Quantitative and Qualitative article critique

Rehabilitation Counseling Bulletin 2017, Vol. 60(2) 77 –87 © Hammill Institute on Disabilities 2016 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0034355215621036 rcb.sagepub.com

Article

In North America, approximately 20,000 people acquire spinal cord injury (SCI) each year, and approximately 270,000 individuals with SCI live within the United States (Cripps et al., 2011; National Spinal Cord Injury Statistical Center [NSCISC], 2012). In addition to functional impair- ment directly caused by the initial injury, individuals with SCI often experience secondary health conditions, psycho- social adjustment challenges, and limitations related to architectural and attitudinal barriers in the broader work environment (Schoen & Leahy, 2012). Work is critical to the overall health and subjective well-being (SWB) of indi- viduals with SCI, with unemployment and poverty restrict- ing access to high-quality health care and rehabilitative resources (Cao, Krause, Saunders, & Bingham, 2014; Krause & Terza, 2006; Marini, Lee, Chan, Chapin, & Romero, 2008).

Compared with people without disabilities, a signifi- cantly lower proportion of individuals with SCI are employed (Cao et al., 2014; Marini et al., 2008). Longitudinal data indicate that nearly 60% of individuals with SCI are employed prior to injury, but only about 30% are employed following rehabilitation from injury (NSCISC, 2012; Young & Murphy, 2009). Cao et al. (2014) found that over a 10-year period, a substantial proportion of individu- als with SCI are living in poverty, with 21% reporting annual household income less than US$10,000, and 27% reporting annual income between US$10,000 and US$24,999. Conversely, individuals with SCI who reported

an annual household income of US$25,000 or more had higher SWB and fewer problems with health and other life situations than individuals in the lower-income groups (Cao et al., 2014).

In recent years, there has been a growing interest in the field of organizational behavior and industrial/organiza- tional (I/O) psychology in adopting a positive psychology approach when investigating work-related behaviors, atti- tudes, and outcomes in employment settings (Luthans, 2002a). Positive organizational behavior (POB) has its roots in positive psychology and has been defined as “the study and application of positively oriented human resource strengths and psychological capacities” (Luthans, 2002b, p. 59). Organizational behavior and I/O findings indicate that attachment and hope are related to several important vocational variables among the general population (Wandeler, Baeriswyl, & Shavelson, 2011). However, there is a dearth of research applying POB and positive psychol- ogy concepts to improve employment outcomes of people

621036RCBXXX10.1177/0034355215621036Rehabilitation Counseling BulletinBlake et al. research-article2015

1West Virginia University, Morgantown, USA 2University of North Texas, Denton, USA 3University of Wisconsin–Madison, USA

Corresponding Author: John Blake, Assistant Professor, Counseling, Rehabilitation Counseling & Counseling Psychology, West Virginia University, P.O. Box 6122, 504-C Allen Hall, Morgantown, WV 26506-6122, USA. Email: [email protected]

Attachment and Employment Outcomes for People With Spinal Cord Injury: The Intermediary Role of Hope

John Blake, PhD, CRC1, Jessica Brooks, PhD, CRC2, Hannah Greenbaum, MA1, and Fong Chan, PhD, CRC3

Abstract The purpose of this article is to evaluate the mediation effect of hope on the relationship between attachment and full-time employment for people with spinal cord injury (SCI). Quantitative descriptive research design using logistic regression, multiple regression, and correlational techniques were used. Eighty-four persons with SCI were recruited from several SCI advocacy organizations in Canada, the United Kingdom, and the United States. The results show that secure attachment, anxious attachment, and hope were significantly related to employment. Hope was found to be a significant mediator of the relationship between attachment and full-time employment. Results provide support for the use of hope-based interventions by vocational rehabilitation counselors working with individuals with SCI.

