26, 1172-1184. J o s p e , M. ( 1 9 7 8 ) . The p l a c e b o e f f e c t i n h e a l i n g . L e x i n g t o n , Mass.: L e x i n g t o n B o o k s . J y l h a , M., L e s k i n e n , E., A l a n e n , E . , L e s k i n e n , A. L., & H e i k k i n e n , E . ( 1 9 8 6 ) . S e l f - r a t e d h e a l t h and a s s o c i a t e d f a c t o r s among men o f d i f f e r e n t a g e s . J o u r n a l o f G e r o n t o l o g y . 4 1 ( 6 ) , 710-717.  85  K a t z , F. ( 1 9 6 9 ) . N u r s e s . I n A. E t z i o n i ( E d . ) , T h e s e m i - p r o f e s s i o n s and t h e i r o r g a n i z a t i o n . New Y o r k : Press.  Free  K e l l y , G. R., Mamon, J . A., & S c o t t , J . E . ( 1 9 8 7 ) . U t i l i t y o f t h e h e a l t h b e l i e f model i n e x a m i n i n g m e d i c a t i o n c o m p l i a n c e among p s y c h i a t r i c o u t p a t i e n t s . S o c i a l S c i e n c e and M e d i c i n e , 2 5 ( 1 1 ) , 1205-1211. K i r s c h t , J . P. ( 1 9 7 4 ) . The h e a l t h b e l i e f m o d e l a n i l l n e s s b e h a v i o r . H e a l t h E d u c a t i o n M o n o g r a p h s . 2 ( 4 ) , 387-407. K i r s c h t , J . P . , B e c k e r , M. H., & E v e l a n d , J . P. ( 1 9 7 6 ) . P s y c h o l o g i c a l and s o c i a l f a c t o r s a s p r e d i c t o r s o f m e d i c a l b e h a v i o r . M e d i c a l C a r e . 1 4 ( 5 ) , 422-431. L a n g l i e , J.K. ( 1 9 7 7 ) . S o c i a l n e t w o r k s , h e a l t h b e l i e f s , p r e v e n t i v e h e a l t h b e h a v i o r . J o u r n a l o f H e a l t h and S o c i a l B e h a v i o r . 18, 244-260. L a R o c c a , H.  (1987).  Spine.  12(7, s u p p l . 1 ) ,  and  s8-s39.  L e a v i t t , F. ( 1 9 7 9 ) . The h e a l t h b e l i e f m o d e l a n d u t i l i z a t i o n o f ambulatory care s e r v i c e s . S o c i a l S c i e n c e and M e d i c i n e . 18, 105-112. L e w i n , K. ( 1 9 3 5 ) . A d y n a m i c t h e o r y o f p e r s o n a l i t y . Y o r k : McGraw H i l l .  New  Lundh, L. G. ( 1 9 8 7 ) . P l a c e b o , b e l i e f , and h e a l t h . A c o g n i t i v e e m o t i o n a l model. S c a n d i n a v i a n J o u r n a l o f P s y c h o l o g y . 28, 128-143. Maddox, G. L. ( 1 9 6 4 ) . S e l f a s s e s s m e n t o f h e a l t h s t a t u s , a l o n g i t u d i n a l study of s e l e c t e d e l d e r l y s u b j e c t s . Journal of Chronic Diseases 17 449-460. f  f  Mahard, R. E. ( 1 9 8 8 ) . The CES-D a s a m e a s u r e o f d e p r e s s i v e mood i n t h e e l d e r l y P u e r t o R i c a n p o p u l a t i o n . J o u r n a l o f G e r o n t o l o g y . 43.(1) , 24-25. Mahon, N. E . , & Y a r c h e s k i , A. ( 1 9 8 8 ) . L o n e l i n e s s i n e a r l y a d o l e s c e n t s : An e m p i r i c a l t e s t o f a l t e r n a t e e x p l a n a t i o n s . N u r s i n g R e s e a r c h . 3.7(6) , 330-335. Maiman, L.A., & B e c k e r , M.H. (1974). The h e a l t h b e l i e f m o d e l : O r i g i n s and c o r r e l a t e s i n p s y c h o l o g i c a l t h e o r y . H e a l t h E d u c a t i o n Monographs 2 ( 4 ) , 336-353. f  M a r t u s , R.F. ( 1 9 8 5 ) . The e x p e r i e n c e o f b e l i e v i n g i n t h e h e a l i n g process. (Doctoral d i s s e r t a t i o n , Union f o r E x p e r i m e n t i n g C o l l e g e s Without W a l l s and U n i o n Grad. S c h . PhD. 1 9 8 5 ) . D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l .  86 8523671. M e c h a n i c , D., & H a n s e l l , S. ( 1 9 8 7 ) . A d o l e s c e n t Competence, p s y c h o l o g i c a l w e l l - b e i n g , and s e l f - a s s e s s e d p h y s i c a l h e a l t h . J o u r n a l o f H e a l t h a n d S o c i a l B e h a v i o r . 28, 364-374. M i l l e r , P. ( 1 9 8 8 ) . F i s h b e i n model o f r e a s o n e d a c t i o n applied to cardiovascular health beliefs. C a r d i o v a s c u l a r N u r s i n g , 2 4 ( 6 ) , 38-39. Montano, D. E . ( 1 9 8 6 ) . P r e d i c t i n g a n d u n d e r s t a n d i n g influenza vaccination behavior a l t e r n a t i v e s t o the h e a l t h b e l i e f m o d e l . M e d i c a l C a r e . 24.(5), 438-453. N a g i , S. Z., R i l e y , L. E . , & Newby, L. G. ( 1 9 7 3 ) . A s o c i a l epidemiology o f back p a i n i n a g e n e r a l p o p u l a t i o n . J o u r n a l o f C h r o n i c D i s e a s e s . 26, 769-779. O ' C o n n e l l , J . K., P r i c e , J . H., R o b e r t s , S. M., J u r s , S. G., & M c K i n l e y , R. ( 1 9 8 5 ) . U t i l i z i n g t h e h e a l t h b e l i e f model t o p r e d i c t d i e t i n g a n d e x e r c i s i n g b e h a v i o r o f obese and nonobese a d o l e s c e n t s . H e a l t h E d u c a t i o n Q u a r t e r l y . 1 2 ( 4 ) , 343-351. O r n s t e i n , R., & S o b e l , D. ( 1 9 8 7 ) . T h e h e a l i n g b r a i n : B r e a k t h r o u g h d i s c o v e r i e s a b o u t how t h e b r a i n k e e p s u s h e a l t h y . New Y o r k : Simon & S c h u s t e r I n c . P e n d e r , N. J . , W a l k e r , S. N., S e c h r i s t , K. R., & S t r o m b o r g , M. F. ( 1 9 8 8 ) . D e v e l o p m e n t a n d t e s t i n g o f t h e h e a l t h promotion model. C a r d i o v a s c u l a r N u r s i n g , 2 4 ( 6 ) , 41-43. P o l l o c k , S. ( 1 9 8 6 ) . Human r e s p o n s e s t o c h r o n i c i l l n e s s : P h y s i o l o g i c and p s y c h o s o c i a l a d a p t i o n . N u r s i n g R e s e a r c h . 