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BackgroundTinnitus (ie, ear or head noises not caused by external sounds) is common among the general population and is the most prevalent service-connected disability in the United States' Department of Veterans Affairs system. While numerous clinical interventions have been created to systematically address the range of issues caused by tinnitus, only a few tinnitus interventions have focused on both teaching and assessing coping strategies. The present pilot study involved a randomized clinical trial comparing 3 brief group interventions to a usual-care (UC) group (ie, a wait-list control group): the first intervention based on acceptance and commitment therapy (ACT), a second based on cognitive-behavioral therapy (CBT), and a third based on coping effectiveness training (CET). Each intervention group also received tinnitus-related audiological education.ParticipantsForty individuals met the eligibility requirements and were randomized into 1 of the 4 groups (ACT, CBT, CET, or UC). An intent-to-treat analysis was used in this study.MeasuresThe Brief COPE scale was used to assess coping. Coping was assessed at 3 time points (pre-intervention, post-intervention, and at 4-week follow-up). The outcomes were 3 coping factors (engagement coping, disengagement coping, and social support coping).ResultsWhen examining differences among the groups on mean coping scores over time, significant group differences were found on social support coping, with the CET group scores significantly higher than the UC group.DiscussionWhile all 3 brief interventions teach stress-reduction techniques, ACT and CBT focus primarily on managing one's unwanted thoughts and emotions. CET teaches participants both a range of coping strategies (eg, stress-management approaches) to more effectively manage stressors that cannot be changed, as well as coping strategies (eg, such as problem-solving) that can be used to eliminate stressors that can be changed. CET also teaches communication skills for telling others about one's tinnitus-related issues. CET instructs individuals on how to select coping strategies that are appropriate for different kinds of stressors and how to seek social support, which is a skill not explicitly taught by ACT or CBT. Results of this study were derived from a small sample size, and thus, future research should focus on replicating the results among a larger sample. In addition, future research could focus on adapting the CET intervention to a different delivery format.

The purpose of this cross-cultural research is to examine prototypical perspectives about disability groups in the United States and Russia by extending the research on disability prototypes that was conducted by McCaughey and Strohmer. Open-ended questions permitted participants to describe what they thought were prototypical characteristics of people in three disability groups (AIDS, hearing impairment, and spinal cord injury). A series of chi-square analyses indicate that there are significant differences across superordinate categories between the two countries, in addition to significant differences within two superordinate categories when examining the two samples across three disability categories. Tentative conclusions of the findings, possible implications for rehabilitation counselors, and directions for further research are briefly discussed. (Contains 3 tables.)

Rehabilitation counseling involves the construction of vocational goals, which involves future-oriented thinking. Yet, research indicates that time orientations may change after the experience of a trauma. Due to the potential importance of a future time orientation (FTO) in rehabilitation counseling, predictors of an FTO were examined among 317 veterans and civilians with spinal cord injuries using spinal cord injury clinics. Results indicated that after controlling for the demographic and disability-related variables, reactions of adaptation to disability explained 24% of the variance in FTO. Shock, depression, and acknowledgment were significant predictors of FTO. The facilitation of greater FTO in clients may be integral to achieving the long-term, career-focused planning that is emphasized in rehabilitation counseling. (Contains 2 tables.)

Because the onset of a spinal cord injury may involve a brush with death and because serious injury and disability can act as a reminder of death, death anxiety was examined as a predictor of posttraumatic stress levels among individuals with disabilities. This cross-sectional study used multiple regression and multivariate multiple regression to examine whether death denial and death awareness predicted posttraumatic stress disorder (PTSD) among veterans and civilians with spinal cord injuries (N = 313). The results indicated that death anxiety (after controlling for demographic and disability-related variables) predicted a significant amount of the total levels of posttraumatic stress reactions among individuals with spinal cord injuries. Further, death awareness, pain level, and spiritual/religious coping significantly predicted the posttraumatic stress clusters of reexperiencing, avoidance, and hyperarousal. Death denial significantly predicted only hyperarousal. Because death anxiety predicts various aspects of PTSD reactions, one possible therapeutic implication is that addressing death-related topics may help to reduce PTSD reactions. Further research is needed to better ascertain the possible causality among these variables.

