Cognitive and affective features of postpolio syndrome: Illness uncertainty, attributional style, and adaptation

  • Larry L. Mullins
  • John M. Chaney
  • Valerie L. Hartman
  • Kim Albin
  • Bret Miles
  • Shawn Roberson


We examined a sample of 58 individuals with postpolio syndrome (PPS). Subjects completed measures of illness severity, perceived support from the medical community, attributional style, illness uncertainty, and general emotional adaptation. We found elevated levels of emotional distress across several parameters of emotional adaptation. Illness uncertainty and generalized negative outcome expectancies were strongly associated with poorer adaptation; disease severity and perceived support from the medical community did not relate to measures of emotional adaptation. Hierarchical multiple regression analyses revealed that illness uncertainty and both stable and global attributions for negative events contributed significant, unique variance to the prediction of psychological distress beyond the influence of illness severity and demographic parameters. In general, individuals with PPS appear to be at risk for problems in adaptation, and specific cognitive appraisal processes appear to play an influential role in the development of these problems. Our findings have general implications for clinical management of persons with PPS.

Key Words

postpolio syndrome adaptation attributional style uncertainty 


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  1. Abramson, L., Seligman, M., and Teasdale, J. (1978). Learned helplessness in humans: Critique and reformulation.J. Abnorm. Psychol. 87: 49–74.PubMedGoogle Scholar
  2. Abramson, L., Metalsky, G., and Alloy, L. (1989). Hopelessness depression: A theory-based subtype of depression.Psychol. Rev. 96: 358–372.Google Scholar
  3. Affleck, G., Tennen, H., Pfeifer, C., and Fifield, J. (1987). Appraisals of control and predictability in adapting to a chronic disease.J. Pers. Soc. Psychol. 53: 273–279.PubMedGoogle Scholar
  4. Agre, J., Rodriquez, A., and Sperling, K. (1989). Symptoms and clinical impressions of patients seen in a postpolio clinic.Arch. Phys. Med. Rehabil. 70: 367–370.PubMedGoogle Scholar
  5. Agre, J., Rodriquez, A., and Tafel, J. (1991). Late effects of polio: Critical review of the literature on neuromuscular function.Arch. Phys. Med. Rehabil. 72: 923–931.PubMedGoogle Scholar
  6. Alloy, L. (1982). The role of perceptions and attributions for response-outcome noncontingency in learned helplessness: A commentary and discussion.J. Person. 50: 443–479.PubMedGoogle Scholar
  7. Alloy, L., Peterson, C., Abramson, L., and Seligman, M. (1984). Attributional style and the generality of learned helplessness.J. Pers. Soc. Psychol. 46: 681–687.PubMedGoogle Scholar
  8. Bandura, A. (1986).Social Foundations of Thought and Action: A Social Cognitive Theory. Prentice-Hall, Englewood Cliffs, NJ.Google Scholar
  9. Bruno, R., and Frick, N. (1990a). Five year follow-up to the 1985 post-polio survey.Arch. Phys. Med. Rehabil. 10: 886.Google Scholar
  10. Bruno, R., and Frick, N. (1990a). Psychological profile of polio survivors.Arch. Phys. Med. Rehabil. 10: 889.Google Scholar
  11. Bruno, R., and Frick, N. (1991). The psychology of post-polio as prelude to post-polio sequelae: Behavior modification and psychotherapy.Orthopedics. 14: 1185–1193.PubMedGoogle Scholar
