Positive and Negative Emotions in Cardiac Patients: The Contributions of Trait Optimism, Expectancies and Hopes

Abstract

ABSTRACT Coronary heart disease (CHC) is the leading cause of death in industrialized societies, and numerous studies have pointed out the impact of emotional distress on CHD morbidity and mortality (e.g., Denollet, 1993, 1997). The study aimed to investigate the inter-relations between several constructs relevant to predicting distress and positive mood in cardiac patients. Participants (N = 67), all diagnosed with CHD and scheduled for surgery in the following days, completed measures related to distress and positive mood, trait optimism, and response expectancies and response hopes for distress and positive mood. Results showed that individuals distinguish between expectancies and hopes, both constructs being related to distress and positive mood. Surprisingly though, the relations between response expectancies/response hopes and mood appear to be mediated by trait optimism, which indicates that response expectancies and hopes for distress and positive mood might be used as coping mechanisms in dealing with stressful situations. KEYWORDS: coronary heart disease, distress, positive emotions, trait optimism, response expectancy, response hope Coronary heart disease (CHC) is the leading cause of mortality in industrialized societies (De Vreede, Gorgels, Verstraaten et al., 1991). Coronary artery disease, the most common form of CHC, represents the major cause of disability in developed countries, being forecasted to become the worldwide major cause of disease burden by 2020 (Murray & Lopez, 1997; Stafford, Berk, Reddy, & Jackson, 2007). While many biological, genetic, environmental or behavioral factors contribute to the onset and development of CHC symptoms, research has shown that emotional distress (e.g., depression, anxiety, life stress) has a considerable long-term impact on CHD morbidity and mortality (Denollet, 1993; 1997; Rozanski, Blumenthal, & Kaplan, 1999). Comorbid depression, for example, is associated with a two- to threefold increased risk for future cardiac events (Lett, Blumenthal, Babyak et al., 2004; Rudisch & Nemeroff, 2003), due to both biological and direct pathophysiological mechanisms (Rozanski et al., 1999). Also, depressive symptoms have a strong negative impact on health related quality of life of CHD patients, even when the medical and surgical treatments are successful (Stafford et al., 2007). Anxiety and depression symptoms are also commonly reported in patients undergoing coronary artery bypass surgery (Andrews, Baker, Kneebone, & Knight, 2000), and they are associated with worse outcomes following cardiac surgery (Pignay-Demaria, Lesperance, Demaria, Frasure-Smith, & Perrault, 2003; Saur et al., 2001). Taking into account the enduring effects of psychological distress on disease prognosis and the quality of life of CHD patients, there is an increased need for research into the mechanisms responsible for distress and well-being in CHD patients. One consistent predictor of distress and well-being in chronic patients is optimism. Trait optimism can be defined as a stable personality trait conveying positive expectations about future outcomes (Scheier & Carver, 1985) and it has been associated with higher levels of immune function (Segerstrom, Taylor, Kemeni, & Fahey, 1998), faster recovery from coronary bypass surgery (Scheier, Matthews, Owens, et al., 1989), a reduction of CHD risk factors in cardiac rehabilitation (Shepperd, Maroto, & Pbert, 1996), and less negative mood at the time of diagnosis and during treatment for cancer patients (Carver et al., 1993; David, Montgomery, & Bovjerg, 2005). Research has constantly shown that optimism and its opposite construct, pessimism, contribute to the variability in the level of emotional distress in stressful situations (Chang, 2001; Scheier & Carver, 1985), optimism being a consistent resilience factor. Also, studies indicate that optimism/pessimism mediate the relation between different coping strategies and emotional distress (David et al. …

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