35, 90-95. Pollock,  S. ( 1 9 8 8 ) .  (personal  communication).  P o l l o c k , S. ( 1 9 8 9 ) . The h a r d i n e s s c h a r a c t e r i s t i c : A m o t i v a t i n g f a c t o r i n adaption. Advances i n N u r s i n g S c i e n c e . 1 1 ( 2 ) , 53-62. R i c k e l s , K. ( 1 9 6 8 ) . C r i t i q u e . I n K. R i c k e l s , N o n s p e c i f i c f a c t o r s i n d r u g t h e r a p y (pp. 1 3 6 - 1 3 9 ) . S p r i n g f i e l d : C h a r l e s C. Thomas. R i c k e l s , K., Baum, N. C , T a y l o r , W., & Raab, E . Humanism i n c l i n i c a l r e s e a r c h . P s y c h o s o m a t i c s . 315-316.  (1964). 5,  R i c k e l s , K., B o r e n , R., & S t u a r t , H. ( 1 9 6 4 ) . C o n t r o l l e d psychopharmacological research i n general p r a c t i c e : A c o n t r i b u t i o n t o t h e methodology o f c l i n i c a l drug  87 e v a l u a t i o n . J o u r n a l o f New  D r u g s . 4,  138-148.  R o b e r t s , N., S m i t h , R., B e n n e t t , S., Cape, J . , N o r t o n , R., & K i l b u r n , P. ( 1 9 8 4 ) . H e a l t h b e l i e f s and rehabilitation a f t e r lumbar d i s c s u r g e r y . Journal of P s y c h o s o m a t i c R e s e a r c h . 2 8 ( 2 ) , 139-144. R o b i n s o n , J . B., & S h a v e r , P. R. ( 1 9 7 3 ) . M e a s u r e s o f s o c i a l p s y c h o l o g i c a l a t t i t u d e s . Ann A r b o r : U. o f Michigan. R o s e n s t o c k , I . M. b e l i e f model. 328-335.  (1974). H i s t o r i c a l o r i g i n s o f t h e h e a l t h H e a l t h E d u c a t i o n M o n o g r a p h s . 4,  R o s e n s t o c k , I . M. ( 1 9 7 4 ) . The h e a l t h b e l i e f m o d e l preventive health behavior. Health Education M o n o g r a p h s . 2 ( 4 ) , 355-385.  and  R o s e n s t o c k , I . M., S t r e c h e r , V. J . , & B e c k e r , M. H. ( 1 9 8 8 ) . S o c i a l l e a r n i n g t h e o r y and t h e h e a l t h b e l i e f m o d e l . H e a l t h E d u c a t i o n Q u a r t e r l y . U 5 ( 2 ) , 175-183. R o s s , M., & O l s e n , J . ( 1 9 8 1 ) . An e x p e c t a n c y - a t t r i b u t i o n model o f t h e e f f e c t s o f p l a c e b o s . P s y c h o l o g i c a l Review 8 8 ( 5 ) , 408-437. R u t l e d g e , D. N., & D a v i s , G. T. ( 1 9 8 8 ) . B r e a s t s e l f - e x a m i n a t i o n c o m p l i a n c e and t h e h e a l t h b e l i e f m o d e l . O n c o l o g y N u r s i n g Forum 1 5 ( 2 ) , 175-179. f  S a n g s t e r , J . I . (1989). D i s e a s e c h a r a c t e r i s t i c s , p a i n , o p t i m i s m , c o p i n g s t r a t e g i e s , and p s y c h o l o g i c a l w e l l - b e i n g of rheumatoid a r t h r i t i s p a t i e n t s . Unpublished master's t h e s i s , U n i v e r s i t y of B r i t i s h Columbia. S a u n d e r s , H. D. ( 1 9 8 3 ) . Back c a r e p r o g r a m : t a p e , [ v i d e o ] . H. D. S a u n d e r s  promotional  S c h e i e r , M. F., & C a r v e r C. S. ( 1 9 8 5 ) . O p t i m i s m , c o p i n g , and h e a l t h : a s s e s s m e n t and i m p l i c a t i o n s o f g e n e r a l i z e d outcome e x p e c t a n c i e s . H e a l t h P s y c h o l o g y . 4 ( 3 ) , 219-247. S c h e i e r , M. F., W e i n t r a u b , J . K., & C a r v e r , C. S. (1986). Coping w i t h s t r e s s : Divergent s t r a t e g i e s o f o p t i m i s t s and p e s s i m i s t s . J o u r n a l o f P e r s o n a l i t y and S o c i a l P s y c h o l o g y . 5 1 ( 6 ) , 1257-1264. S h a p i r o , A. K. ( 1 9 6 4 ) . F a c t o r s c o n t r i b u t i n g t o t h e p l a c e b o e f f e c t . T h e i r i m p l i c a t i o n s f o r psychotherapy. American J o u r n a l o f P s y c h o t h e r a p y . 27, 73-88.  88 S h a p i r o , A. K. ( 1 9 7 1 ) . P l a c e b o e f f e c t s i n m e d i c i n e , p s y c h o t h e r a p y and p s y c h o a n a l y s i s . I n A. B e r g i n & S. G a r f i e l d ( E d s . ) , Handbook o f p s y c h o t h e r a p y and b e h a v i o r chancre: E m p i r i c a l a n a l y s i s (pp. 439-473) . New York: W i l e y . S h a p i r o , A. K., & M o r r i s L. A. ( 1 9 7 8 ) . The p l a c e b o e f f e c t i n m e d i c a l and p s y c h o l o g i c a l t h e r a p i e s . I n S. L. G a r f i e l d & A. E . B e r g i n ( E d s . ) , Handbook o f p s y c h o t h e r a p y and b e h a v i o r c h a n g e (pp. 3 6 9 - 4 1 0 ) . New York: W i l e y . S i e g e l , B. S. ( 1 9 8 6 ) . Love, Y o r k : H a r p e r & Row.  m e d i c i n e and m i r a c l e s .  S k i n n e r , B. F. ( 1 9 3 8 ) . The b e h a v i o r o f o r g a n i s m s . York: A p p l e t o n - C e n t u r y - C r o f t s .  