Keywords hope, attachment, mediation analysis, spinal cord injury, employment

78 Rehabilitation Counseling Bulletin 60(2)

with disabilities, including people with SCI (Chan, Chan, Ditchman, Phillips, & Chou 2013; Elliott, Witty, Herrick, & Hoffman; 1991; Smedema, Pfaller, Moser, Tu, & Chan, 2013; Wilson et al., 2013). To explore the relevance of attachment and hope for vocational rehabilitation profes- sionals, the goals of this study were to evaluate the relation- ships between attachment, hope, and full-time employment in a sample of individuals with SCI.

Attachment

Experiences of caregiver availability and responsiveness during infancy and early childhood contribute to the devel- opment of adult attachment profiles (Bowlby, 1951, 1969, 1973; Mikulincer & Shaver, 2005). Attachment theory (Bowlby, 1951) posits that intimate bonds between infant and caregiver are essential for positive psychological devel- opment. Adult attachment behavior is the product of inter- nal working social-relational models that are comprised of early caregiver relationship dynamics (Fraley, Vicary, Brumbaugh, & Roisman, 2011). Bowlby (1969, 1973) described attachment in adults as the unconscious need to recreate and maintain interpersonal relationships from childhood. Over the course of the last century, several scholars in developmental and social psychology have hypothesized that attachment is a fundamental human moti- vation to feel a sense of belonging and connection to others (e.g., Ainsworth, Blehar, Waters, & Wall, 1978; Baumeister & Leary, 1995; Freud, 1930; Fromm, 1956; Hazan & Shaver, 1990; Maslow, 1968; Ryan, 1991).

A significant body of research has indicated that adult attachment is linked to work-related outcomes (e.g., Collins & Read, 1990; Feeney & Noller, 1990; Hazan & Shaver, 1987, 1990; Little, Nelson, Wallace, & Johnson, 2011; Richards & Schat, 2011). Hazan and Shaver (1990) found that securely attached adults (50% of study participants) had the highest levels of work satisfaction and overall well- being, that individuals with anxious/ambivalent attach- ments (30% of participants) were less productive at work than those with secure attachments, and that individuals with avoidant attachment (19% of participants) were over- involved with their jobs and used work activity to avoid social interactions. Other studies have indicated that securely attached employees are more willing to engage in career exploration, have higher career self-efficacy, and fewer problems with career commitment (Ketterson & Blustein, 1997; Wolfe & Betz, 2004). Securely attached people also have less dysfunctional thoughts about work problems and more positive relationships with coworkers and employers (Mikulincer & Florian, 1998; Mikulincer & Shaver, 2005; van Ecke, 2007).

Attachment has also been linked to health and disabil- ity outcomes (e.g., Davies, Macfarlane, McBeth, Morriss, & Dickens, 2009; Gick & Sirois, 2010; Huebner, Thomas,

& Berven, 1999; Ponizovsky, Arbitman, Baumgarten- Katz, & Grinshpoon, 2014; Rossi et al., 2005; Wilson et al., 2013). However, little is known about the underly- ing processes that explain the relationships between attachment and rehabilitation outcomes, and related find- ings have been mixed (Lopez, Mauricio, Gormley, Simko, & Berger, 2001). For instance, Wilson et al. (2013) found that secure attachment patterns significantly contributed to subjective happiness in people with SCI. Sela-Kaufman, Rassovsky, Agranov, Levi, and Vakil (2013) found that avoidant attachment style significantly moderates the rela- tionship between injury severity and occupational func- tioning among individuals with traumatic brain injury, with low avoidant attachment (secure attachment) predict- ing higher levels of occupational functioning. Conversely, Yokotani (2011) found that people with autistic spectrum disorders reported better work adjustment when they experience a more avoidant attachment style. Mixed find- ings highlight the need for rehabilitation researchers to evaluate the implications of specific attachment patterns among clients with different disabilities, including SCI.

