 

:2V

.7.

LL... .

:5

_.3
.05? 7.... .1

up .u...

$3.31...
.- nil- '1
f...

tilt...
t’z..na.:

.. Pa... 9

§

a . «2,4,:

215:...
kn?

s é... 1.3.1.3...
.. .. .9. . i .,
5114a.) . .3’33.»
2. 1K»-
.9...
.5?

Nu“. v 5:)! $3.31“...
I. ..
v .21 .. . .3: .:
Tﬂv.a.n}.\:rh. .Iﬁ.
l... 5...}! a. .t
.775: ‘1‘3 I."
a

Q“:
.2 .50.
.9le...
I.

36.?

15.17.

1
2..
it.
1

.‘Ar
$1. '9)
30932.91;
)1. .. Sll:

5»me L
:. days“... n...
. . .‘K‘
«Ia
1841”“???
Juan. . i. A.
..

. s.
.4. 5.? Rm...
9......3.......?

. .9
21.9.9...
9:...

v5.
30’.

9mm. vWWW.
(9......3 rﬁ.
3,39% :32... 9M4.

.3... ..

fglmmm; Sunny
.9: 5957...
. r..

O
)1
.3...

1|!
‘1... .9
h,‘\

 

I .9311! I
.17.??2...u«

THE82S

2
2600

 

LIBRARY
Michigan State
University

 

 

 

This is to certify that the

dissertation entitled

The relationship between the stress
appraisal process, coping disposition,
and level of acceptance of disability.

presented by

Darlene Ann Grace Groomes

has been accepted towards fulfillment
of the requirements for

Ph.D. degree in Wation
Counselor Education

Wile

Major professoi

Date July 11. 2000

MS U is an Afﬁrmative Action/Equal Opportunity Institution 0-12771

 

PLACE IN RETURN Box to remove this checkout from your record.
To AVOID FINES return on or before date due.
MAY BE RECALLED with earlier due date if requested.

 

DATE DUE

DATE DUE

DATE DUE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6/01 cJCIRC/DateDue.p65-p.15

THE RELATIONSHIP BETWEEN THE STRESS APPRAISAL PROCESS, COPING
DISPOSITION, AND LEVEL OF ACCEPTANCE OF DISABILITY

By

Darlene A.G. Groomes

A DISSERTATION

Submitted to
Michigan State University
in partial fulﬁllment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY
Department of Counseling, Educational Psychology and Special Education

2000

ABSTRACT

THE RELATIONSHIP BETWEEN THE STRESS APPRAISAL PROCESS, COPING
DISPOSITION, AND LEVEL OF ACCEPTANCE OF DISABILITY

By

Darlene A.G. Groomes

The transactional theory of stress and coping (Lazarus & Folkman, 1984) has
served as a useful lens for examining the interaction between a person and his or her
varying responses to situational demands. Despite this theory’s helpful framework for
understanding the coping dispositions that follow primary appraisals in the general
population, evidence for people with disability is unavailable. It is important to know
about the subjective meanings that people with disability assign to situational demands
that elicit stress, and to understand to what extent their coping disposition and level of
acceptance of disability relate to that stress response. The primary purpose of this study
was to examine the relationship between the stress appraisal process, coping disposition
and level of acceptance of disability for people with disabilities. The sample for this
study consisted of 151 people with disabilities who were randomly selected and asked to
complete four survey questionnaires. Data were collected in person from three distinct
rehabilitation service settings in Michigan.

Principal components analysis in which all information from the newly developed
Stress Appraisal Inventory for Life Situations (SAILS) instrument were analyzed and
revealed ﬁve factor areas that depicted areas of stress appraisal for people with
disabilities. These ﬁve factor areas became the basis for the stress appraisal process

identiﬁed in this study.

Results of this study indicate that a person’s coping disposition is related to two
factors of stress appraisal, Intensity of Stress and Environment. A person’s level of
acceptance of disability is related to two different factors of stress appraisal, Challenge
and Experience, despite the understanding that coping disposition and acceptance of
disability were found to relate to one another among the participants in this study.
Acceptance of disability did not mediate the theoretically recognized relationship
between stress and coping. Post-hoe exploratory analyses were performed to begin to
understand the relationship between the SAILS factors and demographic characteristics
secured in this study.

This investigation is the ﬁrst to empirically examine the stress appraisal process
of certain psychosocial situations for people with disabilities, and the ﬁrst of its kind to
contribute to stress and coping theory by examining the relationship between stress
appraisal, coping dispositions, and level of acceptance of disability. The ﬁndings of this
study indicate that certain subjective meanings that people with disabilities attribute to
stressful situations are related to particular ways of coping and levels of acceptance of

disability. Implications for education, practice, and research are provided.

C0pyﬁght by
DARLENE ANN GRACE GROOMES
2000

DEDICATION
To Tim and Lans for their undeniable love, support, and patience throughout this

entire process.

ACKNOWLEDGMENTS

This dissertation and all the steps leading to its completion would not have been
possible without the efforts of several people. I wish to give thanks to those people who
have graciously helped me in this endeavor.

Speciﬁcally, I would like to express my gratitude to Dr. Michael Leahy, my major
advisor and dissertation chair, for his endless encouragement and tireless guidance
throughout this process. His tremendous amount of support ensured that my research
progressed smoothly and without hindrance. His enthusiasm about the value of research
was a generous gift.

In addition, I would like to thank my dissertation committee members: Dr. Nancy
Crewe, Dr. Mark Reckase, and Dr. Kenneth Rice. I am grateful to each of them in
immeasurable ways for the support they offered throughout the process.

I am also thanka to the various rehabilitation service agencies for providing
open access to prospective participants in this study. Speciﬁcally, I am grateful to the
state director, district managers, orientation leaders, and staff at the four ﬁeld ofﬁces of
the Michigan Department of Career Development-Michigan Rehabilitation Services; the
director, independent living counselor coordinator, and staff at the Capital Area Center
for Independent Living; and the director and staff at Michigan State University’s
Resource Center for Persons with Disabilities.

I am appreciative of those people who openly shared their expertise and
experience with me as I formulated my ideas for this study. In particular, I am indebted

to Dr. Donald Linkowski, Dr. Jan Wallander, and Dr. Norman Endler for taking the time

vi

to talk with me about acceptance of disability, coping, and coping measures so that I
could have a deeper appreciation for these concepts as they related to my study. I want to
particularly thank Dr. Linkowski for generously offering the use of the Acceptance of
Disability Scale ﬁ'ee-of-charge for my research study.

Finally, for her support and willingness to talk through my thinking, I thank Dr.
Rochelle Habeck. Even when she was no longer a member of my educational faculty,
she continued to inﬂuence my personal and professional growth. I would be remiss to
not express a special thank you to my family and friends for their endless support and
understanding. My husband, Tim and dog, Lansing are wonders in this universe and I
beneﬁt from their love on a daily basis. I am forever grateful to them for so many things,
but the hugs and licks on the cheek were most meaningful to me. My parents, in-laws,
and siblings offered their love and support and I could not have accomplished this

without them. Thank you.

vii

TABLE OF CONTENTS

Page

LIST OF TABLES ...................................................................... X

LIST OF FIGURES ..................................................................... xii

LIST OF ABBREVIATIONS ......................................................... xiii

CHAPTER 1

INTRODUCTION ...................................................................... 1
Statement and Signiﬁcance of the Problem ................................. 6
Purpose of the Study ........................................................... 7
Deﬁnition of Terms ............................................................ 8
Assumptions and Limitations ................................................ 10

CHAPTER 2

REVIEW OF LITERATURE ......................................................... 13
Stress and the Appraisal Process ............................................. 14
The Coping Construct ......................................................... 24
Coping Disposition ............................................................ 7-9
Measures of Coping ............................................................ 32
Acceptance of Disability ...................................................... 35
Conclusion ....................................................................... 38

CHAPTER 3

METHODOLOGY ...................................................................... 39
Participants ...................................................................... 40
Instrumentation .................................................................. 42
Procedures ........................................................................ 54
Data Analysis .................................................................... 55

CHAPTER 4

RESULTS ................................................................................. 60
Participants ...................................................................... 50
Characteristics of the Sample ................................................. 61
Principal Components Analysis .............................................. 70
Stress Appraisal Factors ....................................................... 71
Psychosocial Situations that Evoke Stress Appraisal ...................... 81
Stress Appraisal and Coping Disposition .................................... 82
Acceptance of Disability and Stress Appraisal .............................. 86
Acceptance of Disability and Coping Disposition .......................... 38
Acceptance of Disability as a Mediating Variable ......................... 90

viii

Page

CHAPTER 5

DISCUSSION ............................................................................... 97
The Appraisal Process ............................................................. 97
Stress Appraisal Process and Psychosocial Situational Demands ........... 100
Stress Appraisal Process and Coping Disposition .............................. 101
Acceptance of Disability and Stress Appraisal Process ...................... 105
Stress Appraisal Process, Coping Disposition, and Acceptance of

Disability ........................................................................ 107

Post Hoc Analyses ................................................................. 109
Assumptions and Limitations ..................................................... 112
Implications for Education ........................................................ 113
Implications for the Rehabilitation Counseling Practice ...................... 114
Suggestions for Future Research ................................................. 116
Conclusions ........................................................................ 1 18

APPENDICES

A. LETTER OF INVITATION TO PROSPECTIVE MSU-RCPD
STUDENTS ....................................................................... 121

B. CONTACT INFOMRATION FOR PREVIEW COPY OF THE

CISS ............................................................................... 124
C. ACCEPTANCE OF DISABILITY SCALE ................................. 126
D. DEMOGRAPHIC AND GENERAL INFOMRATION

QUESTIONNAIRE ............................................................. 135
E. STRESS APPRAISAL INVENTORY FOR LIFE SITUATIONS ....... 137

F. CONSENT FORM ..............................................................
154

REFERENCES .................................................................................
157

ix

LIST OF TABLES

Table Page

1. Stress Appraisal Subscales for the Stress Appraisal Inventory

for Life Situations .................................................................. 47
2. Participants Categorized by Service Setting and Area ........................ 62
3. Demographic Characteristics of the Sample ................................... 65
4. Age Variable ........................................................................ 66
5. Type of Disability Characteristic of the Sample ............................... 67
6. Total Years with Disability Variable ............................................ 68

7. Participants Categorized by Gender, Race, and Years with Disability. . 69

8. Component Eigenvalues, Percent Variance, and Cronbach Alphas

Based on Principal Components Analysis ....................................... 72
9. SAILS Factor 1: Temporal Stress ................................................ 74
10. SAILS Factor 2: Person ........................................................... 76
11. SAILS Factor 3: Environment .................................................. 78
12. SAILS Factor 4: Challenge ...................................................... 79
13. SAILS Factor 5: Experience ..................................................... 80

14. Relationship between Standard SAILS Score and Psychosocial
Situation ............................................................................. 82

15. Means and Standard Deviations of SAILS Factors for Coping

Disposition .......................................................................... 84
16. Tukey’s HSD Comparisons of Coping Disposition for the SAILS 85
Factors ...............................................................................
17. Range of Raw Scores for Levels of Acceptance of Disability ............... 87

Table

18.

19.

20.

21.

22.

23.

24.

25.

Page
Correlation Matrix among the SAILS Factors to Acceptance of
Disability ...........................................................................
87
Multiple Regression of SAILS Factors on Level of Acceptance of
DisabilIty ........................................................................... 88
Descriptive Statistics of Acceptance of Disability for Coping
Disposition ..........................................................................
89
Tukey’s HSD Comparisons of Coping Disposition for Acceptance of
Disability ........................................................................... 90
Signiﬁcant Relationships among the Demographic Variables .............. 91
Correlation Matrix among Coping Dispositions, SAILS Factors,
and Acceptance of Disability .................................................... 94
SAILS Factors ..................................................................... 98

Comparison of Signiﬁcant Relationships among the Three Variables... .. 109

xi

LIST OF FIGURES

Figure Page
1. Scree Plot of Eigenvalues from Principal Components Analysis. . . .. 70
2. Mediational Model of the Three-Variable System .......................... 107

xii

LIST OF ABBREVIATIONS

AD ...................... Acceptance of Disability Scale

ANOVA ............... Analysis of Variance

CACIL ................. Capital Area Center for Independent Living

CISS ................... Coping Inventory for Stressful Situations

DGIQ ................... Demographic and General Information Questionnaire

MANCOVA ........... Multivariate Analysis of Covariance

MANOVA ............ Multivariate Analysis of Variance

MDCD-MRS ......... Michigan Department of Career Development-Michigan
Rehabilitation Services

PCA .................... Principal Components Analysis

RCPD .................. Resource Center for Persons with Disabilities

SAILS .................. Stress Appraisal Inventory for Life Situations

SPSS .................... Statistical Package for the Social Sciences

xiii

Chapter 1
INTRODUCTION

Times of uncertainty and difﬁculty often reveal how people cope with stress.
Much of the stress and coping literature addresses the notion that all human beings
encounter difﬁcult situations and employ strategies for dealing with and lessening
perceived stress. Antonovsky (1980) maintained that stressors are an inherent part of the
human experience. He further suggested that understanding the subjective meaning of
life situations is not important because of the ubiquitous nature of stressors. Because
stress and tension inundate human reality, it is not important, perhaps even not useful, to
elaborate on understanding the dynamic array of stress responses across humans who
confront difﬁcult situations everyday. Those who espouse the rehabilitation philosophy
might disagree.

The foundation of the rehabilitation philosophy is the belief in the dignity and
worth of people with disabilities. The focus of the philosophy is on the assets of the
person and the resources of the environment (Maki & Riggar, 1997). Appreciating the
internal operation of the individual in conjunction with the external situations posed {Tom
the environment is the exact type of interaction rehabilitation professionals seek to
understand. The prevalence of disability remains high; therefore, it is important to
recognize the different meanings that people with disabilities attribute to life situations.
According to the United States Census Bureau (1999), about 54 million Americans report
having a disability. Twenty-Six million Americans report having a severe disability and
half of these people are between the ages of 22 and 64 (United States Census Bureau,

1999). People with disability face a unique set of difﬁculties that challenge

Antonovsky’s (1980) assertion that subjective meanings of events are not important. It is
not enough to focus solely on what the individual brings to the event when examining
stressful Situations. Rather, it is critical to examine how the environment impacts an
individual’s phenomenological interpretation of the event. In accordance with McCarthy,
Lambert, and Brack (1997), stress resides neither in the person nor in the environment,
but in the interaction between the two. Therefore, uncovering information from person-
environment interactions in stressful Situations may assist in developing an understanding
of stress response in people with disability.

When trying to understand the stress response, speciﬁcally the stress appraisal
process among people with disability, it is useful to examine three areas of psychosocial
impact: employment, health care, and social support. Each of these impacts, when
appropriately managed, results in adaptation to disability that is more successful (Krause,
1996; Livneh & Antonak, 1997). Rehabilitation literature contends that these particular
areas of impact often elicit stress, and improvement upon these impacts can enhance a
person’s sense of well-being and independence (Herrick, Elliott, & Crow, 1994; Krause,
1996; President’s Committee on Employment of People with Disabilities, 1994; Rintala,
Young, Hart, Cleannan, & Fuhrer, 1992; Wright, 1980).

It is also critical to consider four speciﬁc aspects of subjective response. The ﬁrst
aspect of subjective response examines the extent to which the person appraises the
situation as stressful. If a person believes that the situation is not at all stressful, then he
or she makes a benign or irrelevant appraisal of the situation. The second aspect
concerns the type of stress appraisal. Speciﬁcally, a person will appraise a situation as

stressful if they perceive harm, threat, or challenge from the situation. The third aspect is

the level of experience with the stressﬁrl situation. This aspect involves a person’s
assessment of how often he or she experiences a situation, which inﬂuences the extent of
consequences to his or her sense of well-being. According to Shontz (1975), stressful
situations become less threatening as familiarity increases and conﬁdence in effective
coping mechanisms is learned. Therefore, a person will experience less consequence to
his or her sense of well-being when particular situations occur more often. The ﬁnal
aspect of subjective response is the location of the difﬁculty or uncertainty in the
situation. This aspect involves a person’s perception that the source of difﬁculty and
uncertainty is located within themselves or within some external element (i.e., person or
thing) from the environment. If the source of difﬁculty is located within the
environment, the person with disability will feel more consequence to his or her sense of
well-being or level of independence because the environmental barrier hinders individual
choice or action.

Psychology literature (Chaturvedi, 1983; Cox & Ferguson, 1991; Lazarus &
Folkman, 1984a; Paterson & Neufeld, 1989; Shontz, 1975) focuses on these four aspects
because they illustrate the nuances of the situational demand, thus inﬂuencing the person-
environment interaction involved with stress appraisal. It is important to clearly
understand this interaction because it is the capstone of the rehabilitation philosophy.
Rehabilitation research has not examined the assumptions that lie within the four aspects
of subjective response. Therefore, examining the stress appraisal process for people with
disability is one step in that direction. More fully understanding whether a person with a
disability has a stress response to any of these psychosocial areas, and the subjective

nature of that person-environment interaction, would assist in creating intervention

programs to mediate negative evaluations of one’s well-being or quality of life.
Consequently, the advancement of knowledge about how such persons might appraise
these Speciﬁc life situations is a much-needed contribution to rehabilitation literature.

While it is important to uncover the subjective meanings that people with
disability assign to speciﬁc life situations, it is equally important to apply a theoretical
model of coping that incorporates the role of primary appraisal to overall coping effort.
One such model is the transactional model of coping (Lazarus & F olkrnan, 1984a).
According to Lazarus and Folkman (1984a, 1984b), people manage internal and external
demands, and when they think these demands are taxing or exceeding their resources,
they employ a coping process. Both the characteristics of the person and the environment
contribute to the meaning that a person assigns a speciﬁc event. This process is primary
appraisal, and serves as a catalyst for a person’s coping response (Lazarus & F olkrnan,
1984a). The theory implies that a person’s attribution of person-environment interaction
to a speciﬁc event naturally evokes a coping response for effectively dealing with the
taxing situation. Having a disability or living in social environments that hinder quality
of life for people with disability may promote demands that exceed a person’s resources
for dealing with certain situations. The transactional theory of coping explicitly attempts
to explain how people manage themselves at times when internal and external demands
exceed their resources. Thus, it would be important to apply this theory to the stress
appraisal process of people with disability who sometimes face a multitude of taxing
situations.

Coping theory literature has ﬁrrther deﬁned speciﬁc types of coping responses, or

coping dispositions, that vary according to a person’s method of dealing with stress.

While researchers differ on narrring these styles, the most popular coping dispositions are
identiﬁed as problem-focused, emotion-focused, and avoidance (Billings & Moos, 1984;
Endler & Parker, 1990; Lazarus & Folkman, 1984b; Pearlin & Schooler, 1978; Skodol,
1998; Snyder & Dinoff, 1999; Stone, Helder, & Schneider, 1988). Research about
primary and secondary appraisal processes supports the theory that persons with
problem-focused coping fare better than those with emotion- or avoidance-focused
coping dispositions because of their ability to more clearly resolve taxing situations
(Billings & Moos, 1981; McCarthy, Lambert, & Brock, 1997; Swindle, Heller, & Lakey,
1988). Due to the lack of investigation in coping with stress among people with
disability, it is difﬁcult to determine whether coping disposition is a contributing factor to
the subjective meanings assigned to life situations, and whether particular coping
dispositions of people with disability relate to the extent of stress appraisal in a particular
situation. It is important to resolve these difﬁculties so that what is already understood
about the transactional model of coping can be enhanced and so that the gap that exists in
rehabilitation literature can be lessened.

Another factor that might inﬂuence a person’s subjective understanding of a life
situation is acceptance of disability. Linkowski (1971) and Wright (1983) stated that
acceptance of disability requires a process of value change in four areas: enlargement of
scope of values, subordination of physique, containment of disability effects, and
transformation from comparative to asset values. Livneh and Antonak (1997) called this
adaptation to disability, and deﬁned it as the process of gradually approaching person-
environment congruence. Here, the interaction between the person and the environment

promotes such a sense of well—being that psychosocial impacts may not readily elicit need

for stress appraisal. However, having a disability may be stressful (Brarnston, Fogarty, &
Cummins, 1999) regardless of level of acceptance or congruence, and it would be
important to examine whether such acceptance inﬂuences a person’s appraisal of a
particular psychosocial situation. Moreover, it would be helpful to understand whether
coping disposition and levels of acceptance of disability relate with the appraisal process
for people with disabilities. Rehabilitation literature has not explored whether such
relationships exist.

Nonetheless, to more fully understand the subjective meanings made by people
with disability in relation to their life situations it may be important to examine the
relationship among these three constructs. Such examination has a threefold purpose: 1)
it may enhance the limited understanding of stress and coping with disability, 2) it may
contribute to the rehabilitation literature that appears to need more understanding of the
stress and coping processes of people with disabilities, and 3) it may establish rationale
for intervention programs that speciﬁcally aim to enhance the well-being and
independence of people with disability.

Statement and Signiﬁcance of the Problem

The transactional theory of stress and coping has served as a useful lens for
examining the interaction between a person and his or her varying responses to
situational demands. While the theory has provided a framework for understanding the
coping dispositions that follow primary appraisals in the general population, evidence for
people with disability is unavailable. It is important to know about the subjective
meanings that people with disability assign to situational demands, particularly in

situations that illustrate employment, health care, and social support impacts of disability.

Questions remain as to whether a person perceives a situation as stressful, benign, or
irrelevant. Speciﬁc to this aspect of appraisal, there is a need to establish support for
whether the type of stress appraisal, the level of experience with the stressor, and/or the
locus of stressor relates to a person’s coping disposition. There is need for insight into
whether acceptance of disability relates to speciﬁc stress appraisals. Additionally, if
acceptance of disability, coping disposition, and stress appraisal process relate to one
another, it would be important to clarify whether there is a mediation effect for
acceptance of disability between coping disposition and stress appraisal. Given the
transactional theory of coping, it can be assumed that people with disability offer new
perspective on the interaction between person and environment when assessing stress and
coping response. This study aimed to uncover such an interaction and expose the
elements that draw out and relate to stress appraisals for people with disability. The
primary appraisals of people with disability can offer a unique insight into their
experience with life situations. It was important to discover what qualiﬁed as a stressful
situation and what did not. Later, it may be necessary to examine how to foster effective
coping processes for people who appraise a situation as stressful.
Purpose of the Study

The purpose of this study was to explore the relationship between the stress appraisal
process, coping disposition, and level of acceptance of disability. This study represents a
ﬁrst attempt at gaining insight into the subjective meaning that people with disability
attribute to stressful situations. Psychology literature grounds the relationship between
stress and coping in various theoretical frameworks. This study made a unique

contribution to the rehabilitation counseling profession by applying the transactional

theory of coping, and enhancing knowledge about whether acceptance of disability is a
key factor in understanding the relationship between stress and coping.
Speciﬁc research questions aimed at achieving this purpose were:
1. Which psychosocial situations are more likely to evoke a stress appraisal from
persons with physical or emotional disability?
2. Do type of stress appraisal, level of experience with the situation, and/or locus of
stressor relate to the person’s coping disposition?
3. Does acceptance of disability relate to stress appraisal?
4. Does acceptance of disability relate to coping disposition?
5. Does acceptance of disability mediate the relationship between coping style and
stress appraisal?
Data were collected and analyzed from several instruments that explicated the stress
appraisal process, coping disposition, and acceptance of disability in an attempt to
address these questions.
Deﬁnition of Terms
Knowing the meaning of terms in this study was helpful in meeting the purpose of
this study. The deﬁnitions of terms provided below have been adapted from the literature
(Chaturvedi, 1983; Kohn, 1996; Lepore & Evans, 1996; Paterson & Neufeld, 1989;
Shontz, 1975; Wright, 1983):
Disability: any person who has a physical or mental impairment which
substantially limits one or more major life activities; one who has a record of such

impairment; or one who is regarded as having such an impairment.

Appraisal process: The progressive steps taken to evaluate the demands of a

 

particular life situation as it inﬂuences one’s well-being. The key to understanding a
person’s evaluation of demands is the interaction between individual characteristics of
the person and the environment that surrounds that person. An appraisal can fall into one

of three categories: stress, benign, irrelevant. A stress appraisal is a potentially negative

 

evaluation of one’s well-being. There is a perception that one’s sense of well-being is in

doubt. The extent of stressful appraisal can range ﬁom extremely stressful to not at all

 

stressful. A benign gipraisal is a positive evaluation of one’s well-being. Often the

 

appraisal signiﬁes a sense of security. An irrelevant appraisal is a neutral evaluation of

 

one’s well-being. No assessment of the implications for harm or challenge occurs.

Types of stress appraisals: Three speciﬁc types of stress appraisal exist. Harm

 

refers to damage already done and usually requires undoing or reinterpreting what is
already past. Perception of too much harm or loss results in depression. Meat refers to
anticipatory evaluation whereby a person prepares for harm that may come. Challenge
refers to expectation of gain with a positive outlook and enthusiasm toward the life
Situation.

Level of experience with the situation: Evaluation of the history with a particular

 

situation and the direct negative effects of the stressor on the well-being of the person.

Rare experience means the person has not had previous history with the situation and the

 

stress that results is likely to have a negative effect on the psychological well-being of the

individual. Daily experience means the person has previous history with the situation and

 

the stress that results is likely to have little effect on the overall psychological well-being

of the individual.

Locus of stressor: The source of difﬁculty or uncertainty perceived from the

 

situation. Person locus refers to some characteristic, value, or goal within the individual

 

that precipitates the stress appraisal. Environment locus refers to an external event that

 

imposes modiﬁcation upon the individual, which incites the stress appraisal.
Coping disposition: An enduring style of employing strategies to lessen danger

and enhance well-being. Problem-focused refers to a style of coping that lessens the

 

effect of the original trigger. Emotion—focused refers to a style of coping that lessens the

 

heavy extent of the stress response. Avoidance refers to a style of coping that alters the
perception of the stressor altogether.

