Self-Blame Attributions and Cardiac Symptom Experiences in Cardiac Rehabilitation Patients: A Preliminary Study

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 adjustment process to serious diseases, especially when etiologic factors can be identified. In CVD, a disease for which specific health behaviors (Roger et al., 2011) have been linked to onset, patients readily search for a cause. For example, Bennett and Marte (2013) content analyzed CVD patients' attributions after enrollment in a CR program. Results showed that patients created at least one causal attribution (sometimes more), and that attributions fell into three main categories: behavioral ones that were controllable, biological ones that were uncontrollable, and stress-related causes. Distinguishing between controllable and uncontrollable attributions is one, among several, means of distinguishing them. Self-Blame Attributions and Adjustment Janoff-Bulman (1979) outlined how behavioral and characterological self-blame attributions may affect adjustment processes. Janoff-Bulman hypothesized that characterological self-blame is maladaptive for adjustment because blame is attributed to one's personality that is presumed to be non-modifiable. This type of internal attribution is similar to what is described in the reformulated learned helplessness model (Abramson, Seligman, & Teasdale, 1978), and is akin to what Heider (1958) suggested social actors create following an event. In contrast, Janoff-Bulman (1979) posited that behavioral self-blame is adaptive for adjustment because blame is attributed to modifiable factors, thereby increasing control appraisals. Enhancements in control appraisals are predicted to be the mechanism that links behavioral self-blame attributions to improved adjustment. It is noteworthy that Janoff-Bulman's predictions about the benefits of behavioral self-blame attributions rest on the presumption that behavior is controllable. In reality, it is likely that the controllability of any given behavior ranges along a continuum of high to low, and that cognitive and motivational processes affect where one views a behavior along that continuum. Despite Janoff-Bulman's (1979) predictions, behavioral and characterological self-blame have been associated with mostly negative adjustment outcomes in samples of patients diagnosed with various forms of cancer. For example, both characterological and behavioral self-blame have been associated with poor psychological functioning in women with breast cancer (Glinder & Compas, 1999). …