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reasons of resource availability and applicability to routine clinical practice. For the purpose of measuring coping strategies, an existing instrument was examined for its suitability and adapted for use in the target population. The Coping Behaviours Inventory (CBI) (Litman et al. 1983) was chosen as the most suitable instrument for this patient population.
Litman and her colleagues (1983) conducted interviews with hospitalised alcoholic patients in which they were asked to describe the methods they used to avoid relapse. On the basis of these interviews, sentence completion questionnaires were devised using the patients' own concepts and language, and these, together with further interviews were used to construct the Coping Behaviours Inventory (CBI), consisting of a combination of cognitive and behavioural strategies. Frequency of use of these coping strategies was rated on a four point scale from (0) ‘I have never tried this’, (1) ‘I have sometimes tried this’, (2) ‘I have often tried this’ to (3) ‘I have usually tried this’. The CBI was administered to current alcoholic patients at four hospitals in London and Manchester and to past patients from these hospitals known to have been abstinent from alcohol for six months or more. Principal components analysis yielded four factors and these were: i) positive thinking, ii) negative thinking, iii) avoidance and iv) distraction or substitution. The positive thinking factor refers to being realistic about having an alcohol problem, the negative thinking factor refers to thoughts about the negative consequences of having such a problem, avoidance refers to the behavioural strategy of avoiding drinkers and drinking situations and distraction or substitution refers to the pursuit of activities alternative to and inconsistent with drinking. Thus there are two cognitive and two behavioural factors in this inventory. Using only those items which most significantly discriminated relapsers from survivors, questionnaire items were reduced from 60 to 36 and administered to 256 patients presenting for treatment of their alcohol problem at seven different treatment agencies including in-patient and out-patient hospital facilities which were a mixture of private, National Health Service and non-statutory facilities.
Stability of the structure of coping behaviours was demonstrated by the repetition after five years, across different sites, socio-demographic groups and geographical groups of patients. In this study, the number of coping strategies used discriminated between relapsers and survivors and a significant discriminator was the positive thinking factor. Additional information obtained from respondents included drinking and relapse history, measures of self-efficacy and self-esteem, locus of control, perceived social supports, commitment, motivation and the patient's perception of the therapist.
The Effectiveness of Coping Behaviours Inventory is a self-report scale measuring how effective these coping behaviours are perceived to be (Litman et al. 1984). Subjects are required to
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