New New  S m i t h , T. W., Pope, M. K., R h o d e w a l t , F., & P o u l t o n , J . ( 1 9 8 9 ) . O p t i m i s m , n e u r o t i c i s m , c o p i n g , and symptom r e p o r t s : An a l t e r n a t i v e i n t e r p r e t a t i o n o f t h e l i f e o r i e n t a t i o n t e s t . J o u r n a l o f P e r s o n a l i t y and S o c i a l P s y c h o l o g y . 5 6 ( 4 ) , 640-648. S p a t z , C., & J o h n s t o n , J . 0. ( 1 9 7 6 ) . B a s i c e d . ) . M o n t e r e y Ca.: B r o o k s / C o l e .  Statistics  L.  (3rd  S t e i n , J . , & U r d a n g , L. ( 1 9 6 6 ) . The Random h o u s e d i c t i o n a r y o f t h e E n g l i s h l a n g u a g e . New Y o r k : Random House. Swalm, D. M. ( 1 9 8 7 ) . P l a c e b o e f f e c t s on v e r b a l and nonverbal expression of pain. Unpublished master's t h e s i s , U n i v e r s i t y o f B r i t i s h Columbia. T i s s u e , T. ( 1 9 7 5 ) . A n o t h e r l o o k a t s e l f r a t e d h e a l t h t h e e l d e r l y . J o u r n a l o f G e r o n t o l o g y . 27, 91-94.  among  T i r r e l l , B. E . , & H a r t , L. K. ( 1 9 8 0 ) . The r e l a t i o n s h i p s o f h e a l t h b e l i e f s and k n o w l e d g e t o e x e r c i s e c o m p l i a n c e i n p a t i e n t s a f t e r c o r o n a r y b y p a s s . H e a r t and L u n g , 9 ( 3 ) , 487-493. U h l e n h u t h , E . H., R i c k e l s , K., F i s h e r , S., P a r k , L. C., L i p m a n , R. S., & Mock, J . ( 1 9 6 6 ) . D r u g s , d o c t o r ' s v e r b a l a t t i t u d e and c l i n i c a l s e t t i n g i n t h e s y m t o m a t i c r e s p o n s e t o p h a r m a c o t h e r a p y . P s y c h o p h a r m a c o l o g i a . 9, 392-418. U l l m a n n , L. P., & K r a s n e r , L. ( 1 9 6 9 ) . A p s y c h o l o g i c a l a p p r o a c h t o a b n o r m a l b e h a v i o r . New J e r s e y : Prentice-Hall. V o u d o u r i s , N.  J . , P e c k , C.  L.,  & Coleman, G.  (1985).  89 Conditioned placebo responses. Journal and S o c i a l P s y c h o l o g y . 4 8 ( 1 ) / 47-53.  of Personality  W i l l i a m s , D. A., & T h o r n , B. E . ( 1 9 8 9 ) . An e m p i r i c a l a s s e s s m e n t o f p a i n b e l i e f s . P a i n . 36, 351-358. Z i m b a r d o , P. ( 1 9 6 9 ) . The c o g n i t i v e c o n t r o l o f G l e n v i l l e : S c o t t Foresman.  motivation.  APPENDIX A Letter, and  Informed  Instruction  Consent Sheet  91  ST. V I N C E N T ' S 749  WEST 33BD  HDSPITAL AVENUE  V A N C O U V E R , B.C. V5Z 2K4 (604) 8 7 6 - 7 1 7 1 FAX  876-6729  Dear Re:  B a c k a n d Neck P a t i e n t R e s e a c h  Study.  I am s e e k i n g y o u r i n v o l v e m e n t i n a s t u d y b e c a u s e y o u a r e a p a s t back and/or neck p a t i e n t o f S t . V i n c e n t s H o s p i t a l . I n o r d e r t o b e t t e r u n d e r s t a n d t h e h e a l i n g p r o c e s s I am s o l i c i t i n g your support i n p r o v i d i n g us w i t h i n f o r m a t i o n about your experience. The r e s u l t s o f t h i s s t u d y may h e l p us i n our approach t o other p a t i e n t s . T h i s w i l l i n v o l v e you f i l l i n g i n t h e enclosed q u e s t i o n n a i r e s a n d m a i l i n g them b a c k t o me i n t h e s e l f a d d r e s s e d , stamped e n v e l o p e t h a t i s i n c l u d e d . I f y o u have o n l y had a s h o r t b o u t o f d i s c o m f o r t , o r o n l y one t r e a t m e n t t h i s i n f o r m a t i o n w i l l s t i l l be v e r y h e l p f u l . I am c o n d u c t i n g t h i s s t u d y a s p a r t i a l f u l f i l l m e n t o f t h e requirements f o r a masters degree i n t h e department o f Counselling Psychology i n the Faculty o f Education a t t h e U n i v e r s i t y o f B r i t i s h Columbia. My s u p e r v i s o r i s D r . B. Long. Your p a r t i c i p a t i o n i n t h i s study w i l l be most a p p r e c i a t e d . A l l t h e i n f o r m a t i o n c o l l e c t e d w i l l be k e p t s t r i c t l y c o n f i d e n t i a l and used f o r r e s e a r c h p u r p o s e s o n l y . When t h e s t u d y i s f i n i s h e d a l l t h e d a t a w i l l be d e s t r o y e d . In k e e p i n g w i t h t h e c o n f i d e n t i a l i t y p l e a s e do n o t p u t y o u r name o r a n y i d e n t i f i c a t i o n on t h e q u e s t i o n n a i r e s . Participation i n this project i s entirely voluntary. In no way w i l l y o u r p a r t i c i p a t i o n , o r l a c k o f p a r t i c i p a t i o n , h a v e any e f f e c t on y o u r r e l a t i o n s h i p w i t h S t . V i n c e n t s H o s p i t a l o r t h e U n i v e r s i t y of B r i t i s h Columbia.  Participating in the Healing Ministry  93  P L E A S E NOTE; T h i s q u e s t i o n n a i r e w i l l t a k e b e t w e e n minutes and 1 hour t o f i l l i n .  read  the instructions  20  1.  Please  carefully.  2.  Please complete t h e enclosed questionnaires answering all t h e questions you can, t r y i n g n o t t o leave any o u t .  3.  Please r e t u r n t h e completed q u e s t i o n n a i r e s , pages 11, i n t h e a d d r e s s e d and stamped e n v e l o p e .  