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The influence of seriousness and contagiousness ofdisease on emotional reactions to ill personsAnton J. Dijker a & Floor Raeijmaekers aa Department of Health Education , Maastricht University , P. O. Box 616, 6200 MD,Maastricht, The NetherlandsPublished online: 19 Dec 2007.

To cite this article: Anton J. Dijker & Floor Raeijmaekers (1999) The influence of seriousness and contagiousness of diseaseon emotional reactions to ill persons, Psychology & Health, 14:1, 131-141, DOI: 10.1080/08870449908407319

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THE INFLUENCE OF SERIOUSNESS AND CONTAGIOUSNESS OF DISEASE ON

EMOTIONAL REACTIONS TO ILL PERSONS

ANTON J. DUKER* and FLOOR RAEUMAEKERS Department of Health Education, Maastricht University, l? 0. Box 616,

6200 MD Maastricht, The Netherlands

(Received 5 December; 19%; inJnaI form 7 October; 1997)

Extends research on illness cognition by arguing that two major dimensions of illness cognition - seriousness and contagiousness of disease - are responsible for different emotional wsponses to ill persons. and that the activation of these dimensions is dependent on type of contact with these pmons. Using a vignet methodology. nursing students (N1333) were asked to imagine having different types of contact with patients with diseases differing in seriousness and contagiousness. When participants imagined pmonal contact with the patient, their anxiety mponses and self-efficacy expcctations were primarily determined by Scriousmss of disease. In con- trast. when they anticipated close physical contact with the patient. subjects' anxiety rractions and self-efficacy expcctations were primarily influenced by contagiousness of disease. Seriousness of disease appcad to k a major determinant of foelings of pity. powerlessness. sadness. and motivation to psychologically support the patient. Theoretical and praaical implications are discussed.

KEY WORDS: Illness cognition, emotion, stigmatization of ill persons.

Students in the field of health psychology increasingly recognize that the lay person's cognitive representations of illnesses not only influence such important health-related variables as symptom recognition and medical help seeking, but also reactions to ill persons (for reviews, see Bishop, 1991a; Clark, 1994; Croyle and Barger, 1993; Skelton and Croyle, 1991). Empirical research has revealed three important illness dimensions in terms of which people categorize, interpret, and cognitively represent a wide variety of diseases (e.g.. Bishop, 1991b; Crandall and Moriarty, 1995; Lalljee. Lamb and Carnibella, 1993). These illness dimensions are the perceived seriousness (or lethal character) and contagiousness of the disease, and the extent to which the ill person can be held personally responsible for getting the disease. Several researchers have demonstrated that these dimensions are correlated with social Ejection of ill persons (e.g., Bishop, 1991b; Crandall and Moriarty, 1995). Specifically, when given a choice, people tend to refuse to make friends or work together with persons with relatively serious, contagious, or self-inflicted illnesses (see also Westbrook, Legge and Pennay. 1993).

One problem that has been relatively neglected in this area of research is how cognitive representations of illnesses motivate social rejection of victims of disease. Weiner (e.g., 1996; Weiner. Perry and Magnussen, 1988) has described how one particular illness dimension - personal responsibility for getting the disease - motivates social rejection via its influence on two kinds of emotions - anger and pity. Specifically, he argues that the more perceivers see the onset of a deviant condition such as an illness as personally

Comsponding author. E-mail: adijhr@gvo.unimaas.nl.

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I32 A.J. DUKER AND F. RAEUMAEKERS

controllable, the more anger and the less pity they will experience. Anger motivates hos- tility, whereas pity motivates prosocial and helping behavior towards the deviant indi- vidual. Dijker and Koomen (1996) recently elaborated and refined this model. They propose that (a) the arousal of the emotion of pity should be explained from the extent to which an illness is perceived as serious and is associated with physical and/or psycho- logical suffering, (b) the perceived sqiousness of a disewe not only causes pity but also fear or anxiety, and (c) the latter emotion is also influenced by the perceived contagious- ness of the disease. Dijker and Koomen (1996) argue that social rejection of ill persons becomes more likely the more anxiety and the less pity is experienced. (For other aspects of the extended model, see Dijker and Koomen, 1996.)