Accgtance of Disability: A state of not resigning to the disability or devaluing

 

the self. When a person enlarges their scope of values, subordinates physique, contains
disability effects, and transforms comparative-status values into asset values, then he or
she accepts having a disability.
Assumptions and Limitations

It is important to appreciate a number of assumptions and limitations in this study.
A major assumption underlying this study concerns the validity of self-report to assess
stress appraisal, coping disposition, and acceptance of disability. Self-report is a
reasonable way to obtain this information because each of these constructs exist in the
perceptions or judgments about one’s self. This may inﬂuence the validity of responses
differently than if employment of direct observation of behavior in stressful situations
occurred. While limited in validity, many studies interested in coping with stress have

used self-report as a method of data collection (Billings & Moos, 1984; Brarnston,

10

Fogarty, & Cummins, 1999; Endler & Parker, 1990; F olkrnan, Lazarus, Dunkel-Schetter,
DeLongis, & Gruen, 1986; Revenson & Felton, 1989).

A second assumption of this study is the use of the transactional theory of coping.
In order to understand the stress appraisals and coping dispositions of people with
disability, this guiding theoretical framework is applicable. It is a reasonable framework
because it appreciates person-environment interactions; similar to what the rehabilitation
philosophy promotes as an individual’s adaptation to disability.

One limitation of this study involved the generalizability of the results. The study
was limited to adults with physical or emotional disabilities who come from speciﬁed
regions of Michigan. Individuals from the sample may be similar to other individuals
with physical or emotional disabilities who might encounter psychosocial situations that
evoke stress appraisals. This study focused on an array of physical and emotional
disabilities in an attempt to best represent individuals with disabilities in Michigan or
elsewhere.

A second limitation concerned weaknesses in instrumentation. The author
developed and ﬁeld-tested two of the instruments. Therefore, test-retest reliability, other
forms of internal consistency reliability, and evidence of validity were limited. Because
this study was the ﬁrst of its kind to examine the subjective meanings of situations that
evoke stress appraisals, it was reasonable to expect such weakness. In addition,
compromised internal validity may have existed if techniques for gathering data were not
consistent across the different scheduled dates of instrument administration.

A ﬁnal limitation involved the nature of the design of the study. This study was a

one-time exploration of the relationship between stress appraisal process, coping

ll

disposition, and acceptance of disability, which assumed that these relationships can be
understood without employing a longitudinal framework of inquiry. In addition, the
design of the SAILS relies on hypothetical situations rather than real life situations.
Since this study was the ﬁrst of its kind, it was practical to establish relationships among

the variables and then employ designs that are more sophisticated later.

12

Chapter 2
REVIEW OF THE LITERATURE

This chapter provides a review of the literature pertaining to the relationship
between the stress appraisal process, coping disposition, and level of acceptance of
disability. The review begins with literature on stress research and deﬁnes a useful
theory to apply to people with disability when examining their stress and coping
processes. Discussion about the importance of primary appraisal and four subjective
evaluation areas of this process takes place to understand the components that ﬁarne a
stress appraisal. The review provides description of the various stress responses that
result from the appraisal process and surveys rehabilitation literature to provide
information about employment, healthcare, and social support as psychosocial elements
known to attract a stress response. There is limited empirical research pertaining to the
primary appraisal processes for people with disability.

The review then moves to discuss the construct of coping within the framework of
transactional theory of stress and coping. This chapter provides information about coping
with disability to highlight coping efforts and adaptation to disability. Psychology
literature addresses coping disposition as a component of personality and as a
contributing partner in the overall base of coping process theory. The review asserts that
examining personality traits separate from coping disposition is not necessary. A review
of instrumentation used to measure coping disposition occurs, with speciﬁc attention paid
to the Coping Inventory for Stressful Situations (Endler & Parker, 1994).

Finally, the review deﬁnes acceptance of disability, describes its contribution to

rehabilitation literature and explores its place in stress and coping literature. A review of

13

The Acceptance of Disability Scale (Linkowski, 1971) supports its utility in this proposed
study. Highlights from several empirical studies offer support for this construct.
Stress and the Appraisal Process

Response, stimulus, and interactional models of stress are prominent in
psychology literature (Romano, 1992). Each has made inﬂuential contribution to stress
theory. Selye (1976) discussed the response model of stress in terms of an individual’s
physical response to a demand. How the physiology of a human being responded to a
positive or negative event was the focus of this model. The stimulus model of stress
focused on the life events (i.e., stressors) themselves and what effect these stressors had
on the physical well-being of the person. Holmes and Rahe (1967) developed
instruments that measure life events and their relationship to physical health. However, a
major criticism of the stimulus model was its exclusion of individual differences in
experience of the stressor (Romano, 1992).

Therefore, Lazarus and F olkrnan (1984a) proposed a third conceptualization of
stress, the interactional or transactional model. Stimulus and response models of stress
may have limited utility because a person deﬁnes stimulus as stressful only in terms of
their stress response (Lazarus & Folkman, 1984a). The analysis of stress should consider
differences among individuals and their differing responses to situational demands
(Zeitlin and Williamson, 1994). In the transactional model, a person’s appraisal of the
event in terms of risk to well-being and the ability to cope with the situation mediates the
impact of the stressor. The deﬁnition of stress in this model emphasizes the relationship

between the person and the environment (Lazarus & Folkman, 1984a).

14

When measuring life events, items should be representative of the life experiences
of the population studied (Cohen, 1988) and should examine effects as transactions
between the individual and environment (Monroe & Peterman, 1988). Here, evidence
indicates that the Lazarus and Folkman (1984a) transactional model of stress is preferred
over stimulus or response models. According to Tetrick (1992), it is an individual’s
perception or cognition of the environment that inﬂuences his or her behavior; therefore,
the transactional model of stress may be a more powerful determinant of the types of
evaluations of events that people make. Rarely is the measurement of stressors for
people with disabilities made. It becomes important then to develop appropriate
instruments to measure life experiences that represent people with disabilities and to
frame these instruments in the transactional model or theory of stress.

Deﬁning the term “stress” is a difﬁcult task, and researchers in the ﬁeld do not
support such an attempt (Paterson & Neufeld, 1989; Romano, 1992). Instead, researchers
appear interested in focusing on three aspects of stress: stressors, or the physical and
environmental conditions that a person perceives as threatening (Lepore & Evans, 1996);
primary appraisal, or the evaluation of a particular encounter as relevant to well-being
(Cox & Ferguson, 1991); and stress response, or the collective consequences of such
stressors within the individual (Paterson & Neufeld, 1989). Rehabilitation counseling
literature sporadically addresses these three aspects of stress. Instead, focus has been on
coping strategies and coping with disability theories, which have omitted discussion
about aspects of stress. Consequently, a limited perspective on the coping process of
people with disability actually exists. Information about the meaning a person assigns to

a particular stressor might then inform the type of coping process that the person uses.

15

Stressors. According to Lepore and Evans (1996), stress research focuses on ﬁve
categories of stressors. Cataclysmic stressors are sudden life events that impose great
adjustment to the lives of people (e. g., natural disasters, war, airplane wrecks); major life
events are often unchangeable events that impose great adaptive demand (e. g., divorce,
job loss, disability); daily stressors are ongoing stressors that are experienced day-to-day
(e. g., ﬁnancial problems, interruptions); ambient stressors are difﬁcult environmental
conditions that impose demands on people (e. g., noise, trafﬁc congestion, crowding); and
role stressors are ongoing difﬁculties related to fulﬁlling obligations (e.g., excessive
workload, lack of social support, lack of control).

People with adventitious disabilities have experienced the “major life event”
category of stressor and are faced with having to experience additional categories on a
daily basis. While it would be important to examine the extent to which people with
disabilities deal effectively with multiple stressors, it must not be assumed that people
with disabilities live in a constant state of frustration or stress from having experienced a
major life event (Wright, 1983). Fogarty, Bramston, and Cummins (1997) supported this
idea when they found that both the general population and a group of individuals with
intellectual disabilities identiﬁed many of the same stressors. It appeared that having a
disability did not cause people to react to stress any differently.

It is not unusual for people to think that major catastrophes such as loss of job,
divorce, or major accident are stressful events. However, Zautra, Guamaccia, Reich, and
Dohrenwend (1988) suggested that small events, like an argument with a ﬁiend, a
parking ticket, or encountering a rude sales associate can also be stressful and lead to

poor psychological or physical health outcomes. Bramston, Bostock, and Tehan (1993)

16

examined self-perceived stress levels of people with mild intellectual disabilities by
administering the Daily Stress Inventory (DSI; Brantley & Jones, 1989). The DSI detects
variations in the frequency and impact of rrrinor stressors (Bramston, et a1., 1993). These
researchers found that on average, each of the 28 participants experienced seven stressful
events per day, with the most stressful events involving difﬁculties in interpersonal
relationships. Bramston, F ogarty, and Cummins (1999) found that 459 people with a
rrrild intellectual disability reported experiencing eight to nine stressors from a list of 31
stressors listed on the Lifestress Inventory. While this study measured the subjective
stress levels of persons with a mild intellectual disability, the authors did not attempt to
uncover the meaning behind the event in question.

Consequently, rehabilitation researchers need to categorize the level of experience
with the situation that people with disability have in two ways, rare experience and daily
experience. This categorization may help to not support disability-related effects alone,
and it may assist in exposing some meaning behind a person’s appraisal of an event.

To summarize, people with disability may not sense speciﬁc types of stressors
that differ from stressors of the general population. Life situations occur rarely or daily,
each of which exposes the level of experience a person has with a stressor that comes
from that life situation. Use of the transactional model clariﬁed the impact of a stressor
as mediated by a person’s appraisal of the event, and help to discover the person-
environment interactions that assist in making a primary appraisal. In addition, it
provided perspective on the coping process of person with disability. Rehabilitation
research needs to develop instruments that fully represent the life experiences of people

with disability. It is not powerful enough to develop and use instruments that measure

17

stress levels that do not consider the subjective evaluation of events for people with
disability. Even more critical is the need for instruments to probe deeper into the
meaning behind the event. To facilitate this, it is necessary to understand the construct of
primary appraisal.

Primary Appraisal. Those who contribute to the literature on stress mainly focus

 

their efforts on the primary and secondary appraisals made by individuals. The deﬁnition
of primary appraisal is the evaluation of a particular situation as it relates to a person’s
well-being (Chaturvedi, 1983; Cox & Ferguson, 1991). When interested in ﬁnding
meaning behind an event, which largely answers questions like, “Am I in trouble?” or
“Have I experienced this before?” focus needs to be on the primary appraisal of the event.
Secondary appraisal evaluates how to effectively cope with the situation (Cox &
Ferguson, 1991). Lazarus and Folkman (1984a) asserted that all cognitive appraisals
(whether primary or secondary) are largely evaluative because they continuously occur
and go beyond information processing by focusing on meaning or signiﬁcance. Folkman,
Lazarus, Dunkel-Schetter, DeLongis, and Gruen (1986) interviewed 85 married couples
over a six-month timeframe to examine the relations between primary appraisal and
secondary appraisal processes. They found that secondary appraisal is a function of a
person’s judgments about what is at stake (primary appraisal) in a speciﬁc stressful
situation. F olkrnan et al. (1986) were helpful in supporting this proposed study’s
assumption that understanding the contextual features of a speciﬁc Situation and the
coping processes of the individual are of utmost importance. Wallander and Vami

(1995) also supported this idea when they found among adolescents with disability that

18

the meaning of the event, rather than its mere occurrence is what deﬁned the actual
assessment of a situation and led to coping processes.

A person evaluates a situation as stressful, benign, or irrelevant. According to the
literature, an irrelevant appraisal is made when a person believes that there is no impact
upon his or her well-being; a benign appraisal is made when a person believes that his or
her well-being will be preserved or enhanced; a stressﬁrl appraisal occurs when a person
believes that harm, threat, or challenge to his or her well-being will occur (Chaturvedi,
1983; Lazarus & Folkman, 1984a; Paterson & Neufeld, 1989). These three kinds of
primary appraisal illustrate how complex the appraisal process is and how it largely
depends on person factors and situational context (Lazarus & F olkman, 1984a).
According to Shontz (1975), the person’s appraisal or evaluation of a stimulus is the key
to understanding stress. He further stated that one’s appraisal of an event is relational
because it connects to both the person and the environment. For example, one person
may be confronted by a stranger and determine that the person’s behaviors are benign
enough to engage in a discussion; whereas another person may decide that the stranger’s
actions are threatening and ﬂee from the presence of this dangerous person. The
relationship between the person and her environment elicits a particular response, and
one’s primary appraisal of the situation determines this response.

Lazarus and Folkman (1984a) deﬁned the person factors and situation factors that
inﬂuence primary appraisal. Two examples of person factors that inﬂuence a primary
appraisal are commitments, or things that underlie choices that people make and express
what is important to that person; and beliefs, or co gnitions that determine what is truth in

the enviromnent and determine how a person evaluates what is happening. Three

19

examples of situational factors include: novelty, the extent to which a person has had
previous experience with the event; event uncertainty, the likelihood of an event’s
occurrence; and temporal factors such as irnminence and duration. It is interesting to
consider these person and situational factors because they set the stage for the meaning
and signiﬁcance assigned to primary appraisals.

All human beings have a need for social and psychological equilibrium (Moos &
Schaefer, 1986). The extent to which person and situational factors inﬂuence the
appraisal process, which is a continuously occurring phenomenon, serves to enhance or
weaken this equilibrium. This is often evident in the stress appraisal process. A stressful
appraisal means that the person would evaluate the situation as harmful, threatening, or
challenging (Lazarus & F olkrnan, 1984a, 1984b). Harm, which includes loss, represents
damage that occurred in the past; threat involves the anticipation of or potential for harm;
and challenge involves the directed attention at what the person gains, not loses, under
difﬁcult odds (Lazarus & Folkman, 1984b). Many factors inﬂuence whether a person
appraises a situation as stressful, including history and/or experience with a stressor and
whether he or she locates the stressor in the person or the environment (Bramston,
Fogarty, & Cummins, 1999; F ogarty, Bramston, & Cummins, 1997; Lepore & Evans,
1996; Paterson & Neufeld, 1989; Shontz, 1975). There is no rehabilitation counseling
research that examined the stress appraisal process for people with disability.
Consequently, little is known about the extent to which stress is felt, the type of stress
experienced, the level of experience with the situation, and where that person located the

source of difﬁculty (i.e., in themselves or the environment). Information about these

20

person and situational factors would be a useful ﬁrst step in discovering the meaning
assigned to a particular event and understanding a person’s choice of stress response.

Examining an individual’s appraisals in context with these inﬂuential factors is
critical for three reasons. First, it could uncover that one’s disability provides an
experiential context for dealing with stressors, thus enhancing the likelihood of benign or
irrelevant appraisals in the future. Second, it may uncover the extent to which a person
experiences these events. Third, it may uncover important information about whether a
stressor is located within a person or the environment. This proposed study included 1)
the extent to which stress was perceived, 2) the type of stress experienced, 3) the level of
experience with the situation, and 4) where that person located the source of difﬁculty.
These may provide preliminary evidence of the transactional nature of the appraisal
process and illuminate the stress response of people with disability.

Stress Response. No two people react to stress in the same way (Shontz, 1975).

 

Consequently, understanding stress response is not simple (Dohrenwend & Dohrenwend,
1981). A person’s appraisal of a stressful situation, whether harm, threat, or challenge
dictates the type of stress response outcome for the individual. Paterson and Neufeld
(1989) asserted that when a person evaluates a stressor as danger of harm or loss, anxiety
in the form of fear persists. However, if that person thinks that other people or things
caused the stress, anxiety in the form of anger is likely. If anxiety accompanies negative
judgments of coping effectiveness, depression is likely to follow. Finally, if the stressor
is a situation of achievement, a person may evaluate the experience as challenging and
respond with excitement. Rutter (1994) encouraged the notion that accumulation of

events over time contributes to a person’s sense of resiliency or vulnerability. The extent

21

to which people are able to function effectively in the midst of stressful situations
determines how well they adapt to the situation over time (e. g., divorce in the family).
According to Paterson and Neufeld (1989), a history of success in dealing with a stressor
may lead to an irrelevant appraisal, but if the person experiences variable success in
dealing with the stressor, a person will appraise the stressful situation as challenging. In
the case of people with disability where stressful situations appear over time, it would be
important to examine whether they cope effectively and whether they experience the
situation less or more often. While a vast amount of research has looked at coping
effectiveness in people with disability, very few have done the groundwork to examine
the stress appraisal process (i.e., the stressor, the primary appraisal, and the stress
response) in relation to coping response.

In discussing adaptation to disability, Shontz (1975) stated that three factors:
intensity of threat, type of situation and personal variables determine the type of stress
response that occurs. Adaptation is most effective and efﬁcient when stress is moderate;
otherwise extreme levels of threat are associated with poor coping, poor judgment, and
diminished control (Shontz, 1975). Three types of situations: relationships with social
supports, employment, and health care are known to elicit levels of threat to people with
disability, and require adaptation efforts (Wright, 1980). These psychosocial impacts of
disability are documented in rehabilitation literature as quality of life indicators
(Roessler, 1990).

According to Herrick, Elliott, and Crow (1994), social support protects an
individual from the harmful effects of stressful encounters. Rintala, Young, Hart,

Clearman, and Fuhrer (1992) found that for 140 persons with spinal cord injury, total

22

social support related to more satisfaction with life and better physical well-being.
Krause (1996) longitudinally examined whether better adjusted people with spinal cord
injury were more likely to obtain employment and whether becoming employed
enhanced post-spinal cord injury adjustment. Krause concluded that enhanced
adjustment correlated with employment status and termination of employment was
associated with declines in adjustment.

The President’s Committee on Employment of People with Disabilities (1994)
concluded that fair and effective health care reform was a number one priority in the
disability community. Their report stated that many participants listed health care as their
single greatest concern, and nearly all participants agreed that health care reform was a
prerequisite for advancement in employment, quality of life, and independent living. The
proposed study ﬂamed speciﬁc situations using these three types of psychosocial
impacts. These situations served as stressors to uncover the appraisal process and better
understand the stress response of people with disability.

Historically, people with disabilities maintained a marginal role in society and not
much opportunity existed to experience threat or challenge. However, with the passage
of legislation like the Americans with Disabilities Act of 1990, opportunity to experience
new situations such as access to public places, employment opportunities, and use of new
technology and communication devices is possible. Social integration provides a sense
of belonging and stability a person’s life context, which in turn assists in maintaining a
sense of well-being (Cronkite & Moos, 1995). Bramston, F ogarty, and Cummins (1999)
suggested that rehabilitation policy has paved the way for people with disability to have

more choice and new responsibilities. Furthermore, encouragement of autonomy may

23

produce situations that challenge one’s coping responses (Bramston, Bostock, & Tehan,
1993). For these reasons, it is imperative to understand the stressors that people with
disabilities experience, the kinds of primary appraisals they make, the kinds of stress
responses that result, and what coping responses may be needed to effectively deal with a
stressful situation. The review now turns to examine the construct of coping taken from
literature that supports the transactional theory.

The Coping Construct

Primary appraisal Shapes the coping decisions employed by all humans. These
decisions are the secondary appraisal of humans. Secondary appraisal involves a
person’s belief about the viable Options for coping (Cronkite & Moos, 1995). Lazarus
and Folkman (1984a) carefully distinguished the decision for coping as the process of
managing internal and external demands appraised as taxing or exceeding the resources
of the person. Such distinction is widely accepted across coping theory literature (Endler
& Parker, 1990; Lepore & Evans, 1996; Skodol, 1998; Zeitlin & Williamson, 1994).
Humans use coping responses with the intention of protecting themselves from the effects
of stressors (Lepore & Evans, 1996). It is unlikely that individuals would employ a
coping strategy if they appraised a situation as benign or irrelevant.

According to Lazarus and Folkman (1984a), coping is the process of
understanding what a person actually does in a speciﬁc context and what thoughts or
actions change as a stressful situation unfolds. The act of coping consists of altering the
source of stress, enhancing well-being, and reducing emotional consequences (Brown,
1993). Kohn (1996) asserted that the most important thing about how a person copes

with stressful situations is how well the coping effort ﬁts the demand of the situation.

24

Few understand what a person with a disability actually does in certain contexts to ﬁt the
demand of the situation, mainly because there is limited knowledge about how a person
appraises such demand. Before this proposed study made such an attempt, it was helpful
to understand how the literature discussed the coping with disability process.

Coping with disabiligl. Vash (1981) maintained that emotional, behavioral, and
environmental reactions are common in response to disability. She further stated that
these reactions depend on a person’s personality, philosophical outlook, family and
community support, and remaining resources for developing effective and gratifying
lifestyles. Roessler and Bolton (1978) stated that reaction to disability is a highly
individualized matter that focuses on the person-environment ﬁt and the way disability
disrupts the ﬁt. When reacting to changes in one’s self and environment, overwhelming
feelings of loss require special coping strengths and abilities (Robinson, West, &
Woodworth, 1995). An individual’s reactions to disability are a means of keeping
distress within manageable limits (Livneh & Antonak, 1997); therefore, successful
management of these reactions may lead to positive outcome and goal achievement.

According to Wright (1983), the succumbing framework highlights the negative
effects of disability, offering limited focus on the challenge for change and meaningful
adaptation. The coping framework is oriented toward seeking solutions to difﬁculties,
presenting without facade when faced with difﬁculties, and discovering satisfactions
(Wright, 1983). Robinson et al. (1995) encouraged the adoption of the coping-
succurnbing continuum view because it extends the thinking about coping as continued
effort at solving problems and recognizes that such effort may be effective or ineffective.

Effective coping includes the decision not to cope, at some time preferring temporary

25

reprieve before resuming active coping (Robinson, et al., 1995). Reaction to disability
does not stop when a person has successfully adjusted; rather it simply changes with each
step in the learning process (V ash, 1981). Thus, it becomes important that people with
disability and rehabilitation professionals learn to emphasize positive meaning of
disability and asset values in order to elicit an effective coping response over time.
Furthermore, Brickman, Rabinowitz, Karuza, Coates, Cohn, and Kidder (1982) suggested
that people with disability adopt a compensatory model of coping so that they see
themselves as deprived by a social environment that refuses to yield necessary resources
for independent living. This view emphasizes the role of the environment in developing
assertion and values change in a person so that maintenance of effective coping or
adherence to the coping framework continues.

In instances of traumatic onset disability, people ﬁrst attempt to comprehend the
extent of what happened before beginning the coping process (V ash, 1994). Here, an
individual’s perceptions about situational demands may add fuel to the ﬁre of stress-
induced coping, making personal and environmental mastery an unthinkable goal. Both
Vash (1981) and Wright (1983) discussed mastery as a product of an effective coping
process. It may be more helpful to reconceptualize the goal of mastery as personal and
environmental management (Lazarus & Folkman, 1984a) because environmental barriers
represent a continuous struggle and source of stress that is more likely managed than
mastered. In order to manage the environment most effectively, people with disability
will need to recognize whether they evaluate an environmental situation as eliciting harm,
threat, or challenge. Kulkarrri (1985) stated that when people perceive harm, they

withdraw from the situation or display aggressive behaviors; if people feel threatened,

26

they may feel anxious and use various defense mechanisms to cope; and when
challenged, they may actively strive to overcome or master the situation.

A useﬁrl deﬁnition of maladaptive coping is the failure to move through the entire
coping process by avoiding the healing and restructuring of life (Robinson, West, &
Woodworth, 1995). Zeidner and Saklofske (1996) stated that determining whether
coping is adaptive or maladaptive requires an examination of personal and environmental
reactions to the stress-inducing event. Not all reactions labeled as “effective” in most
situations will lead to adaptive coping. For instance, Skinner (1995) described an
instance of terminal illness (when circumstances are quite uncontrollable) where
persistent, active attempts to ameliorate a problem led to frustration, exhaustion, and a
sense of powerlessness. Janoff-Bulman (1999) discussed an automatic process that
people go through before rebuilding their assumptions of benevolence, meaningfulness,
and personal worth. She maintained that following a traumatic experience an individual
largely shuts down and ignores the threatening or challenging aspects of the trauma.
Furthermore, J anoff-Bulman (1999) stated that numbing and denial help establish
psychological balance, which over time dissipates to permit the ability to engage with the
experience and its implications. Consequently, it is important to recognize the person’s
need for ineffective coping behavior and detachment. However, in situations where
maladaptive behaviors have persisted too long (Kahn, 1995) redirection toward adaptive
strategies and rebuilding need to be encouraged.

Personality and coping. While it is difﬁcult to see the unfolding nature of stressful
Situations and changes in a person’s coping response, the coping process can be described

as reﬂective of personality disposition (Lazarus & Folkman, 1984a). According to the

27

American Psychiatric Association (1994), personality traits are enduring patterns that
determine how people think about and relate to themselves and their environment.
Lazarus and F olkrnan (1984a) asserted that the type of process used in coping is generally
premised on the personality traits of the individual. Skodol (1998) supported this
assertion when he referred to personality traits and coping processes as personal
dispositions in life stress literature. Moreover, Chaturvedi (1983) and Watson, David,
and Suls (1999) stated that coping processes reﬂect the personality tendencies within the
individual.

McCrae and Costa (1986) supported the link between personality and coping with
a longitudinal survey design. Their study was broken into two parts. In the ﬁrst study,
they asked 154 men and 101 women to recall which ways of coping they had used in
dealing with a stressful event. The authors chose the event'from a checklist of recent life
events that each person had experienced in the past year. This checklist categorized the
events for the people into harm/loss, threats, and challenge events. In addition,
participants were administered a battery of tests to assess psychological well-being. Four
months later, the authors asked the participants to complete a personality inventory. Six
months later (ten months from the occurrence of the stressful situation) they asked the
participants to recall the assigned event and to indicate which coping strategies they
employed to deal with that speciﬁc event.

McCrae and Costa (1986) developed a second study to satisfy participants who
could not identify with any of the categorizations provided on the checklist in Study 1.
Study II asked participants to suggest their own stressﬁrl Situation. This study also

differed in terms of timing. In Study 11, 80 men and 71 women completed the personality

28

inventory before nominating a stressful situation. Six months later, they mailed
participants a questionnaire to assess their coping efforts. There was no assessment of
well-being for these participants so it was not considered an outcome variable as it was in
Study 1.