Hope

Decades after seminal attachment research, Snyder (1994) developed his hope theory. Hope is defined as “a cognitive set that is based on a reciprocally derived sense of success- ful: (a) agency (goal-directed determination) and (b) path- ways (planning of ways to meet goals)” (Snyder et al., 1991, p. 570). Like Scheier and Carver’s (1985) optimism model, Snyder et al.’s (1991) hope theory proposes a cogni- tive set related to outcome expectancies. However, while Scheier and Carver’s (1985) theory posits that outcome expectancies are the primary determinants of goal-directed behavior, with efficacy expectancies as minor contributors, Snyder et al.’s (1991) hope model describes an iterative process between an efficacy expectancy comprised of self- beliefs about goal-achievement ability (agency) and an out- come expectancy comprised of perceptions of available routes to goal achievement (pathways). Therefore, Snyder et al.’s (1991) theory is more closely aligned with Rotter’s (1966) locus of control.

Hope is empirically related to psychological factors such as positive affect (Ciarrochi, Heaven, & Davies, 2007), cop- ing (Chang & DeSimone, 2001), adjustment (Gilman, Dooley, & Florell, 2006), happiness (Alarcon, Bowling, & Khazon, 2013), SWB (Şahin, Aydın, Sarı, Kaya, & Pala, 2012), and meaning of life (Dogra, Basu, & Das, 2011). Unlike attachment profiles, states of hope are transient and amenable to intervention (Cheavens, Feldman, Gum, Michael, & Snyder, 2006; Davidson, Feldman, & Margalit, 2012). Hope-based interventions center on increasing cli- ents’ goal-directed thinking and emphasize the role of adap- tive coping in relation to achieving therapy goals.

Blake et al. 79

A growing body of POB research links hope to work- related outcomes (e.g., Luthans, Avolio, Avey, & Norman, 2007; Luthans, Norman, Avolio, & Avey, 2008; Youssef & Luthans, 2012). Organizational researchers consider hope to be a part of the higher-order construct of psychological capital. Psychological capital refers to an “individual’s pos- itive psychological state of development” and includes resources such as hope, optimism, self-efficacy, and resil- ience (Luthans, Youssef, & Avolio, 2007, p. 3). A recent meta-analysis (Avey, Reichard, Luthans, & Mhatre, 2011) found that psychological capital had a significant impact on job satisfaction, job tenure, organizational commitment, organizational citizenship behaviors, and job performance. Another meta-analysis provided empirical evidence for sig- nificant relationships between the hope subconstructs (i.e., pathways and agency), work performance, and employee well-being (Reichard, Avey, Lopez, & Dollwet, 2013). In an experimental study, Luthans, Avey, and Patera (2008) found that participants in a psychological capital training inter- vention developed more psychological capital than study participants from a comparison group.

Several studies have indicated that hope levels are linked to a range of health and rehabilitation outcomes. Elliott et al. (1991) reported that higher hope individuals with SCI exhibited reduced symptoms of depression and psychoso- cial impairment. Smedema et al. (2013) reported that hope was significantly related to positive rehabilitation con- structs, including self-efficacy, self-esteem, disability acceptance, community participation, and life satisfaction for people with SCI. In a pilot study, Hergenrather, Geishecker, Clark, and Rhodes (2013) found that a hope- based intervention helped improve goal-setting skills, health-promoting behaviors, and employment-seeking behaviors among people with HIV/AIDS. Chan et al. (2013) tested the power of an expanded model of Snyder’s hope theory for prediction of participation in employment and other life activities for people with SCI. The hope subcon- structs (i.e., agency and pathways) were positively related to participation, causality, perceived control, resilience, and SWB. Furthermore, path analytic findings indicated that direct effects of agency and causality, along with indirect effects of pathways, perceived control, and resilience accounted for a significant amount of variance in participa- tion and life satisfaction (Chan et al., 2013).