3 to  If y o u wish t o r e c e i v e a copy o f t h e r e s u l t s o f t h e study p l e a s e f i l l o u t t h e i n f o r m a t i o n below, and r e t u r n a t a l a t e r date. Name: Address:  Please  r e t u r n t o : S h i r r a Kenworthy Director of Rehabilitation St. Vincent's Hospital 749 W e s t 3 3 r d A v e . V a n c o u v e r , B. C. V5Z 2 K 4  Medicine.  94  APPENDIX  B  Rosenberg Self-Esteem Lack of S o c i a l  Self-Confidence  Control Faith Life  Scale Subscale  Subscale  i n Therapy  subscale  Orientation Test  Will D e m o g r a p h i c and  to Live  Scale  Ancillary  Questionaire  95  E a c h i t e m i s a b e l i e f s t a t e m e n t w i t h w h i c h y o u may a g r e e or d i s a g r e e . C i r c l e t h e number t h a t r e p r e s e n t s t h e extent t o which you agree o r d i s a g r e e w i t h t h e statement. The more s t r o n g l y y o u a g r e e w i t h a s t a t e m e n t , t h e n t h e l o w e r w i l l be t h e number y o u c i r c l e . The more s t r o n g l y y o u d i s a g r e e w i t h a s t a t e m e n t , t h e t h e h i g h e r w i l l be t h e number y o u c i r c l e . P l e a s e make s u r e y o u a n s w e r e v e r y i t e m a n d t h a t y o u c i r c l e o n l y one number p e r i t e m . Response c a t e g o r i e s :  1. S t r o n g l y a g r e e . 2. A g r e e . 3. D i s a g r e e . 4. S t r o n g l y d i s a g r e e .  1. I f e e l t h a t I'm a p e r s o n o f w o r t h , a t l e a s t on a n e q u a l p l a n e w i t h o t h e r s . 1.  2.  3.  4.  2. I f e e l t h a t qualities.  1.  2.  3.  4.  1.  2.  3.  4.  1.  2.  3.  4.  5. I f e e l I do n o t h a v e much t o be proud o f .  1.  2.  3.  4.  6. I t a k e a p o s i t i v e myself.  1.  2.  3.  4.  1.  2.  3.  4.  1.  2.  3.  4.  1.  2.  3.  4.  1.  2.  3.  4.  I h a v e a number o f g o o d  3. A l l i n a l l , I am i n c l i n e d t h a t I am a f a i l u r e .  to feel  4. I am a b l e t o do t h i n g s a s w e l l most o t h e r p e o p l e .  attitude  7. On t h e w h o l e I am s a t i s f i e d myself. 8. I w i s h for  as  toward with  I c o u l d h a v e more r e s p e c t  myself.  9. I c e r t a i n l y 10. A t t i m e s all.  feel  useless at times.  I t h i n k I am no good a t  96  E a c h i t e m i s a s t a t e m e n t w h i c h y o u may b e l i e v e t o b e v e r y c h a r a c t e r i s t i c o f you, q u i t e c h a r a c t e r i s t i c o f you, somewhat c h a r a c t e r i s t i c o f y o u , o r n o t c h a r a c t e r i s t i c o f you. C i r c l e t h e number t h a t b e s t r e p r e s e n t s t h e l e v e l t o which t h e statement i s c h a r a c t e r i s t i c o f you. T h e more c h a r a c t e r i s t i c you b e l i e v e t h e statement t o be o f you, t h e n t h e l o w e r w i l l be t h e number y o u c i r c l e . T h e more t h e c h a r a c t e r i s t i c i s n o t what y o u c o n s i d e r y o u r s e l f t o be, t h e n t h e h i g h e r w i l l be t h e number y o u c i r c l e . P l e a s e make s u r e y o u answer e v e r y i t e m a n d t h a t y o u c i r c l e o n l y one number p e r i t e m . Response c a t e g o r i e s :  1. V e r y C h a r a c t e r i s t i c . 2. Q u i t e C h a r a c t e r i s t i c . 3. Somewhat C h a r a c t e r i s t i c . 4. N o t C h a r a c t e r i s t i c .  1. When I h a v e a d e c i s i o n t o make, I always ask f o r a d v i c e .  1.  2.  3.  4.  2. I w o u l d r a t h e r be a f o l l o w e r t h a n a leader.  1.  2.  3.  4.  3. I f e e l c o n f i d e n t o f my a b i l i t y t o d e a l w i t h most o f t h e p e r s o n a l p r o b l e m s I am l i k e l y t o meet i n life.  1.  2.  3.  4.  4. I am q u i c k t o a g r e e w i t h t h e o p i n i o n s e x p r e s s e d by o t h e r s .  1.  2.  3.  4.  5. I t i s h a r d f o r me t o a s k someone for a favor.  1.  2.  3.  4.  6. I n a n argument, I g i v e i n e a s i l y .  1.  2.  3.  4.  7. When I go t o a p a r t y I e x p e c t t h a t t h e o t h e r p e o p l e w i l l l i k e me.  1.  2.  3.  8. I t i s h a r d f o r me t o make up my m i n d a b o u t a T.V. show o r m o v i e u n t i l I know what o t h e r p e o p l e t h i n k . 1.  2.  3.  9. I n s o c i a l s i t u a t i o n s I t e n d t o be very self-conscious.  1.  2.  3.  10.I h a v e a l o t o f t r o u b l e m a k i n g d e c i s i o n s by m y s e l f .  1.  2.  3.  4.  9  Response c a t e g o r i e s :  11. 12. 13.  14. 15.  I don't myself.  like  1. V e r y C h a r a c t e r i s t i c . 2. Q u i t e C h a r a c t e r i s t i c . 3. Somewhat C h a r a c t e r i s t i c . 4. Not C h a r a c t e r i s t i c .  t o buy  When I meet new t h a t I won't do  clothes  by  p e o p l e , I'm a f r a i d the r i g h t thing.  I would r a t h e r stay f r e e of involvements with others than r i s k disappointments. I am v e r y c o n f i d e n t j udgement.  about  my  I d o n ' t h a v e what i t t a k e s t o a good l e a d e r .  to  1.  2.  3.  1.  2.  3.  1.  2.  3.  own 1 . 2 . 3 . be 1.  2.  3.  