  12. Chaney, J., Mullins, L., Uretsky, D., Doppler, M., Palmer, W., Wees, S., Klein, H., Doud, D., and Reiss, M. (1995). Attributional style and depression in rheumatoid arthritis: The moderating role of perceived illness control.Rehabil. Psychol. (in press).Google Scholar
  13. Cohen, J., and Cohen, P. (1983).Applied Multiple Regression/Correlational Analyses for the Behavioral Sciences (2nd ed.), Lawrence Erlbaum, Hillsdale, NJ.Google Scholar
  14. Conrady, L., Wish, J., Agre, J., Rodriquez, A., and Sperling, K. (1989). Psychological characteristics of polio survivors: A preliminary report.Arch. Phys. Med. Rehabil. 70: 458–463.PubMedGoogle Scholar
  15. Coyne, J., and Gotlib, I. (1983). The role of cognition in depression: A critical review.Psychol. Bull. 94: 472–505.PubMedGoogle Scholar
  16. Derogatis, L. (1983).SCL-90-R: Administration, Scoring and Procedures Manual II, Clinical Psychometric Research, Baltimore.Google Scholar
  17. Derogatis, L., and Spencer, P. (1989).The Brief Symptom Inventory: Administration, Scoring, and Procedures Manual, Clinical Psychometric Research, Baltimore.Google Scholar
  18. Devins, G., Edworthy, S., Guthrie, N., and Martin, L. (1992). Illness intrusiveness in rheumatoid arthritis: Differential impact on depressive symptoms over the adult lifespan.J Rheumatol. 19: 709–715.PubMedGoogle Scholar
  19. Frank, R., Chaney, J., Clay, D., Shutty, M., Beck, N., Kay, D., Elliott, T. and Grambling, S. (1992). Dysphoria: A major symptom factor in persons with disability or chronic illness.Psychiat. Res. 43: 231–241.Google Scholar
  20. Fries, J., Spitz, P., and Young, D. (1982). The dimensions of health outcomes: The Health Assessment Questionnaire Disability and Pain Scales.J. Rheumatol. 9: 789–793.PubMedGoogle Scholar
  21. Lazarus, S., and Folkman, S. (1984).Stress, Appraisal, and Coping, Springer, New York.Google Scholar
  22. Leavitt, F. and Katz, R. (1989). Is the MMPI valid for assessing psychological disturbance in pain related organic conditions?J. Rheumatol. 16: 521–526.PubMedGoogle Scholar
  23. Lorish, C., Abraham, N., Austin, J., Bradley, L., and Alarcon, G. (1991). Disease and psychosocial factors related to physical functioning in rheumatoid arthritis.J. Rheumatol. 18: 1150–1157.PubMedGoogle Scholar
  24. McIntosh, J. (1976). Process of communication, information seeking and control associated with cancer.Soc. Sci. Med. 8: 167–187.Google Scholar
  25. Miller, S., and O'Leary, A. (1993). Cognition, stress, and health. In Dobson, K., and Kendall, P. (eds.),Psychopathology and Cognition. Academic Press, San Diego, CA, pp. 159–189.Google Scholar
  26. Mishel, M. (1981). The measurement of uncertainty in illness.Nurs. Res. 30: 258–263.PubMedGoogle Scholar
  27. Mishel, M., and Braden, C. (1988). Finding meaning: Antecedents of uncertainty in illness.Nurs. Res. 37: 98–127.PubMedGoogle Scholar
  28. Mishel, M., Hostetter, T., King, C., and Graham, V. (1984). Predictors of psychosocial adjustment in patients newly diagnosed with gynecological cancer.Cancer Nurs. 7: 291–299.PubMedGoogle Scholar
  29. Ohman, A., and Bohlin, G. (1989). The role of controllability in cardiovascular activation and cardiovascular disease: Help or hindrance? In Steptoe, A., and Appels, A. (eds.),Stress, Personal Control, and Health, Wiley, New York, pp. 257–276.Google Scholar
  30. Peterson, C., Semmel, A., von Baeyer, C., Abramsom, L., Metalsky, G., and Seligman, M. (1982). The Attributional Style Questionnaire.Cogn. Ther. Res. 6: 287–300.Google Scholar