Attachment, Hope, and Employment

Snyder’s (1994) hope theory incorporates the construct of attachment and describes a dynamic in which attachment style is linked to adult levels of hope. Findings from one recent meta-analysis focused on the relationship between adult attachment and hope are consistent with this hypoth- esis, with results indicating significant bivariate relation- ships between secure attachment and hope (r = .39),

avoidant attachment and hope (r = −.23), and anxious attachment and hope (r = −.22; Blake & Norton, 2014). In addition, several studies have yielded findings, indicating that hope was a significant mediator of relationships between attachment and rehabilitation-relevant outcomes. For example, Zhang et al. (2012) found that hope partially mediated the relationship between attachment and SWB for middle-school students. Shorey, Snyder, Yang, and Lewin (2003) found that hope partially mediated the relationship between attachment and mental health for college students. Simmons, Nelson, and Quick (2003) found that hope explained relationships between secure attachment and employee health, as well as avoidant attachment and poor employee health for home care nurses. However, not all mediation analyses have produced significant effects. Simmons, Gooty, Nelson, and Little (2009) found that at the bivariate level, workers’ attachment and hope were signifi- cantly related, and that attachment and hope significantly correlated with trust in supervisor and worker burnout. Nevertheless, mediation analyses indicated that hope did not explain relationships between attachment and outcome.

Purpose of Study

Rehabilitation literature indicates a need for cohesive posi- tive psychological frameworks to guide evidenced-based practice research in rehabilitation. Several studies have indi- cated that attachment and hope are significant predictors of key health, rehabilitation, and employment-related outcomes. Emerging research has also indicated that hope is related to attachment, and that hope may be a significant mediator of relationships between attachment and health, rehabilitation, and employment-related outcomes. However, there is a lack of research examining the relationships between attachment, hope, and employment participation. As individuals with SCI have a high unemployment rate, there were two main aims of this study: (a) to examine the relationships between attach- ment, hope, and full-time employment for individuals with SCI, and (b) to examine the mediation effect of hope on the relationships between attachment and full-time employment for individuals with SCI.

Method

Participants

Eighty-four participants were recruited from the member- ships of SCI advocacy organizations, including the Canadian Paraplegic Association (CPA), National Spinal Cord Injury Association (NSCIA), Paralyzed Veterans of America (PVA), Spinal Cord Injury Network (SCIN)— United Kingdom, and affiliated organizations. Participant eligibility was determined by self-report of (a) presence of a SCI, (b) age between 18 and 64 years, and (c) sixth-grade

80 Rehabilitation Counseling Bulletin 60(2)

or above reading level. Data were collected via an anony- mous, online survey, which participants accessed through the advocacy organizations’ websites newsletters. Therefore, participant response rate cannot be calculated. One hundred fifty-five surveys were attempted and 105 were completed. Eighty-eight completed surveys met inclu- sion criteria for the current study. Two cases were elimi- nated for missing data, and two cases were eliminated for participant response errors (N = 84). Participants ranged from 21 to 64 years of age (M = 47.05, SD = 10.72). Sample participants reflected a higher proportion of women than is estimated for individuals with SCI in the United States, with 26 female and 57 male participants (31% and 67.9%, respectively). One participant did not mark a response for gender. Participants were asked to select all applicable racial/ethnic identities. Most participants identified as Caucasian (88.1%), 6% were Black or African American, 3.6% were Asian American, and 2.4% were Native American. Two participants (2.4%) self-described as “other race,” and one participant did not report racial/ethnic iden- tity. Participants were asked to select all applicable employ- ment status descriptors. Twenty-three participants reported full-time employment (27.4%). Nine participants reported part-time employment (10.7%) and 11 were volunteers (13.1%). Forty-eight reported being unemployed (57.2%). Nearly all participants reported completing high school (97.7%), and the majority of participants had completed some post-secondary education (85.5%). Participants reported more partial injuries (56%) than complete injuries (44%). Thirty-eight participants had cervical-level injuries, 32 had thoracic-level injuries, and 14 had lumbar injuries. Table 1 includes descriptive data on key demographic variables.

Measures

Full-time employment status was coded as a binary out- come from collected demographic data. Participants who reported full-time employment were coded as employed full time. Participants who reported that they were not employed full time were coded as not unemployed full time.