The causal relation between perceived seriousness of disease and the arousal of both pity and fear (or anxiety), is suggested by social-psychological studies on reactions to suffering persons. For example, Batson (e.g.. 1990) has found that, dependent on their perspective, people may experience “personal distress” (an emotional blend of being shocked, alarmed, and frightened) and/or pity when observing another person suffering. Earlier, Lazarus (1966) has interpreted the emotional state that is aroused by looking at injured and suffering persons as a stress or anxiety response. Lazarus sees anxiety as a reaction to a demanding situation that is perceived as difficult to influence and control. This response is related to lack of confidence of how to deal with the situation or low self-efficacy expectations (see also Bandura, 1988).

Research on reactions to seriously ill persons also suggests the relevance of both pity and anxiety. For example, feelings of helplessness that are observed in response to lethally ill persons (Chesler and Barbarin, 1984; Silver, Wortman and Crofton, 1990) can be interpreted as partially being based on pity responses. Specifically, a seriously ill person may arouse pity and a correspondent commitment to care for, and provide psychological support to, the person. Yet if one realizes that help will not result in noticeable improve- ment and loss of the person’s life will be unavoidable, a feeling of powerlessness may be aroused along with sadness. The notion of “burnout” (e.g., Maslach, 1982) has been used to refer to a similar psychological state that health care workers tend to experience when they are committed to perform emotionally exhausting services (for an analysis of caring for persons with AIDS in terms of burnout, see Nesbitt, Ross, Sunderland and Shelp, 1996). In sum, in addition to anxiety, pity, and a tendency to help the patient, seriousness of disease may also arouse feelings of powerlessness and sadness. The first goal of the present study is to examine in detail which emotional reactions are related to the illness dimensions seriousness and contagiousness.

In addition to the motivational consequences of illness representations, the field of ill- ness cognition has also neglected the question of how type of contact with ill persons moderates the influence of illness dimensions on social rejection of ill persons. Past research has shown that, when nothing else is known about persons other than their health status, people are less likely to choose seriously or contagiously ill persons as, for example, colleagues, friends, or marriage partners than they are to choose less seriously or contagiously ill or healthy persons. The higher social distance maintained from the more seriously or contagiously ill persons, however, is hardly surprising and not very informative with respect to the process of stigmatization because, solely on the basis of their health status, relationships with these persons can be realistically expected to be more difficult and hence less pleasant and desirable. A theoretically more interesting and practically relevant question would be: Given a particular kind of interpersonal contact with an ill or handicapped person, how does the nature of that contact mfluence negative

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EMOTIONAL REACTIONS TO ILL PERSONS 133

and positive responses to this person? A second goal of the present study, therefore, is to examine whether different types of interpersonal contact activate different illness dimen- sions and thus are responsible for the arousal of the emotions that are typically related to these dimensions. Answers to this question may lead to a better prediction of negative responses to ill persons, and may suggest under which circumstances which interpersonal strategies are likely to be effective in avoiding or reducing these responses.

The Present Study

In the present study, nursing students imagined to care for a patient with a particular dis- ease varying in seriousness and contagiousness, and to have different types of contact with the patient (personal contact, medical examination, and injecting). We measured anxiety and self-efficacy to capture how subjects emotionally reacted to complex and demanding situations that involve both particular disease properties and a particular kind of contact with the patient. In addition, we tried to specify emotional responses to ill per- sons in terms of pity, sadness, powerlessness, and hostile feelings.