Overall, their ﬁndings from this thoughtful examination suggested that coping and
well-being relate to personality, and personality represents a powerﬁrl explanation for the
effects of coping. Since two separate study groups examined the measurement of
personality; one preceding and the other following the speciﬁc stressors and coping
efforts, personality is “causally prior to the stressors, coping efforts, and well-being states
assessed in [their] research” (McCrae & Costa, 1986, p. 400). It would not be necessary
to examine personality traits as a separate variable from coping disposition.

Consequently, assessing coping disposition would be an important measure of
individual difference, especially in terms of coping with disability. Because the appraisal
process is a highly individualized process and coping processes vary according to
situational context, it becomes important to examine coping disposition as a relational
variable with the stress appraisal process for people with disability.

Coping Disposition

Literature has maintained that personal coping resources are relatively stable
dispositions or styles that inﬂuence the selection of a coping process (Cronkite & Moos,
1995; Holahan, Moos, & Schaefer, 1996; O’Driscoll & Cooper, 1994; Pearlin &
Schooler, 1978). Schwarzer and Schwarzer (1996) conceptualized coping disposition as
a set of actions that reﬂect a particular strategy for managing a demand. For example,

under the transactional model of coping, a person who uses instrumental actions to

29

change the person-environment relationship uses problem-focused coping efforts. A
person who does not change the interaction, but assigns new meaning to the situation
uses emotion-focused coping efforts. It is important to note that one set of actions is not
more successful than the other (Schwarzer & Schwarzer, 1996).

Problem-focused, emotion-focused, and avoidance coping are the most widely
accepted dimensions of coping effort (Billings & Moos, 1984; Endler & Parker, 1990;
Lazarus & F olkrnan, 1984a; Pearlin & Schooler, 1978; Skodol, 1998; Snyder & Dinoff,
1999). Problem-focused coping, also named task-focused coping aims to lessen the
effect of the original trigger (Paterson & Neufeld, 1989). Examples of this coping style
in context to people with disabilities include gathering information about possible
surgeries or medications, taking independent action such as modifying one’s home to
make it wheelchair accessible, and identifying alternative rewards that replace permanent
losses (Brodwin, Tellez, & Brodwin, 1993). Emotion-focused c0ping or response-
directed coping aims to lessen the heavy impact of the stress response (Paterson &
Neufeld, 1989). Examples of this coping style speciﬁc to people with disability include
controlling one’s emotions in public situations encountered for the ﬁrst time, releasing
frustration, anger, or despair, and resigned acceptance or coming to terms with the
disability or impairment (Brodwin, et al., 1993). Avoidance or appraisal-directed coping
aims to cognitively alter the perception of the stressor (Paterson & Neufeld, 1989).
Examples of this coping style in relation to people with disability include breaking down
the overwhelming aspects and focusing on small, manageable components of a situation;

employing statements of cognitive restructuring such as, “there are people worse off than

30

I”; and minimizing or denying serious aspects of the disability to preserve psychological
strength (Brodwin, et al., 1993).

Kulkarni (1985) made a speciﬁc attempt to deﬁne coping processes for people
with disability. His model delineated three categories: coping, defending, and
fragmenting. He viewed these dimensions as if they were on a dynamic continuum with
coping representing a higher level of adaptation to disability. He theorized that disability
served as an activating experience for stress and that individuals may perceive life
experiences that result from disability as a harm, threat, or challenge. Kulkarni
developed The Coping with Disability Inventory (CDI) to measure a person’s coping
efforts. While his proposed model may be useful in categorizing adaptive responses to
disability, no evidence from a person’s stress appraisal validated Kulkarni’s assumption
that coping, fragmenting, and defending adaptive responses were indicative of a person’s
feelings, thinking, or action. His theory that certain actions from people with disabilities
delineated particular strategies remained limited in scope and there was no empirical
support for these categories. Therefore, the study described in this present dissertation
used the theoretically driven processes of problem- or task-focused, emotion—focused, and
avoidance.

Billings and Moos (1984) examined the relationship between stress and coping
disposition in 424 depressed patients who were receiving services in several community
mental health facilities. Their cross-sectional design adequately reached conclusions that
problem-solving styles of coping were associated with less dysﬁmction and emotion-
focused and avoidance styles of coping related to more depression. They found that

women used emotion-focused coping styles more often. Moore and Starnbrook (1992)

31

concluded that neither problem-focused nor emotion-focused coping styles were
associated with better outcome among persons with head injury. Unfortunately, the use
of multivariate analyses on a sample of 53 male participants seriously limited their ability
to detect signiﬁcant results. Revenson and Felton (1989) examined disability and coping
as predictors of psychological well-being among 45 people with rheumatoid arthritis.
They concluded that disability acted much like a stressor on psychological well-being,
and that people employed emotion-focused strategies more often. Data collected were
consistent with coping disposition research, especially in terms of more women using
emotion-focused strategies. However, 80% of the sample was women, thus confounding
the signiﬁcance that women used emotion-focused strategies more often. Each of these
studies attempted to associate coping disposition with outcomes of psychological well-
being. The prevalence of problem- and emotion-focused and avoidance coping styles
was very apparent and researchers have offered support for various demographic
relationships. Therefore, this proposed study examined these particular coping styles as
relational variables to the stress appraisal process of people with disabilities.
Measures of Coping

Schwarzer and Schwarzer (1996) provided a critical survey of 13 coping
instruments and they suggested the development of “multilevel instruments that match
the complexity of coping” (p. 129). This would mean that a coping inventory would
describe both the actual coping in a particular situation and the stable coping style of the
person taking the instrument. Many instrument developers who debate coping
instrumentation would ﬁnd this difﬁcult because there is no resolution about measuring

Situation-speciﬁc coping efforts rather than dispositional coping efforts (De Ridder,

32

1997). Coping process supporters attempt to study how coping efforts change in
response to particular types of stressful situations; whereas, coping disposition supporters
argue that people have fairly stable coping efforts that they use across many types of
situations (De Ridder, 1997).

Each methodological approach has merit. Situation-speciﬁc measures like the
Ways of Coping Questionnaire (WCQ; Folkman & Lazarus, 1988) or the Coping
Strategies Inventory (CSI; Tobin, Holroyd, Reynolds, & Wigal, 1989) take one particular
situation and examine coping efforts within that one situation. Dispositional measures
like the COPE Scale (Carver & Scheier, 1994) or the Coping Inventory for Stressful
Situations (CISS; Endler & Parker, 1994) examine coping efforts across a number of
general situations and see if stability in coping effort is preserved. Most researchers have
developed alternate forms of their original instrument to reﬂect the need for both types of
coping measurement. This proposed study was interested in coping dispositions as they
relate to stress appraisals across a variety of Situations; therefore it was beneﬁcial to use a
dispositional coping instrument like the Coping Inventory for Stressful Situations (CISS;
Endler & Parker, 1994).

The CISS (Endler & Parker, 1994) was preferred over other dispositional
instruments for use in the proposed study because it captured the most common
dimensions of coping: problem-focused, emotion-focused, and avoidance coping. While
the COPE Scale (Carver & Scheier, 1994) examined problem-, emotion-, and avoidance-
focused coping and is considered a suitable dispositional measure of individual difference

(Schwarzer & Schwarzer, 1996), its internal consistency and evidence of validity remains

33

weak (Carver & Scheier, 1994; De Ridder, 1997). The CISS provided more evidence of
appropriate psychometric properties.

Endler and Parker (1994) examined the factor structure of the CISS using two
groups of participants, 832 college students and 483 adults. Factor analyses and
intercorrelation studies provided evidence for the multidirnensionality of the CISS.
Internal consistency reliabilities for Task, Emotion, Avoidance, Distraction, and Social
Diversion scales are as follows: .91, .89, .84, .78, and .83 respectively.

Endler and Parker (1994) investigated the construct validity of the CISS against
two other coping style inventories, the Coping Strategy Indicator (CSI; Amirkhan, 1990)
and the Defense Style Questionnaire (DSQ; Bond & Vaillant, 1986). They found
moderate positive correlations between the CISS Task scale and the CSI Problem-
Solving scale (.53 for men; .46 for women) and between the CISS Emotion and
Distraction scales and the CSI Avoidance scale (.49 men’s Emotion, .46 men’s
Distraction; .57 women’s Emotion, .48 women’s Distraction). Similarly, they found
moderate positive correlations between the CISS and DSQ scales. Finally, Endler and
Parker (1994) examined the concurrent validity of the CISS by asking two groups of
college students (n = 186; n = 231, respectively) to provide retrospective reports about
the types of coping responses they had when experiencing either adjustment to university
life or completion of a midterm examination. Results indicated that there were
correlations between the CISS Task scale and the amount of task-oriented coping
reported by students in each stressful situation. They found similar patterns of results for

the other two scales. Overall, the study did support using basic coping styles across

34

differing situations. Consequently, the CISS was the best choice of instrument given the
purposes of this proposed study.
Acceptance of Disability

In addition to primary appraisal and coping style, it is important to consider
acceptance of disability as a third construct in relation to understanding the appraisal
process and stress responses of people with disability. While she would not clearly
recognize acceptance of disability as a personality trait, Wright (1983) maintained that
disability is an inextricable part of one’s identity and one’s life. She acknowledged that
accepting a disability might imply general personality adjustment because it represents
the outlook of a mature person. However, she encouraged research and systematic
observation as a point of validation for her assertion.

Wright (1983) deﬁned acceptance of disability as a person’s intolerance of
resignation and self-devaluation. Attainment of such acceptance is possible once value
change has occurred. Barker (1948) stated that removal of all restrictions upon people
with disabilities, whether psychological or physical is not possible; therefore, reaction to
disability needs to involve changes in the value systems of people with disability. The
process of value change means that the person is able to prevail over the feeling of shame
and inadequacy resulting from disability assumed as loss of value (Dembo, Leviton, &
Wright, 1956; Wright, 1983). According to Wright (1983), speciﬁc value changes that
occur for people with disability who are perceived as having high levels of acceptance of
disability include: 1) enlarging the scope of values, which represents valuing those
satisfactions that remain and reckoning with what has been lost; 2) subordinating

physique, which means believing that physical appearance matters less than personality

35

and doing one’s best; 3) containing disability effects, which means recognizing that not
all areas of one’s life need to be or are connected to having a disability; and 4)
transforming comparative-status values into asset values, which means believing in one’s
own personal strengths rather than emphasizing the need to compare oneself to others’
perceived or real strengths. Such value changes are essential for the lasting feeling of
dignity (Linkowski, 1971; Wright, 1983).

Linkowski (1971) developed an instrument to measure levels of acceptance of
disability based on the acceptance of loss theory (Dembo, et al., 1956; Wright, 1983).
The Acceptance of Disability Scale (AD) is prominent in many rehabilitation studies
(Belgrave, 1991; Heinemann & Shontz, 1982; Li & Moore, 1998; Linkowski & Dunn,
1974) and it has had great inﬂuence on acceptance of disability becoming a salient
variable in rehabilitation research. The AD uses a Six-point Likert scale that asks
respondents how much they agree or disagree with statements related to adaptation of
disability. Scores ranging from 50 through 300 are possible, with high scores falling
about 254 or higher and low scores falling below 180 (Joiner, Lovett, & Goodwin, 1989).
Many researchers have noted the effectiveness of the AD Scale as a measure of
acceptance of disability and have illustrated correlations with several demographic and
disability-related variables.

Heinemann and Shontz (1982) thoughtfully examined disability acceptance, self-
esteem, sex-role attributes, and reading ability in a group of deaf adolescents. They
found positive correlations between disability acceptance and self-esteem, which
supported similar ﬁndings reported by Linkowski and Dunn (1974). Joiner, Lovett, and

Goodwin (1989) examined the relationship between assertive behaviors, demographic

36

variables (i.e., race, marital status, and type of disability), and acceptance of disability.
They sampled 160 adults who received rehabilitation counseling services from state
vocational rehabilitation agencies and found several positive relationships. For example,
assertive behavior correlated with acceptance of disability, thus concluding that people
would move through rehabilitation services more quickly and achieve acceptance of their
disabilities. Persons with disabilities who were divorced were signiﬁcantly more
accepting of their disabilities than other marital status groups. They found Caucasian
people with disability were positively accepting of disability than were people of color.
Finally, people with spinal cord injury, with neurological disorders, with cardiac
problems, and with substance abuse issues were signiﬁcantly more accepting of their
disability than people who have mental retardation. The people with mental retardation
in the study functioned at a high level and many expressed frustration with their
condition, perhaps contributing to lower acceptance scores.

Finally, Li and Moore (1998) conveniently sampled l, 266 adults, who utilized
state vocational rehabilitation services, to examine relationships between acceptance of
disability and various person characteristics. They found signiﬁcant correlation between
age, marital status, income, and acceptance. Younger, married, and higher income people
reported more favorable acceptance of disability. Finding that married persons reported
higher levels of acceptance contradicted Joiner et a1. (1989). People with a single
disability scored higher than people with multiple conditions and people with congenital
disabilities scored higher than did people with adventitious disabilities.

One area of research that has not used acceptance of disability as a variable is in

stress and coping with disability. There has been no attempt to conceptually understand

37

its relationship with the appraisal process or with coping styles or as a mediator between
appraisal and coping style. Therefore, it does appear important to explore acceptance of
disability in relation to the stress appraisal process and coping disposition of people with
disability.
Conclusion

This literature review has identiﬁed the need to examine the stress appraisal
process of people with disabilities and to relate this process to coping disposition and
level of acceptance of disability. This type of examination is worthwhile to provide and
enhance knowledge about stress and coping with disability. Literature on stress and
coping theory, coping with disability, personality and coping, and acceptance of disability
helped to inform this study. Knowledge from this preliminary study on stress appraisal
process helped inform rehabilitation research and contributed to clinical application

efforts that seek to enhance the psychological well-being of people with disabilities.

38

Chapter 3
METHODOLOGY
The purpose of this study was to examine the relationships between the stress
appraisal process of people with disability, their coping disposition, and their acceptance
of disability. Because the primary intention was to study these relationships, there was
no introduction of experimental treatment. Instead, this investigation was a correlational
ﬁeld study that exposed variation between participants at a single point in time (Cone &
Foster, 1995; Cook & Campbell, 1979). The research questions were:
1. Which psychosocial situations are more likely to evoke a stress appraisal from
persons with physical or emotional disability?
2. Do type of stress appraisal, level of experience with the situation, and/or locus of
stressor relate to the person’s coping disposition?
3. Does acceptance of disability relate to stress appraisal?
4. Does acceptance of disability relate to coping disposition?
5. Does acceptance of disability mediate the relationship between coping style and
stress appraisal?
Several hypotheses were also examined. These were:

1. Persons who have emotion- or avoidance-focused coping dispositions will
perceive situations as harmful or threatening more often than persons with
problem-focused coping dispositions will.

2. Persons who have task- or problem-focused coping disposition will perceive
Situations as challenging more often than persons with other coping

dispositions and will experience the hypothetical situations more often.

39

3. Persons who have task- or problem-focused coping disposition will locate the
source of difﬁculty/uncertainty in the environment (i.e., totally outside
inﬂuences) more often than persons with other coping dispositions will.

4. Acceptance of disability will mediate the relation between coping disposition
and stress appraisal process. Speciﬁcally, among persons with low levels of
acceptance of disability, coping disposition will relate less strongly to stress
appraisal, whereas among persons with high levels of acceptance of disability,
coping disposition will relate more strongly in a positive direction with stress
appraisal.

This chapter describes the participants, instruments, procedures, and the statistical
analyses employed in this study.
Participants

Description of Sample

 

Using Cohen (1988), power analysis yielded a sample size of 150 when
performing tests of multiple correlation with level of signiﬁcance at or = .05, medium
effect size of f2 = .10, and power at .80.

A sample was selected for the study from three distinct settings: the Michigan
Department of Career Development, Michigan Rehabilitation Services ﬁeld ofﬁces; the
Capital Area Center for Independent Living; and Michigan State University’s Resource
Center for Persons with Disabilities. The purpose of sampling from these three sites was
to ensure variability within the sampling frame, which enhances generalizability of
results across the population of people with disability in Michigan. The entire sample of

participants came from these sites.

40

While it would have been optimal to randomly select ﬁeld ofﬁces, this study only
used speciﬁc ﬁeld ofﬁces of the Michigan Department of Career Development, Michigan
Rehabilitation Services, which offered group orientation sessions. No difference, except
volume of people, existed between group and individually scheduled orientation
meetings. Therefore, sampling from people who attended group orientations was more
convenient for achieving the necessary number of participants needed for this study.
Permission to sample from the Michigan Department of Career Development, Michigan
Rehabilitation Services ﬁeld ofﬁces was sought and the study was proposed to the State
Director and several district managers. Upon approval, a contact person was established
in each ofﬁce and plans to attend an upcoming group orientation were scheduled. At the
orientation, interested people were invited to participate once they had completed the
orientation services offered at each ofﬁce.

In addition, contact was made with the Director of the Capital Area Center for
Independent Living (CACIL) to obtain permission to sample participants from this Site.
Sensitivity to the independent living philosophy of personal choice was upheld when
asking the Director about the most appropriate way to contact possible participants who
use CACIL services to seek support, advocacy, and community services (e. g.,
transportation arrangements, and support group services). Once permission was granted,
ﬁve Consumer Café Meetings, which provide consumers with advocacy information,
wellness information, and or group support were attended. Individuals were invited to
participate in the study at the end of each meeting.

Finally, contact with the director was made and permission to sample participants

from Michigan State University’s Resource Center for People with Disability (RCPD)

41

was sought. Participants who utilize the services offered through the RCPD are students
of Michigan State University who are taking classes toward completion of an
undergraduate or graduate degree. The director of the RCPD sent out a letter to all
students on campus who utilize services via electronic e-mail. This letter (see Appendix
A) stated the purpose of the study and invited interested persons to participate in one of
various scheduled meeting times. The letter encouraged students to individually contact
the investigator of this study if questions or need for non-group administration was
preferred.

To summarize, the sampling frame was inﬂuenced by the need for adequate
representation of people with disabilities who experience stress and coping in a variety of
situations. To perform statistical tests, this study needed a total number of approximately
150 participants. Therefore, to secure the sufﬁcient number of participants, a sample was
drawn from the Michigan Department of Career Development, Michigan Rehabilitation
Services ﬁeld ofﬁces, the Capital Area Center for Independent Living, and the Resource
Center for People with Disabilities at Michigan State University.

Instrumentation

An extensive search of tests and measures was completed to ﬁnd the most
appropriate instruments for use in this study. For example, professional journals in
rehabilitation counseling, psychology, sociology, and Sweetland and Keyser (1991) were
reviewed to explore the full range of options available. Individual authors were
interviewed over the telephone and through electronic mail regarding their thoughts about
the best ways to measure stress appraisal, coping disposition, and acceptance of

disability. The decision to use the Coping Inventory for Stressful Situations (CISS;

42

Endler ~& Parker, 1994) and the Acceptance of Disability Scale (AD; Linkowski, 1971)
was made after reviewing the literature and talking with various authors about their
instruments. Additionally, it was determined that an instrument that measured the
meaning in life situations for people with disability and a demographic questionnaire that
would gather typical research data (e.g., age, gender, employment, marital status) and
research data speciﬁc to disability condition (e. g., type of disability, time since onset)
needed to be developed. Therefore, these instruments were developed for use in this
study. Due to copyright restrictions, a copy of the Coping Inventory for Stressful
Situations (CISS; Endler & Parker, 1994) is not included in the Appendices. Readers are
encouraged to contact Multi Health Systems for a preview copy of the CISS (see
Appendix B). Readers can ﬁnd copies of the Acceptance of Disability Scale (Linkowski,
1971), the Demographic and General Information Questionnaire and the Stress Appraisal
Inventory for Life Situations in Appendices C, D and B, respectively.

Instrument Development

 

Several measures of stress were examined, yet none yielded the speciﬁc objective
desired in this study. Most measures attempted to focus on the relationship between life
changes (i.e., stressors) and physical health (Romano, 1992). For example, Holmes and
Rahe (1967) developed the Schedule of Recent Experiences later revised as the Social
Readjustrnent Rating Scale (SRRS) to assess an individual’s total life stress. This highly
used and respected instrument was not suitable for reﬂecting the life events experienced
by person with disability. Therefore, the Stress Appraisal Inventory for Life Situations

(SAILS) was developed for use in this study.

43

The Stress Appraisal Inventory for Life Situations. The Stress Appraisal
Inventory for Life Situations (SAILS) was an instrument designed by the author with the
purpose of measuring the stress appraisals of people with disability. The instrument was
adapted, with permission, from the Adolescent Disability Coping Inventory (ADCI;
Wallander & Varni, 1995). While the ADCI speciﬁcally measures common coping
dispositions among adolescents, the scenarios used in the inventory and the
classiﬁcations of stress areas provided in Wallander and Varni (1995) support the
purpose behind the development of the SAILS. J. L. Wallander (personal
communication, October 15, 1999) stated that the ADCI and its empirically based
Taxonomy of Areas of Stress could serve as a useful guide in developing an appraisal
inventory for adults with disabilities. In addition, the ACDI is a useful model for
developing an adapted version (i.e., the SAILS) because it grounds itself in the
transactional theory of coping (Lazarus & F olkrnan, 1984b) and focuses speciﬁcally on
people with disability.

While developing the SAILS, the author of this study sought consultation from
two rehabilitation counselor educators who have speciﬁc expertise in instrumentation and
psychosocial adaptation of people with disability. A draft version of the instrument was
provided to both consultants who made speciﬁc comments about the content of the
scenarios and the form of the instrument. Consequently, both the consultants and
investigator determined that the SAILS scenarios needed to include a person’s cognitive
reﬂection (e.g., “you wonder what kind of discomfort you will experience”) or deﬁnitive
action step (e.g., “you ask your supervisor to make opportunities for advancement

available to you”) so that the situation would present itself more like a primary appraisal

44

than the secondary appraisal format found in the ADCI (Wallander & Varni, 1995).
Furthermore, creation of seven Likert scale statements ensured differentiation across four
subjective response aspects: extent of stress response, type of stress response, experience
with the situation, and location of stress response. These seven statements elaborate on
the subjective meanings of primary appraisals and directly link to what the literature
suggested as factors inﬂuencing the primary appraisal process (Bramston, Fogarty, &
Cummins, 1999; McCarthy, Lambert, & Brack, 1997; Chaturvedi, 1983; Lazarus &
Folkman, 1984a; Shontz, 1975).

Demographic and General Information Questionnaire. An instrmnent that

 

captured the demographic information wanted in this study was not available. Therefore,
the author developed a demographic and disability characteristics instrument to capture
the information needed speciﬁcally for the purpose of this study. The data collected from
this instrument yielded information needed for the proposed post hoc analyses described
later in this chapter.

Information regarding the background of the participants was collected with the
use of the Demographic and General Information Questionnaire (DGIQ). This survey
instrument was designed speciﬁcally for this research study. Self-report questions asked
of the participants were: gender, age, race/ethnicity, marital status, level of employment
outside the home (full- or part-time), type of disability, and total years with disability.
These variables were chosen based on results from a review of the literature that showed
these variables as most pertinent to rehabilitation process and outcome study. These
variables may illuminate greater variation when attempting to understand the relationship

between stress appraisal process, coping disposition, and acceptance of disability.

45

Description of Final Instrument (see Appendix E)

 

The SAILS provides 15 general life situation/event scenarios and asks persons to
complete seven, 5 point Likert scale statements (1-5), by circling the number that most
closely matches how they think about the situation presented on each page (see Table 1).
The ﬁrst statement asks the person to rate to what extent they think the situation would be
stressﬁrl. Data collected from this helped to inform the ﬁrst research question.

The second, third, and fourth statements although formed separately, were
intended to measure the second aspect of subjective response--whether the person
perceives harm, threat, or challenge from the situation. A person might in fact perceive a
situation as harmful (i.e., depressing) or threatening, yet be inclined to act on the situation
because of some perceived challenge. Therefore, three individual Likert scales were
developed. Collecting data from these three statements served to better inform the
second research question and provided rich information about the stress appraisal process
for people with disability.

The ﬁfth statement asks the person to rate how often they encounter the situation.
Data collected from this captured the third aspect of subject response, level of experience
with the situation, and yielded information to answer the second research question.
Finally, the sixth and seventh statements ask the person to rate how often they believe
they ﬁnd the source of difficulty or uncertainty in the situation located in the environment
or in them. Data collected on these highlighted the fourth aspect of subjective response,
locus of stressor, and helped inform the second research question.

This study used three psychosocial impacts of living with disability: social

support, employment, and healthcare to ground the situations. Five scenarios for each of

46

Table 1

Stress Appraisal Subscales for the Stress Appraisal Inventory for Life Situations

 

For each statement that follows the situation, circle the number that most closely matches
how you think about the situation.

Subscale 1.

Subscale 2.

Subscale 3.

Subscale 4.

Subscale 5.

Subscale 6.

Subscale 7.

This situation would be...

Extremely Stressful Moderately A little Not at all
Stressful Stressful Stressful Stressful
5 4 3 2 1

Dealing with this situation would be. . ..

Extremely Depressing Moderately A little Not at all
Depressing Depressing Depressing Depressing
5 4 3 2 1

Dealing with this situation would be. . ..

Extremely Threatening Moderately A little Not at all
Threatening Threatening Threatening Threatening
5 4 3 2 l

I would expect to gain something positive from this Situation. . ..

Never Rarely Sometimes Most Often Always
5 4 3 2 1

I go through this type of situation...
Never Rarely Sometimes Most Often Always
5 4 3 2 1

The stress from this situation would come from external sources (other people or
things)...