The Attachment Style Questionnaire (ASQ; Feeney, Noller, & Hanrahan, 1994) was used to measure attachment. The ASQ is a self-report measure comprised of 40 items and yields separate scale scores for secure, avoidant, and anxious attach- ment. Respondents rate their level of agreement according to a Likert-type scale from 1 (totally disagree) to 6 (totally agree). Scale scores are consistent with the secure, avoidant, and anxious-ambivalent attachment domains reported by Hazan and Shaver (1987). Scales include items such as “Overall I am a worthwhile person.” ASQ validity is sup- ported by intercorrelations among the three subscales. The Secure and Avoidant subscales were negatively correlated (r = −.49); the Secure and Anxious subscales were negatively

correlated (r = −.29); and the Avoidant and Anxious subscales were positively correlated (r = .35). Reported test–retest reli- abilities over 10 weeks were between .74 and .80. Cronbach’s alphas ranged from .83 to .85 (Feeney et al., 1994). In the present study, Cronbach’s alpha was computed to be .75 for the Secure subscale, .83 for the Anxious subscale, and .81 for the Avoidant subscale.

The Trait Hope Scale (THS; Snyder et al., 1991) was developed as a 12-item instrument that yields scores on total hope, pathways thoughts, and agency thoughts. Four distractor items were omitted for the current study; there- fore, participants responded to eight THS items. Respondents indicated level of agreement with item statements accord- ing to a Likert-type scale from 1 = definitely false to 4 = definitely true. Example items include “I can think of many ways to get out of a jam” and “I meet the goals I set for myself.” Reported Cronbach’s alphas ranged from .74 to .84 for total hope (Snyder et al., 1991). Construct validity is

Table 1. Participant Demographic and SCI Characteristic (N = 84).

Variable n (%) M (SD)

Age 47.05 (10.72) Age at injury 32.8 (12.49) Gender Male 57 (67.9) Female 26 (31.0) Race/ethnicity White 74 (88.1) African American 5 (6.0) Asian American 2 (3.6) Native American 2 (2.4) Other race 2 (2.4) Highest level of education Some high school 1 (1.2) Graduated from high school 10 (11.9) Some college 30 (35.7) Graduated from college 25 (29.8) Some graduate school 3 (3.6) Completed graduate school 14 (16.7) Employment status Full-time employment 23 (27.4) Part-time employment 9 (10.7) Volunteer 11 (13.1) Unemployed 48 (57.2) SCI level Cervical (neck) 38 (45.2) Thoracic (upper back) 32 (38.1) Lumbar (lower back) 14 (16.7) SCI completeness Partial 47 (56.0) Complete 37 (44.0)

Note. SCI = spinal cord injury.

Blake et al. 81

supported by predictable relationships with similar instru- ments such as Scheier and Carver’s (1985) Life Orientation Test and Rosenberg’s (1965) Self-Esteem Scale (Snyder et al., 1991). In the current study, Cronbach’s alpha for the THS was computed to be .84.

Data Analysis

All statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS 23.0). A simple impu- tation method using regression was used to estimate missing data. The imputation method computes estimations based on the values of other related item variables in the same measure to replace missing data. This method is preferred over case deletion, as it will not decrease the sample size (i.e., statistical power loss) or affect the sample representativeness. According to Fox-Wasylyshyn and El-Masri (2005), simple imputation and multiple imputation methods will yield simi- lar results when the missing data are less than 5%.

Descriptive statistics were computed to provide informa- tion about the demographic characteristics of the sample pop- ulation and for the predictor, mediator, and outcome variables. Three mediation analyses were performed using multiple regression and logistic regression to investigate hope (M) as a potential mediator of the relationships between (a) secure attachment (X