The main hypothesis that was tested was that the activation of illness dimensions and their characteristic emotional correlates would be moderated by the kind of contact the perceiver expects to have with the ill person. Specifically, we predicted two two-way interactions of illness dimension and type of contact on anxiety responses and self-efficacy expectations. First, it was predicted that seriousness of disease and type of contact would interact in such a way that when subjects expected personal contact with the patient in which the lethal character of the illness would likely come up as conversation topic, serious diseases would arouse more anxiety and lower self-efficacy expectations than nonserious diseases, whereas when expecting to inject the patient, seriousness of disease would have no effect on anxiety and self-efficacy expectations. Second, it was predicted that contagiousness of disease would interact with type of contact in such a way that especially when subjects expected close physical contact with the patient (i.e.. inject the patient), they would respond with more anxiety and lower self-efficacy expectations to the contagious than the noncontagious diseases. We did not have clear predictions for subjects anticipating to perform a primarily intellectual and skilled task during interaction with the patient such as conducting a medical examination. In general, research on coping behaviors during stress (e.g., Lazarus, 1966) suggests that anxiety levels will be reduced when individuals try to distance themselves from a stressor by means of intellectualiza- tion. It seemed conceivable that the reduced anxiety level would make differential anxiety responses to different diseases relatively invisible.

In addition to effects on contact-related responses, we also hypothesized that feelings of pity, powerlessness, and sadness, and subjects’ motivation to supply psychological support to the patient, would be primarily influenced by seriousness of disease.

The present study also explored the influence of the ill person’s sexual orientation on subjects’ emotional responses. In accordance with previous research (Dijker, Kok and Koomen. 1996; Pryor and Reeder, 1993). we expected that the target’s homosexual orien- tation would intensify hostile feelings towards persons with AIDS. In addition, we manipulated the extent to which support from colleagues would be available. Because support from colleagues may moderate stress responses to the demands of caring for terminally ill or contagious patients (e.g., Barbour, 1995), we expected that the availability of such support would primarily affect anxiety responses and self-efficacy expectations when having to care for a seriously and/or contagiously ill patient.

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134

METHOD

AJ. DIJKER AND F. RAEUMAEKERS

Subjects and Design

It was decided to select research subjects who, due to frequent (real or imagined) con- frontations with persons suffering from various diseases, could easily discriminate among different serious and contagious diseases, and who would have no difficulty imagining different kinds of contact with these persons. For this purpose, we choose to study the emotional responses of nursing students. A total of 333 subjects from 11 Dutch colleges for baccalaureus nursing education, who were in their last or second-last year of study, took part in the present experiment. The sample consisted of 289 females and 44 males, with a mean age of 23 years (SD =4.67). Subjects were randomly assigned to a 2 (serious- ness of disease: Nonserious (appendicitis, hepatitis) versus serious (kidney cancer, AIDS)) x 2 (contagiousness of disease: Noncontagious (appendicitis, kidney cancer) versus contagious (hepatitis, AIDS)) x 2 (target’s sexual orientation: Heterosexual versus homo- sexual) x 2 (availability of support from coworkers: Available versus not available) design. Each of the 16 experimental cells contained between 19 and 22 subjects. The relatively small number of males was distributed evenly across the design, with 2-5 males in each cell.

Procedure

The experiment was carried out during class. The experimental materials and question- naires were contained in 16 different booklets on the cover of which was printed the text “Working with patients”. Subjects were first asked to imagine that, after finishing their education, they worked as a nurse in a hospital in which they had the responsibility for the care of the patients in two rooms. It was further explained that “yesterday afternoon. a new patient arrived in one of your rooms. You have not seen the man yet but your col- leagues have already given you some personal information about him and his diagnosis.” After urging subjects to uy to imagine the situation as well as possible and to form an impression of the patient, the next page gave a general description of the patient in which several personal attributes were mentioned. In all conditions, the patient was described as Frank, 32 years old, working as a financial advisor, with reading and sports as hobbies. To further increase the vividness of the scenarios it was remarked that colleagues had observed that Frank reacted somewhat annoyed to the daily hospital routine but that he cooperated well. It was also told that he left his bed several times last night because he could not sleep; around 3:30 a.m. he finally fell asleep quietly. The target’s sexual orientation was manipulated by stating that “on a question concerning sexual orientation Frank indicated that he is a hetemsexuallhomosexual.” To prevent an impression of sexual promiscuity in case of the sexually transmitted disease (AIDS), which could lead to assign differential responsibility to the target persons, it was mentioned that the target had a relationship with a female friend (in case of the heterosexual) or a male friend (in case of the homosexual) with which he lived together. On a subsequent page titled “Recent developments” the seriousness and contagiousness of the patient’s disease was manipulated by presenting the most salient symptoms of one of 4 different diseases: Kidney cancer (serious and noncontagious). AIDS (serious and contagious), appendicitis (nonserious and noncontagious), and hepatitis (nonserious and contagious). Again in order to prevent differential perception of diseases in terms of the patient’s responsibility,