Never Rarely Sometimes Most Often Always
5 4 3 2 1

The stress from this situation would come from internal sources (myself)...
Never Rarely Sometimes Most Often Always

5 4 3 2 l

 

47

the three areas of impact make for 15 Situations. Based on a review of the literature, each
of the ﬁve scenarios adequately captures the three psychosocial domains of living with
disability. One example of a Social Support situation is, “You and your ﬁiends are
discussing the subject of sex. You have something to add to the conversation, but no one
asks your opinion and they act as if you would not be interested in an intimate
relationship.” An example of an Employment situation is, “You are interviewing for an
important job opening. The interviewer states that you will only be hired because there is
a law that requires hiring people with disability. You really want this job, so you say
nothing to the interviewer about his/her attitude toward you.” An example of a Health
Care situation is, “Your doctor recommends a new experimental treatment that might
beneﬁt you. You do not want to try this treatment, but trust your doctor’s
recommendation. You decide to take the experimental treatment even though you have
doubts about it.”

Coping Inventory for Stressful Situations

 

The most commonly used measure to assess coping with a stressﬁrl situation has
been the Ways of Coping Questionnaire (Lazarus & F olkrnan, 1988). This instrument
asks persons to think about one speciﬁc stressful situation and to answer what ways of
coping they use to deal effectively with that situation. While this is a well-respected
instrument, its limited focus on one stressful Situation did not match this study’s purpose
of ﬁnding meaning in several situations and relating COping disposition to such situations.

Research considers the Coping Inventory for Stressful Situations (CISS; Endler &
Parker, 1994) an instrument of choice for today and future research (Cook & Heppner,

1997). The CISS is a 48-item self-report questionnaire that lists a variety of coping

48

responses and asks persons to indicate how much they engage in such responses when
confronted with difﬁcult or stressful situations. Unlike other coping inventories, the
CISS speciﬁcally asks persons to think about any type of stressful situation; it does not
provide the stressful situation, as do other inventories. Therefore, the CISS is an
appealing measure to use in this study because participants completed the SAILS, which
covered a multitude of situations that might elicit a stress response.

The CISS is particularly concerned with examining three types of coping styles:
task-, emotion- and avoidance-oriented coping (Endler & Parker, 1994). Scores on each
of the three factors sum to form scale scores; higher scores specify greater use of that
precise coping style (Cook & Heppner, 1997). One example of a Task—oriented coping
item is, “Think about how I have solved similar problems.” One example of an Emotion-
oriented coping item is, “Tell myself that it is not really happening to me.” One example
of a Distraction scale, Avoidance-oriented coping item is, “Go out for a snack or meal.”
One example of a Social Diversion scale, Avoidance-oriented coping item is, “Try to be
with other people.” While the task-oriented coping category appears to have a different
name from the commonly known problem-focused coping, it is simply a difference in
nomenclature, not in deﬁnition.

Endler and Parker (1994) have attempted to reﬁne the reliability and validity of
the CISS. Cronbach alpha coefﬁcients for Task, Emotion, Avoidance, Distraction, and
Social Diversion scales are as follows: .91, .89, .84, .78, and .83 respectively. De Ridder
(1997) provided a general overview of many coping measures, which highlighted the

CISS as a useful dispositional measure because of a Cronbach’s alpha > .70 and/or test-

retest correlation > .70 and because it had good construct and/or predictive validity.

49

Interestingly, the most recent research effort related to the factor structure of the CISS
found that data from 329 undergraduate students at a large midwestem university
provided stronger support for a four-factor, not three-factor model (Cook & Heppner,
1997). Therefore, use of the Distraction and Social Diversion subscales might be
preferred over the Avoidance-oriented scale. N.S. Endler (personal communication,
October 19, 1999) stated that it is best to administer the CISS in the three-factor model
for conﬁdence in reliability of the measure.

Endler and Parker (1994) discussed evidence of validity based on various
correlation tests with other measures of coping. For example, they found moderate
positive correlations between the CISS Task scale and the CSI Problem-Solving scale
(.53 for men; .46 for women) and between the CISS Emotion and Distraction scales and
the CSI Avoidance scale (.49 men’s Emotion, .46 men’s Distraction; .57 women’s
Emotion, .48 women’s Distraction). They found similar moderate positive correlations
between the CISS and DSQ scales. The CISS was selected for use in this study because
it represented a systematic approach to the assessment of coping disposition. In addition,
the development of the instrument was based on the transactional theory of stress and
coping (Lazarus & F olkrnan, 1984a), a thorough review of coping assessment literature,
and a statistically sound psychometric validation effort.

Acceptance of Disability Scale

 

Few instruments measure a person’s level of acceptance of self in relation to
adaptation to disability. Antonak (1981) developed the Scale of Attitudes toward
Disabled Persons (SADP) from the original Attitude toward Disabled Persons Scale

(ATDP; Yuker, Block, & Campbell, 1960). While this instrument is psychometrically

50

sound and respected in rehabilitation research, its general purpose is to measure attitudes
of non-disabled persons toward physically disabled people and attitudes of disabled
persons toward themselves. This study was primarily interested in levels of acceptance
of disability from the view of the person with a particular disability, not general attitudes
toward self and others.

The Acceptance of Disability Scale (AD) has been a widely accepted measure of
adjustment to disability since its creation in 1969 (Bolton, 1994). It is a SO—item self-
report questionnaire derived from the theory of acceptance of loss (Dembo, Leviton, &
Wright, 1956), which emphasizes the meanings, values, and emotions that people with
disability associate with having a disability (Bolton, 1994; Linkowski, 1971). This
measure was selected to Operationalize the construct of acceptance of disability because it
speciﬁcally addresses subjective meanings associated with disability, it has a short
administration time of approximately 20 minutes, it can be used with adult populations
who might read at a fourth grade or higher reading level, and it has well established
reliability and validity. Responses to the test items use a standard 6-point Likert format
of agreement or disagreement, and participants need only check their answer directly on
the questionnaire. Scores sum into a total score, indicating one’s level of acceptance of
disability; higher scores reﬂect greater levels of acceptance of disability. According to
Joiner, Lovett, and Goodwin (1989), high acceptance of disability scores fall ﬁom about
254 or higher and low scores fall below 180. One example of an acceptance of disability
item is, “There is practically nothing a person in my condition is able to do and really

enjoy it.”

51

The AD has acceptable levels of reliability and evidence of validity. Many
researchers have reported the AD as an effective measure of acceptance of disability
(Davis, Anderson, Linkowski, Berger, & F einstein, 1985; Glueckauf, Horley,
Poushinsky, & Vogel; Heinemann & Shontz, 1982; Kaiser, Freeman, Wingate, &
Chandler, 1987). However, these studies did not report speciﬁc internal consistency
coefﬁcients. Linkowski (1971) reported an internal consistency coefﬁcient of .93 ﬁ'om a
sample of 46 clients with physical disabilities who were in the vocational evaluation and
planning phase of rehabilitation (Bolton, 1994; Linkowski, 1971).

Empirical evidence of content, construct, and concurrent validity exists. Most
recently, Li and Moore (1998) examined the relationships between acceptance of
disability and three explanatory variables: demographic characteristics; disability
conditions such as disability onset and multiple disabilities; and psychosocial factors such
as emotional support and perceived discrimination. From a sample of 1, 266 adults with
disabilities Li and Moore found that the strongest positive correlates with disability
acceptance were self-esteem and emotional support (.53 and .35 respectively). They
perceived the strongest negative correlates were with disability acceptance discrimination
and chronic pain (-.37 and -.33 respectively). Overall results of their study conclude that
acceptance of disability is “signiﬁcantly related to general self-image “ (p. 22). In
addition, Hampton and Crystal (1999) found that females had signiﬁcantly lower levels
of acceptance of disability than did males (mean difference for males = 185.30, mean
difference for females = 168.09, t = 2.30, p< .05).

A principal factor analysis of the 50 response items for samples of 46 clients in a

rehabilitation center and 55 college students resulted in support for a unidimensional

52

construct (Linkowski, 1971). However, multifactor rotations may provide insight and
basis for a multidimensional construct (Bolton, 1994). According to DC. Linkowski
(personal commmrication, October 14, 1999), he intends to revise the AD to improve its
psychometric qualities. However, he did state that the AD has empirical correlational
evidence (i.e., positively related to adjustment of disability, locus of control, and
education, while negatively associated with depression) that supports the reliability and
validity of the scale in its current form.

Field Testingof the Instruments

 

Before using these instruments for the purpose of this study, all instruments were
ﬁeld-tested on ﬁve individuals from one ﬁeld ofﬁce of the Michigan Department of
Career Development, Michigan Rehabilitation Services, and four students from Michigan
State University’s Resource Center for People with Disability. The purpose of this
strategy was to know how long it would take to complete all of the instruments. In
addition, feedback on the Stress Appraisal Inventory for Life Situations (SAILS)
regarding appropriate terminology, ease of reading, ease of administration, and order of
administration was needed because it was a newly developed instrument to measure the
meaning of life situations for people with disability. Ten dollars was offered to
individuals who agreed to be part of this pre-testing effort, and participants were told that
the information they supplied would not be used or reported in any way as data, but that it

would only supply feedback about the instruments.

53

Procedures

M

The intent of the present study was to explore the relationship between the stress
appraisal process, coping disposition, and level of acceptance of disability using a one-
time administration of four self-report questionnaires. The study utilized a self-report
format because the information within the questionnaires could not be scientiﬁcally
observed, and the participants were most able to evaluate their meanings of Stressful
situations, their coping disposition, and their level of acceptance of disability. It was
assumed that the participants were willing and able to respond honestly and accurately to
all four questionnaires. In order to achieve the necessary sample Size for this study, each
participant was offered ten dollars for the completion of the questionnaires.

Data Collection

 

. Data collection began on February 14, 2000 and ended on April 10, 2000. During
this timeﬁame, visits were made to the Michigan Department of Career Development,
Michigan Rehabilitation Services, the Capital Area Center for Independent Living, and
Michigan State University’s Resource Center for People with Disability, to invite people
to participate in the study. Each participant (n = 151) who agreed to take part in the study
completed a standard research consent form required by the University Committee on
Research Involving Human Subjects at Michigan State University (See Appendix F).
Participants were told that the study was interested in examining life situations from the
perspective of people with disability, and that the information they share would

contribute to an enhanced understanding of the well-being of people with disability.

54

Next, participants were informed that the study involved the administration of
four self-report questionnaires that would take approximately one hour to complete.
Each participant understood the intention of each questionnaire and was read the
directions for completing the questionnaires aloud. The instructions to the participants
were also offered in a self-explanatory format in order to promote independence in
completing the packet of questionnaires. The investigator was present at each group
administration to answer questions from participants that arose (e.g., a meaning of a word
or phrase). The most frequently asked type of question from several participants was for
clariﬁcation of a term or phrase in the Coping Inventory for Stressﬁrl Situations (i.e.,
what does “schedule my time better” mean?) The same example was told, as an attempt
to clarify the meaning of the term or phrase, to each participant (i.e., if you missed the
bus, how often would you think to schedule your time differently to make the bus on-time
on the next occasion?) Four questionnaires were read to seven people who needed
accommodation because of a visual impairment or learning disability.

At the time each participant handed over the completed instruments, each
instrument was scanned for completeness. If any items were blank, the individuals were
asked to complete those items. The participants were thanked and paid ten dollars each
for their participation in the study. A

Data Analysis

This investigation required a one-time administration of four self-report surveys
to all participants in the study. Descriptive statistics were computed on sample
characteristics from the Demographic and General Information Questionnaire.

Examination of the following continuous variables: age and total years with disability

55

and of the following categorical variables was necessary to deﬁne the selected
characteristics of the sample: gender, employment status, marital status, race, and type of
disability. The means, standard deviations, frequencies and percentages were examined
for each type of variable.

Before further analyses concerning the ﬁve research questions and four
hypotheses for this study, a principal components analysis (PCA) was conducted on the
105 Stress Appraisal Inventory for Life Situations (SAILS) items based on subject
responses (11 = 151) to this questionnaire. The purpose of PCA is to reduce large data
items into a few meaningful components based on the intercorrelation among the items,
often revealing relationships that were not previously suspected or easily interpretable
(Johnson & Wichem, 1992). Because PCA explains the variation that is unique to an
item and its error variance, as well (Pedhazur & Schmelkin, 1991), it was chosen as the
best data reduction method. The rule of eigenvalues greater than one (Johnson &
Wichem, 1992) was utilized to determine which factors to retain, and a scree test was
plotted to determine the number of retained factors in this study. Both Varimax and
Direct Oblimin (oblique) rotation methods were used to ensure that the best factor
solution was identiﬁed.

In order to address the ﬁrst research question, the Fisher’s r to Z transformation
procedure (Hays, 1963) was used to transform all Varimax rotated factor loadings and
normalize their correlations. Using these standardized factor loadings, ﬁve analyses of
variance (AN OVA) models were run to test the differences in means across the three
types of stressful psychosocial situations (i.e., social, employment, and health care). Post

hoc comparisons were followed up on all signiﬁcant F ratios using Tukey’s honestly

56

Signiﬁcant difference post hoc comparison procedure (Shavelson, 1988; SPSS User’s
Guide, 1999).

Before answering the remaining four research questions, the Bartlett’s estimation
of common-factor score procedure (Mulaik, 1972) was utilized to obtain variables for the
ﬁve factors identiﬁed using a principal components procedure. This procedure accounted
for all factor loadings and not just those that were identiﬁed as the highest loadings ﬁ'om
the PCA. All future mentioning of SAILS factors indicates those derived from the
Bartlett’s estimation of common-factor score procedure.

To address the second research question, a general multivariate linear model
(MAN OVA) was utilized. The three possible proﬁle scores from the Coping Inventory
for Stressful Situations (CISS) were the predictor variables and the ﬁve SAILS factors
were the dependent variables in the model. Upon ﬁnding signiﬁcant F (W ilks’ Lambda,
p = < .05) and to test the ﬁrst three research hypotheses on the relationship between stress
appraisal and coping disposition, Tukey’s honestly signiﬁcant difference post hoc
comparison procedure was used to locate the differences found.

To address the third research question, a linear multiple regression model was
used to test the relationship between level of acceptance of disability and stress appraisal.
Acceptance of disability raw scores was the predictor variable and the SAILS factors
were the dependent variables in the model. Signiﬁcant Beta weight coefﬁcients were
analyzed to determine whether positive and /or negative linear relationships resulted.

The fourth research question was addressed by using a general univariate linear

model to test the relationship between acceptance of disability and coping disposition.

57

Tukey’s honestly signiﬁcant difference post hoc comparison procedure was used to
locate the signiﬁcant differences found.

To address the ﬁfth research question and the fourth research hypothesis, a
general linear multivariate covariance (MANCOVA) model was used to test for
mediation effect. Acceptance of disability was the covariate, coping proﬁle scores were
the ﬁxed factors, and the two signiﬁcant SAILS factors, Intensity of Stress and
Environment, were the dependent variables. Level of signiﬁcance for the F ratio
deterrrrined whether a mediation effect occurred between coping disposition and stress
appraisal.

Additional Analyses

 

Post hoc exploratory analyses were run using demographic variables to gain
greater understanding into the stress appraisal process for people with disability. No a
priori hypotheses were formed about demographic and disability condition characteristics
because of the limited application of stress and coping theory to people with disabilities.

A general multivariate linear model (MAN OVA) was not possible to test for
signiﬁcant relationship between the ﬁve dependent SAILS factor variables and the seven
independent demographic variables: gender, age, race, marital status, employment status,
type of disability, and total years with disability. Completing an omnibus test was not
reasonable given the number of participants for the number of levels across all variables.
Therefore, the MAN OVA procedure was used with one demographic characteristic at a
time as the independent variable; seven MANOVAS resulted. While this procedure is not
statistically optimal, the exploratory nature of this study may support the ﬁndings and

create future research interest.

58

Finally, given the exploratory nature of this study, a level of Signiﬁcance of a =
.05 was used as the minimum rejection level of all statistical analyses used in this study.
The Statistical Package for the Social Sciences (SPSS) software version 9.0. was

employed in all of the data analyses in this study.

59

Chapter 4
RESULTS
Participants
The participants in this study consisted of 151 individuals who attended one of

three different type service settings for people with disabilities. One hundred and thirty-
seven individuals attended group orientation meetings at four ﬁeld ofﬁces of the
Michigan Department of Career Development, Michigan Rehabilitation Services
(MDCD-MRS). Six individuals attended consumer café meetings at the Capital Area
Center for Independent Living (CACIL). Fourteen individuals came during scheduled
group meetings through Michigan State University’s Resource Center for Persons with
Disabilities (RCPD). An exact participation percentage rate is unknown across all three
service settings because total access to all individuals from each setting was limited.
However, the rate was computed based on the number of people with whom the
investigator had direct contact. Two hundred and eighteen individuals were asked to
participate in the study, of which 157 agreed, for a participation rate of 72%.

The 157 completed surveys yielded 151 useable surveys. Over a period of eight
weeks, the information from these 151 individuals was gathered from a total of 22 visits
to the MDCD-MRS ﬁeld ofﬁces; ﬁve visits to the CACIL; and 11 visits to scheduled
group meetings with individuals from Michigan State University’s RCPD. Only the
primary investigator collected data from the 151 individuals who comprise the sample in

this study.

60

Characteristics of the Sample

Participants were between the ages of 18 through 65, all met the deﬁnition of
having a disability, and were within the normal range of intellectual functioning.
Initially, certain participants were excluded from the study based on cognitive or
psychological functioning. Once data collection began, it became apparent that
collecting data from all interested parties, regardless of diagnosis or impairment, would
yield interesting data about the stress appraisal process. Therefore, clinical judgment was
used and those individuals who disclosed having a physical or emotional disability (i.e.,
learning disability, depression, anxiety disorder) were included in the study.

The ﬁnal sample comes from three geographical areas of the state of Michigan, as
deﬁned by the Michigan Department of Career Development. Table 2 presents a
breakdown of the participants by each of the three service settings according to
geographical area. The Eastern area encompasses the thumb of Michigan. This area is a
largely mixed socioeconomic region, including rural areas, suburbs and cities. The city
of Flint has one of the largest racial and ethnic minority populations in this area. The
Northwestern area includes the northern and western regions of the lower peninsula and

the entire upper peninsula of Michigan. This area is primarily rural and composed of

61

Table 2

Participants Categorized by Service Setting and Area (n= 151)

 

Area/Service Setting N Percent

 

Northwestern Area (n = 28)

Grand Rapids (MDCD-MRS) 28 18.5
Eastern Area (n = 17)

Flint (MDCD-MRS) ' 17 11.3

Southern Area (n = 106)

Ann Arbor (MDCD-MRS) 33 21.9
East Lansing (RCPD) 14 9.3
Lansing

MDCD-MRS 53 35.1

CACIL 6 4

 

62

mainly Caucasians, with the majority of racial and ethnic minorities located in the city of
Grand Rapids. Finally, the Southern area includes the lower portion of the state of
Michigan. This area includes the state Capitol in Lansing and two major university
communities: The University of Michigan in Ann Arbor and Michigan State University
in East Lansing. This area is a largely mixed socioeconomic region and includes suburbs,
cities, and rural farming areas. The highest concentration of minorities is in the Ann
Arbor and Lansing areas.

There is over-representation in the Southern area in the present sample because of
the conveniently chosen service setting locations. Descriptive statistics for the population
were secured from the directors of each service setting, and the following variables were
examined: gender, age, marital status, race/ethnicity, employment status, and type of
disability. No comparative information was available between population and sample
distributions for the total years with disability variable. A review of the population and
sample statistics indicated that the individuals who chose to participate had demographic
characteristics very similar to those of the population.

For gender, marital status, employment status and type of disability variables, the
population and sample distributions were very similar, with no remarkable differences.
An approximate 11% difference in age at the four MDCD-MRS ﬁeld ofﬁces indicates
that this study captured an older sample in Flint and Grand Rapids with a majority in the
30 — 60 year age category (population majority in the 18-29 age category). Differences in
age were similar for two MDCD-MRS ﬁeld ofﬁces: Lansing and Ann Arbor and for the
CACIL and RCPD, as well. The race/ethnicity variable was similar across all service

settings except for a reversed difference between Caucasians and Aﬁican—Americans in

63

Flint. This study captured 87% African-Americans and 3% Caucasians, whereas the
population distribution is 69% Caucasian and 29% Aﬁican-American.

Based on the information that the participant identiﬁed on the Demographic and
General Information Questionnaire, the sample in this study consisted of 83 males (55%)
and 68 females (45%). The racial/ethnic composition of the ﬁnal sample was 92
Caucasians (60.9%), 41 Black/African American (27.2%), 6 Hispanics (4.0%), 4
Asian/Paciﬁc Islander (2.6%), 1 Native American (.7%), and 7 individuals who identiﬁed
themselves as Mixed Race (4.6%). Table 3 provides the breakdown of the sample by
demographic characteristics. The participant’s age ranged ﬁ'om 18 — 63 with mean age of
36 years. The age variable was partitioned into a four level categorical variable as
indicated in Table 4 so that speciﬁc groupings could be examined. Regarding
employment, 61.6% (n = 93) of the sample indicated that they were unemployed, and
13.9% (n = 21) were students. Three participants identiﬁed having multiple employment
positions such as: employed part-time and student, student and volunteer, or employed
part-time and student and volunteer. In terms of marital status, 60.3 % (n = 91) were
married, and one participant did not complete this item.

These demographic data are comparable to national statistics although there were
differences in percentages among the age, race/ethnicity and employment status
variables. The chance of acquiring a disability increases as people grow older.
According to the United States Census Bureau (1999), for people who are 55- 64, 20% of
Caucasians, 35% of African-Americans, and 28% of Hispanics report having a severe
disability. Seventy-seven percent of people with non-severe disabilities are currently

employed, and people with hearing or visual impairments have the highest employment

64

Table 3

Demographic Characteristics of the Sample

 

 

Variable N Percent
Gender
Male 83 55.0
Female 68 45.0
Race/Ethnicity
Asian/Paciﬁc Islander 4 2.6
Black/African-American 41 27.2
Caucasian 92 60.9
Hispanic 6 4.0
Native-American 1 0.7
Mixed Race 7 4.6
Marital Status
Single 91 60.3
Married 29 19.2
Divorced 25 16.6
Widowed 5 3.3
Employment Status
F ull-time 1 3 8.6
Part-time 17 1 1.3
Student 21 13.9
Volunteer 4 2.6
Not Employed 93 61.6
Other: Multiple positions 3 4.6

 

Note: The NS do not total 151 due to missing data.

65

Table 4

Age Variable (n=151)

 

 

Level Age N Percent
1 18 —- 27 years 40 26.5
2 28 — 36 years 38 25.2
3 37 — 44 years 39 25.8
4 45 or more years 34 22.5

 

percentage rate. Despite the grth in employment status, securing employment remains
difﬁcult for people with disabilities who are interested in working (United States Census
Bureau, 1999).

There was great variability in the types of disability presented by the sample.
Table 5 offers the breakdown of the sample by type of disability. Eighty-six percent of
the sample identiﬁed having a physical disability or impairment, whereas 13.2% have
emotional disabilities. Types of chronic diseases listed by participants included:
diabetes, kidney disease, human immunodeﬁciency virus (HIV), hepatitis C, lupus,
cancer, and multiple sclerosis. Types of emotional disabilities listed by participants
included: depression, anxiety, and stress. Types of physical injury listed by participants
included: elbow, hands, foot, shoulder, and hip. One participant did not identify his or
her type of disability. An “Other” category that encompassed two participant’s responses

was created in order to uphold conﬁdentiality of their known type of disability. The

66

Table 5

Type of Disability Characteristic of the Sample

 

 

Disability Type N Percent
Learning Disability 27 17.9
Alcohol/Substance Abuse 26 17.2
Emotional 20 1 3 .2
Back Injury 11 7.3
Chronic Disease 11 7.3
Arthritis 7 4.6
Head Injury 7 4.6
Spinal Cord Injury 6 4
Amputation/Limb Deﬁciencies 6 4
Epilepsy 5 3.3
Nerve Injury 5 3.3
Physical Injury 4 2.6
Visual Impairment 4 2.6
Hearing Impairment 4 2.6
Muscular Dystrophy 3 2
Heart Disease 2 1.3
Other 2 1.3

 

Note: The ES do not compute to 151 due to missing data.

67

investigator did not want to Single out any one type of disability, thereby possibly
exposing the identity of the participants.

In order to examine speciﬁc groupings, the total years with disability variable was
partitioned into a four-level categorical variable as indicated in Table 6. The percentage
of males (24%) to females (25%) in this study who lived zero to six years with disability
was quite even. However, differences were apparent in the remaining categories: 59% of
females (11 = 68) lived seven to 24 years, as compared to 40% of the males (11 = 83), and
36% of males lived 25 or more years with disability, as compared to 16% of females.
These ﬁndings were consistent within and across racial/ethnicity groupings, as well.
Given that Caucasians comprised the majority of the sample, it is feasible to see that they
reported a higher percent of total years with disability for each level of category than
other racial/ethnic groupings. Table 7 presents a breakdown of participants by gender,

race, and total years with disability to illustrate these differences.

Table 6

Total Years with Disability Variable (n= 151)

 

 

Level Years with Disability N Valid %
1 0 — 6 years 37 24.5
2 7 — 15 years 39 25.8
3 16 — 24 years 34 22.5
4 25 or more years 41 27.2

 

68

Table 7

Participants Categorized by Gender, Race, and Years with Disability (n = 151)

 

 

Total Years with Disability
N

Group 0-6 7-15 16-24 25 or more % Total
Females (n = 68)

Asian/Paciﬁc Islander 0 1 1 1 4,4

Black/African-American 5 8 4 1 26.5

Caucasian 10 l l 12 8 60.3

Hispanic 2 0 1 l 5.8

Native-American O O O O 0

Mixed Race 0 l 1 O 3
Males (n = 83)

Asian/Paciﬁc Islander 0 l 0 0 1.2

Black/African-American 6 5 2 1 O 27.7

Caucasian 12 10 12 17 61.5

Hispanic 1 O O 1 2.4

Native American 0 0 1 O 1.2

Mixed Race 1 2 0 2 6

 

69

Principal Components Analysis

Before conducting the analyses regarding speciﬁc research questions for this
study, the SAILS subscale items were grouped into empirically deﬁned categories using a
principal components procedure. In order to determine the number of factors retained by
this data reduction technique, the rule of eigenvalues greater than one (Johnson &
Wicherrr, 1992) was employed. Within matrix theory, eigenvalues specify variance and
the ﬁrst few eigenvalues explain most of the total variance (Pedhazur & Schmelkin,
1991; Johnson & Wichem, 1992). Figure 1 depicts the scree plot that identiﬁed a ﬁve-
factor solution. The x-axis depicts the eigenvalues and the y-axis depicts the number of
components. This factor solution was rotated using the Varimax (orthogonal) procedure,
which maximizes the variances of the factors without changing the mathematical
properties of the solution (Tabachnick & Fidel], 1996). As compared to other solutions,

the ﬁve-factor solution was most meaningfully interpreted because of its parsimony.