98  Instructions: T h i s i s a q u e s t i o n n a i r e d e s i g n e d t o d e t e r m i n e t h e way i n w h i c h d i f f e r e n t people view c e r t a i n important i s s u e s r e l a t e d t o t h e i r health. E a c h i t e m i s a b e l i e f s t a t e m e n t w i t h w h i c h y o u may agree o r disagree. Beside each statement i s a s c a l e which r a n g e s f r o m s t r o n g l y d i s a g r e e (1) t o s t r o n g l y a g r e e ( 6 ) . For e a c h i t e m we w o u l d l i k e y o u t o c i r c l e t h e number t h a t r e p r e s e n t s the extent t o which you agree o r d i s a g r e e w i t h t h e statement. P l e a s e make s u r e t h a t y o u answer e v e r y i t e m a n d t h a t y o u c i r c l e o n l y one number p e r i t e m . Disagree  s  M 0 D E R A T E L Y  S L I G H T L Y  S L I G H T L Y  M 0 D E R A T E L Y  S T R 0 N G L Y  1  2  3  4  5  6  T R 0 N G L Y  1. 2.  When I g e t s i c k blame.  Agree  I am t o  I can avoid i l l n e s s , take care o f myself.  i f I 1  2  3  4  5  6  1  2  3  4  5  6  1  2  3  4  5  6  5. My g o o d h e a l t h i s l a r g e l y a m a t t e r o f good f o r t u n e .  1  2  3  4  5  6  6. No m a t t e r what I do I'm to get sick.  1  2  3  4  5  6  3  4  5  6  3.  Luck p l a y s a b i g p a r t i n d e t e r m i n i n g how s o o n I w i l l r e c o v e r from an i l l n e s s .  4. I am i n c o n t r o l  7.  o f my h e a l t h .  likely  The m a i n t h i n g w h i c h a f f e c t s my h e a l t h i s what I m y s e l f do. 1  8. M o s t t h i n g s t h a t a f f e c t h e a l t h h a p p e n t o me b y accident.  2  my  9. I f I g e t s i c k , i t i s my own behavior which determines how s o o n I g e t w e l l a g a i n .  1  2  3  4  5  6  1  2  3  4  5  6  99 Disagree  s  M 0 D E R A T E L Y  T R 0 N G L Y  10. 11.  12. 13. 14.  I w i l l stay healthy meant t o b e .  Agree S L I G H T L Y  S L I G H T L Y  M 0 D E R A T E L Y  S T R 0 N G L Y  i f it's 1  2  3  4  5  6  No m a t t e r what I do, i f I am going t o get sick, I w i l l get s i c k .  1  2  3  4  5  6  I f I take the r i g h t actions, I can stay healthy.  1  2  3  4  5  6  I c a n be as h e a l t h y as I want t o b e .  1  2  3  4  5  6  I have l i t t l e my h e a l t h .  1  2  3  4  5  6  i n f l u e n c e over  Answer e a c h i t e m b y c i r c l i n g t h e number w h i c h b e s t i n d i c a t e s how you f e e l / t h i n k . The numbers r e p r e s e n t t h e same p o i n t s f r o m S t r o n g l y Agree t o S t r o n g l y Disagree throughout t h e questionnaire. Do n o t l e a v e o u t a n y q u e s t i o n s . STRONGLY AGREE 1.  2.  3.  DISAGREE STRONGLY DISAGREE  I believe that a therapist w i l l b e a b l e t o h e l p me s o l v e my p r o b l e m s . 1  2  3  4  5  6  7  I am o p t i m i s t i c t h a t t h e outcome o f my t h e r a p y w i l l be p o s i t i v e .  1  2  3  4  5  6  7  I f a f e e was c h a r g e d f o r t h e r a p y I would be w i l l i n g to pay. 1  2  3  4  5  6  7  3  4  5  6  7  3  4  5  6  7  4. I d o n ' t e x p e c t t o f e e l b e t t e r when I ' v e f i n i s h e d t h e r a p y . 1 5.  AGREE  I e x p e c t t o b e somewhat changed a f t e r t h e r a p y .  1  2 2  100 P l e a s e i n d i c a t e t h e e x t e n t t o which you a g r e e w i t h each o f the f o l l o w i n g items. C i r c l e t h e r e s p o n s e t h a t most c l o s e l y m a t c h e s how y o u f e e l . P l e a s e be a s a c c u r a t e and h o n e s t a s y o u c a n t h r o u g h o u t and t r y n o t t o l e t y o u r a n s w e r s t o one q u e s t i o n i n f l u e n c e y o u r answers t o o t h e r q u e s t i o n s . T h e r e i s no c o r r e c t o r i n c o r r e c t answer.  1.  2. 3.  4.  5.  6. 7. 8.  9.  10. 11.  12.  In u n c e r t a i n times I u s u a l l y expect the best.  Strongly Strongly Agree Agree N e u t r a l Disagree Disagree 4  3  2  1  0  4  3  2  1  0  I f something can go wrong f o r me, it will.  4  3  2  1  0  I a l w a y s l o o k on the b r i g h t side of things.  4  3  2  1  0  I'm always optimistic my f u t u r e .  4  3  2  1  0  I e n j o y my friends alot.  4  3  2  1  0  I t s important f o r me t o k e e p b u s y .  4  3  2  1  0  I hardly ever expect things to go my way.  4  3  2  1  0  T h i n g s n e v e r work o u t t h e way I want them t o .  4  3  2  I don't get too e a s i l y .  4  3  2  1  0  I'm a b e l i e v e r in the idea t h a t "every c l o u d has a silver lining".  4  3  2  1  0  I r a r e l y count on g o o d t h i n g s h a p p e n i n g t o me.  4  3  2  I t ' s easy to relax.  for  me  about  1  0  upset  1  0  101  T h i s i s a q u e s t i o n n a i r e d e s i g n e d t o d e t e r m i n e t h e way i n which people view a c e r t a i n l i f e i s s u e . Each item i s a b e l i e f s t a t e m e n t w i t h w h i c h y o u may a g r e e o r d i s a g r e e . C i r c l e t h e number t h a t r e p r e s e n t s t h e e x t e n t t o w h i c h y o u agree o r d i s a g r e e with t h e statement. T h e more s t r o n g l y you agree w i t h t h e statement t h e n t h e l o w e r w i l l be t h e number y o u c i r c l e . The more s t r o n g l y y o u d i s a g r e e w i t h t h e s t a t e m e n t , t h e n t h e h i g h e r w i l l b e t h e number y o u circle. P l e a s e make s u r e t h a t y o u a n s w e r e v e r y i t e m . Response c a t e g o r i e s :  1. S t r o n g l y a g r e e . 