Considering the application of the trait/state distinction for response shift research: continuing the conversation

Abstract

The article by Schwartz and Sprangers (this issue) is an extremely interesting article that opens the door to a much wider range of inquiry regarding health-related quality of life (HRQOL). I am very excited by this work, and I think that it has the potential to spark a much-needed dialogue in the HRQOL field, where methodology has gotten ahead of basic theory and conceptualization. In the spirit of continuing a dialogue started by this important article, I will raise several ideas that I hope will stimulate further dialogue. This article relies heavily on the Rapkin and Schwartz (2004) (R&S) [1] appraisal model, which is appropriate because appraisal is the linchpin for understanding the state and trait influences on QOL. As the authors note, the R&S model posits response shift as an inferred epiphenomenon, when changes in appraisal explain discrepancies in observed vs. expected QOL. However, the much larger question that this article raises, and that the R&S model does not address, has to do with the determinants of appraisal processes and changes in appraisal. For this reason, I think it is inconsistent to equate direct and indirect RS with trait and state components of appraisal. For example, a direct response shift would be evident if all people in a sample who shifted their standard of comparison from ‘‘healthy, past ideal’’ to ‘‘other patients with my illness’’ showed a positive improvement in QOL. An indirect response shift would be evident if the positive improvement in QOL only occurred among those people who shifted their standard of comparison and who experienced worsened symptoms. Neither the direct response shift nor indirect response shift scenarios presuppose the determinants of the associated change in appraisal itself. The change in appraisal might have occurred because of affective reservedpeople with more resources might have an easier time modulating their negative affect, getting unstuck in their thinking, and adopting an