Self-Perception of Language Performance Following Stroke M. E. Gaiefsky 1,2, A. B. Moore 1,2,6, L. J. Gonzalez Rothi 1,4, M. Marsiske 2, M. Diehl 3 & B. Crosson 1,2,5 1 Malcom Randall VA RR&D Brain Rehabilitation Research Center; University of Florida, Gainesville, FL Departments of 2 Clinical & Health Psychology, 3 Psychology, 4 Neurology; 5 McKnight Brain Institute, Gainesville, FL; 6 Atlanta VAMC, RR&D/ Atlanta Research & Education Foundation, Decatur, GA Supported by the Office of Academic Affairs for Veterans Affairs and the Brain Research and Rehabilitation Center of Excellence Abstract Acquiring disability in adulthood must be personally devastating. Particularly when the deficit affects language production. In a society whose core foundation is language based, acquired production deficits can result in an inability to function adequately in this society. Often, when receptive language abilities remain intact, people with acquired expressive deficits will withdraw from society, seemingly because they view themselves as no longer able to function effectively in social interactions. The purpose of this study is to understand the relationship between fear of failure and language ability in participants with non-fluent aphasia. Background  Aphasia is an acquired disorder resulting from brain injury or disease in which language production is disrupted (1).  Previous studies examining the psychological effects of stroke have focused on depression.  Psychosocial studies examining stroke survivors have yet to consider self-perception and social anxiety components, particularly in survivors with non-fluent aphasia.  The Performance Failure Appraisal Inventory-Revised (PFAI-R) has not been used previously to examine the self- perceptions of participants with aphasia (2).  The PFAI-R was initially used with athletes to examine their self-perceptions of their athletic performance (2). References ( 1) Nadeau S., Gonzalez-Rothi, L.J., & Crosson, B. (2000) Preface. In S. Nadeau, L.J. Gonzalez-Rothi & B. Crosson (Eds.) Aphasia and language: Theory to practice. Gainesville, FL: University of Florida College of Medicine. (2) Conroy, D. E., Willow, J.P., & Metzler, J.N. (2002). Multidimensional fear of failure measurement: The performance failure appraisal inventory. Journal of Applied Sport Psychology, 14, Method Participants Fourteen participants with nonfluent aphasia Mean age = years, Range = years Months post-stroke: Mean = 73 months, Range = 15 – 155 months post-stroke Eight males and six females completed the task Participants were divided into two groups: high naming scorers and low naming scorers. Groups were determined by the natural median split between Boston Naming Test (BNT) scores. Task Participants first completed a measure of visual confrontation naming (BNT) before completing the Performance Failure Appraisal Inventory- Revised (2). The Performance Failure Appraisal Inventory-Revised (PFAI- R) was administered to each participant visually and auditorally (simultaneously) with the assistance of the investigator. Participants were instructed to think about each statement of the PFAI-R only in terms of their language production abilities and to rank how much they believe the statement applies to them using a 0-5 Likert scale where 0 = Do Not Believe the Statement and 5 = Believe the Statement 100% of the time (See Figure 1). Analyses and Results This measure appears useful in understanding changes in self-perception of language performance experienced by participants with aphasia. Analyses show that for participants with non-fluent aphasia, one of five subscales of the PFAI-R (“fear of important others losing interest,”) does not correlate well with the other subscales, indicating that it may tap a unique construct in this sample. Preliminary analyses also indicate that participants with higher BNT scores rate themselves as experiencing significantly greater “fears of devaluing their self- esteem” than participants with lower BNT scores. Furthermore, analyses suggest a trend towards negative correlations between language performance and self-perception ratings. This suggests that participants with lower confrontation naming abilities endorse less intense feelings of failure regarding language performance across the five self-perception subscales, and participants with higher confrontation naming abilities show a trend of endorsing more intense feelings of failure across these subscales. Analyses and Results continued Figure 1. The Performance Failure Appraisal Inventory- Revised (Conroy, et al., 2002) Do Not BelieveBelieve 50% Believe 100% at all of the time of the time 1. When I am failing, it is often because I am not smart enough to perform successfully.(D) 2. When I am failing, my future seems uncertain. (UF) 3. When I am failing, it upsets important others. (UO) 4. When I am failing, I blame my lack of talent. (D) 5. When I am failing, I believe that my future plans will change. (UF) 6. When I am failing, I expect to be criticized by important others. (UO) 7. When I am failing, I am afraid that I might not have enough talent. (D) 8. When I am failing, it upsets my “plan” for the future. (UF) 9. When I am failing, I lose the trust of people who are important to me. (UO) 10. When I am not succeeding, I am less valuable than when I succeed. (SE) 11. When I am not succeeding, people are less interested in me. (LI) 12. When I am failing, I am not worried about it affecting my future plans. (UF) 13. When I am not succeeding, people seem to want to help me less. (LI) 14. When I am failing, important others are disappointed. (UO) 15. When I am not succeeding, I get down on myself easily. (SE) 16. When I am failing, I hate the fact that I am not in control of the outcome. (D) 17. When I am not succeeding, people tend to leave me alone. (LI) 18. When I am failing, it is embarrassing if others are there to see it. (SE) 19. When I am failing, important others are disappointed. (UO) 20. When I am failing, I believe that everybody knows I am failing. (SE) 21. When I am not succeeding, some people are not interested in me anymore. (LI) 22. When I am failing, I believe that my doubters feel that they were right about me. (SE) 23. When I am not succeeding, my value decreases for some people. (LI) 24. When I am failing, I worry about what others think of me. (SE) 25. When I am failing, I worry that others may think I am not trying. (SE) These 25 statements are then distributed across 5 factors:  Fear of experiencing shame and embarrassment (SE)  Fear of devaluing one’s self-estimate (D)  Having an uncertain future (UF)  Important others losing interest (LI)  Upsetting important others (UO) Boston Naming Test score Fear of experiencing shame and embarrassment Fear of devaluing one’s self- esteem Fear of having an uncertain future Fear of important others losing interest Fear of upsetting important others Correlations Among PFAI-R Scales for Nonfluent Aphasics (N = 14) High BNT scorers N = 8 r =.138 p =.744 r =.524 p =.183 r = p =.381 r =.007 p =.986 r =.112 p =.791 Low BNT scorers N = 6 r =.074 p =.890 r = p =.288 r = p =.817 r = p =.791 r = p =.986 Conclusions  Findings suggest that the PFAI-R may be a useful measure for evaluating fear of failure regarding language production in participants with non-fluent aphasia.  Though the differences between means for high BNT scorers and low BNT scorers are not statistically significant, results indicate that they are clinically significant and are clinically relevant to self-perception of language production abilities post-stroke. Fear of experiencing shame and embarrassmen t Fear of devaluing one’s self- esteem Fear of having an uncertain future Fear of important others losing interest Fear of upsetting important others Fear of experiencing shame and embarrassment r = 1 r =.649* p =.012 r =.734** p =.003 r =.396 p =.162 r =.838** p =.000 Fear of devaluing one’s self-esteem r = 1 r =.637* p =.014 r =.399 p =.158 r =.530 p =.051 Fear of having an uncertain future r = 1 r =.400 p =.157 r =.762** p =.002 Fear of important others losing interest r = 1 r =.582* p =.029 Fear of upsetting important others r = 1 Correlations Between High BNT, Low BNT scorers and PFAI-R *Correlation is significant at 0.05 level ** Correlation is significant at the 0.01 level