Coping Strategies, Life Style Changes, and Pessimism after Open-Heart Surgery
Ben-Zur, Hasida, Rappaport, Batya, Ammar, Ronny, Uretzky, Gideon, Health and Social Work
A mail questionnaire was completed by 171 patients two to 20 months after undergoing coronary artery bypass graft surgery (CABG). The post-CABG period was characterized by fewer working hours, a higher level of physical exercise, a reduction in smoking, and more appropriate nutritional habits, compared with the preoperation period. At the same time, the anxiety level of post-CABG patients was higher than that measured in a community sample. Post-CABG high psychological distress (anxiety and mood states) and low functional national capacity were associated with high levels of pessimism and ineffective emotion-focused coping strategies.. These results may be used by social workers in devising psychological interventions aimed at improving post-CABG patients' quality of life and bolstering their coping strategies.
Coronary heart disease is a major physical illness and one of the main causes of death in Western society (Fitzgerald, Tennen, Affleck, & Pransky, 1993; Trzcieniecka-Green & Steptoe, 1994). People who do not die an early and sudden death may have to consider a major surgical treatment, the most prevalent being coronary artery bypass graft surgery (CABG). More than 350,000 such operations are performed annually in the United States alone (Kulik & Mahler, 1993). This operation prolongs the life of patients in cases of triple-vessel disease (Passamani, Davis, Gillespie, & Killip, 1985). It also improves patients' quality of life (Jenkins, Stanton & Jono, 1994), thus providing them with the opportunity for successful rehabilitation.
The present research investigated physical and behavioral rehabilitation of patients after CABG, assessed by improvements in their functional capacity, daily activities, and life style. The study used patients' anxiety and mood states as distress indicators. The research examined the extent to which these outcomes were associated with dispositional coping and pessimism. Such research findings may contribute to the planning of short-term interventions by social workers and other health professionals for use with patients following CABG.
CABG SURGERY OUTCOMES
During the first several weeks after CABG surgery, states of high anxiety or depression are usually observed (see, for example, Pick, Molloy, Hinds, Pearce, & Salmon, 1994; Trzcieniecka-Green & Steptoe, 1994). In long-term research (that is, approximately one year after the operation), the results present a more positive trend in terms of elevation in positive moods (King, Porter, Norsen, & Reis, 1992; King, Reis, Porter, & Norsen, 1993), as well as an increase in quality of life (Kulik & Mahler, 1993). Such outcomes can be accounted for by illness severity factors. In addition, in recent years, the individual's personality and coping characteristics have been investigated as important determinants of post-CABG patients' emotional reactions and rehabilitation.
Lazarus and Folkman (1984) defined coping as the behavioral and cognitive efforts invested by an individual to deal with stressful encounters. Coping is described as having two main components: (1) problem-focused coping, aimed at changing, managing or tolerating the stressful encounter, and (2) emotion-focused coping, aimed at changing or managing the affective and physiological outcomes of the stressful situation, without actually changing the encounter itself. Following Lazarus and Folkman (1984), Carver, Schejer, and Weintraub (1989) developed a classification of coping according to 15 strategies characterized as problem- or emotion-focused strategies and discussed their adaptive and maladaptive values. Problem-focused strategies usually are found to be adaptive or effective when the stressful situation is manageable. The use of emotion-focused strategies seems to be appropriate in the context of uncontrollable situations. …