 

 

 

 

 

 

1 13 25 37 49 61 73 85 _
7 19 31 43 55 67 79 91 103

Figure 1. Scree Plot of Eigenvalues from Principal Components Analysis.

70

Eigenvalues for the ﬁve-factor solution ranged from 17.43 to 7.02 and accounted
for 46.2% of the variance. All items loaded on at least one of the ﬁve factors with
loading coefﬁcients ranging from .30 to .82, and the highest loadings on each item served
as a basis for factor membership. Finally, these ﬁve factors were named based on the
items that loaded highest in that factor. These ﬁve factor names are: Intensity of Stress,
Person, Environment, Challenge, and Experience (see Table 24).

Finally, in order to estimate the internal consistency of each factor, the reliability
coefﬁcients were computed. Before determining the ﬁnal alpha coefﬁcient value, a
reliability scale analysis with “items deleted” was run to see if the coefﬁcients increased
and if item deletion was necessary. The analysis resulted in two reliability scales
increasing by an average of 0.25 percent, which is not enough to warrant item deletion.
Consequently, all reliability coefﬁcients remained at their original value, ranging from
.88 through .97 and no items ﬁ'om the SAILS instrument were deleted. The value of each
reliability scale indicates high to moderate internal consistency. Table 8 presents the
labels, eigenvalues, percentages of variance accounted for, and alpha coefﬁcients for each
SAILS factor. The following section in this chapter provides further elaboration on the
ﬁve factors and their loadings.

Stress Appraisal Factors

Before running various statistical tests to answer the speciﬁc research questions
and hypotheses, the Bartlett procedure for estimating common factors (Mulaik, 1972)
was utilized to create variables for each of the ﬁve SAILS factors. According to Mulaik

(1972), Bartlett estimators are generally superior to least-square regression estimators of

71

Table 8
Component Eigenvalues, Percent Variance, and

Cronbach Alphas Based on Varimax Rotation

 

 

Factor Eigenvalue % Variance Cronbach Alpha
1. Intensity of Stress 17.43 16.60 .97
2. Person 8.23 7.83 .93
3. Environment 8.01 7.62 .91
4. Challenge 7.83 7.45 .91
5. Experience 7.02 6.69 .88

 

common-factor scores. The Bartlett method optimally creates variables and meets the
assumptions for independence of errors (Lewis-Beck, 1980) required for statistical
testing. These variables were used in analyzing the speciﬁc research questions for this
study. Each of these ﬁve newly created variables have means equal to zero and standard
deviations equal to one.

In order to provide meaning for the stress appraisal factors, Tables 9-13 illustrate
how exploratory factor analysis deﬁned the ﬁve SAILS factors given the speciﬁc loading
values. Fifteen situations depicted in the SAILS asked participants to respond to the
same seven subscale items for each situation. The item loadings Show the highest to
lowest values for the speciﬁc aspect of stress appraisal for which the factor is named.

Table 9 depicts SAILS subscale items one, two, and three (see Table 1) that

deﬁned the ﬁrst factor, Intensity of Stress. More speciﬁcally, whether participants

72

identiﬁed a social support, employment, or health care situation as characteristically
stressful (not benign or irrelevant), and identiﬁed those situations as harmful or
threatening determined this aspect of subjective meaning of their appraisal. Participants
who responded by circling any number from two through ﬁve on these ﬁrst three
subscales indicated that they thought the hypothetical situation would be 1) stressful; 2)
harmful (i.e., referring to damage already done and usually requires undoing or
reinterpreting what is already past); and 3) threatening (i.e., referring to anticipatory
evaluation whereby a person prepares for harm that may come). The Cronbach alpha
coefﬁcient was .97 indicating very high internal consistency of the items contained in this
factor. The Intensity of Stress factor contained 45 of the 105 items from the SAILS, thus
contributing to the high internal consistency coefﬁcient.

Table 10 depicts subscale item seven of the SAILS (see Table 1) that deﬁned the
second factor, Person. Whether the participants located the source of difﬁculty ﬁ'om the
three types of situations within themselves determined this aspect of subjective stress
appraisal meaning. If the participants circled the number one, “always”, on the 5-point
Likert scale options, it was assumed that they most often times located the source of
difﬁculty within their person, thus experiencing a more extreme stress response to that
subjective response characteristic. This particular subscale item was the only item that
was reverse-scored on the SAILS instrument. This factor contained 15 items in total and

yielded a relatively high alpha coefﬁcient of .93.

73

Table 9

SAILS Factor 1: Intensity of Stress

 

 

Situation Type of Psychosocial Situation Subscale Loading
Number Situation Item
14 Employment Harm .762
8 Employment Harm .753
2 Employment Harm .720
12 Health Care Harm .704
14 Employment Extent of Stress .690
6 Health Care Harm .689
14 Employment Threat .674
6 Health Care Extent of Stress .662
Social Support Harm .660
8 Employment Threat .652
12 Health Care Extent of Stress .647
1 1 Employment Harm .636
11 Employment Extent of Stress .635
13 Social Support Threat .628
13 Social Support Harm .624
12 Health Care Threat .619
4 Social Support Harm .619
Employment Extent of Stress .618
6 Health Care Threat .616
2 Employment Extent of Stress .614
10 Social Support Extent of Stress .601
Social Support Threat .597
Social Support Extent of Stress .596
1 Social Support Extent of Stress .594
1 Social Support Threat .590
10 Social Support Harm .589

 

74

Table 9 (cont’d)

 

 

Situation Type of Psychosocial Situation Subscale Loading
Number Situation Item
2 Employment Threat .587
15 Health Care Extent of Stress .577
13 Social Support Extent of Stress .575
l 1 Employment Threat .568
15 Health Care Harm .555
9 Health Care Extent of Stress .552
Health Care Harm .543
10 Social Support Threat .540
5 Employment Threat .533
7 Social Support Extent of Stress .527
3 Health Care Extent of Stress .527
5 Employment Harm .5 19
9 Health Care Harm .503
7 Social Support Harm .486
3 Health Care Threat .485
7 Social Support Threat .467
9 Health Care Threat .451
5 Employment Extent of Stress .443
15 Health Care Threat .423

 

Table 10

SAILS Factor 2: Person

 

 

Situation Type of Psychosocial Loading
Number Situation

8 Employment .816
14 Employment .759
13 Social Support .757
1 1 Employment .746
6 Health Care .728
15 Health Care .7 18
5 Employment .696
9 Health Care .681
12 Health Care .670
7 Social Support .669
10 Social Support .654
1 Social Support .594
4 Social Support .594
3 Health Care .593
2 Employment .537

 

76

Table 11 describes subscale item six of the SAILS (see Table 1) that deﬁned the
third factor, Environment. Whether the participants located the source of difﬁculty from
the situations in the environment, or outside-the-person inﬂuences, determined this aspect
of subject meaning of their stress appraisal. If the participants circled the number ﬁve,
“never”, on the 5-point Likert scale options, it was assumed that they located the source
of difﬁculty outside their person, thus experiencing a more extreme stress response for
that subject response characteristic. This factor contained 15 items in total and indicated
moderate internal consistency with Cronbach alpha = .91.

Table 12 portrays subscale item four of the SAILS (see Table 1) that deﬁned the
fourth factor, Challenge. Whether the participants thought that they could gain
something positive from any type of psychosocial situation determined this aspect of
subjective meaning. If the participants circled the number ﬁve, “never”, on the 5-point
Likert scale options, it was assumed that they did not expect to gain something positive
from the situation, thus experiencing a more extreme stress response for that subject
response characteristic. This factor contained 15 items and had a Cronbach alpha = .91,
which indicates moderate internal consistency.

Finally, Table 13 depicts subscale item ﬁve of the SAILS (see Table 1) that
deﬁned the ﬁfth factor, Experience. Whether participants identiﬁed going through or
experiencing the situations before determined this aspect of subject meaning of their
stress appraisal. If the participants circled the number ﬁve, “never”, on the 5-point Likert
scale options, it was assumed that they had no frequent experience with the type of

situation, thus experiencing a more extreme stress response for that subject response

77

Table 11

SAILS Factor 3: Environment

 

 

Situation Type of Psychosocial Loading
Number Situation
13 Social Support .773
8 Employment .771
14 Employment .748
12 Health Care .739
1 1 Employment .736
6 Health Care .654
2 Employment .650
10 Social Support .624
Social Support .591
4 Social Support .549
15 Health Care .527
9 Health Care .525
5 Employment .433
1 Social Support .302
3 Health Care .300

 

78

Table 12

SAILS Factor 4: Challenge

 

 

Situation Type of Psychosocial Loading
Number Situation

6 Health Care .741
13 Social Support .737
12 Health Care .734
7 Social Support .732
15 Health Care .689
5 Employment .683
9 Health Care .679
1 1 Employment .660
10 Social Support .657
8 Employment .619
14 Employment .61 1
3 Health Care .595
4 Social Support .497
2 Employment .439
1 Social Support .301

 

79

Table 13

SAILS Factor 5: Experience

 

 

Situation Type of Psychosocial Loading
Number Situation

8 Employment .696
14 Employment .689
1 1 Employment .684
15 Health Care .666
4 Social Support .605
9 Health Care .574
12 Health Care .536
7 Social Support .529
13 Social Support .528
6 Health Care .493
1 Social Support .492
5 Employment .489
10 Social Support .453
3 Health Care .449
2 Employment .442

 

80

characteristic. This factor contained 15 items in total and yielded a moderately high
alpha coefﬁcient of .88.
Psychosocial Situations that Evoke Stress Appraisal

In order to examine which psychosocial situations evoke a stress appraisal from
persons with physical or emotional disability (research question number one), the sample
factor loadings for each SAILS factor were transformed into standardized loadings with
approximately normal distributions. The Fisher r to Z transformation (Hays, 1963) was
used to create the standard scores that were used in subsequent analyses. These standard
scores meet the assumptions for hypothesis testing.

These ﬁve standardized loadings were used as dependent variables and one
categorical variable, type of psychosocial situation, as the independent variable to run a
single-factor analysis of variance (AN OVA). The three types of psychosocial situations
portrayed in the SAILS were social support, employment, and health care. Each situation
was represented ﬁve times, to which participants responded with the seven subscale items
discussed earlier.

The purpose of the AN OVA was to compare the means of the ﬁve standardized
loading groups. Variation between and within the ﬁve groups was not statistically
signiﬁcant (11 5 .05) in relation to type of psychosocial situation. All obtained F values
were small with a range of values between .054 and 1, as indicated in Table 14.
Consequently, the AN OVA did not support a relationship between type of situation and

the SAILS factors.

81

Table 14

Relationship between Standardized SAILS Loadings and Psychosocial Situation

 

 

Factor Degrees of Freedom F Signiﬁcance
Level
Factor 1 (Intensity of Stress) Between Groups 2 .218 .804

Within Groups 102

Factor 2 (Person) Between Groups 2 .260 .772
Within Groups 102

Factor 3 (Environment) Between Groups 2 1.0 .369
Within Groups 102

Factor 4 (Challenge) Between Groups 2 .441 .645
Within Groups 102

Factor 5 (Experience) Between Groups 2 .054 .948
Within Groups 102

 

Stress Appraisal and Coping Disposition

In order to attend to the second research question and test research hypotheses one
through three, a multivariate analysis of variance (MANOVA) was conducted. A general
linear multivariate model procedure with the Type III sums of squares was used. Type III
sums of square is the most commonly used method and has advantages over the other
sums of square types (SPSS Base 9.0 User’s Guide, 1999). The purpose of the
MANOVA was to test the differences among the coping dispositions on the SAILS
factors.

A signiﬁcant multivariate E (Wilks’ Lambda = .78, F (15, 395) = 2.51, p = < .05)

was found for the coping disposition variable. The coping disposition variable was the

82

proﬁle score obtained by adding up an individual’s total response on the CISS and
categorizing it into three levels of problem-focused, emotion-focused, and avoidance-
focused styles. Six participants did not have a clearly identiﬁed coping disposition, thus
the category “not speciﬁed” was created. Post-hoe comparisons (Tukey’s HSD, a = .05)
followed, which indicated that participants differed in terms of coping disposition for
Factor 1 (Intensity of Stress) and Factor 3 (Environment). No other SAILS factors
differed signiﬁcantly. Table 15 depicts the differences in SAILS factor means for coping
disposition. Table 16 presents the results of the Tukey’s HSD comparisons of coping
dispositions for the SAILS factors. According to Newton and Rudestam (1999), Tukey’s
test is popular for exploring all pairwise comparisons with a large number of groups, and
it examines the difference among group means by referring to the difference between the
range of means as a measure of their dispersion.

The MANOVA results in Table 16 do not support research hypotheses one
through three in this study. No support for Hypothesis 1 was found because participants
who had problem-focused coping dispositions (n = 22) were signiﬁcantly likely to
perceive situations as harmful and threatening as were participants with emotion- focused
(n = 69), but not participants who had avoidance-focused coping dispositions
(n = 54). Interestingly, with a signiﬁcance level equal to one, participants who had
avoidance-coping dispositions had means lower than expected and in the direction
opposite than hypothesized. Hypothesis 2 was not supported because coping disposition
did not at all relate to Factor 4 (Challenge). Finally, Hypothesis 3 was not supported

because participants who had avoidance-focused coping dispositions were signiﬁcantly

83

Table 15

Means and Standard Deviations of SAILS Factors for Coping Disposition

 

 

SAILS Factor Coping Disposition Mean Standard Deviation
Intensity of Stress Problem-Focused -.286 .999
Emotion-Focused .332 .870
Avoidance-Focused -.280 l .06
Person Problem-Focused .005 1 . 13
Emotion-Focused .008 .933
Avoidance-Focused -.1 82 1 .04
Environment Problem-Focused -.522 .966
Emotion-Focused -.009 .926
Avoidance-Focused .333 l .04
Challenge Problem-Focused -.160 .876
Emotion-Focused .003 .966
Avoidance-Focused .002 1 .08
Experience Problem-Focused .401 .925
Emotion-Focused -.010 .898
Avoidance-Focused -.003 1 . 14

 

84

Table 16

Tukey’s HSD Comparisons of Coping Disposition for the SAILS Factors

 

F actor/Coping Disposition Comparison Coping Disposition Signiﬁcance

 

Level

Factor 1 (Intensity of Stress)

Problem-Focused Emotion-Focused .043*

Emotion-Focused Avoidance-Focused .003*

Avoidance-Focused Problem-Focused 1
Factor 2 (Person)

Problem-Focused Emotion-Focused 1

Emotion-Focused Avoidance-Focused .478

Avoidance-Focused Problem-Focused .788
Factor 3 (Environment)

Problem-Focused Emotion-Focused .252

Emotion-Focused Avoidance-Focused .081

Avoidance-Focused Problem-Focused .003*
Factor 4 (Challenge)

Problem-Focused Emotion-Focused .867

Emotion-Focused Avoidance-Focused 1

Avoidance-Focused Problem-Focused .889
Factor 5 (Experience)

Problem-Focused Emotion-Focused .170

Emotion-Focused Avoidance-Focused .985

Avoidance-Focused Problem-Focused .309

 

Note: *p < .05

85

likely to locate the source of difﬁculty/uncertainty ﬁ'om the situation in the environment,
as were participants with problem-focused coping styles. Persons with emotion-focused
dispositions did not relate at all to Factor 3, suggesting that they did not locate the source
of difﬁculty from the situations within the environment.

Acceptance of Disability and Stress Appraisal

In order to address research question number three, a linear multiple regression
model was utilized to discern relationship between level of acceptance of disability and
stress appraisal. Participants’ total raw score from the AD Scale was used as the
dependent variable. Acceptance of disability raw scores ranged from 115 through 300,
with a mean score of 210. The AD raw scores were then categorized into three levels, as
illustrated in Table 17.

Table 18 displays the correlations between the variables. The correlations for the
SAILS factors range from a low of -.269 between Factor 4 and Acceptance of Disability
and a high of .407 between Factor 5 and Acceptance of Disability.

Table 19 presents the unstandardized regression coefﬁcient (B), the standardized
coefﬁcients (Beta), R2, and adjusted R2. R for regression was Signiﬁcantly different from
zero, F (5, 145) = 9.69, p < .05. Only two of the SAILS factors (Factor 4, Challenge and
Factor 5, Experience) contributed signiﬁcantly to explain level of acceptance of

disability. Altogether, these two stress appraisal factors explained 25% (23% adjusted) of

86

Table 17

Range of Raw Scores for Levels of Acceptance of Disability

 

 

 

Level (Raw Scores) N Percent

High (254 — 300) 20 13.2

Medium (180 — 253) 95 62.9

Low (50 —179) 36 23.8
Table 18

Correlation Matrix among the SAILS Factors to Acceptance of Disability

 

Variables Correlations

 

AD F1 F2 F3 F4 F5

Acceptance of Disability 1 -.092 .023 -.058 -.269* .407*
Factor 1 (Intensity of Stress) -.092 1

Factor 2 (Person) .023 1

Factor 3 (Environment) -.058 1

Factor 4 (Challenge) -.269* 1

Factor 5 (Experience) .407* 1

 

Note: *p < .01 (2-tailed)

87

Table 19

Multiple Regression of SAILS Factors on Level of Acceptance of Disability

 

 

Variables/Model Summary B [3 Signiﬁcance Level
Factor 1 (Intensity of Stress) -3.60 -.092 .202

Factor 2 (Person) .886 .023 .752

Factor 3 (Environment) -2.26 -.058 .423

Factor 4 (Challenge) -10.5 -.269 .000*

Factor 5 (Experience) 15.87 .407 .000*

R2 = .251

Adjusted R2 = .225

 

Note: *p < .05

the variability in level of acceptance of disability. As Table 19 indicates, participants
with low levels of acceptance of disability were more likely to perceive that they could
gain something positive from the situations and participants with high levels of
acceptance of disability reported that extent of experience with the Situation inﬂuenced
their stress appraisal.
Acceptance of Disability and Coping Disposition

To address the fourth research question, a general univariate linear model was
used to test the relationship between level of acceptance of disability and c0ping
disposition. Table 20 depicts the differences in acceptance of disability means for coping
disposition. Most participants (11 = 69) responded having an emotion-focused coping
disposition, which had the lowest level of acceptance of disability, whereas 22
participants responded having problem-focused coping dispositions and the highest level

of acceptance of disability.

88

A signiﬁcant univariate E (1, 3) = 13.10, p < .05 was found for the coping
disposition variable. Post hoc comparisons (Tukey’s HSD, a = .05) indicated that
differences among coping dispositions were signiﬁcant, as illustrated in Table 21.
Consequently, participants’ level of acceptance of disability related more signiﬁcantly to
problem-focused or emotion-focused coping dispositions than to avoidance-focused

coping dispositions.

Table 20

Descriptive Statistics of Acceptance of Disability for Coping Disposition

 

 

COping Disposition N Mean Standard Deviation
Problem-Focused 22 244 33.01
Emotion-Focused 69 193 33.67
Avoidance-Focused 54 2 1 8 36.89

 

Note: The NS do not compute to 151 due to missing data.

89

Table 21

Tukey’s HSD Comparisons of Coping Disposition for Acceptance of Disability

 

 

 

Coping Disposition Comparison Coping Disposition Signiﬁcance
Level
Problem-Focused Emotion-Focused .000*
Emotion-Focused Avoidance-Focused .001 *
Avoidance-Focused Problem-Focused .01 7*
Note: *p < .05

Acceptance of Disability as a Mediating Variable

In order to address research question number ﬁve, only those relationships found
to be signiﬁcant for stress appraisal and coping disposition were used in a general linear
multivariate covariance (MAN COVA) model. Signiﬁcant relationships were found
between SAILS Factor 1 and SAILS Factor 3 on coping disposition using a MANOVA
procedure in research question two. Therefore, to test for mediation effects, acceptance
of disability was the covariate, SAILS Factor 1 and SAILS Factor 3 were the dependent
variables, and coping disposition was the ﬁxed variable.

A signiﬁcant multivariate E (Wilks’ Lambda = E .997 (2, 145) = .207, p > .05)
was not found for acceptance of disability. The results indicated that acceptance of
disability was not a mediating variable between the relationship between stress appraisal
and coping disposition. This means that the relationship between stress appraisal and

coping disposition did not diminish when acceptance of disability was controlled for in

90

the test. Consequently, Hypothesis 4 was not supported because the mediating variable
was not an important variable of explanation.

Additional Analyses

 

A series of post hoc data analyses were performed in an attempt to explore the
generalizability of relationships between the demographic variables and the ﬁve SAILS
factors. Seven multivariate analyses of variance were computed, each computing for a
single demographic variable at a time. Including all independent variables was not
technologically possible when using SPSS 9.0. Table 22 depicts which variables

signiﬁcantly related to the SAILS Factors.

Table 22

Signiﬁcant Relationships among the Demographic Variables

 

 

Variable Relationship with SAILS
Gender Factor 1: Intensity of Stress
Age Factor 3: Environment
Race/Ethnicity Factor 3: Environment

Factor 4: Challenge
Employment Status Factor 3: Environment

Total Years with Disability Factor 4: Challenge

 

91

A signiﬁcant multivariate F (Wilks’ Lambda, 1: = .88 (5, 145) = 3.85, p < .05) was
found for the gender variable. A mean of -.265 males (n = 83) and .323 females (n = 68)
responded differently only on SAILS Factor 1, Intensity of Stress. Therefore, females are
more likely to perceive stress, harm, and threat in situations.

A signiﬁcant multivariate E (Wilks’ Lambda, E = .84 (15, 395) = 1.75, p < .05)
was found for the age variable. Post hoc comparisons (Tukey’s HSD, a = .05) indicated
that for SAILS Factor 3, participants between 18 through 44 years located the source of
difﬁculty in the environment more often than participants aged 45 through 63 years.

A Signiﬁcant multivariate F (Wilks’ Lambda, _E = .77 (15, 373) = 2.42, p < .05)
was found for the race/ethnicity variable. Post hoc comparisons (Tukey’s HSD, a = .05)
indicated that for SAILS Factors 3 and 4, Caucasian and Aﬁican-Americans located the
source of difﬁculty in the environment, and perceived that they could gain something
positive from the situations.

A signiﬁcant multivariate F (Wilks’ Lambda, E = .78 (25, 525) = 1.45, p < .05)
was found for the employment status variable. Post hoc comparisons (Tukey’s HSD, a =
.05) indicated that for SAILS Factor 3, participants who were students or not employed
located the source of difﬁculty in the environment more often than participants who were
employed (i.e., full-time or part-time) or volunteers.

A signiﬁcant multivariate F (Wilks’ Lambda, E = .82 (15, 395) = 1.91, p < .05)
was found for the total years with disability variable. Post hoc comparisons (Tukey’s
HSD, a = .05) indicated that for SAILS Factor 4, participants who lived with disability 25
years or more perceived that they could gain something positive from the situation more

often than participants who lived with disability zero to 24 years.

92

No signiﬁcant multivariate test differences for the marital status or primary type
of disability variables were found in relation to the SAILS factors.

In an attempt to examine data and research hypotheses and questions in another
way, exploration of coping disposition as a continuous variable was completed. It was
thought that exploring the data in this manner might yield more meaningﬁrl information
about the ﬂuidity of the coping process in relation to stress and acceptance of disability,
rather than treating it as a categorical variable.

A bivariate correlation matrix was examined for signiﬁcant relationship among
the three variables of interest: stress appraisal process, coping disposition, and
acceptance of disability. Table 23 displays the correlations between the variables.
Regarding relationship with the SAILS factors, coping disposition correlations ranged
from -.178 between Problem-Focused coping and Factor 2 (Person) and .284 between
Emotion-Focused coping and Factor 1 (Intensity of Stress). For the Acceptance of
Disability variable, the coping disposition correlations ranged from -.422 between
Emotion-Focused coping and Acceptance of Disability and .254 between Problem-
Focused coping and Acceptance of Disability. No signiﬁcant correlation between
Avoidance-Focused coping and the SAILS factors or Acceptance of Disability was
found.

These ﬁndings were similar to the data reported for the categorical analysis of
coping dispositions, except a difference was found to suggest that people with problem-
focused coping dispositions related in a negative direction to SAILS Factor 2 (Person).
This ﬁnding lends credence to Hypothesis 3 because people who have higher scores to

reﬂect problem-focused dispositions would be less likely to locate the source of difﬁculty

93

Table 23

Correlation Matrix among Coping Dispositions, SAILS Factors,

 

 

and Acceptance of Disability
Variables Correlations

F 1 F2 F3 F4 F5 AD
Problem-Focused -.087 -.178* -.082 -.089 .092 .254*
Emotion-Focused .284* -.043 .008 .098 -.O73 -.422*
Avoidance Focused .016 -. 148 .100 .000 .044 .1 15
Factor 1 (Intensity of Stress) 1 -.092
Factor 2 (Person) 1 .023
Factor 3 (Environment) 1 -.058
Factor 4 (Challenge) 1 -.269
Factor 5 (Experience) 1 .407
Acceptance of Disability -.092 -.023 -.058 -.269* .407* 1

 

in the person. However, there is no relationship to SAILS Factor 3 (Environment)
suggesting that people in this study who had problem-focused dispositions would not
locate the source of difﬁculty in the environment. Further research would be necessary to
clarify where the source of difﬁculty is coming from for people in this study who had
problem-focused coping dispositions.