1 ) and full-time employment (Y), (b) anxious

attachment (X 2 ) and full-time employment, and (c) avoidant

attachment (X 3 ) and full-time employment. We used the boot-

strap testing approach recommended by Hayes (2013) to test our mediation hypotheses. Hayes and his colleagues (Hayes, 2009, 2013; Preacher & Hayes, 2008; Rucker, Preacher, Tormala, & Petty, 2011) indicated that because of limitations of the Baron and Kenny (1986) assumptions for mediation analysis, tests of mediation should now be based on an esti- mate of the indirect effect, and interpretation of the results should be focused on the size and sign of the indirect effect. In addition, we evaluated the significance of the individual paths (X → M) and (M → Y) to provide supplementary information for the models. The SPSS INDIRECT macro written by Preacher and Hayes (2008) was used to estimate the total, direct, and indirect effects of attachment on full-time employ- ment through hope. It should be noted that because the out- come variable (full-time employment) is a dichotomous variable, the SPSS INDIRECT macro calculated estimates for direct and total effects, and the path from the proposed media- tor to the outcome variable using logistic regression (Preacher & Hayes, 2008).

Results

Descriptive Statistics

The overall employment rate for participants was low (38.1%) compared with the general population (74.2%), but

slightly higher than current estimates for the broader popu- lation of people with SCI (32.3%; Houtenville, Brucker, & Lauer, 2014). The current study is focused on effects of attachment and hope for full-time, paid employment. Participants who reported full-time, paid employment were coded as employed full time. Participants who did not report full-time, paid employment were coded as not employed full time. Twenty-three participants (27.4%) were employed full time. Regarding attachment, participants with SCI in the present study had moderately secure attachment (M = 4.34, SD = 0.72) and low-moderate levels of avoidant (M = 3.10, SD = 0.64) and anxious attachment (M = 2.98, SD = 0.74). The average hope rating of 3.13 (SD = 0.48) indicates that participants had moderately high levels of hope and overall agency and pathways thinking. Table 2 includes means and standard deviations for questionnaire subscales.

Correlation Analysis

Bivariate correlations between all variables investigated in the study are reported in Table 2.

Secure attachment was found to be positively associated with hope (r = .35, p < .001) and full-time employment (r = .23, p < .05). In contrast, anxious attachment and avoid- ant attachment were inversely related to hope (r = −.39 and r = −.35, p < .001, respectively) and full-time employment (r = −.29, p < .01 and r = −.20, n.s., respectively). Hope was positively associated with full-time employment (r = .36, p < .001). Secure attachment was negatively related to avoidant attachment (r = −.66, p < .001) and anxious attachment (r = −.44, p < .001), while the two insecure domains were positively correlated (r = .53, p < .001).

Mediation Analysis

Three simple mediation analyses were computed to evalu- ate hope as a mediator of the relationship between secure attachment and employment, anxious attachment and full- time employment, and avoidant attachment and full-time employment. The SPSS INDIRECT macro written by

Table 2. Bivariate Correlations, Means, and Standard Deviations (N = 84).

Variable 1 2 3 4 5

1. Secure attachment 1 2. Anxious attachment −.44** 1 3. Avoidant attachment −.66** .53** 1 4. Hope 35** −.39** −.35** 1 5. Full-time employment .23* −.29** −.20 .36** 1 M 4.34 3.10 2.98 3.12 — SD 0.72 0.64 0.74 0.47 —

*p < .05. **p < .01.

82 Rehabilitation Counseling Bulletin 60(2)

Preacher and Hayes (2008) was used to estimate the total, direct, and indirect effects of attachment on full-time employment through hope. As an example, the following are the equations for the secure attachment analysis:

Log odds full-time employment

constant secure attachmen

( ) = +c tt error.( )+

(1)

Hope constant secure attachment error.= + ( )+a (2)

Log odds full-time employment

constant secure attachmen

( ) = +c’ tt hope error.( )+ ( )+b

(3)

Total effect Direct effect Indirect effectc c a b( ) = ( )+ ( )×’ .

Indirect effect Total effect Direct effecta b c×( ) = ( )− ( )c’ .

Because full-time employment is a dichotomous vari- able, coefficients in Equations 1 and 3 were estimated in INDIRECT using logistic regression, whereas ordinary- least-squares (OLS) regression was used for the coefficients in Equation 2. The Nagelkerke R2 for the secure attachment model was computed to be .21, indicating a moderate effect size. A graphical representation of this simple mediation model and information for the unstandardized path coeffi- cients (a, b, c, and c′) are presented in Figure 1.

