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This study examined relationships between self-blame attributions (behavioral and characterological) and cardiac symptom experiences in 93 patients with cardiovascular disease who were participating in a cardiac rehabilitation program, and whether depressive symptoms was a mediator. Participants completed surveys at the beginning of cardiac rehabilitation (Time 1), three months later at the end of cardiac rehabilitation (Time 2), and 18-months post-cardiac rehabilitation (Time 3). Although path analyses did not reveal depressive symptoms to be a mediator, baseline characterological self-blame was associated with higher reported cardiac symptoms 18 months later. In addition, baseline behavioral self-blame positively predicted depressive symptoms at the end of cardiac rehabilitation. These findings do not support any benefit to engaging in self-blame, and suggest that providers should identify patients who exhibit feelings of self-blame for intervention.
Identifying a potential cause, or creating an attribution, is a salient part of the adjustment process to serious diseases, especially when etiologic factors can be identified. In cardiovascular disease (CVD), a disease for which specific health behaviors such as diet, exercise, and smoking (Roger et al., 2011) have been linked to onset, patients readily search for a cause. Janoff-Bulman (1979) made a distinction between the tendency for some patients to attribute their illnesses to their own behaviors, referred to as behavioral self-blame, and the tendency for some patients to attribute their conditions to their dispositions, referred to as characterological self-blame. Research has been mixed about the health outcomes associated with each type of self-blame. Thus, the present study aimed to examine the associations between self-blame attributions, depressive symptoms, and cardiac symptom experiences (a health status outcome) among patients with CVD participating in a cardiac rehabilitation (CR) program.
Causal Attributions and Adjustment
Previous research has identified a relationship between causal attributions and adjustment to chronic illness (Christensen et al., 1999; Malcarne, Compas, Epping-Jordan, & Howell, 1995). Taylor (1983) outlined a theory of cognitive adaptation that describes the process of adjustment after a traumatic event as involving three themes: a search for meaning, an attempt to regain mastery, and self-enhancement. Taylor described how recently-diagnosed breast cancer patients engaged in a causal search to explain their diagnoses, which subsequently led to attempts to regain mastery and the restoration of self-esteem. Creating an attribution is a salient part of the...