Hypothesis 1 was not fully supported because people with avoidance—focused
coping dispositions did not relate with SAILS Factor 1 (Intensity of Stress). Yet, the
ﬁndings supported Hypothesis 1 because people with emotion-focused coping
dispositions were positively related to SAILS Factor 1. This ﬁnding suggests that people
from the sample who had emotion-focused coping dispositions would most likely
perceive stress, harm, or threat from a situation, whereas people with avoidance- and

problem-focused coping dispositions would not. Only people with emotion-focused

94

dispositions related with this factor, and no signiﬁcant relationship for people with
problem- or avoidance-focused dispositions were found. This discrepancy suggests that
an interaction between the three types of coping dispositions may be occurring,
speciﬁcally between problem- and avoidance-focused coping dispositions. In the
categorical analysis, people with problem- and emotion-focused coping related together,
whereas people with avoidance-focused dispositions had lower means than expected and
related in the opposite direction than did the other two coping dispositions.

Hypothesis 2 remained unsupported by the supplemental analysis because SAILS
Factor 4 (Challenge) did not Signiﬁcantly relate to coping disposition.

The supplemental analysis that examined the relationship between coping
disposition and acceptance of disability was similar to the categorical variable analysis.
Acceptance of disability related more signiﬁcantly to problem-focused or emotion-
focused coping dispositions. There Was no signiﬁcant relationship between acceptance of
disability and avoidance-focused dispositions. Also supported was the ﬁnding that
people with problem-focused dispositions were likely to have higher levels of acceptance
of disability, whereas people with emotion-focused dispositions had lower levels of
acceptance.

In summary, the examination of the coping dispositions variable as a continuous,
rather than categorical variable, did yield interesting information. Similar relationships
were found among the variables, with the exception of people with emotion-focused
dispositions relating in a positive direction with SAILS Factor 1 (Intensity of Stress).
Further research that explores the possible interaction is needed to clarify this ﬁnding.

Only limited information about the ﬂuidity of the coping process was obtained through

95

this supplemental analysis. Further examination of the SAILS with a coping variable that
is continuous (non-categorical) is needed to more fully explore the ﬂuid nature of the

stress and coping process for people with disabilities.

96

Chapter 5
DISCUSSION

The purpose of the present study was to explore the relationship between the
stress appraisal process, coping disposition, and level of acceptance of disability, using
the underpinnings of the transactional theory of stress and coping. Lazarus and F olkrnan
(1984a) asserted that the transactional theory of stress and coping is a useful model when
examining the interaction between a person and his or her response to situational
demands. A unique feature of this investigation was the selection of people with
disabilities for whom the transactional approach to stress and coping makes sense, but for
whom application of such theory has not occurred. A stress appraisal inventory was
developed to determine the subjective meanings that persons assign to life situations,
which resulted in ﬁve empirically derived areas of stress appraisal for people with
disabilities (see Table 24). These ﬁve areas were examined for relationship with a
person’s coping disposition and level of acceptance of disability, thus operationalizing
the transactional theory of stress and coping speciﬁcally for people with disabilities.

The Appraisal Process

Before this study was implemented, a review of the literature suggested that there
were four areas of subjective response to stress: extent of stress appraisal, type of stress
appraisal, level of experience, and location of the difﬁculty. The SAILS instrument was
developed to highlight these four areas and to provide information about the appraisal
process speciﬁc to people with disabilities. However, exploratory factor analysis
determined that the instrument did not succinctly capture these four areas of response as

the literature had suggested.

97

Table 24

 

 

SAILS Factors
Factor Name Deﬁnition
Factor 1: Intensity of Stress Perception that the situation may be stressful

and that harm or threat is likely.

Factor 2: Person Perception that the source of difﬁculty in the
situation comes from within the person.

Factor 3: Environment Perception that the source of difﬁculty in the
situation comes from the environment.

Factor 4: Challenge Perception that the person will gain
something positive from the situation.

Factor 5: Experience Perception that the person has some past
experience with the situation.

 

Instead, extent of stress appraisal did not stand alone as its own factor; it related
with two aspects of stress appraisal: harm and threat. This ﬁrst factor was named
Intensity of Stress because it reﬂects the strength behind the negative evaluation that is
attributed to one’s well-being (actual harm, threat of harm). This ﬁnding suggests that
regardless of the extent of stress appraisal, participants in this study may have evaluated
the demands posed in the hypothetical Situations as negatively inﬂuencing their well-
being. This may have occurred because the instrument did not direct people to move on
to the next situation once they appraised a situation as not at all stressful (i.e., benign
appraisal). The consequence of this was positive in that participants continued to

explicate other subjective response areas thus contributing to the unique meaning that

98

they assign to certain circumstances, and unfortunate in that information that rrright have
directly implicated transactional theory was misguided.

According to transactional theory, a stressful appraisal means that an individual
would evaluate a situation as harmful, threatening, or challenging. However, in this
study, challenge was not found to be related strongly enough with aspects of harm or
threat to be part of the ﬁrst SAILS factor. The exploratory factor analysis placed
Challenge as its own separate factor, suggesting that participants who perceived gain as a
positive aspect of a situation, would not likely appraise the Situation as stressful (i.e.,
benign appraisal). It is not known what this ﬁnding means, although there is speculation
that the sample from this study might make a unique contribution to what the literature
currently offers, which traditionally addresses challenge as part of a stress appraisal for
the general population. Perhaps the wording of Subscale Item 4 of the SAILS (see Table
1) needs to be reworked to accurately reﬂect the meaning of challenge as participants
from this study may deﬁne it.

Level of experience was its own distinctive factor, and the only area of subjective
response to align itself with what the literature suggested. Participants perceived
themselves as having more or less experience with a particular situation, thus
contributing to their stress appraisal process.

It was thought that the fourth area of subjective response, locus of stressor, would
have loaded together to become its own factor. However, Person and Environment were
separate factors. This was not unsettling given that locus of stressor was based on
whether a person sensed that the negative inﬂuence on well-being was coming from an

external imposition (environment factor) or a personally prescribed one (person factor).

99

In addition, because the transactional theory advocates person-environment interaction, it
was likely that these two would form separate factors.

In summary, overall results of the principal components analysis suggested that
not all areas of subjective response for the stress appraisal process were supported as
discussed in the literature about the general population. This may mean that participants
in this study offer an inimitable perspective to the stress appraisal process and to some
extent support the transactional theory of stress and coping. On the other hand, it is
possible that the SAILS, which was designed to reﬂect the subjective response areas is
responsible for the differences in these areas, and this limited the subsequent exploratory
factor analysis. Nevertheless, there are certain features of the appraisal process for the
sample in this study that do not support the literature or the transactional theory and
ﬁrrther research is needed. Suggestions for future research are discussed later in the
chapter.

Stress Appraisal Process and Psychosocial Situational Demands

Three types of psychosocial situations: social support, employment, and health
care delineated the situational demands in the SAILS instrument. It was not known
which category of situations would more likely evoke a stress appraisal ﬁ'om people with
disabilities in the sample. Exploratory factor analysis empirically validated the
subjective response areas and did not speciﬁcally locate the type of psychosocial situation
within any meaningful order. Instead, the type of situation was evenly distributed across
and within the ﬁve factors.

These results are interesting because they suggest that regardless of situational

context, it is the person-environment interaction that deﬁnes a person’s stress response.

100

For example, SAILS Situation Three states, “Your physician has told you that you
require a surgical operation. You wonder what kind of discomfort you will experience
and what the outcome will be.” A person who read this situation was not particularly
stressed because the content was dealing with a health care situation, but because of how
that person was perceiving herself in interaction with the environment around her. These
results suggest that people with disabilities in this study would agree with McCarthy,
Lambert, and Back (1997) who contend that stress resides neither in the person nor the
environment, but in the interaction between the two. The individual who is appraising a
situation as benign or stressﬁrl is inﬂuenced by both person and environmental factors
(Lazarus & Folkman, 1984a), which set the stage for the meaning and signiﬁcance
assigned to primary appraisals. All attempts to claim that certain types or categories of
Situations from the SAILS elicit stress would be in error. Such outcome would have
direct implication for practice and these are discussed later in the chapter.
Stress Appraisal Process and Coping Disposition

Humans use coping responses with the intention of protecting themselves from
the effects of stressors and to reduce emotional consequences (Brown, 1993; Lepore &
Evans, 1996). Results from examining the relationship between the ﬁve SAILS factors
and coping dispositions indicated that there is relationship between two of the SAILS
factors and coping disposition. The information from the results not only answered
research question two, but also helped to elaborate on the ﬁrst three hypotheses in this
study.

It was initially hypothesized that persons who have emotion- or avoidance-

focused coping dispositions would perceive situations as harmful or threatening more

101

often than persons with problem-focused coping dispositions. This was hypothesized
because literature suggested that persons with problem-focused dispositions actively seek
to change the person-environment interaction, rather than change its meaning or ignore
its effect (Billings & Moos, 1981; McCarthy, Lambert, & Brock, 1997 ; Swindle, Heller,
& Lakey, 1988). While no one coping disposition is better than the other (Schwarzer &
Schwarzer, 1996), it was thought that those people who actively moved toward change
would perceive less harm or threat. However, people with problem-focused dispositions
were just as likely to perceive harm and threat from a situation.

It is interesting to note that people with avoidance-focused coping dispositions in
this study related in the opposite direction to those people with problem-focused
dispositions for Factor 1 (Intensity of Stress). This aspect supported research hypothesis
one, unlike those with emotion-focused dispositions. This may mean that the participants
who avoid stressful Situations are denying the negative impact of harm and threat on their
well-being, whereas people with problem- and emotion-focused dispositions are more
realistically able to face the difficulty knowing that their coping strategies afford them
some ability to enhance their well-being. This ﬁnding supports J anoff-Bulman (1999) in
that denial can help establish psychological balance, while also suggesting the importance
of Kahn’s (1995) assertion that redirection away from maladaptive coping needs to be
encouraged.

The second hypothesis that persons with problem-focused dispositions would
perceive situations as more challenging was not considered because the fourth SAILS

factor (Challenge) was not related to coping disposition. Since this subjective response

102

area did not relate with coping disposition, it was not appropriate to explore this a priori
hypothesis.

Another result from examining the relationship between the ﬁve SAILS factors
and coping dispositions indicated that participants who have problem- or avoidance-
focused coping dispositions had stress appraisals that located the source of
difﬁculty/uncertainty in the environment. Thus, there was no support for the third
hypothesis, which stated that persons with problem-focused dispositions would locate the
source of difﬁculty or uncertainty ﬁ'om the situation within the environment more often
than persons with other coping styles. This suggests that participants who seek to change
or those who ignore the effect of the Situation might often believe that the environment
poses barriers to successful life management. In addition, this may mean that there are
some similarities between those persons who seek to change the effect of what has
triggered the stress (problem-focused) and those who totally alter their perception of the
stressor altogether (avoidance-focused). In some way, participants who are seeking to
change the negative aspect of a situation are trying to alter the perception, yet in a
healthier, task-oriented way that offers long-term effective solution to stress.

Curiously, people with emotion-focused dispositions did not have similar
relationship to those with the other coping styles. They approached relationship with
avoidance-focused dispositions on the third SAILS factor (Environment), but not to a
Signiﬁcant level (see Table 16). This may mean that a participant who is attempting to
lessen the heavy extent of the stressor (emotion-focused) is unable to see outside of their

own personal inﬂuence on the situation, thus refusing to acknowledge outside inﬂuences

103

as part of the problem. They may assign new meaning to a Situation, and do not see
environmental inﬂuences as presenting barriers to successﬁrl life management.

It is important to note that ﬁnding signiﬁcance in Factor 3 supports Bramston,
Bostock, and Tehan (1993) because it may mean that encouraging autonomy challenges
the participants’ coping responses. However, the source of the stress that is challenging
the coping response in certain people is not coming from a characteristic within
themselves, but from external barriers that pose threats to their well-being. This ﬁnding
supports the rehabilitation and independent living philosophies, which maintain that
stressful demands exist in the environment, not only in the person and that sociopolitical
attention is needed at this level.

SAILS factors 2 (Person), 4 (Challenge) and 5 (Experience) were not related to
the type of coping disposition that participants in this study possessed. These ﬁndings
demonstrate that, in this study, participants would not seek to alter those situations where
the difﬁculty was coming from within themselves, or where they perceived they would be
challenged. In addition, they would not be stressed based on level or extent of experience
with these situations. It appears that participants feel as though they are not taxed by
situations where these three aspects of stress appraisal can be personally managed.
Consequently, participants might appraise such situations as benign or irrelevant and not
employ a coping strategy. Including the person, challenge, and experience aspects of
stress appraisal that are supported for the general population may not ﬁt the stress
appraisal process of the sample used in this study. Most people with disabilities do not
live in a state of frustration because of their disability (Wright, 1983), but having a

disability might yield a different stress response that is not yet appreciated. Caution

104

Should be taken in generalizing this result beyond the parameters posed in this study;
however, there is indication that searching for a theoretical foundation of stress for people
with disabilities is warranted. Further research into the stress appraisal process might
extenuate the need for updating coping with disability theory, as well.

In summary, these ﬁndings demonstrate that people with disabilities in this study
do seek to protect themselves from the effects of stressors that elicit feelings of harm or
threat, and participants with certain dispositions seek to reduce emotional consequences
that they perceive coming from the environment. Regardless of coping disposition, harm
and threat were often perceived from the situation, whereas challenge was not. People
with emotion-focused dispositions did not locate the difﬁculty or uncertainty from the
situation within the environment, whereas people with problem- or avoidance-focused
dispositions did. Level of experience with a Situation, whether rarely or daily, did not
relate to the type of coping disposition that the person possessed. None of the hypotheses
from the study was supported. This may mean that one coping disposition is no more
effective than another as the literature often cites (Billings & Moos, 1981; McCarthy,
Lambert, & Brock, 1997; Swindle, Heller, & Lakey, 1988), and further examination of
the relationship between stress and coping for people with disabilities is needed.

Acceptance of Disability and Stress Appraisal Process

Acceptance of disability was found to be related to two aspects of the stress
appraisal process for participants in this study: the fourth SAILS factor (Challenge) and
the ﬁfth SAILS factor (Experience). The other three factors: Intensity of Stress, Person,
and Environment were not found to be signiﬁcantly related to level of acceptance of

disability. Speciﬁcally, participants who had low levels of acceptance perceived

105

situations as more challenging, whereas people with high levels of acceptance reported
that extent of experience mattered whether they appraised a situation as stressful or not.

According to Dembo, Leviton, and Wright (1956), reaction to disability needs to
involve changes in the value systems of people with disabilities, and this process of
change means that the person prevails over the feelings of shame and inadequacy
resulting from disability. When this change occurs, a person with a disability is said to
have a high level of acceptance of disability (Linkowski, 1971; Wright, 1983). Findings
from this study seem to support these authors’ arguments that over time, with certain
levels of experience, people would have higher levels of acceptance of disability. These
ﬁndings also raise important questions because people with low level of acceptance were
more challenged by or saw themselves as gaining more from certain situations. Perhaps
people who have not moved through the value change that is needed to support
acceptance of self with disability are perseverant on directing their attention to what is
possible to gain from difficult odds rather than actually modifying their behavior toward
healthy coping and personal resource management. Further research is needed to
examine the role of challenge in the lives of people with disabilities.

There are few explanations as to why perceptions of harm, threat or locus of
stressor did not relate to acceptance of disability. These aspects of stress appraisal for
participants in this study may offer more general and external information about the
appraisal process than do the individually natured and internal factors of challenge and
experience. These two factors may highlight the individualized nature of stress appraisal
that intensity of stress and locus of stressor do not, thereby relating more to the internal

psychological process of acceptance of disability.

106

Stress Appraisal Process, Coping Disposition, and Acceptance of Disability

No attempt had been made to conceptually understand whether coping disposition
and acceptance of disability relate to each other, or to understand if acceptance of
disability might mediate the theoretical underpinnings of the relationship between stress
and coping. According to Baron and Kenny (1986), a mediational model assumes a
three-variable system in which two exploratory paths feed into the outcome variable: the
direct impact of the predictor variable and the impact of the mediator, and the impact of
the predictor variable to the mediator (see Figure 2). Knowing in this study that certain
aspects of both coping disposition and acceptance of disability related to the stress
appraisal process of persons with disabilities, test for mediation effect of acceptance of
disability on the relationship with stress and coping was feasible. However, it was ﬁrst

necessary to see if acceptance of disability related to coping disposition (Research

 

 

 

 

 

 

 

Question 4).
Mediator:
Acceptance
/ of Disability
Predictor Outcome
Variable: Variable:
Coping Disposition > Stress Appraisal Process

 

 

 

 

 

 

Figure 2. Mediational Model of the Three-Variable System.

107

Acceptance and coping. A signiﬁcant relationship between acceptance of
disability and coping disposition was found in this study. The majority of people with
disabilities in this study had either emotion- or avoidance-focused coping dispositions
and low to medium levels of acceptance of disability. These ﬁndings suggest that
participants could beneﬁt from changing their system of personal values, and might proﬁt
by actively working to change Situations or increase personal resources to cope with
taxing demands. People with problem-focused dispositions in this study had medium to
high levels of acceptance of disability, which means that people who are intolerant of
self-devaluation (Wright, 1983) may seek opportunities to change the situation or seek
information to improve the situation. These ﬁndings may support Livneh and Antonak
(1997) who contend that approaching person-environment congruence (i.e., adaptation to
disability) promotes a sense of well-being, thus less need to elicit a stress appraisal.

Mediation effect. Results from this study indicated that including acceptance of

 

disability in the framework did not diminish the relationship between stress appraisal and
coping disposition. These ﬁndings suggest that the relationship between the stress
appraisal process and coping disposition for participants in this study is important,
regardless of a mediating variable and is in need of further clariﬁcation.

It is interesting to note that, in this study, what was signiﬁcant in the relationship
between stress appraisal and coping was not found signiﬁcant in the relationship between
stress appraisal and acceptance of disability (see Table 25), yet coping disposition and
acceptance to disability were strongly related to one another. No reason for this puzzling

result could be adequately identiﬁed, and further research speciﬁcally on the relationship

108

Table 25

Comparison of Signiﬁcant Relationships among the Three Variables

 

Variable Relationship with SAILS

 

Coping Disposition Factor 1: Intensity of Stress
Factor 3: Environment

Acceptance of Disability Factor 4: Challenge
Factor 5: Experience

 

between the stress appraisal process and coping dispositions of people with disabilities
might generate additional hypotheses worthy of examination.
Post Hoc Analyses

Exploration of generalizability regarding the relationships between the
demographic variables and the ﬁve SAILS factors yielded several Signiﬁcant ﬁndings.
The results indicated that several SAILS factors were signiﬁcantly related to gender, age,
race/ethnicity, employment status, and total years with disability (see Table 22).

Speciﬁc post-hoe results. Interpretation of speciﬁc results of post-hoe analysis
appears more problematic than the interpretation of the general ﬁndings discussed earlier.
Insightful conclusions about why some demographic characteristics related with only one
or few SAILS factors remains a challenge. Males and females appraised stress with
perceptions of harm or threat in differing ways, yet no differences were found with
respect to challenge or the remaining two aspects of subjective response: locus of
stressor or extent of experience. It is possible that males and females approach harm and

threat in similar ways; thus, examining the nuances of these subjective response areas for

109

people with disabilities may be important. Since SAILS factor three (Environment) was
Signiﬁcant in the general ﬁndings on the stress appraisal process, question remains as to
why there was no difference in the way males and females located difﬁculty/uncertainty
in the environment.

A second intriguing ﬁnding was in terms of age where only SAILS factor three
(Environment) was found signiﬁcant. Perhaps people between the ages of 18 through 44
are experiencing more demands that account for locating the source of difﬁculty in the
environment (i.e, educational demands, employment demands, familial demands),
whereas people 45 through 63 years old seem to understand what the barriers in the
environment are, know how to work with them, or know that trying to work with them is
an unbeatable circumstance. This interpretation is plausible, but it would seem to
implicate SAILS factor 5 (Experience) as signiﬁcant, which it did not.

Another ﬁnding was that people of various races/ethnicities differed with respect
to SAILS factor three (Environment) and SAILS factor four (Challenge). Speciﬁcally,
Caucasian and Aﬁican—Americans located the source of difﬁculty in the environment,
and perceived that they could gain something positive from the situations more often than
the other racial/ethnicity groupings. These ﬁndings are not surprising considering that
these two groups made up 88% of the sample. However, it is remarkable that no other
SAILS factors were found to be signiﬁcant, mainly with respect to extent of appraisal and
type of stress appraisal.

The employment status variable was the fourth characteristic on which differences
in stress appraisal were found. Students and unemployed people located the source of

difﬁculty in the environment (SAILS Factor 3) more often than employed people did.

110

This ﬁnding is plausible when one considers that employment is a situation that often
elicits stress (Krause, 1996, Wright, 1980), and barriers perceived to affect one’s work
status do appear to affect the overall sense of well-being in the person. It is interesting
that differences in perception of challenge (SAILS Factor 4) were alsonot found
considering that participants might believe they could gain something positive if they
were currently employed or remaining productive in a volunteer setting or as a student.
These ﬁndings have important implications for rehabilitation counselors whose primary
goals are to seek out employment opportunities and to return people with disabilities to
full-time employment.

A ﬁnal area of relationship was between total years with disability and SAILS
factor four (Challenge). People who lived 25 years or longer with disability may be more
capable of seeing themselves as gaining ﬁ'om a particular situation because they have had
more experience with handling various life situations with disability. However, it seems
implausible that SAILS factor ﬁve (Experience) did not also relate with the total years
with disability variable. Perhaps there is a distinction between developmentally living
life with disability and extent of experience, which was not differentiated in this study.

Nonsigrriﬁcant ﬁndings Two nonsigniﬁcant ﬁndings from this study warrant

 

further discussion. Marital status and type of disability were not found to relate with the
stress appraisal process of persons with disabilities. It would appear that having social
supports, in the form of a signiﬁcant partner, did not inﬂuence a person’s stress appraisal
process. This information does not coincide with literature that suggests that social
support positively inﬂuences one’s sense of well-being (Rintala, Young, Hart, Clearman,

& Fuhrer, 1992). Regardless of whether people were single, married, divorced, or

111

widowed, they were not impacted by the need to elicit a stress appraisal. However,
having a partner Should not be considered the only means of social support because
family, friends, and others can serve in this capacity, as well.

Likewise, speciﬁc type of disability did not inﬂuence the need for a stress
appraisal. This ﬁnding suggests that perhaps the appraisal process and areas of subject
response are more important foundations of stress theory than are a person’s speciﬁc type
of disability. It may be plausible to assume that the appraisal process of people with
disabilities in this study is based on the notion of disability in general and not on a
Speciﬁc type. Further research and additional validation of the SAILS based on Speciﬁc
type of disability is needed to substantiate this claim.

Assumptions and Limitations

The primary assumption underlying this study concerned the validity of self-
report to assess stress appraisal, coping disposition, and acceptance of disability. It was
assumed that the participants had the ability and judgment to honesty and accurately
assess their stress appraisals, coping disposition and level of acceptance of disability.

A second assumption of this study was the use of the transactional theory of
coping. In order to understand the stress appraisals and coping dispositions of people
with disability, this guiding theoretical framework was applicable. It was a reasonable
framework because it appreciates person-environment interactions; similar to what the
rehabilitation philos0phy promotes as an individual’s adaptation to disability.

One limitation of this study involved the generalizability of the results. The study
was limited to adults with physical or emotional disabilities who come from speciﬁed

regions of Michigan, and from three different types of service settings. It cannot be

112

assumed with a 72% participation rate that individuals from the sample may be similar to
other individuals with physical or emotional disabilities who might encounter the need to
elicit stress appraisals. However, this study attempted to capture an array of physical and
emotional disabilities from various service settings in an attempt to best represent
individuals with disabilities in Michigan or elsewhere.

A second limitation concerned weaknesses in instrumentation. The author
developed and ﬁeld-tested two of the instruments. Therefore, test-retest reliability, other
forms of internal consistency reliability, and evidence of validity were limited. Despite
thoughtful instrument development efforts, it is recognized that certain psychosocial
situations that evoke stress appraisal were not included in the instrument, and therefore
not subject to analyses.

A ﬁnal limitation involved the nature of the design of the study. This study was a
one-time exploration of the relationship between stress appraisal process, coping
disposition, and acceptance of disability, which assumed that these relationships can be
understood without employing a longitudinal framework of inquiry. Since this study was
a preliminary examination, it was practical to ﬁrst establish relationships among the
variables.

Implications for Education

The results of this investigation indicate that the stress appraisal process of this
study’s sample may be linked to certain areas of coping disposition, mainly perceptions
of stress, harm, threat and environmental locus. The current rehabilitation counseling
curriculum, which pays close attention to the process of coping with disability may

beneﬁt from including information about the subjective meaning that persons assign to

113

events in which coping strategies are employed. In addition, it would be important to
acknowledge the important inﬂuence that acceptance of disability has on coping with
disability and on the stress appraisal process, as well. Continuing efforts to train students
to appreciate the rehabilitation and independent living philosophies that support person-
environment interactions is critical. Broadening the curriculum to include examples of
how people with disabilities assign meaning from these interactions in order to
effectively manage life situations appears important when attempting to promote the
dignity and worth of people with disabilities.

Implications for Rehabilitation Counseling Practice

One of the most signiﬁcant ﬁndings of this study was the understanding that type
of psychosocial situation was not as important as understanding the subjective response
aspects of stress. Rehabilitation counselors can beneﬁt from asking clients about the
meaning behind their appraisal, whether aspects of intensity of stress, person,
environment, challenge, or experience are inﬂuencing the need to cope with the stress.
The stress appraisal process of people with disabilities in this study is a highly
individualized one. Assuming that a person with a disability automatically employs
strategies to manage life with disability is inaccurate and may hinder a person’s goal-
setting activities.

Appreciation for avoidance-focused coping dispositions is desirable because 36%
of the participants had avoidance-focused dispositions, as opposed to 15% who had
problem-focused ones. However, rehabilitation counselors may need to develop ways of
encouraging people with disabilities to adapt healthy coping strategies so that ﬁrture

stress appraisals are minimized. It would be helpful if rehabilitation counselors could

114

assist persons with emotion-focused dispositions to explore environmental reasons for
stress because, in this study 46% of the participants were not able to locate the source of
difﬁculty in the environment. Practitioners and clients alike might beneﬁt from focusing
efforts on legislative change that can improve the quality of life, including minimizing
the likelihood of encountering social and environmental barriers for people with
disabilities.