As can be observed in Figure 1, the odds of being employed full time were higher among individuals with relatively high levels of secure attachment (path c = .57). Secure attachment was positively associated with hope (path a = .34). Finally, hope was positively associated with the odds of full-time employment (path b = .90). The direct effect of secure attach- ment (path c′ = .30) was not statistically significant. Most rel- evant to the mediation hypothesis was the estimate of the indirect effect of secure attachment on full-time employment, computed as the product of the OLS regression coefficient estimating hope from secure attachment (path a in Figure 1) and the logistic regression coefficient estimating full-time employment from hope controlling for secure attachment (path b in Figure 1). If the bias-corrected bootstrap confidence interval (CI) for the product of these paths (ab) does not include 0, it will provide evidence of a significant indirect effect of secure attachment on employment through hope (Hayes, 2009; Preacher & Hayes, 2008). Using the INDIRECT procedure with 5,000 bootstrap samples revealed a significant indirect effect of secure attachment on full-time employment through hope (point estimate = .33, 95% CI = [.09, .80]).

The Nagelkerke R2 for the anxious attachment model was computed to be .21. A graphical representation of this simple mediation model and information regarding the unstandardized path coefficients (a, b, c, and c′) are pre- sented in Figure 2.

As can be observed in Figure 2, the odds of full-time employment were lower among individuals with relatively higher levels of anxious attachment (path c = −.71). Anxious attachment was negatively associated with hope (path a = −.38). Finally, hope was positively associated with the odds of employment (path b = .85). The direct effect of anxious attachment (path c′ = −.42) was not statistically significant. Using the INDIRECT procedure with 5,000 bootstrap sam- ples revealed a significant indirect effect of anxious attach- ment on full-time employment through hope (point estimate = −.34, 95% CI = [−.74, −.08]).

The Nagelkerke R2 for the avoidant attachment model was computed to be .20. A graphical representation of this simple mediation model and information regarding the unstandardized path coefficients (a, b, c, and c′) are pre- sented in Figure 3.

As can be observed in Figure 3, the association between full-time employment and avoidant attachment was not

Figure 1. Path coefficients for simple mediation analysis on employment status (N = 84). Note. Dotted lines denote the effect of secure attachment on employment status when hope is not included as a mediator. b, c, and c′ are unstandardized logistic regression coefficients, a is an unstandardized ordinary-least-squares (OLS) regression coefficient. †p = .34. *p < .05. **p < .01.

Figure 2. Path coefficients for simple mediation analysis on employment status (N = 84). Note. Dotted lines denote the effect of anxious attachment on employment status when hope is not included as a mediator. b, c, and c′ are unstandardized logistic regression coefficients, a is an unstandardized ordinary-least-squares (OLS) regression coefficient. †p = .15. *p < .05. **p < .01.

Blake et al. 83

statistically significant (path c = −.49). Avoidant attachment was negatively associated with hope (path a = −.37). Finally, hope was positively associated with the odds of employ- ment (path b = .93). The direct effect of avoidant attachment (path c′ = −.23) was not statistically significant. Using the INDIRECT procedure with 5,000 bootstrap samples revealed a significant indirect effect of avoidant attachment on full-time employment through hope (point estimate = −.36, 95% CI = [−.78, −.08]).

Discussion

The employment rate for people with SCI (32.3%) is lower than the employment rate for the general population (74.2%; Houtenville et al., 2014). In addition, the employment rate for vocational rehabilitation (VR) consumers with SCI (54%) is lower than the overall employment rate for VR consumers (60%; Marini et al., 2008). Results from our study contribute to a growing body of empirical evidence supporting positive psychology as a useful framework for shaping work-related behaviors, attitudes, and employment outcomes. Bivariate analysis and tests of indirect effect indicated that attachment and hope were significantly related, that attachment and hope were predictive of full- time employment, and that hope was a significant mediator of the relationship between attachment and full-time employment. Therefore, our findings provide empirical support for Snyder’s (1994) model of hope, and a dynamic in which attachment predicted hope, and that together, attachment and hope were predictive of full-time employ- ment for people with SCI.