2. A g r e e . 3. D i s a g r e e . 4. S t r o n g l y d i s a g r e e .  1. I b e l i e v e I h a v e a s t r o n g w i l l  to live.  2. L i v i n g t o 100+ y e a r s h a s no g r e a t f o r me.  to  live  life  and don't  live  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  3  4  wish  t o a v e r y o l d age.  5. I b e l i e v e I w i l l  2  appeal  3. I w i l l make my l i f e l a s t a s l o n g a s I p o s s i b l y c a n u n d e r any c i r c u m s t a n c e s . 4. I am f r u s t r a t e d w i t h  1  t o 100+ y e a r s .  6. My d e s i r e t o l i v e a l o n g l i f e i s n o t very strong. 7. I e n j o y l i v i n g a n d want t o make t h e m o s t out o f every minute.  1  2  102 APPENDIX I The f o l l o w i n g i n f o r m a t i o n w i l l be u s e d s i m p l y respondents t o t h i s survey.  to describe the  BACKGROUND INFORMATION ON INJURY. 1. P l e a s e c i r c l e t h e a p p r o p r i a t e l e v e l o f y o u r r e c o v e r y a t t h e p r e s e n t t i m e a s i t compares t o y o u r c o n d i t i o n o n y o u r f i r s t d a y of treatment.  _  _  _  no recovery  __  moderate recovery  _^ good recovery  BACKGROUND INFORMATION ON TREATMENT. 2. Have y o u r e c e i v e d a d d i t i o n a l t r e a t m e n t f o r y o u r n e c k o r b a c k , s i n c e you l a s t had p h y s i o t h e r a p y treatments a t S t . V i n c e n t s Hospital? P l e a s e t i c k one. a) . y e s b) . no c).  I f " y e s " p l e a s e i n d i c a t e ; i ) t h e t y p e , i i ) t h e number o f t r e a t m e n t s and i i i ) t h e a p p r o x i m a t e p e r i o d o f t i m e o v e r which these treatments occurred. i) type i i ) no. o f t r e a t m e n t s phys i o t h e r a p y ii) iii) chiropracter i i ) i i i ) naturopathy ii) iii) accupunctur e _ _ i i) iii) other (please describe)  11)  i i i ) time  period  hi)  3. S i n c e i n j u r y i n g y o u r n e c k o r b a c k , h a v e y o u b e e n on a p r e s c r i b e d home e x e r c i s e program? P l e a s e t i c k one. a) . Y e s . b) . No. 4. I f t h e a n s w e r t o q u e s t i o n number 3 was " y e s " , p l e a s e c i r c l e t h e a p p r o p r i a t e l e v e l t h a t r e p r e s e n t s how r e g u l a r l y y o u f o l l o w e d y o u r home e x e r c i s e p r o g r a m . 1• not a t all  2•  3• moderately  4•  5• very regularly  5. To what d e g r e e do y o u f e e l e m o t i o n a l l y s u p p o r t e d b y t h e p e o p l e important t o you. P l e a s e c i r c l e t h e a p p r o p r i a t e number. 1L • no support  2•  3* moderate support  4•  5• great support  103 6.  M a j o r l i f e e v e n t s sometimes b r i n g about changes i n t h e l i v e s o f t h o s e who e x p e r i e n c e them. Sometimes we p e r c e i v e t h e s e e x p e r i e n c e s as b e i n g n e g a t i v e . P l e a s e i n d i c a t e i f you have e x p e r i e n c e d s u c h an e v e n t s i n c e y o u f i r s t s o u g h t t r e a t m e n t a t St. V i n c e n t ' s P h y s i o t h e r a p y Department. Briefly describe this event. I n d i c a t e on t h e f o l l o w i n g s c a l e , t h e e x t e n t on y o u r l i f e t h a t t h e e v e n t had.  T~.  somewhat negative  7.  T.  5. extremely negative  2•  3• moderate health  4•  5• very healthy  When y o u t h i n k a b o u t y o u r b a c k o r n e c k i n j u r y do y o u f o c u s a t t e n t i o n more on b e i n g i n j u r e d o r more on b e i n g h e a l e d ? Please c i r c l e the appropriate l e v e l of your focus.  T.  being injured  9.  47.  impact  When y o u t h i n k a b o u t y o u r s e l f do y o u t h i n k o f y o u r s e l f a s b e i n g v e r y h e a l t h y o r n o t v e r y h e a l t h y when c o m p a r i n g y o u r s e l f t o y o u r own age g r o u p ? Please c i r c l e the appropriate l e v e l . 1• not v e r y healthy  8.  37, moderately negative  of negative  2~7  3~7 being somewhat i m p r o v e d  4~7  5. being healed  To what d e g r e e do y o u m a i n t a i n y o u r p h y s i c a l h e a l t h and t h r o u g h e x e r c i s e and a c t i v i t i e s ? Please c i r c l e the appropriate level. T7 not all  at  2~7  3~7 moderate fitness  4~7  fitness  5. full fitness  BACKGROUND DEMOGRAPHICS. 10.  Sex.  12.  M a r i t a l S t a t u s . ( T i c k one). Single . Married . Divorced/Separated . Widowed .  14.  E t h n i c background.  Thankyou.  .  11. 13.  Age  your  years.  Work S t a t u s . ( T i c k F u l l time Part time/casual Unemployed Housewife Retired  one).  104  APPENDIX C Rosenberg  Self-Esteem  Scoring  105  The  Rosenberg S e l f - E s t e e m This  Scale  (RSE).  