While acceptance of disability did not inﬂuence the relationship between stress
and coping for people with disabilities in this study, it is important that counselors realize
that level of acceptance of disability does inﬂuence the meaning that people assign to the
positive aspects of stressful events (e. g., challenge and experience). Trying to assist
peOple through a values change process, to the point where positive aspects of managing
stress are recognized may improve a person’s overall sense of well-being. Rehabilitation
counselors may need to appreciate the results of this study that indicate that perceptions
of challenge and level of experience affect the internal psychological perceptions of
living with disability, whereas the other aspects of stress appraisal (intensity of stress,
locus of stressor) are more externally perceived.

Finally, it is necessary that rehabilitation counselors understand that certain
demographic characteristics of their clientele may inﬂuence the stress appraisal process.
Whether respecting multicultural worldviews, understanding developmental perspectives
of disability, discovering vocational goals, or returning people to work, rehabilitation
counselors are responsible for knowing that people will differ in their subjective response

to situations encountered in their individualized rehabilitation plans.

115

Suggestions for Future Research
A range of alternatives can be offered in terms of directions for further research.
Two areas of critical importance deal with implications for stress and coping theory
Speciﬁcally for people with disabilities and for further development on the Stress
Appraisal Inventory for Life Situations (SAILS).

Stress and Copigg Theory

 

The results from this study indicate that more research is needed in terms of a
theoretical foundation of stress for people with disabilities. While the four areas of
subjective response in the general population were empirically validated, ﬁve speciﬁc
response areas were implicated for people with disabilities. Intensity of Stress, Person,
Environment, Challenge, and Experience explained by the SAILS need further deﬁnition
and differentiation from one another in order to advocate for a theory speciﬁc to people
with disabilities.

Differences in the way participants in this study perceive challenge do not seem to
ﬁt the Lazarus and F olkrnan (1984a) transactional deﬁnition of stress appraisal.
Conceivably, something about the participants from the sample leads challenge to be
perceived as a benign appraisal. Perhaps ﬁrrther examination of the speciﬁc personal and
Situational factors that inﬂuence primary appraisal, such as commitments, beliefs,
irnminence, and duration (Lazarus & F olkrnan, 1984a) is needed to more fully appreciate
the ﬁndings ﬁom this study.

Knowing from transactional theory that primary appraisal inﬂuences the need for
secondary appraisals, it is perplexing that more factors from the SAILS did not relate to

coping. Perhaps exploring a more ﬂuid nature of coping rather than examining coping

116

disposition might elicit a stronger stress-coping connection. Aspects of challenge,
experience, and person locus need further examination as to why these response areas did
not relate with coping disposition for the participants in this study. The results ﬁom this
study indicate that the stress-coping continuum is strong because no mediation effect
diminished its strength. However, clariﬁcation about a possible theory of primary
appraisal leading to secondary appraisal process for people with disabilities is warranted.

Instrument Development

 

There are several limitations, beyond those already mentioned, that suggest that
further validation of the SAILS is desired. Replicating this study with similar
participants and ﬁnding the same ﬁve factors might suggest stability of the stress
appraisal process for people with disabilities, and it might conﬁrm the component
structure identiﬁed in this study. The factors identiﬁed in this study may differ according
to a different sample, perhaps indicating another approach to understanding the stress
appraisal process and its relationship to coping for people with disabilities. Nevertheless,
a larger sample size would be beneﬁcial to uphold the merits of exploratory factor
analysis. Developing a structural equation model to test the current results may be
helpful in strengthening the signiﬁcance of the ﬁndings.

Restructuring the SAILS to prompt individuals to move onto the next Situation if
they indicate the current situation is not at all stressful may be important. The purpose of
this study was to understand the subjective meanings of stress using the transactional
theory as a guide, and caution in direct linkage to the theory is encouraged. The prompt
to move to the next situation would more closely differentiate between a benign and

stressful appraisal and may strengthen the validation of the SAILS beyond its current

117

level. It may also be more useful to design the SAILS so that the person identiﬁes the
stressful situation rather than read various hypothetical situations. Doing so would not
only focus on the stress appraisals, but may provide opportunity to connect the personal
and situational factors mentioned earlier into the instrument. Possibly the type of
situation in terms of stress appraisal would then become important to consider.
Conclusions

This study was the ﬁrst to empirically determine the relationship between the
stress appraisal process, coping disposition, and level of acceptance of disability. It
provided evidence that the stress appraisal process of the participants in this study may be
unique rather than similar to the general population. Results from this study reveal that
coping disposition may inﬂuence certain aspects of stress appraisal, although avoidance-
focused dispositions were not in the expected direction for perceptions of harm and
threat. Evidence from this study indicates that acceptance of disability may be related to
stress appraisal, although not all aspects of the appraisal process are important. The
ﬁndings from this study lend support to a relationship between coping disposition and
acceptance of disability, which may yield interesting future research in this direct line.

The ﬁve subjective response areas from the SAILS indicate that people with
disabilities ﬁom this study do assign meaning to stressful situations that connect to their
need to employ coping strategies. This study was only a ﬁrst step towards increased
understanding, and it demonstrated the need to connect stress appraisal to coping with
disability research. Perhaps this study will encourage researchers who are committed to

examining coping with disability and coping strategies for people with disabilities to

118

explicitly include aspects of stress appraisal. The result may be more meaningfully
contributions to rehabilitation counseling literature.

Given the current professionalization issues in counseling, it is important to
encourage best practices. Resources continue to grow scarce and those counselors most
capable of understanding how stress appraisal ﬁts in with well-being and achieving life
goals may be called upon more often to assist those people with disabilities who are

deserving of quality in and of life.

119

APPENDICES

120

APPENDIX A

LETTER OF INVITATION TO PROSPECTIVE MSU-RCPD STUDENTS

121

February 2000

Dear MSU Student:

It is a pleasure to introduce myself to you. My name is Darlene Groomes and I am a
doctoral student in the Rehabilitation Counseling Education program, here at MSU. I am
currently working on my dissertation research and I need your help.

I am looking for a number of students with physical and/or sensory disabilities to
complete several questionnaires that ask how they perceive Situations in life that may be
difﬁcult to handle. Michael Hudson, the Director of the Resource Center for Persons
with Disabilities, has agreed to help me by forwarding this e-mail to you. I have no
knowledge of who you are and will not know your speciﬁc disability unless you choose
to participate in this study. If you have a physical disability (e. g., spinal cord injury,
multiple sclerosis, muscular dystrophy, carpal tunnel syndrome) and/or a sensory
disability (e. g. visual impairment, hearing impairment), I will pay you $10 for completing
four questionnaires, which take 45-60 minutes to complete. If you require
accommodations, please let me know and I will make appropriate arrangements to meet
your needs.

By participating in this study, you may gain insight into how you perceive various life
situations and how you would most often choose to handle difﬁculties that arise ﬁ'om
these Situations. If you are interested in earning $10 by participating in the study, you
will need to attend ONE of the group sessions in Bessey Hall. Dates, times, and room
numbers for the group sessions are indicated below:

 

Date Time Room Number
February 14 3:00pm 235-F Bessey Hall
February 17 11:00am 105 Bessey Hall
February 24 1:00pm 313 Bessey Hall
February 28 7:00pm 220 Bessey Hall
March 1 10:00am 313 Bessey Hall
March 2 1:00pm 313 Bessey Hall
March 14 9:00am 271 Bessey Hall

(continued on next page)

122

 

Date Time Room Number
March 16 1:00pm 313 Bessey Hall
March 29 7:00pm 220 Bessey Hall
April 6 1 1:00am 105 Bessey Hall
April 10 7:00pm 220 Bessey Hall

Please come ONLY to the time slot and room number that matches the speciﬁc date that
you choose. You do not need to bring anything with you; all materials will be supplied to

you.

If you are interested in participating in this study, but are unable to make the scheduled
group sessions dates listed above, or you are uncomfortable as part of a small group
format, please contact me at 517-347—9832 or at groomesd@msu.edu to arrange a more
convenient time for you.

If you have questions about your involvement in this study, please call me or send me an

 

e-mail message. I will be glad to discuss your questions with you.

Sincerely,

11.3....

Darlene A.G. Groomes

Ph.D. Candidate

123

APPENDIX B

CONTACT INFOMRATION FOR PREVIEW COPY OF THE CISS

124

To receive information about or a copy of the Coping Inventory for Stressful Situations
(CISS; Endler & Parker, 1994), please contact:

Multi Health Systems, Inc.
Research and Development Department

In the US: 908 Niagara Falls Blvd.
North Tonawanda, NY, 14120-2060

Phone: (800) 456-3003

In Canada: 3770 Victoria Park Ave.
Toronto, Ontario, M2H 3M6

Phone: 416-492-2627 or (800) 268-6011
Fax: 416-492-3343 or (888) 540-4484

E-mail address: www.mhs.com

 

125

APPENDIX C

ACCEPTANCE OF DISABILITY SCALE

126

Acceptance of Disability Scale
(Linkowski, 1971)

READ EACH STATEMENT AND PUT AN “X” IN THE SPACE INDICATING HOW
MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT.

1.

A physical disability may limit a person in some ways, but this does not mean
he/she should give up and do nothing with his/her life.

_ I disagree very much __ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

Because of my disability, I feel miserable much of the time.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

More than anything else, I wish I didn’t have this disability.

__ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

Disability or not, I’m going to make good in life.

__ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

Good physical appearance and physical ability are the most important things in
life.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

My disability prevents me from doing just about everything I really want to do
and from becoming the kind of person I want to be.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

127

7. I can see the progress I am making in rehabilitation, and it makes me feel like an
adequate person in spite of the limitations of my disability.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

8. It makes me feel very bad to see all the things nondisabled people can do which I
cannot.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

9. My disability affects those aspects of life that I care most about.

_ I disagree very much __ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

10. Though I am disabled, my life is full.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

11. If a person is not entirely physically able, he/she is that much less a person.

__ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

12. A person with a disability is restricted in certain ways, but there is still much
he/she is able to do.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

13. There are many more important things in life than physical ability and
appearance.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree 3 little : I agree very much

128

14. There are times I completely forget that I am physically disabled.

__ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

15. You need a good and whole body to have a good mind.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

16. There are many things a person with my disability is able to do.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

17. Since my disability interferes with just about everything I try to do, it is foremost
in my mind practically all the time.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

18. If I didn’t have my disability, I think I would be a much better person.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

19. My disability, in itself, affects me more than any other characteristic about me.

_ I disagree very much __ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

20. The kind of person I am and my accomplishments in life are less important than
those of nondisabled persons.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

129

21. I know what I can’t do because of my disability, and I feel that I can live a full
and normal life.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

22. Though I can see the progress I am making in rehabilitation, this is not very
important since I can never be normal.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

23. In just about everything, my disability is annoying to me so that I can’t enjoy
anything.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

24. How a person conducts him/herself in life is much more important than physical
appearance and ability.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

25. A person with my disability is unable to enjoy very much in life.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

26. The most important thing in this world is to be physically normal.

_ I disagree very much __ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

27. A person with a disability ﬁnds it especially difﬁcult to expand his/her interests
and range of abilities.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

130

28. I believe that physical wholeness and appearance make a person what he/she is.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

29. A physical disability affects a person’s mental ability.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

30. With my condition, I know just what I can and cannot do.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

31. Almost every area of life is closed to me because of my disability.

__ I disagree very much __ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

32. Because of my disability, I have little to offer other people.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

33. Besides the many physical things I am unable to do, there are many other things
that I am able to do.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

34. Personal characteristics such as honesty and a willingness to work hard are much
more important than physical appearance and ability.

_ I disagree very much _ I agree a little

I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

131

35. I get very annoyed with the way some people offer to help me.

_ I disagree very much __ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

36. With my disability, there isn’t a single area of life that is not affected in some

major way.
_ I disagree very much __ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

37. Though I can see that disabled people are able to do well in many ways, still
they can never lead normal lives.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

38. A disability, such as mine, is the worst possible thing that can happen to a
person.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

39. No matter how hard I try or what I accomplish, I could never be as good as a
person as one without my disability.

__ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

40. There is practically nothing a person in my condition is able to do and really

enjoy it.
_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

132

41. Because of my disability, 1 am unable to enjoy social relationships as much as I
could if I were not disabled.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

42. There are more important things in life than those my physical disability
prevents me from doing.

_ I disagree very much __ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

43. I want very much to do things that my disability prevents me from doing.

_ I disagree very much __ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

44. Because of my disability, other people’s lives have more meaning than my own.

_ I disagree very much __ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

45. Oftentimes, when I think of my disability, it makes me feel so sad and upset that
I am unable to think of or do anything else.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

46. A disability changes one’s life completely. It causes one to think differently
about everything.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

47. I feel that I should be as able as the next person, even in areas where my
disability prevents me.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

133

48. Life is full of so many things that I sometimes forget for brief periods of time
that I am disabled.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

49. Because of my disability, 1 can never do most things that normal people can do.

__ I disagree very much __ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

50. I feel satisﬁed with my abilities, and my disability doesn’t bother me too much.

_ I disagree very much _ I agree a little
I disagree pretty much I agree pretty much
: I disagree a little : I agree very much

134

APPENDIX D

DEMOGRAPHIC AND GENERAL INF OMRATION QUESTIONNAIRE

135

Demographic and General Information Questionnaire
w

 

. Gender (please circle): Male Female
. Age: years old
. Marital Status (please circle): Single Married Divorced Widowed

. Race/Ethnicity (please circle): a. Asian or Paciﬁc Islander
b. Black/African-American, not of Hispanic Origin
c Caucasian/White, not of Hispanic Origin
(1. Hispanic
e Native-American
f Mixed Race

. Current Employment Status (please circle): a. Full-time outside the home
b. Part-time outside the home
c. Student
d. Volunteer position
e

. Not employed

. Primary type of disability (please circle):

 

 

a. Learning disability g. Heart disease

b. Alcoholism/drug abuse h. Amputation

c. Back injury i. Visual impairment

(1. Arthritis j. Hearing impairment

e. Epilepsy k. Chronic disease

f. Spinal cord injury 1. Other
. Were you born with this disability (please circle): Yes No
. How long have you had this disability: years

 

. Secondary type of disability (please circle only if applicable)

 

 

a. Learning disability g. Heart disease
b. Alcoholism/drug abuse h. Amputation
0. Back injury i. Visual impairment
d. Arthritis j. Hearing impairment
e. Epilepsy k. Chronic disease
f. Spinal cord injury 1. Other

10. How long have you had this disability: years

 

136

APPENDIX E

STRESS APPRAISAL INVENTORY FOR LIFE SITUATIONS

137

STRESS APPRAISAL INVENTORY
FOR

LIFE SITUATIONS
(SAILS)

 

@1999
Michigan State University
Darlene A.G. Groomes

Directions for Use

Please read the situation that is presented on every page. For each
statement that follows the situation, circle the number that most closely
matches how you think about the situation.

138

Situation One

You are at a social event with your friend who provides transportation assistance for you.
You tell your friend that you both need to leave, but your ﬁiend tells you to ﬁnd another
way home. You are now faced with having to ask a person who is not familiar with your
transportation needs to drive you home.

 

This situation would be...

Extremely Stressful Moderately A little Not at all
Stressﬁrl Stressful Stressful Stressful
5 4 3 2 1

Dealing with this situation would be. . ..

Extremely Depressing Moderately A little Not at all
Depressing Depressing Depressing Depressing
5 4 3 2 1

Dealing with this situation would be. . ..

Extremely Threatening Moderately A little Not at all
Threatening Threatening Threatening Threatening
5 4 3 2 1

I would expect to gain something positive from this situation. . ..

Never Rarely Sometimes Most Often Always
5 4 3 2 1
I go through this type of situation. ..
Never Rarely Sometimes Most Often Always
5 4 3 2 l

The stress from this situation would come ﬁ'om external sources (other people or
things)...

Never Rarely Sometimes Most Often Always
5 4 3 2 1

The stress from this situation would come from internal sources (myself)...

Never Rarely Sometimes Most Often Always
5 4 3 2 1

139

Situation Two
You are interviewing for an important job opening. The interviewer states that you will
only be hired because there is a law that requires hiring persons with disability. You
really want this job, so you say nothing to the interviewer about his/her attitude toward
you.

This situation would be...
Extremely Stressful Moderately A little Not at all
Stressﬁrl . Stressful Stressful Stressﬁrl
5 4 3 2 1

Dealing with this situation would be. . ..

Extremely Depressing Moderately A little Not at all
Depressing Depressing Depressing Depressing
5 4 3 2 1

Dealing with this situation would be. . ..

Extremely Threatening Moderately A little Not at all
Threatening Threatening Threatening Threatening
5 4 3 2 1

I would expect to gain something positive from this situation. . ..

Never Rarely Sometimes Most Often Always
5 4 3 2 1

I go through this type of situation. ..

Never Rarely Sometimes Most Often Always
5 4 3 2 1

The stress from this situation would come from external sources (other people or
things)...

Never Rarely Sometimes Most Often Always
5 4 3 2 1

The stress from this Situation would come from internal sources (myself)...

Never Rarely Sometimes Most Often Always
5 4 3 2 1

140

Situation Three

Your physician has told you that you require a surgical operation. You wonder what kind

of discomfort you will experience and what the outcome will be.

This situation would be...

Extremely Stressﬁrl Moderately A little
Stressﬁrl Stressful Stressful
5 4 3 2

Dealing with this Situation would be. . ..

Extremely Depressing Moderately A little
Depressing Depressing Depressing
5 4 3 2

Dealing with this situation would be. . ..

Extremely Threatening Moderately A little
Threatening Threatening Threatening
5 4 3 2

I would expect to gain something positive from this situation. . ..

Never Rarely Sometimes Most Often
5 4 3 2

I go through this type of situation. ..

Not at all
Stressful
1

Not at all
Depressing
1

Not at all
Threatening
1

Always

Always
1

Never Rarely Sometimes Most Often
5 4 3 2
The stress from this situation would come from external sources (other people or
things)...
Never Rarely Sometimes Most Often
5 4 3 2

The stress from this situation would come from internal sources (myself)...

Never Rarely Sometimes Most Often
5 4 3 2

141

Always
1

Always
1

Situation Four

 

You are at a restaurant with your family. Your relatives have ordered a meal
for you without considering that you can do so without their assistance. You

say nothing and eat the meal that is chosen for you.

This situation would be...

Extremely Stressful Moderately A little
Stressful Stressful Stressful
5 4 3 2
Dealing with this situation would be. . ..
Extremely Depressing Moderately A little
Depressing Depressing Depressing
5 4 3 2
Dealing with this situation would be. . ..
Extremely Threatening Moderately A little
Threatening Threatening Threatening
5 4 3 2

I would expect to gain something positive from this situation. . ..

Not at all
Stressﬁrl
1

Not at all
Depressing
1

Not at all
Threatening
1

Always

Always
1

Always

Never Rarely Sometimes Most Often
5 4 3 2
I go through this type of situation. ..
Never Rarely Sometimes Most Often
5 4 3 2
The stress from this situation would come from external sources (other people or
things)...
Never Rarely Sometimes Most Often
5 4 3 2

The stress from this situation would come from internal sources (myself)...

Never Rarely Sometimes Most Often
5 4 3 2

142

1

Always
l

Situation Five

You recently become aware of several job promotions in your current place of
employment. You think about the things you might like to do in your career and feel
limited in the employment opportunities offered to you. You ask your supervisor to
make opportunities for advancement available to you.

 

This situation would be. ..

Extremely Stressful Moderately A little Not at all
Stressful Stressful Stressful Stressful
5 4 3 2 1

Dealing with this situation would be. . ..

Extremely Depressing Moderately A little Not at all
Depressing Depressing Depressing Depressing
5 4 3 2 1

Dealing with this situation would be. . ..

Extremely Threatening Moderately A little Not at all
Threatening Threatening Threatening Threatening
5 4 3 2 1

I would expect to gain something positive from this situation. . ..

Never Rarely Sometimes Most Often Always
5 4 3 2 1

I go through this type of situation. ..

Never Rarely Sometimes Most Often Always
5 4 3 2 1

The stress from this situation would come from external sources (other people or
things)...

Never Rarely Sometimes Most Often Always
5 4 3 2 1

The stress from this situation would come from internal sources (myself)...

Never Rarely Sometimes Most Often Always
5 4 3 2 1

143

Situation Six

Your managed care provider is requiring you to change your primary care physician.
You have a pleasant and long-standing relationship with your current physician and do

not want to establish a new relationship.

This situation would be...
Extremely Stressful Moderately A little
Stressful Stressful Stressful
5 4 3 2
Dealing with this situation would be. . ..
Extremely Depressing Moderately A little
Depressing Depressing Depressing
5 4 3 2
Dealing with this situation would be. . ..
Extremely Threatening Moderately A little
Threatening Threatening Threatening
5 4 3 2

I would expect to gain something positive from this situation. . ..

Not at all
Stressful
1

Not at all
Depressing
1

Not at all
Threatening
1

Always

Always
1

Always
1

Never Rarely Sometimes Most Often
5 4 3 2
I go through this type of situation. ..
Never Rarely Sometimes Most Often
5 4 3 2
The stress from this situation would come from external sources (other people or
things)...
Never Rarely Sometimes Most Often
5 4 3 2

The stress from this Situation would come from internal sources (myself)...

Never Rarely Sometimes Most Often
5 4 3 2

144

Always
1

Situation Seven
You and your friends are discussing the subject of sex. You have something to add to the

conversation, but no one asks your opinion and they act as if you would not be interested
in an intimate relationship.

 

This situation would be...

Extremely Stressful Moderately A little Not at all
Stressful Stressful Stressful Stressful
S 4 3 2 1

Dealing with this situation would be. . ..

Extremely Depressing Moderately A little Not at all
Depressing Depressing Depressing Depressing
5 4 3 2 1

Dealing with this situation would be. . ..

Extremely Threatening Moderately A little Not at all
Threatening Threatening Threatening Threatening
5 4 3 2 l

I would expect to gain something positive from this situation. . ..

Never Rarely Sometimes Most Often Always
5 4 3 2 1

I go through this type of situation. ..

Never Rarely Sometimes Most Often Always
5 4 3 2 1

The stress from this situation would come from external sources (other people or
things)...

Never Rarely Sometimes Most Often Always
5 4 3 2 1

The stress from this Situation would come from internal sources (myself)...

Never Rarely Sometimes Most Often Always
5 4 3 2 1

145

Situation Eight
Your supervisor does nothing to encourage your full participation at work. Your
supervisor always speaks for you and answers questions from co-workers for you.

 

This situation would be...
Extremely Stressful Moderately A little Not at all
Stressful Stressﬁrl Stressﬁrl Stressful
5 4 3 2 1
Dealing with this situation would be. . ..
Extremely Depressing Moderately A little Not at all
Depressing Depressing Depressing Depressing
5 4 3 2 1
Dealing with this Situation would be. . ..
Extremely Threatening Moderately A little Not at all
Threatening Threatening Threatening Threatening
5 4 3 2 1
I would expect to gain something positive from this situation. . ..
Never Rarely Sometimes Most Often Always
5 4 3 2 l
I go through this type of situation. ..
Never Rarely Sometimes Most Often Always
5 4 3 2 1
The stress ﬁom this situation would come from external sources (other people or
things)...
Never Rarely Sometimes Most Often Always
5 4 3 2 1
The stress ﬁ'om this situation would come from internal sources (myself)...
Never Rarely Sometimes Most Often Always
5 4 3 2 1

146

Situation Nine
Your doctor recommends a new experimental treatment that might beneﬁt you. You do
not want to try this treatment, but trust your doctor’s recommendation. You decide to
take the experimental treatment even though you have doubts about it.

This situation would be...
Extremely Stressful Moderately A little Not at all
Stressful Stressful Stressful Stressful
5 4 3 2 1

Dealing with this situation would be. . ..

Extremely Depressing Moderately A little Not at all
Depressing Depressing Depressing Depressing
5 4 3 2 1

Dealing with this situation would be. . ..

Extremely Threatening Moderately A little Not at all
Threatening Threatening Threatening Threatening
5 4 3 2 1

I would expect to gain something positive from this situation. . ..

Never Rarely Sometimes Most Often Always
5 4 3 2 1

I go through this type of situation. ..

Never Rarely Sometimes Most Often Always
5 4 3 2 1

The stress from this situation would come from external sources (other people or
things)...

Never Rarely Sometimes Most Often Always
5 4 3 2 1

The stress from this situation would come from internal sources (myself)...

Never Rarely Sometimes Most Often Always
5 4 3 2 1

147

Situation Ten

 

Your signiﬁcant other wants to spend the evening at a comedy club. You would much
rather stay at home and watch television. You think that if you say this to your

signiﬁcant other, an argument will occur.

This situation would be...

Extremely Stressful Moderately A little
Stressful Stressful Stressful
5 4 3 2
Dealing with this situation would be. . ..
Extremely Depressing Moderately A little
Depressing Depressing Depressing
5 4 3 2
Dealing with this situation would be. . ..
Extremely Threatening Moderately A little
Threatening Threatening Threatening
5 4 3 2

I would expect to gain something positive from this situation. . ..

Not at all
Stressful
1

Not at all
Depressing
1

Not at all
Threatening
1

Always

Always
1

Never Rarely Sometimes Most Often
5 4 3 2
I go through this type of situation. ..
Never Rarely Sometimes Most Often
5 4 3 2
The stress from this situation would come from external sources (other people or
things)...
Never Rarely Sometimes Most Often
5 4 3 2

The stress from this situation would come from internal sources (myself)...

Never Rarely Sometimes Most Often
5 4 3 2

148

Always
1

Always
1

Situation Eleven

You hear a co-worker and supervisor talking about an idea for improving work
conditions. The supervisor seems enthusiastic about the idea even though you brought it
up a few days ago and the supervisor ignored it.