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EMOTIONAL REACTIONS TO ILL PERSONS 135

the two contagious conditions (AIDS and hepatitis) were presented as being caused by a blood transfusion (i.e.. as not the patient’s own fault).

After the disease description, subjects were informed that the head of the ward had assigned them a number of tasks to be carried out. The fmt task (personal contact) consisted of bringing the patient his breakfast and having a chat with him in order to get to know him better. The second task (medical examination) required subjects to make up the medical status of the patient and to carry out two relatively simple activities - mea- suring the patient’s blood pressure and his temperature (under the tongue). The third task (injecting) consisted of giving the patient an injection. The different nature of the three tasks can be readily seen. The fmt involves interpersonal contact and the sharing of thoughts and feelings, the second mainly requires intellectual and skilled activity without personal involvement and the third very close physical (blood) contact. Availability of suppor? from colleagues was manipulated by stating (after each task description) in the high availability condition that “when there are problems, or you feel any need for assistance, you can always request the help of your colleagues on the floor.” In the low availability condition, subjects were informed that “under the present circumstances, it is not possible to request the help of your colleagues when there are problems, or you feel any need for assistance.”

Dependent Measures

Anxiety responses and self-efficacy expectations were measured after each task descrip- tion. All subsequent questions did not refer anymore to specific tasks.

Contact-related anxiety and self-eficacy. Subjects’ anxiety was measured by asking them how nervous, tense, unpleasant, and uneasy they would feel in the described situa- tion. These and all subsequent responses were measured on 7-point scales, running from (1) not at all. to (7) very much. Combining the four items resulted in reliable scales with Cronbach’s alpha =0.91,0.94, and 0.95 for personal contact, medical examination, and injecting, respectively. Self-eficucy was also measured after each task description with the two items “How certain would you feel in this situation?’ and “How much confidence do you have in your own abilities in this situation?’ Combining these two items resulted in scales with alpha=0.82,0.77, and 0.86 for the three tasks, respectively. Both anxiety and self-efficacy items can be readily recognized in research in which effects of cognitive and behavioral interventions on anxiety and self-efficacy are examined (e.g.. Bandura, 1988; Bandura, Adams and Beyer, 1977).

Pity, powerlessness, sadness, and motivation to provide psychological support. After subjects had responded to the three tasks, feelings of pity, powerlessness, and sadness were measured, each with a single 7-point rating scale (see above). An example of the wording of these questions is: “To what extent would you feel pity?” Motivation to pro- vide psychological support was measured by asking subjects whether they felt they had to support the patient emotionally and be concerned with the impact of the disease on the patient’s family, partner, and friends (alpha of the two-item scale=0.60. with higher scores on the 7-point rating scale indicating stronger motivation).

Manipulation check. Using similar 7-point rating scales, subjects were asked to judge the contagiousness of the illness condition by indicating the risks involved in caring for this kind of patient and the general contamination danger involved (alpha of this two-item

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136 AJ. DUKER AND F. RAEUMAEKERS

scale =0.58). In order to check the effectiveness of the seriousness manipulation, subjects were asked to indicate their optimism about the patient’s condition.

Friendly/hostile feelings towards the target were measured by asking subjects whether they felt the patient was likeable, they could be a friend of the patient, the patient aroused imtation and disgust, whether they would feel at ease in the presence of the patient, and whether, if possible, they rather would leave the care of the patient to a colleague. These items were, after appropriate recoding, combined into a scale (alpha=0.72) with higher scores indicating more hostile and less friendly feelings. Finally, subjects’ sex and age were measured.