  31. Peterson, C., Kirsch, N., and Tate, D. (1989). Coping with post-polio III. Optimism and cognitive style.Arch. Phys. Med. Rehabil. 70: A25.Google Scholar
  32. Pincus, T., Leigh, F., Callahan, L., Bradley, L., Vaughan, W., and Wolfe, F. (1986). Elevated MMPI scores for hypochondriasis, depression, and hysteria in patients with rheumatoid arthritis reflect disease rather than psychological status.Arthritis Rheum. 29: 1456–1466.PubMedGoogle Scholar
  33. Pittman, T., and Pittman, N. (1979). Deprivation of control and the attribution process.J. Pers. Soc. Psychol. 39: 377–389.Google Scholar
  34. Schulman, P., Castellon, C., and Seligman, M. (1989). Assessing explanatory style: The content analysis of verbatim explanations and the Attributional Style Questionnaire.Behav. Res. Ther. 27: 505–512.PubMedGoogle Scholar
  35. Smith, T., Peck, J., Milano, R., and Ward, J. (1988). Cognitive distortion in rheumatoid arthritis: Relation to depression and disability.J. Consult. Clin. Psychol. 3: 412–416.Google Scholar
  36. Smith, T., Peck, J., and Ward, J. (1990). Helplessness and depression in rheumatoid arthritis.Health Psychol. 9: 377–389.PubMedGoogle Scholar
  37. Sweeney, P., Anderson, K., and Bailey, S. (1986). Attributional style in depression: A meta-analytic review.J. Pers. Soc. Psychol. 50: 974–991.PubMedGoogle Scholar
  38. Tate, D., Forchheimer, M., Kirsch, N., Maynard, F., and Roller, A. (1993). Prevalence and associated features of depression and psychological distress in polio survivors.Arch. Phys. Med. Rehabil. 74: 1056–1060.PubMedGoogle Scholar
  39. Tate, D., Kirsch, N., Maynard, F., Peterson, C., Forchheimer, M., Roller, A., and Hansen, N. (1994). Coping with the late effects: Differences between depressed and nondepressed polio survivors.Am. J. Phys. Med. Rehab. 73: 27–35.Google Scholar
  40. Thompson, R., Jr. (1985). Coping with the stress of chronic childhood illness. In O'Quinn, A. (ed.),Management of Chronic Disorders of Childhood, G.K. Hall, Boston, MA, pp. 11–41.Google Scholar
  41. Thompson, R., Jr., Gustafson, K., Hamlett, K., and Spock, A. (1992). Psychological adjustment of children with cystic fibrosis: The role of child cognitive processes and maternal adjustment.J. Pediatr. Psychol. 17: 741–755.PubMedGoogle Scholar
  42. Weinberg, J., and Levine, S. (1980). Psychobiology of coping in animals: The effects of predictability. In Levine, S., and Ursin, H. (eds.),Coping and Health, Plenum, New York, pp. 39–60.Google Scholar
  43. Weisz, J., Sweeney, L., Proffitt, V., and Carr, T. (1993). Control related beliefs and self-reported depressive symptoms in late childhood.J. Abnorm. Psychol. 102: 411–418.PubMedGoogle Scholar
  44. Zautra, A., Burleson, M., Matt, K., Roth, S., and Burrows, L. (1984). Interpersonal stress, depression, and disease activity in rheumatoid arthritis and osteoarthritis patients.Health Psychol. 13: 139–148.Google Scholar

Copyright information

© Plenum Publishing Corporation 1995

Authors and Affiliations

  • Larry L. Mullins
    • 3
  • John M. Chaney
    • 3
  • Valerie L. Hartman
    • 1
  • Kim Albin
    • 2
  • Bret Miles
    • 2
  • Shawn Roberson
    • 2
  1. 1.Department of BiopsychologyUniversity of Oklahoma Health Sciences CenterUSA
  2. 2.Department of PsychologyUniversity of Central OklahomaUSA
  3. 3.Department of PsychologyOklahoma State UniversityStillwater

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