s c a l e scored according t o Rosenberg's  i n s t r u c t i o n s h a s a r a n g e o f -6 t o +6.  original  The h i g h e r t h e  score the greater the self-esteem. C o m p a r i s o n o f t h e means i s d i f f i c u l t studied  e l s e w h e r e w i t h t h e same i n s t r u m e n t s  similar. 1.91).  as t h e samples  In t h i s (See T a b l e  o b t a i n e d b y Mahard SD = 6.2) P u e r t o  study 11).  are not  t h e RSE h a d a mean o f 4.72 This i s higher than  (1988) w i t h an e l d e r l y  Rican population  (SD =  t h e mean  ( a g e M = 64.7,  (M = 3.13, SD = . 6 0 ) ,  and  t h e mean o b t a i n e d b y W i l l i a m s a n d T h o r n  WCB  c h r o n i c p a i n p a t i e n t s who h a d a n a v e r a g e a g e o f 37.6  years  (M = 1.78, SD = 1.44).  participants  (1989)  This suggests  with  that the  i n t h e SVH s t u d y h a d h i g h e r s e l f - e s t e e m  those p a r t i c i p a n t s Analysis scale resulted  than  i n t h e above two s t u d i e s .  o f degree o f recovery with t h e r e s c o r e d i n s i g n i f i c a n t m u l t i v a r i a t e group  effect,  F ( 1 2 , 2 8 4 ) = 3.83, p_ <.001, and an e x a m i n a t i o n  of the  univariate  differences  F tests  revealed significant  group  f o r s e l f - e s t e e m , F ( 2 , 1 4 7 ) = 3.64, p_ <.029.  S e e T a b l e 12.  106 Table  11  Means a n d S t a n d a r d D e v i a t i o n s Degree  Self-Esteem for the  o f Recovery Groups.  Variables  self  for  esteem  PR g r o u p  MR  (n = 33)  (n = 71)  M  SD  4.0(2.5)  M  group  SD  group  (n = 46)  M  5.0(1.6)  N o t e . PR = p o o r r e c o v e r y ; MR = m o d e r a t e  GR  4.8(1.7)  r e c o v e r y ; GR =  g o o d r e c o v e r y . H i g h s c o r e s on s e l f - e s t e e m i n d i c a t e self-esteem.  SD  more  107 Table  12  Summary o f MANOVA and f o l l o w u p Recovery Groups  ANOVAS f o r t h e D e g r e e o f  (n = 1 5 0 ) •  Source  SS  df  F  p_<  Between G r o u p s multivariate  12,284  3.83  .001  25. 64  2, 147  3 .64  .029  self-confidence  232. 61  2, 147  2 .14  . 121  locus  of control  455. 71  2, 147  2. 06  . 131  faith  i n therapy  554. 51  2, 147  18. 13  378. 62  2, 147  7. 24  . 001  28. 61  2, 147  1. 31  .273  Univariate self-esteem  optimism will  to  live  .001  108  APPENDIX Correlation Matrix Treatment Measures,  D  f o r Dependent  Measures,  A n c i l l a r y Data, and  Age.  T a b l e 13 C o r r e l a c l o n M a t r i x f o r Dependent M e a s u r e s , T r e a t m e n t M e a s u r e s , A n c i l l a r y D a t a , and Age  ATOT ATOT BTOT CTOT DTOT E TOT FTOT INTENS INTENS2 G2 G3 G4 H1 H 19 H20 H22 H23 H24 H25 H27 TXNIO TXDAYS  1.0000 . 5075 . 1 380 . 2370 -.5170 . 2464 .0282 .0514 - .0735 .0598 . 0868 • . 1964 -.0651 -.1693 .0823 -.2796 -.17 4 0 -.1911 . 0602 -.0210 .0230  CTOT  BTOT .5075'' .0000 . 3759* * .14 14 .4767 • . 2539" .0606 .0886 . 1336 .0124 .0477 . 1084 .0183 .1015 .0414 . 1950* . 1 166 . 1901 .2325' .0967 .0123 1  . 1380 . 3759" 1.0000 .2313* - .3228'' .2383* .0241 . 1 330 -.1039 .0386 .0749 -.1652 - .0553 - .0608 .0267 - .2748'' -.1890 -.2238* .2506 * • -.0436 -.0165  DTOT .2370* .14 14 .2313* 1.0000 -.2952* * .0468 .2338* -.0334 -.1426 -.0196 .0339 - .4425" -.2458 - . 1360 .0598 - . 2658*' - .3 0 5 4 " -.1821 -.2015* -.0219 - .0373  ETOT -.5170'* - .4767" -.3228*' - .2 9 5 2 " 1.0000 - .2831 " -.0136 .0727 .0925 - .0105 - .0325 . 2934" . 1629 . 2669" -.1556 .3532* ' .2393* . 1920* .0477 .0516 .0886  FTOT .2464* .2539" .2383' .0468 -.2831 " 1.0000 -.0782 .0196 -.0808 -.0224 -.0237 -.1100 -.0755 -. 1 8 2 9 .0828 -.2022* - . 1723 -.273 1 " .0578 -.0526 -.0225  INTENS  INTENS2  .0282 .0606 .0241 .2338' -.0136 -.0782 1.0000 -.0235 -.2214* .0374 .2547 " -.2219* .1413 - . 1698 .2237 -.1184 -.1 1 14 .0530 -.0454 .1763 .2270*  0514 0886 1330 0334 0727 0196 0235 0000 0285 0439 0404 0378 1848 0633 2359 0728 0272 0434 0840 0609 6036"  G2 - .0735 -.1336 -.1039 - . 1426 .0925 - .0808 -.2214" .0285 1.0000 -.0189 - .0368 .3505' -.2586 .0225 -.1909 .0314 .0337 .0429 .0265 - .054 1 - .0633  G3 .0598 .0124 .0386 .0196 .0105 .0224 .0374 .0439 .0189 .0000 .9478" .0112 . 2329 .0047 .0057 .0103 .0913 .0186 . 1507 .7074" .2287'  G4 .0868 .0477 .0749 .0339 -.0325 - .0237 .2547" -.0404 - .0368 .9478'* 1.0000 -.0161 . 2349 - .0657 .0308 - .0527 -.1396 -.0082 .14 17 .6926" .2606* '  O  H1 ATOT BTOT  CTOT  DTOT ETOT FTOT INTENS INTENS2 G2 G3 G4 H1 H19 H20 H22 H23 H24 H25 H27 TXNO TXDAYS  H19  •.1964' -.1084 •.1652 -.4425' .2934' •.1100 - .2219" .0378 .3505" .01 12 - .0161 1.0000 -. 1 176 .2499* •.2473 .3578' .3671' . 1505 . 1 120 -.0934 - .0879  • .0651 .0183 • .0553 •.2458 . 1629 •.0755 .14 13 . 1848 •.2586 . 2329 . 2349 • . 1 176 1.0000 . 1032 -.0115 . 1796 .3366' .3846* . 1996 .3261' . 2845'  Note. ATOT - Rosenberg Self-Esceem  H20 - . 1693 - . 1015  •.0608  •.1360 . 2669* * -.1829 - . 1698 .0633  .0225  -.0047 -.0657  .2499* . 1032  1.0000 •.0644 .2408* . 1328 . 1569 .0252 - .0327 • .0544  H22 .0823 -.0414 .0267 .0596 -.1556 .0828 .2237 . 