RESULTS

Manipulation Check

Participants saw the contagious diseases (M=4.44) as more contagious than the noncon- tagious diseases (M=3.37), t(331) =6.49. p <0.001. This result confirmed the effective- ness of the manipulation of contagiousness. Furthermore, confirming the manipulation of seriouspess, participants were more optimistic about patients having a nonserious (M=3.87) than a serious disease (M=2.84), r(332)=7.80,p<0.001.

Contacr-related Anxiety and Selfefficacy

A mixed-model analysis of variance (ANOVA) with seriousness, contagiousness, target’s sexual orientation, and availability of support from co-workers as between-subjects factors and type of contact (personal contact, medical examination. injecting) as a within- subjects factor resulted in a main effect for type of contact, F(2.634) = 102.99, p <0.001, indicating that subjects anticipated the least anxiety when performing a medical examina- tion (M= 1.74) and the most anxiety when expecting to inject the patient (M=2.63). Anxiety in case of personal contact (M=2.19) fell between these means.

As predicted, an interaction between seriousness of disease and type of contact, F(2,634)=3.00, p<O.O5. showed up. The simple main effect for seriousness when subjects imagined to have personal contact with the patient was significant, F( 1,317) =9.38, p<O.Ool. indicating that the serious diseases (M=2.36) aroused more anxiety than the nonserious ones (M- 2.02). However, when subjects anticipated to inject the patient, nonserious (M=2.61) and serious diseases (M=2.66) evoked a similar level of anxiety; the simple main effect for seriousness was not significant, F < 1. Furthermore, when sub- jects imagined to perform a medical examination, serious (M= 1.69) and nonserious diseases (M= 1.80) also evoked a similar level of anxiety; the simple main effect for seriousness was not significant, F < 1.

Contrary to expectations, no two-way interaction between contagiousness and type of contact showed up. Instead, the analysis revealed an interaction of seriousness, con- tagiousness, and type of contact, F(2.634) =5.01, p <0.01, indicating that contagious- ness and type of contact only interacted in the predicted manner when disease was serious. Specifically, the simple interaction of contagiousness and type of contact was significant for the serious diseases, F(2.634) =4.09, p <0.05, but not for the nonserious ones, F(2,634) = 1.77, p > 0.10. As Figure 1 shows, contagiousness primarily affected anxiety responses to the prospect of injecting a patient with a serious disease.

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EMOTIONAL REACTIONS TO ILL PERSONS

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NOflserkus SerkUS Disease

mgurc 1 Influence of discasc and kind of contact with patient on anxiety reactions. Ns = 84.83.82, and 84 for appendicitis. hepatitis, kidney cancer, and AIDS, respectively.

Figure 1, panel c, also suggests why the two-way interaction of contagiousness and type of contact did not show up. Unexpectedly, the prospect of injecting a person with the contagious hepatitis did not arouse more anxiety than expecting to inject a patient with the noncontagious appendicitis. One explanation for the relatively strong anxiety reactions to appendicitis may be that this condition is associated with an emergency

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138 AJ. DUKER AND F. RAELTMAEKERS

situation with salient signs of suffering in which the health care worker is concerned about the possibility that an invasive procedure such as giving an injection will trigger an emergent crisis for the person with appendicitis.

A similar mixed-model ANOVA performed on the self-efficacy measure resulted in a main effect for type of contact, F(2,632)=55.71. p<O.OOl. indicating that subjects expected higher levels of self-efficacy when conducting the medical examination (M=5.82) than either having personal contact with the patient (M=5.19) or giving him an injection (Mr5.23). As predicted, an interaction between seriousness of disease and type of contact showed up, F(2,632)=5.48, ~ ~ 0 . 0 1 . When subjects expected personal contact, the simple main effect for seriousness was marginally significant, F( 1,3 16) = 3.29, p = 0.07. indicating that self-efficacy expectations for having personal contact with patients with serious diseases (M = 5.09) were lower than for having personal contact with patients with nonserious diseases (M=5.30). In contrast, when subjects imagined to perform a medical examination on the patient or to inject him, seriousness did not affect self-efficacy expectations; the simple main effects for these two types of contact were not significant, Fs < 2.17, ps > 0.14.

