A Vulnerability-Stress-Coping Model Of Adjustment To The Individual Negative Symptoms Of Schizophrenia

This research program represents the first systematic exploration of the subjective experience of alogia, anhedonia, attention problems, avolition, and emotional blunting, and its relation to other objective and subjective factors in schizophrenia. Using a combined rational-empirical approach, a vulnerability-stress-coping model of adjustment to the 5 negative symptoms was developed and tested. Three aspects of appraisal were examined, the primary appraisals of symptom severity and distress, and the secondary appraisal of control. The dimensions of coping with individual symptoms were initially examined using a rational approach, and then empirically using exploratory factor analyses. The Appraisal and Coping with Negative Symptoms Interview Schedule (ACNSIS) was developed for use in Study 1. Both qualitative and quantitative appraisal and coping data were examined for 20 people with negative symptoms. Responses to the ACNSIS demonstrated that appraisals and coping responses varied across participants and individual negative symptoms. Previously employed categorisations of coping behaviour were used to examine and quantify coping. Negative symptom-specific differences were found in awareness of negative symptom presence, degree of agreement with objective ratings, appraisals, reliance on different types of coping, and relations with participant characteristics. Participant coping responses from Study 1 were used to construct the self-report measure used in subsequent studies. Study 2 involved the development, administration, and evaluation of the selfreport Appraisal and Coping with Negative Symptoms Questionnaire (ACNSQ). Both an electronic and paper version of the ACNSQ were developed. The ACNSQ was administered to 120 people with schizophrenia or schizoaffective disorder. Participants were required to make severity, distress and control appraisals for each negative symptom they believed they were suffering from. Following symptom appraisals, a number of symptom-specific and general coping items were presented for each negative symptom. In Study 2A, the multidimensionality of coping responses and the nature of empirically derived subscales were explored individually for each negative symptom. Factor analyses of data from 119 participants resulted in 3 underlying coping dimensions for each symptom. These dimensions, which formed the basis of the ACNSQ coping subscales, were labelled as active, emotional, or avoidant forms of coping. Coping subscales were found to be moderately similar across symptoms. The subscales were shown to be internally consistent and largely independent within symptoms. It was found that the degree of reliance on particular coping subscales was negative symptom-specific, although participant coping was related across symptoms. In Study 2B, the nature of negative symptom appraisals and the psychometric properties of the ACNSQ were examined. There was evidence that the nature of appraisals varied according to negative symptom. Retest reliability analyses indicated that overall, ACNSQ appraisals had a low to moderate degree of reliability while coping subscales demonstrated a moderate to high degree of reliability. Differential associations between appraisal and coping and a range of theoretically related variables provided evidence of the construct validity of the ACNSQ. Study 3 used exploratory techniques to conduct cross-sectional tests of a vulnerability-stress-coping model of adjustment to individual negative symptoms based on the data of the 119 participants. Associations between the objective indicator of negative symptom stressor level, and the subjective experience variables of insight, appraisal and coping were examined in relation to adjustment using a multidimensional approach. Two models of the relations between negative symptom predictors and 3 separate domains of adjustment were investigated. Study 3A provided moderate support for a direct effects model for each of the 5 negative symptoms. Objective negative symptom level, insight, primary appraisals and coping subscales all had significant direct effects on one or more domains of adjustment. In general, higher objective negative symptom levels, higher severity and distress appraisals, and greater reliance on avoidant forms of coping were associated with poorer adjustment. The direct effects of active and emotional forms of coping were less consistent and varied across symptoms and adjustment domains. Study 3B extended these findings by providing a limited amount of support for a mediated effects model. Appraisal and coping were found to act as mediators in some of the relations between objective indicators and subjective experience variables for alogia, attention problems and avolition. There was evidence that the impact of insight on coping was partly mediated by control appraisals. Coping partly mediated the relation between stress and adjustment, and appraisal and adjustment. Overall, this series of exploratory studies make a unique contribution to understanding the subjective experience of the negative symptoms of schizophrenia. The proposed vulnerability-stress-coping model demonstrated utility in identifying variables important in the prediction of adjustment to individual negative symptoms, and in delineating the nature of associations between variables. Further research is required to improve the psychometric properties of the ACNSQ. However, it offers promise as an instrument with which to assess negative symptom appraisals and coping responses, in both clinical and research settings. The present findings have important theoretical and clinical implications concerning the role of subjective and objective factors involved in adjustment to the negative symptoms of schizophrenia. This research program provides a valuable foundation for future research to test the vulnerability-stress-coping model in its entirety.