Diabetes is a chronic illness that can wreak havoc on many systems of the body. Despite this, having diabetes does not have to be viewed as the antithesis of a full and happy life. After describing the biological aspects of diabetes, this article details multiple aspects of living with diabetes and some of its implications that the author has experienced. (GCP)

The purpose of this archival research was to investigate whether coping moderated the association between disability status and the outcome of psychosocial adaptation while controlling for demographic variables, posttraumatic stress disorder, and environmental conditions and social support. This research analyzed data from the U.S.'s National Vietnam Veterans Readjustment Study (NWRS; R.A. Kulka et al., 1990a). In this study, the existence of a disability significantly and negatively predicted psychosocial adaptation after controlling for specific variables. Further, the multiple regression analysis showed that the association of disability and adaptation was moderated by problem-solving coping, indicating that the negative effect of disability on adaptation was smaller for participants with lower levels of problem-solving coping. Clinical implications of these findings are discussed. Keywords: Vietnam veterans; psychosocial adaptation; coping; PTSD; disability

The factorial structure of trauma-related stress reactions was explored using the Purdue Posttraumatic Stress Disorder revised scale, in a sample of 106 adults with insulin-dependent diabetes mellitus. An exploratory factor analysis yielded 2 factors, (a) arousal and passive cognitive-affective avoidance reactions and (b) re-experiencing and active avoidance reactions. The 2-factor structure, however, may also be reflective of the scale format which limits its interpretative power.

From 313 individuals who sustained spinal cord injuries self reported responses were examined on their psychosocial adaptation to disability and perceived quality of life. A multidimensional scaling analysis yielded a 2-dimensional structure of adaptation. The first dimension indicated adaptive versus nonadaptive reactions. The second dimension was suggestive of denial versus realization of the affect related to the medical impairment.

Because the co-occurrence of depression and posttraumatic stress disorder (PTSD) has been noted in multiple studies, this research examined whether depression predicted posttraumatic stress levels among veterans with service-connected disabilities (N = 245). Three scales (D, PK, and PS scales) of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) were used in this study. The results indicated that after controlling for demographic variables, depression was a strong predictor of posttraumatic stress levels and explained 44% of the variance in the PK scale and 46% of the variance in the PS scale. These findings suggest that if rehabilitation counselors note symptoms of depression among veterans with disabilities, they should request an assessment for elevated levels of posttraumatic stress., Epidemiological studies give evidence that posttraumatic stress disorder (PTSD) is a mental health issue among many different cross-sections of society (Breslau, Davis, Andreski, & Peterson, 1991; Breslau et al., 1998; [...]

Individuals with diabetes face the daily threat of potentially dangerous insulin reactions. This study examined whether immediate psychosocial responses to insulin reactions were similar to individuals' extended adaptation to the reality of diabetes. A questionnaire about psychosocial experiences with insulin reactions (Responses to Insulin Reactions Survey; RIRS) and a multidimensional measure of psychosocial adaptation to disability (Reactions to Impairment and Disability Inventory; RIDI) were administered to individuals with diabetes. Results suggest that: (a) RIDI's psychosocial distress responses are positively associated with RIRS negative affectivity experiences and negatively linked to RIRS level of acceptance of insulin reactions, (b) RIDI's adaptive responses are mostly independent of any of RIRS reactions, and (c) RIDI's Denial scale is negatively correlated with RIRS' level of acceptance but independent of its negative affectivity and avoidance/resistance factor. Implications for rehabilitation practice are discussed and suggestions for future research are outlined., As a chronic illness, both insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) can develop into long-term disabling conditions by causing significant complications in major bodily systems that can [...]