Also as predicted, the interaction of contagiousness and type of contact was significant, F(2,632) = 3.73, p <0.05. When subjects imagined to inject the patient, the simple main effect for contagiousness was significant, F( 1.3 16) =4.10, p ~0.05, indicating that when subjects imagined to inject the patient, they had lower self-efficacy expectations for the contagious diseases (M=5.10) than for the noncontagious diseases (M=5.51). In contrast, when subjects imagined to perform a medical examination on the patient or having personal contact with him. contagiousness did not influence self-efficacy expecta- tions, Fs < 2.43, p > 0.12.

Pity, Powerlessness, Sadness, and Motivation to Support Patient

A multivariate analysis of variance (MANOVA) was conducted on pity, powerlessness, sadness, and motivation to provide psychological support, with seriousness, contagious- ness, target’s sexual orientation, and availability of support from co-workers as inde- pendent variables. The results of the MANOVA are summarized in Table 1 where it can be seen that both seriousness and contagiousness of disease influence subjects’ feelings. In addition, seriousness influences subjects’ desire to support the patient. Furthermore, the two illness dimensions appear to interact on all four dependent variables. Consistent with our hypothesis, the means in Table 2 indicate that the serious diseases arouse more pity (as well as more sadness and powerlessness) and a higher motivation to help the patient than the less serious diseases. Furthermore, within the category serious diseases, contagiousness does not influence these feelings. However, unexpectedly, the pattern of means responsible for obtaining an interaction between seriousness and contagiousness indicates that within the category nonserious diseases, contagiousness has an effect on the dependent variables. Specifically. hepatitis arouses more pity, powerlessness, and sadness, and a stronger motivation to support the patient, than appendicitis.

Hostile Feelings

An ANOVA on friendly/hostile feelings towards the ill person only resulted in an interaction of contagiousness and target’s sexual orientation, F( 1,311)= 19.50, p <O.OOI. The pattern of means indicate that in case of contagious diseases, subjects expressed more hostile and

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EMOTIONAL REACTIONS TO ILL PERSONS 139

Table 1 Results of multivariate and univariate tests of effects of seriousness and conta- giousness on pity, powerlessness. sadness, and motivation to provide psychological support

source Multivariate rest Univariare rest

F 4f Depcndcruvariabk F 4f Seriousness (A) 45.71*** 4,313 pity

powerlessness Sadness motivation to provide psychological support

Contagiousness ( B) 4.88*** 4.3 13 pity p o W d C S S m s S sadness motivation to provide psychological support

4.11** 4,313 pity powdessaess sadness motivation to provide psychological support

A x B

44.17*** 1,316 139.48*** 1.3 16 99.31*** 1.316 17.39*** 1,316

6.14. 1.316 10.88** 1.316 15.80*** 1.316 0.49 1,316

4.00’ 1.316 10.89** 1.316 4.18. 1316 5.47. 1.316

NOW F-vduet arc bucd on ANOVAs with two additional ladcpcnderu vari~blcr. n u ~ c l y target’: r x d orientation and Nppm fran collugueJ. *p<o.os **p<0.01 ***p<0.001.

Table 2 Emotional reactions to the different illnesses

Emotion Illness

Nonserious Serious

Noncontagious Contagious Noncontagious Contagious MPP) W P ) (KC) W D S )

pity 2.88 3.53 4.13 4.20 Powerlessness 2.42 3.44 4.76 4.76 Sadness 2.32 3.26 4.19 4.49 Motivation to provide 5.73 6.03 6.37 6.21 psychological support

Nore: App = rppendicitis, Hep -hepatitis, KC - kidney .cancer, AIDS - A c q t k d h u n o d e r i c i ~ SYodrome. Ns = 84.83.82. a d 84 for App. Hep, KC, and AIDS. respectively.

less friendly feelings for a homosexual (M= 2.58) than a heterosexual patient (M= 2.30). The reverse was true in case of noncontagious diseases, with subjects showing less hostile and more friendly feelings for a homosexual (M=2.34) than a heterosexual patient (M = 2.82).