2359 -.1909 -.0057 .0308 - .2473 -.0115 -.0644 1 .0000 - . 1045 -.2919' .0024 -.2594' .0737 .2553'  H23 - . 2796" - . 1950* -.2748** -.2658* ' .3532' ' -.2022* -.1184 .0728 .0314 - .0103 -.0527 .3578* * . 1796 .2408* - . 1045 1.0000 .2895"' .4330" .0432 .0026 .0103  H24 -.1740 - . 1 166 - . 1890 -.3054'' .2393* -.1723 -.1114 .0272 .0337 - .0913 - . 1396 .367 1 " . 3366" . 1328 -.2919' . 2895" 1.0000 . 1785 .1312 -.0885 .0242  H27  H25 -.1911* -.1901 -.2238* -.1821 .1920' - .2731 " .0530 .0434 .0429 .0186 - .0082 . 1505 . 3846" . 1569 .0024 .4330" . 1785 1 .0000 .0280 .1313 .1511  .0602 .2325' .2506" - . 2015' .0477 .0578 - .0454 .0840 .0265 . 1507 .1417 . 1 120 . 1996 .0252 -.2594* .0432 .1312 .0280 1.0000 .0337 .0016  TXNO -.0210 - .0967 - .0436 - .0219 .0516 -.0526 . 1763 .0609 - .0541 . 7074" . 6926" - .0934 .3261' -.0327 .0737 .0026 - .0885 .1313 .0337 1.0000 .6600''  TXDAYS .0230 - .0123 - .0165 - .0373 .0886 -.0225 .2270* .6036* * -.0633 .2287* . 2606" -.0879 .2845' - .0544 .2553* .0103 .0242 .1511 .0016 .6600*' 1 .0000  S c a l e ; BTOT - Lack o f S o c i a l S e l f - C o n f i d e n c e s u b s c a l e o f I n t e r p e r s o n a l Dependency I n v e n t o r y ; CTOT - s u b s c a l e  of C o n t r o l i n Che Healch R e l a t e d H a r d i n e s s  S c a l e ; DTOT - s u b s c a l e F a i t h i n Therapy i n Che C l i e n t Readiness  L i f e O r i e n t a t i o n T e s t ; FTOT - W i l l t o L i v e S c a l e ; INTENS - Che number o f days over which t r e a t m e n t  f o r Therapy I n v e n t o r y ; ETOT - the  a t St. Vincent's H o s p i t a l occurred divided  by che number o f creacmencs r e c e i v e d a t S t . V i n c e n t ' s H o s p i t a l ; INTENS2 - t h e number o f days over w h i c h t o t a l t r e a t m e n t s  o c c u r r e d d i v i d e d by  the c e c a l number of creacmencs; G2 - the t h e r a p i s t s r a t i n g o f the degree o f r e c o v e r y ; C3 - t h e number o f S t . V i n c e n t ' s H o s p i t a l t r e a t m e n t s ; G4 - che number o f days over which che Sc. VincenCs H o s p i c a l creacmencs o c c u r r e d ; HI - the p a t i e n t ' s s e l f - r a t i n g o f r e c o v e r y ; H19 - the amount the pacienc complied w i t h Che home e x e r c i s e program; H20 - Che amount o f e m o t i o n a l s u p p o r t r e c e i v e d ; H22 - n e g a t i v e l i f e  i m p a c t ; H23 - s e l f - r a c i n g  of h e a l c h ; H24 - focus of a c c e n c i o n on b e i n g i n j u r e d o r h e a l e d ; H25 - degree o f p h y s i c a l f i t n e s s m a i n t a i n e d ; H27 - age; TXNO - t o t a l number o f creacments; TXDAYS - t o c a l treacmenc days. • - S I G N I F . LE .01  "  - S I G N I F . L E .001  Ill  APPENDIX E Data A n a l y s i s w i t h t h e Portuguese P o p u l a t i o n Removed  112 Table  14  Means a n d S t a n d a r d D e v i a t i o n s f o r D e p e n d e n t M e a s u r e s f o r the  D e g r e e o f R e c o v e r y G r o u p s w i t h no P o r t u g u e s e .  PR g r o u p  MR  group  GR g r o u p  (n = 20)  (n = 51)  (n = 38)  Variables  M  self-esteem  SD  M  SD  M  SD  18. 4 (5.1)  16 .6(3.8)  16 .0(4.1)  29. 2 (6.5)  28 .5(7.0)  29 .5(6.6)  locus of Control  42. 0(8. 1)  43 .2(10.4)  39 .1(11.3)  faith  16. 9 ( 3 . 1)  14 .1(4.2)  12 .1(3.9)  optimism  20. 2 (5.7)  20 .4(4.8)  22 .8(4.4)  will  15. 0(3. 8)  14 .8(2.5)  14 .4(3.5)  lack of  social  self-confidence  i n therapy  to live  N o t e . PR = p o o r r e c o v e r y ; MR = m o d e r a t e r e c o v e r y ; GR = g o o d r e c o v e r y . Low s c o r e s on s e l f self-confidence, optimism,  locus of control,  and w i l l  to live  more s e l f - c o n f i d e n c e , therapy,  less  esteem, faith  lack of  i n therapy,  i n d i c a t e ; more s e l f  higher control,  social  esteem,  more f a i t h i n  o p t i m i s m , and a g r e a t e r w i l l  to live.  113 Table  15  Summary o f MANOVA and f o l l o w u p ANOVAS f o r t h e D e g r e e o f R e c o v e r y G r o u p s w i t h no P o r t u g u e s e  (n = 1 0 9 ) .  Source  df  F  p<  12,202  2.59  .004  SS  Between G r o u p s Multivariate Univariate self-esteem  78. 73  2, 106  2. 28  . 107  self-confidence  20. 58  2, 106  0. 22  .800  locus  of  control  382. 54  2, 106  1. 78  . 173  faith  i n therapy  306. 60  2, 106  9. 95  . 001  154. 12  2, 106  3. 31  .041  5. 51  2 .106  0. 28  .758  optimism will  to  live  114 Table  16  Critical  Values  (Scheffe Tests) of S i g n i f i c a n c e  Dependent Measures R e c o v e r y w i t h no  Between G r o u p s  esteem  faith  i n therapy  PR  g r o u p ; GR groups  & GR  PR  of  .&  4.40  3.02  0.45  6.85*  6.12  0.03  5.57  = p o o r r e c o v e r y g r o u p ; MR r e c o v e r y group;  significantly  MR  group  3.86  = good  & MR  group  19.61*  optimism  Note.  f o r t h e Degree  Portuguese.  PR  self  f o r the  = moderate  (*)  GR  group  recovery  denotes p a i r s  d i f f e r e n t a t t h e p_ <.05  level.  of  

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