Coffey Laura, Gallagher Pamela, Desmond Deirdre, Ryall Nicola
School of Nursing and Human Sciences, Dublin City University, Ireland; Dublin Psychoprosthetics Group, Ireland.
Br J Health Psychol. 2014 May;19(2):409-24. doi: 10.1111/bjhp.12051. Epub 2013 May 17.
This study examined the relationships between tenacious goal pursuit (TGP), flexible goal adjustment (FGA), and affective well-being in a sample of individuals with lower limb amputations.
Cross-sectional, quantitative.
Ninety-eight patients recently admitted to a primary prosthetic rehabilitation programme completed measures of TGP, FGA, positive affect, and negative affect.
Hierarchical regression analyses revealed that TGP and FGA accounted for a significant proportion of the variance in both positive and negative affect, controlling for sociodemographic and clinical characteristics. TGP was significantly positively associated with positive affect, while FGA was significantly negatively associated with negative affect. Moderated regression analyses indicated that the beneficial effect of FGA on negative affect was strongest at high levels of amputation-related pain intensity and low levels of TGP.
TGP and FGA appear to influence subjective well-being in different ways, with TGP promoting the experience of positive affect and FGA buffering against negative affect. TGP and FGA may prove useful in identifying individuals at risk of poor affective outcomes following lower limb amputation and represent important targets for intervention in this patient group.
What is already known on this subject? The loss of a limb has a significant impact on several important life domains. Although some individuals experience emotional distress following amputation, the majority adjust well to their limb loss, with some achieving positive change or growth as a result of their experiences. Theories of self-regulation propose that disruptions in goal attainment have negative affective consequences. The physical, social, and psychological upheaval caused by limb loss is likely to threaten the attainment of valued goals, which may leave individuals vulnerable to negative psychosocial outcomes if they do not regulate their goals in response to these challenges. According to the dual-process model of adaptive self-regulation, individuals manage discrepancies between perceived and desired goal attainment by either modifying their life situation or behaviour to fit their goals (tenacious goal pursuit [TGP]) or adjusting their goals to situational constraints (flexible goal adjustment [FGA]). Examining psychosocial adjustment to amputation from this perspective may offer some insight into the diversity of affective outcomes observed. What does this study add? Contributes to our understanding of the mechanisms underlying adjustment to acquired disability. Offers a theory-based explanation for the diversity of psychosocial outcomes observed post-amputation. Identifies important targets for interventions to enhance adjustment in this population.
本研究调查了下肢截肢患者样本中坚定的目标追求（TGP）、灵活的目标调整（FGA）与情感幸福感之间的关系。
横断面定量研究。
98名近期进入初级假肢康复项目的患者完成了TGP、FGA、积极情感和消极情感的测量。
分层回归分析显示，在控制了社会人口学和临床特征后，TGP和FGA在积极情感和消极情感的方差中占很大比例。TGP与积极情感显著正相关，而FGA与消极情感显著负相关。调节回归分析表明，在截肢相关疼痛强度高和TGP水平低时，FGA对消极情感的有益影响最强。
TGP和FGA似乎以不同方式影响主观幸福感，TGP促进积极情感体验，FGA缓冲消极情感。TGP和FGA可能有助于识别下肢截肢后情感结果不佳风险的个体，并代表该患者群体干预的重要目标。
关于该主题已知的内容有哪些？肢体缺失对几个重要生活领域有重大影响。虽然一些个体在截肢后经历情绪困扰，但大多数人能很好地适应肢体缺失，有些人因经历而实现积极改变或成长。自我调节理论提出，目标达成的中断有负面情感后果。肢体缺失引起的身体、社会和心理动荡可能威胁到有价值目标的达成，如果个体不针对这些挑战调整目标，可能易出现负面心理社会结果。根据适应性自我调节的双过程模型，个体通过改变生活状况或行为以符合目标（坚定的目标追求 [TGP]）或根据情境限制调整目标（灵活的目标调整 [FGA]）来管理感知到的和期望的目标达成之间的差异。从这个角度研究对截肢的心理社会适应可能有助于深入了解观察到的情感结果的多样性。本研究增加了什么？有助于我们理解后天残疾适应的潜在机制。为截肢后观察到的心理社会结果的多样性提供基于理论的解释。确定增强该人群适应能力的干预重要目标。
