Department of Clinical and Health Psychology, Utrecht University, PO Box 80140, 3508TC, Utrecht, The Netherlands.
Rheumatology (Oxford). 2012 Feb;51(2):347-53. doi: 10.1093/rheumatology/ker342. Epub 2011 Nov 16.
The aim of this study in employed people with FM was to test the hypothesis that embitterment is a function of the joint experience of invalidation from the work environment and helplessness regarding one's illness.
Sixty-four full-time (36%) or part-time (64%) employed patients with FM (60 females, mean age 45 years) completed the Illness Invalidation Inventory (3*I) to assess work-related discounting and lack of understanding, the Illness Cognition Questionnaire (ICQ) to assess helplessness and the Bern Embitterment Inventory (BEI) to assess embitterment. Hierarchical regression analysis was performed.
Sixteen percent of the participants experienced embitterment levels in the clinical range. The interaction or combination of discounting and helplessness (P = 0.02) and the combination of lack of understanding and helplessness (P = 0.04) were associated with greater embitterment.
The construct of embitterment has substantial face validity and may result from a combination of invalidation and helplessness. Whereas helplessness is a common target of cognitive-behavioural therapy, evidence-based interventions to redress invalidation and embitterment are needed. It is possible, however, to target invalidation by educating people in the work environment about the consequences of FM and patients' valid needs for work that is manageable, given each patient's specific health-related limitations.
本项针对纤维肌痛患者（FM）的研究旨在检验以下假设，即苦恼是工作环境中的挫败感和对自身疾病的无助感共同作用的结果。
64 名全职（36%）或兼职（64%）工作的纤维肌痛患者（60 名女性，平均年龄 45 岁）完成了疾病挫败感量表（3*I）以评估与工作相关的折扣和不理解、疾病认知问卷（ICQ）以评估无助感以及伯尔尼苦恼量表（BEI）以评估苦恼。进行了分层回归分析。
16%的参与者经历了苦恼水平的临床范围。折扣和无助感的相互作用或组合（P=0.02）以及缺乏理解和无助感的组合（P=0.04）与更大的苦恼相关。
苦恼的结构具有实质性的表面效度，可能是挫败感和无助感共同作用的结果。虽然无助感是认知行为疗法的常见目标，但需要针对挫败感和苦恼进行循证干预。然而，可以通过向工作环境中的人们教育纤维肌痛的后果以及患者对于与特定健康相关限制相匹配的可管理工作的合理需求，来针对挫败感进行教育。