DISCUSSION

The above findings are generally consistent with Dijker and Koomen’s (1996) extension of Weiner’s cognition-emotion model of stigmatization of ill persons in which the influence of the cognitive illness dimensions seriousness and contagiousness on social rejection of

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ill persons is mediated by anxiety and pity. Specifically, perceived seriousness of disease tended to arouse both anxiety (especially when personal contact with the ill person was anticipated) and pity. In addition, seriousness influenced perceivers’ feelings of sadness and powerlessness. and was associated with a stronger motivation to help the patient. Also consistent with Dijker and Koomen’s (1996) model, it was found that perceived contagiousness of disease primarily influenced anxiety when close physical contact with the ill person was expected (this was only true for the serious diseases, however).

The prospect of performing a medical examination on the patient aroused the least anxiety and the highest self-efficacy expectations. This finding is consistent with Lazarus’ (1966) work on coping with stress showing that intellectual and impersonal cognitive activity may moderate stress responses.

No evidence was found for an influence of the illness dimensions seriousness and contagiousness on social rejection of, or hostility towards, ill persons; presumably, because the presently used research participants - nursing students - were quite moti- vated and determined to care for patients in general. However, participants appeared to be influenced by the sexual orientation of the patient, showing more hostile feelings towards a homosexual than a heterosexual patient with a contagious disease (for a summary of similar research findings, see Pryor and Reeder, 1993). In sum, the present research represents a f rs t attempt to demonstrate that the illness dimensions seriousness and contagiousness have motivational relevance in that they, dependent on the situation, can potentially arouse different types of emotions. The study thereby does not only extend current research on illness cognition (e.g., Bishop, 1991a,b), but also Weiner’s model in which the emotional consequences of only one illness dimension - personal control - are studied.

One limitation of the present study should be noted. Instead of observing subjects during real interactions with patients, we obtained subjects’ self-reported emotional and behavioral reactions to imagined encounters with patients. Although the assessment of subjects’ expectations and worries about these encounters is relevant in its own right (and a vignet methodology is generally used in this area of research), it may be less useful to reveal every situational influence in detail. This may explain why participants did not react to the (imagined) availability of support from coworkers; a factor which may be better studied during actual interactions in health-care settings.

The present findings illustrate the importance of going beyond previous efforts (e.g., Bishop, 1991b; Crandall and Moriarty, 1995) to determine in a general way whether some dimensions of cognitive representations of illnesses are more important than others in motivating social rejection of ill persons. Although it may be true that seriously and/or contagiously ill persons are seen as less desirable as friends or coworkers than less seri- ously and/or contagiously ill persons, once a relationship with the ill person is anticipated or has been established. negative emotional reactions are moderated by type of contact. Knowledge of the kinds of emotions that are associated with the activation of different illness dimensions, and the types of contact that are likely to activate these dimensions and associated emotions, may have practical consequences. The present research suggests that, in order to reduce anxiety and increase self-efficacy expectations when people expect to care for seriously and/or contagiously ill patients, skills may have to be learned that are specifically adapted to different types of contact with the patient. For example, the relatively high anxiety responses to the prospect of having personal contact with a seriously ill person may be reduced by an emphasis on adopting interpersonal skills. In contrast, technical skills should be emphasized for reducing anxiety and increasing

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EMOTIONAL REACI?ONS TO ILL PERSONS 141

self-efficacy when the task requires primarily close physical contact. It does not seem advisable to reduce anxiety responses by ignoring or downplaying the seriousness of the patients condition, as seriousness increases pity and the motivation to care for the patient (for a similar view, see Silver er al., 1990). However, undesirable feelings of power- lessness that are associated with an increased desire to improve a lethally ill patient’s condition - one of the symptoms of burnout among health-care workers (Maslach, 1982; Nesbiu er al., 19%) - may likewise be reduced by an increase in interpersonal compe- tence in dealing with the patient’s social needs. Future research should examine which kind of competence-enhancing interventions can effectively reduce contact-related anxiety responses among health care workers as well as lay persons who interact under everyday condition with chronically ill persons.

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