 

This situation would be...
Extremely Stressful Moderately A little Not at all
Stressful Stressful Stressful Stressﬁrl
5 4 3 2 1

Dealing with this situation would be. . ..

Extremely Depressing Moderately A little Not at all
Depressing Depressing Depressing Depressing
5 4 3 2 1

Dealing with this situation would be. . ..

Extremely Threatening Moderately A little Not at all
Threatening Threatening Threatening Threatening
5 4 3 2 1

I would expect to gain something positive from this situation. . ..

Never Rarely Sometimes Most Often Always
5 4 3 2 1

I go through this type of situation. ..

Never Rarely Sometimes Most Often Always
5 4 3 2 1

The stress from this situation would come from external sources (other people or
things)...

Never Rarely Sometimes Most Often Always
5 4 3 2 1

The stress from this situation would come from internal sources (myself)...

Never Rarely Sometimes Most Often Always
5 4 3 2 1

149

Situation Twelve
You hear about a new medication that you might beneﬁt from. You would like to try it,
but your HMO has refused to pay for that particular medication.

 

This situation would be...
Extremely Stressful Moderately A little Not at all
Stressful Stressful Stressful Stressful
5 4 3 2 1

Dealing with this situation would be. . ..

Extremely Depressing Moderately A little Not at all
Depressing Depressing Depressing Depressing
5 4 3 2 1

Dealing with this situation would be. . ..

Extremely Threatening Moderately A little Not at all
Threatening Threatening Threatening Threatening
5 4 3 2 1

I would expect to gain something positive from this situation. . ..

Never Rarely Sometimes Most Often Always
5 4 3 2 1

I go through this type of situation. ..

Never Rarely Sometimes Most Often Always
5 4 3 2 1

The stress from this situation would come from external sources (other people or
firings). ..

Never Rarely Sometimes Most Often Always
5 4 3 2 1

The stress from this situation would come from internal sources (myself)...

Never Rarely Sometimes Most Often Always
5 4 3 2 1

150

Situation Thirteen

You and your friends were planning to go to a movie together. You overhear your
friends talking about their frustration with you. They state that if you did not have a
disability it would be much more fun and easy to go to social events.

 

This situation would be...

Extremely Stressﬁrl Moderately A little Not at all
Stressful Stressful Stressful Stressful
5 4 3 2 1

Dealing with this situation would be. . ..

Extremely Depressing Moderately A little Not at all
Depressing Depressing Depressing Depressing
5 4 3 2 1

Dealing with this situation would be. . ..

Extremely Threatening Moderately A little Not at all
Threatening Threatening Threatening Threatening
5 4 3 . 2 1

I would expect to gain something positive from this situation. . ..

Never Rarely Sometimes Most Often Always
5 4 3 2 1

I go through this type of situation...

Never Rarely Sometimes Most Often Always
5 4 3 2 1

The stress from this situation would come from external sources (other people or
things). . .

Never Rarely Sometimes Most Often Always
5 4 3 2 1

The stress from this situation would come from internal sources (myself)...

Never Rarely Sometimes Most Often Always
5 4 3 2 1

151

Situation Fourteen

Your supervisor tells you that you are ﬁred because you are not working adequately and
are not getting along with co-workers. You ﬁle a complaint with the Equal Employment
Opportunity Commission because you believe that your supervisor violated your rights

under the law.

This Situation would be...

Extremely Stressful Moderately A little
Stressful Stressful Stressful
5 4 3 2
Dealing with this situation would be. . ..
Extremely Depressing Moderately A little
Depressing Depressing Depressing
5 4 3 2
Dealing with this situation would be. . ..
Extremely Threatening Moderately A little
Threatening Threatening Threatening
5 4 3 2

I would expect to gain something positive from this situation. . ..

Not at all
Stressful

1

Not at all
Depressing
1

Not at all
Threatening
1

Always

Always
1

Always

Never Rarely Sometimes Most Often
5 4 3 2
I go through this type of situation. ..
Never Rarely Sometimes Most Often
5 4 3 2
The stress from this situation would come from external sources (other people or
things)...
Never Rarely Sometimes Most Often
5 4 3 2

The stress from this situation would come ﬁ'om internal sources (myself)...

Never Rarely Sometimes Most Often
5 4 3 2

152

1

Always
1

Situation Fifteen

Your medical team recommends that you receive physical therapy services three times a
week. You believe that you do not need that much therapy. You tell your medical team
that their recommendation is not appropriate.

 

This situation would be...

Extremely Stressful Moderately A little Not at all
Stressful Stressful Stressful Stressful
5 4 3 2 1

Dealing with this situation would be. . ..

Extremely Depressing Moderately A little Not at all
Depressing Depressing Depressing Depressing
5 4 3 2 1

Dealing with this situation would be. . ..

Extremely Threatening Moderately A little Not at all
Threatening Threatening Threatening Threatening
5 4 3 2 1

I would expect to gain something positive from this situation. . ..

Never Rarely Sometimes Most Often Always
5 4 3 2 1

I go through this type of situation. ..

Never Rarely Sometimes Most Often Always
5 4 3 2 1

The stress from this situation would come from external sources (other people or
things)...

Never Rarely Sometimes Most Often Always
5 4 3 2 1

The stress from this situation would come from internal sources (myself)...

Never Rarely Sometimes Most Often Always
5 4 3 2 1

153

APPENDIX F

CONSENT FORM

154

Participant Consent Form

The purpose of this study is to understand what people with disabilities think about
certain particular life situations that may stressful to them, how they might think about
handling difﬁculties that arise from the situation, and what they think about themselves as
a person with a disability. In order to meet the objective of this study, you will be asked
to ﬁll out four questionnaires, which take approximately 45-60 minutes to complete.

Your participation in this study is greatly needed and appreciated. You are under no
obligation to participate in this study; participation is voluntary. You may leave at any
time if you choose to do so. You do not have to answer certain questions if you choose
not to. Whether or not you participate will NOT affect your ability to receive services
from this organization.

The information you provide is completely conﬁdential. Only the investigator in this
study will use it, and the information will NOT be discussed or released to others for any
purpose. Your responses will be used ONLY when combined with those of many other
participants. Your privacy will be protected to the maximum extent allowable by law.

You will be paid $10 upon full completion of the four questionnaires. You indicate your
voluntary agreement to participate in this study by signing and returning this consent

form.

Participant Signature:

 

Date:

 

If you have questions or concerns regarding this research study, please contact:

Darlene A.G. Groomes
237 Erickson Hall
Michigan State University
East Lansing, MI 48824-1034
(517) 355-1838
groomesd@msu.edu

 

If you have questions about your rights as a human subject of research, please contact:

David E. Wright, Ph.D.
UCRIHS Chair
246 Administration Building
Michigan State University
East Lansing, MI 48824-1046
(517) 355-2180

155

REFERENCES

156

References

American Psychiatric Association (1994). Diagnostic and statistical manual of
mental disorders (4‘11 ed.). Washington, DC: American Psychiatric Association.

Amirkhan, J .H. (1990). A factor analytically derived measure of coping: The
Coping Strategy Indicator. Journal of Personality and Social Psychology, 59, 1066-1074.

Antonak, RF. (1981). Development and psychometric analysis of the Scale of
Attitudes Toward Disabled Persons (Technical Report No. 1). Durham, New Hampshire:
University of New Hampshire, Education Department.

Antonovsky, A. (1980). Health, stress, and coping. San Francisco, California:

J ossey-Bass.

Barker, RC. (1948). The social psychology of physical disability. The Journal
of Social Issues, 4, 28-38.

Baron, R.M., & Kenny, DA. (1986). The moderator-mediator variable
distinction in social psychological research: Conceptual, strategic, and statistical
considerations. Journal of Personality and Social Psychology, 51 (6), 1173-1182.

Belgrave, El. (1991). Psychosocial predictors of adjustment to disability in

African Americans. Journal of Rehabilitation 57, 37-40.

 

Billings, A.G., & Moos, RH. (1981). The role of coping responses and social

resources in attenuating the stress of life events. Journal of Behavioral Medicine, 4 (2),

 

139-157.
Billings, A.G., & Moos, RH. (1984). Coping, stress, and social resources among

adults with unipolar depression. Journal of Personality and Social Psychology, 46 (4),

 

877-891.

157

Bolton, B. (1994). Acceptance of disability scale. In DJ. Keyser & R.C.
Sweetland (Eds.), Test Critigues, Volume 10. Austin, Texas: Pro-Ed.

Bond, M.P., & Valliant, J .S., (1986). An empirical study of the relationship
between diagnosis and defense style. Archives of General Psychiatry, 43, 285-288.

Bramston, P., Bostock, J ., & Tehan, G. (1993). The measurement of stress in
people with an intellectual disability: A pilot study. International Journal of Disability,

Development and Education, 40 (2), 95-104.

 

Bramston, P., Fogarty, G., & Cummins, RA. (1999). The nature of stressors

reported by people with an intellectual disability. Journal of Applied Research in

 

Intellectual Disabilities, 12 (1), 1-10.

 

Brantley, P.J., & Jones, G.N. (1989). Daily Stress Inventory. Florida:

 

Psychological Assessment Resources, Inc.

Brickman, P., Rabinowitz, V.C., Karuza, J., Jr., Coates, D., Cohn, E., & Kidder,

L. (1982). Models of helping and coping. American Psychologist, 37 (4), 368-384.

 

Brodwin, M.G., Tellez, F ., & Brodwin, SK. (1993). Medical, psychosocial and

 

vocational aspects of disability. Athens, Georgia: Elliott & Fitzpatrick, Inc.

 

Brown, JD. (1993). Coping with stress: The beneﬁcial role of positive illusions.
In A.P. Tumbull, J .M. Patterson, S.K. Behr, D.L. Murphy, J.G. Marquis, & M. J. Blue-

Banning (Eds.), Cognitive coping, families, and disability (pp. 123-133). Baltimore,

 

Maryland: Paul H. Brookes.

Carver, C.S., & Scheier, M.F. (1994). Situational coping and coping dispositions

 

in a stressﬁrl transaction. Journal of Personality and Social Psychology, 66, 184-195.

 

Chaturvedi, MK. (1983). Human stress and stressors. New Delhi, India:

 

Cosmo.

158

Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd

ed.). Hillsdale, New Jersey: Lawrence Erlbaum Associates.

Cohen, L.H. (1988). Life events and psychological functioning. In L.H. Cohen
(Ed.), Life events ancﬂsychological functioning: Theoretical and methodological issues
(pp. 7-30). New York: Sage.

Cone, J.D., & Foster, S.L. (1995). Dissertations and theses from start to ﬁnish.
Washington, DC: American Psychological Association.

Cook, T.D., & Campbell, D.T. (1979). (EaSi-experimentation: Design and
analysis of issues for ﬁeld settings. Boston, Massachusetts: Houghton Mifﬂin.

Cook, S.W., & Heppner, PP. (1997). A psychometric study of three coping

measures. Educational and Psychological Measurement, 57 (6), 906-923.

 

Cox, T., & Ferguson, E. (1991). Individual differences, stress and coping. In

C.L. Cooper & R. Payne (Eds.), Personality and stress: Individual differences in the stress

 

process (pp. 7-30). New York: John Wiley & Sons.
Cronkite, R.C., & Moos, RH. (1995). Life context, coping processes, and

depression. In E.E. Beckharn & W.R. Leber (Eds), Handbook of depression (pp. 569-

 

587). New York: The Guilford Press.

Davis, S.H., Anderson, C., Linkowski, D.C., Berger, K., & Feinstein, CF.
(1985). Developmental tasks and transitions of adolescents with chronic illnesses and
disabilities. Rehabilitation Counseling Bulleting, 29, 69-80.

Dembo, T., Leviton, L., & Wright, BA. (1956). Adjustment to misfortune: A

problem of social-psychological rehabilitation. Artiﬁcial Limbs 3, 4-62.

 

159

De Ridder, D. (1997). What is wrong with coping assessment? A review of

conceptual and methodological issues. Iﬁychology and HealthL12, 417-431.

 

Dohrenwend, B.S., & Dohrenwend, RP. (1981). Life stress and
psychopathology. In D.A. Regier & G. Allen (Eds), Risk factor research in the major
mental disorders (National Institute of Mental Health, DHI-IS Publication No. ADM 81-
1086) (pp. 131-141). Washington, DC: National Institute on Mental Health.

Endler, N.S., & Parker, J.D.A. (1990). Multidimensional assessment of coping:

A critical evaluation. Journal of Personality and Social Psychology, 58 (5), 844-854.

 

Endler, N.S., & Parker, J .D.A. (1994). Assessment of multidimensional coping:

Task, emotion, and avoidance strategies. Psychological Assessment, 6 (1), 50-60.

 

Fogarty, G.J., Bramston, P., & Cumrrrins, RA. (1997). Validation of the
Lifestress Inventory for people with a mild intellectual disability. Research in

Developmental Disabilities, 18 (6), 435-456.

 

F olkrnan, S., & Lazarus, RS. (1988). Manual for the Ways of Coping

Questionnaire. Palo Alto, California: Consulting Psychologist Press.

 

Folkman, S., Lazarus, R.S., Dunkel-Schetter, C., DeLongis, A., & Gruen, RJ.
(1986). Dynamics of a stressful encounter: Cognitive appraisal, coping, and encounter

outcomes. Journal of Personality and Social Psychology, 50(5), 992-1003.

 

Glueckauf, R.L., Horley, J., Poushinsky, M.F., & Vogel, R. (1984).
Assertiveness training for disabled individuals in wheelchairs: Preliminary ﬁndings.

International Journal of Rehabilitation Research, 7, 441-443.

 

160

Hampton, N.Z., & Crystal, R. (1999). Gender differences in acceptance of
disabilities among vocational rehabilitation consumers. Journal of Applied Rehabilitation

Counseling, 30 (1), 16-21.

 

Hays, W.L. (1963). Statistics for psychologists. New York: Holt, Rinehart, and
Winston.

Heinemann, A.W., & Shontz, F .C. (1982). Acceptance of disability, self-esteem,
sex role identity, and reading aptitude in deaf adolescents. Rehabilitation Counseling
Bulletin, 25 197-203.

Herrick, S.M., Elliott, T.R., & Crow, F. (1994). Social support and the prediction

of health complications among persons with spinal cord injuries. Rehabilitation

 

Psychology, 39 (4), 231-249.

 

Holahan, C.J., Moos, R.H., & Schaefer, J .A. (1996). Coping, stress, resistance,

and growth: Conceptualizing adaptive functioning. In M. Zeidner & N.S. Endler (Eds),

 

Handbook of coping: Theory, research, applications (pp. 24-43). New York: John Wiley
& Sons.
Holmes, T., & Rahe, R. (1967). The social readjustment rating scale. Journal of

Psychosomatic Research, 11, 213-218.

 

J anoff-Bulrnan, R. (1999). Rebuilding shattered assumptions after traumatic life

events: Coping processes and outcomes. In C .R. Snyder (Ed.), Coping: The psychology

 

of what works (pp. 305-323). New York: Oxford University Press.

Johnson, R.A., & Wichem, D.W. (1992). Applied multivariate statistical

 

analysis (3rd ed.). Upper Saddle River, New Jersey: Prentice Hall.

161

Joiner, J .G., Lovett, P.S., & Goodwin, L.K. (July 1989). Positive assertion and

acceptance among person with disabilities. Journal of Rehabilitation, 22-29.

 

Kahn, AM. (1995). Coping with fear and grieving. In I.M. Lubkin, Chronic

illness: Impact and interventions (pp.241-260). Boston, Massachusetts: Jones and

 

Bartlett.
Kaiser, S.B., Wingate, S.B., Freeman, C.M., & Chandler, J .L. (1987).
Acceptance of physical disability and attitudes toward personal appearance.

Rehabilitation Psghology, 32 (1), 51-58.

 

Kohn, RM. (1996). On coping adaptively with daily hassles. In M. Zeidner &

N.S. Endler (Eds), Handbook of coping: Theory, research, applications (pp. 181-201).

 

New York: John Wiley & Sons.
Krause, J .S. (1996). Employment after spinal cord injury: Transition and life

adj ustrnent. Rehabilitation Counseling Bulletin, 39 (4), 244-255.

 

Kulkarni, MR. (1985). Coping with disability inventory: A study of the
reliability and validity of an instrument designed to measure coping behavior of
physically disabled persons in the United States and India (Doctoral dissertation,

Michigan State University, 1985). Dissertation Abstracts International, 114728THS.

 

Lazarus, R.S., & Folkman, S. (1984a). Stress, Appraisal, and Coping. New

 

York: Springer.
Lazarus, R.S., & Folkman, S. (1984b). Coping and adaptation. In W.D. Gentry

(Ed.), Handbook of behavioral medicine (pp. 282-325). New York: The Guilford Press.

 

162

Lepore, S.J., & Evans, G.W. (1996). Coping with multiple stressors in the
environment. In M. Zeidner & N.S. Endler (Eds), Handbook of coping: Theory,
research, applications (pp. 350-380). New York: John Wiley & Sons.

Lewis-Beck, MS. (1980). Applied regression: An introduction. (Sage
University Paper Series on Quantitative Application in the Social Sciences, series no. 07-
022). Newbury Park, California: Sage.

Li, L., & Moore, D. (1998). Acceptance of disability and its correlates. 111g

Journal of Social Psychology, 138(1), 13-25.

 

Linkowski, DC. (1971). A scale to measure acceptance to disability.

Rehabilitation Counseling Bulletin, 14 (4), 236-244.

 

Linkowski, D.C., & Dunn, M.A. (1974). Self-concept and acceptance of

disability. Rehabilitation Counseling Bulletin, 17, 28-32.

 

Livneh, H., & Antonak, RF. (1997). Psychosocial adaptation to chronic illness

and disability. Gaithersburg, Maryland: Aspen.

 

Maki, D. R., & Riggar, T.F. (1997). Rehabilitation Counseling: Concepts and
paradigms. In D.R. Maki & T.F. Riggar (Eds), Rehabilitation Counseling: Profession
and Practice (pp. 3-31). New York: Springer.

McCarthy, C.J., Lambert, R.G., & Brack, G. (1997). Structural model of coping,

appraisal, and emotions after relationship breakup. Journal of Counseling and

 

Development, 76, 53-64.

 

McCrae, R.R., & Costa, RT. (1986). Personality, coping, and coping

effectiveness in an adult sample. Journal of Personality, 54 (2), 385-405.

 

163

Monroe, S.M., & Peterrnan, AM. (1988). Life stress and psychopathology. In
L.H. Cohen (Ed.), Life events and psychological functioning: Theoretical and
methodological issues (pp. 31-63). New York: Sage.

Moos, R.H., & Schaefer, J.A. (1986). Life transitions and crises: A conceptual
overview. In R.H. Moos (Ed.), Coping with life crises: An integrated apmach (pp. 1-
28). New York: Plenum Press.

Moore, A.D., & Starnbrook, M. (1992). Coping strategies and locus of control

following traumatic brain injury: Relationship to long-term outcome. Brain Injury, 6 (1),

 

89-94.
Mulaik, SA. (1972). The foundations of factor analysis. New York: McGraw-
Hill.

Newton, R.R., & Rudestam, K.E. (1999). Your statistical consultant: Answers

 

to your data analysis questions. Thousand Oaks, California: Sage.

 

O’Driscoll, M.P., & Cooper, CL. (1994). Coping with work-related stress: A
critique of existing measures and proposal for an alternative methodology. Journal of

Occupational and Organizational Psychology 67, 343-354.

 

Paterson, R.J., & Neufeld, R.W.J. (1989). The stress response and parameters of
stressful situations. In R.W.J. Neufeld (Ed.), Advances in the investigation of

psychological stress (pp. 7-42). New York: John Wiley & Sons.

 

Pearlin, L.I., & Schooler, C. (1978). The structure of coping. Journal of Health

 

and Social Behavior, 19, 2-21.

 

Pedhazur, E.J., & Schmelkin, LP. (1991). Measurement, design, and analysis:

 

An integrated approach. Hillsdale, New Jersey: Lawrence Erlbaum Associates.

 

164

President’s Committee on Employment of People with Disabilities (1994).

Operation people ﬁrst: Toward a national disability policy. Journal of Disability Policy

 

Studies 5 (2) 81-106.

 

Rintala, D.H., Young, M.E., Hart, K.A., Clearman, R.R., & Fuhrer, MJ. (1992).
Social support and the well-being of person with spinal cord injury living in the
community. Rehabilitation Psychology, 37 (3), 155-163.

Revenson, T.A., & F elton, 3.]. (1989). Disability and coping as predication of

psychological adjustment to rheumatoid arthritis. Journal of Consulting and Clinical

 

Psychology 57 (3), 344-348.

 

Robinson, F .M., Jr., West, D., & Woodworth, D., Jr. (1995). Coping+Plus:

 

Dimensions of disability. Westport, Connecticut: Praeger
Roessler, RT. (1990). A quality of life perspective on rehabilitation counseling.

Rehabilitation Counseling Bulletin, 34 (2), 82-90.

 

Roessler, R., & Bolton, B. (1978). Psychosocial adjustment to disability.

 

Baltimore, Maryland: University Park Press.
Romano, J.L. (1992). Psychoeducational interventions for stress management

and well-being. Journal of Counseling and Development, 71, 199-202.

 

Rutter, M. (1994). Stress research: Accomplishments and tasks ahead. In R.J.

Haggerty, L.R. Sherrod, N. Garmezy, & M. Rutter (Eds), Stress, risk, and resilience in

 

children and adolescents (pp.354-385). New York: Cambridge University Press.

 

Schwarzer, R., & Schwarzer, C. (1996). A critical survey of coping instruments.

In M. Zeidner & N.S. Endler (Eds), Handbook of coping: Theory, research, applications

 

(pp. 107-132). New York: John Wiley & Sons.

165

Selye, H. (1976). The stress of life. New York: McGraw-Hill.

Shavelson, R.J. (1988). Statistical reasoning for the behavioral sciences (2nd ed.).
Boston, Massachusetts: Allyn and Bacon, Inc.

Shontz, EC. (1975). The psycholggical agrects ofphysical illness and disability.
New York: Macmillan.

Skinner, EA. (1995). Perceived control, motivation, and coping. Thousand
Oaks, California: Sage.

Skodol, AB. (1998). Personality and coping as stress-attenuating or —amplifying
factors. In B.P. Dohrenwend (Ed.), Adversity, stress, and psychopathology (pp. 377-
389). New York: Oxford University Press.

Snyder, C.R., & Dinoff, BL. (1999). Coping: Where have you been? In C.R.

Snyder (Ed.), Coping: The psychology of what works (pp. 3-19). New York: Oxford

 

University Press.

SPSS, Inc. (1999). SPSS Base 9.0 user’s guide. Chicago, Illinois: SPSS, Inc.

 

Stone, A.A., Helder, L., & Schneider, MS. (1988). Coping with stressful events.

In L.H. Cohen (Ed.), Life events and psychological functioning: Theoretical and

 

methodological issues (pp. 182-210). New York: Sage.

 

Sweetland, R.C., & Keyser, D. J. (1991). Tests: a comprehensive reference for

 

assessments in psychology, education, and business. Austin, Texas: Pro-Ed.

 

Swindle, R.W., Heller, K., & Lakey, B. (1988). A conceptual reorientation to the

study of personality and stressful life events. In L.H. Cohen (Ed.), Life events and

 

psychological ﬁrnctioning: Theoretical and methodological issues (pp. 237-268). New

 

York: Sage.

166

Tabachnick, B.G., & Fidell, LS. (1996). Using multivariate statistics (3rd ed.).

New York: HarperCollins.
Tetrick, LE. (1992). Mediating effect of perceived role stress: A conﬁrmatory

analysis. In J .C. Quick, L.R. Murphy, & J.J. Hurrell (Eds), Stress and well-being at

 

work (pp. 134-152). Washington, DC: American Psychological Association.
Tobin, D.L., Holroyd, K.A., Reynolds, R.V., & Wigal, J .K. (1989). The

hierarchical factor structure of the Coping Strategies Inventory. Cognitive Therapy and

 

Research 13, 343-361.

 

United States Census Bureau (1999). Census Bureau facts for features (Public

 

Information Ofﬁce Report No. CB99-FF.13). Washington, DC: Author.
Vash, CL. (1981). The psychology of disability. New York: Springer.
Vash, CL. (1994). Personality and adversity: Psychospiritual aspects of

rehabilitation. New York: Springer.

 

Wallander, J .L., & Varni, J .W. (1995). Appraisal, coping, and adjustment in
adolescents with a physical disability. In J .L. Wallander & L.J. Siegel (Eds), Adolescent

health problems: Behavioral perspectives (209-229). New York: The Guilford Press.

 

Watson, D., Davis, J.P., & Suls, J. (1999). Personality, affectivity, and coping.
In C.R. Snyder (Ed.), Coping: The psychology of what works (pp. 119-140). New York:
Oxford University Press.

Wright, BA. (1983). Physical disability: A psychosocial approach (2nd ed.).

 

New York: HarperCollins.

Wright, G.N. (1980). Total Rehabilitation. Boston, Massachusetts: Little,

 

Brown and Company.

167

Yuker, H.E., Block, J .R., & Campbell, W.J. (1960). A scale to measure attitudes

 

toward disabled persons (Human Resources Study No. 7). Albertson, New York:
Human Resources Center.
Zautra, A.J., Guamaccia, C.A., Reich, J .W., & Dohrenwend, BR (1988). The

contribution of small events to stress and distress. In L.H. Cohen (Ed.), Life events and

 

psychological functioning: Theoretical and methodological issues (pp. 123-147). New
York: Sage.

Zeidner, M., & Saklofske, D. (1996). Adaptive and maladaptive coping. In M.
Zeidner & N.S. Endler (Eds), Handbook of copinggTheow, research, applications (pp.
505-531). New York: John Wiley & Sons.

Zeitlin, S., & Williamson, G.G. (1994). Coping young children: Early

 

intervention practices to enhance adamtive behavior and resilience. Baltimore, Maryland:

 

Paul H. Brookes.

168

IIIIIIIIIIIIIIIIIIIII

111111151131111111111 |
1293 02174

1111

1 1|
iiiilii 1

3