Bivariate relationships between individual attachment domains and hope were consistent with expectations based on previous research. Anxious attachment had a slightly more robust bivariate relationship with hope than secure or avoidant attachment. Bivariate results on attachment and

employment were mostly consistent with pre-study expec- tations. Secure attachment and anxious attachment were significantly related to full-time employment, whereas avoidant attachment was not. For comparison, Simmons et al. (2003) found a significant negative relationship between avoidant attachment behavior at work and health, and Sela-Kaufman et al. (2013) found that lower levels on avoidant attachment predicted higher levels of occupational functioning. Therefore, while results from Simmons et al. (2003) and Sela-Kaufman et al. (2013) suggest that elevated avoidant attachment may impair healthy workplace adapta- tion, results from the current study did not indicate that elevated avoidant attachment directly impaired participants’ abilities to secure and maintain full-time employment. This is consistent with Hazan and Shaver’s (1990) findings that people with an avoidant attachment style often assign high levels of meaning to work, and van Ecke’s (2007) finding of a strong relationship between avoidant attachment and external conflict, suggesting that people with avoidant attachment may prefer to work very hard to avoid dealing with external conflicts.

The present study evaluated the indirect effect of each individual attachment domain on full-time employment through hope for sample participants with SCI. Each of three tested models accounted for significant variance in full-time employment, and significant indirect effects were found for each attachment domain on employment through hope. In the context of previous research suggesting that people with avoidant attachment assign a high level of meaning to work to avoid social relationships (Hazan & Shaver, 1990), our finding that avoidant attachment had a lesser negative effect on full-time employment than anxious attachment is specifically interesting. In the present study, the relationship between avoidant attachment and employ- ment was not significant; however, the indirect effect of avoidant attachment on employment through hope was sig- nificant. It is likely that the negative impact of avoidant attachment on employment is prominent only in conjunc- tion with low levels of hope.

Implications for Rehabilitation Practice

Nearly one half of adults in the general population are inse- curely attached, and insecure attachment may be higher among people with disabilities (Hazan & Shaver, 1987; Howe, 2006; Mikulincer & Orbach, 1995). Attachment pro- files are largely established during infancy and early child- hood; however, attachment-related behavior can be modified (Wilson et al., 2013). Results from our study indicate that hope-based interventions may provide effective components of rehabilitation strategies geared toward improving attach- ment-predicted job-seeking behavior and outcomes.

Each tested model accounted for a relatively small pro- portion of variance in full-time employment; therefore, our

Figure 3. Path coefficients for simple mediation analysis on employment status (N = 84). Note. Dotted lines denote the effect of avoidant attachment on employment status when hope is not included as a mediator. b, c, and c′ are unstandardized logistic regression coefficients, a is an unstandardized ordinary-least-squares (OLS) regression coefficient. †p = .47. ††p = .08. **p < .01.

84 Rehabilitation Counseling Bulletin 60(2)

findings indicate that counselors should also focus on related variables that were not investigated in the study. Attachment profiles are linked to the relative optimism of individuals’ time perspectives. Secure attachment is associ- ated with a positive time perspective, which in turn is linked to increased capabilities, autonomy, and self-determination. Conversely, insecure attachment is associated with a nega- tive time perspective, which in turn is linked to impaired autonomy, competence, and self-determination. Therefore, rehabilitation counselors should endeavor to maintain and enhance positive time perspective for individuals with secure attachment, and ameliorate negative time perspec- tive and engender positive time perspective for individuals with insecure attachment (Laghi, D’Alessio, Pallini, & Baiocco, 2009). In addition, because high levels of anxious and/or avoidant attachment are associated with increased distress and depression, problems with relatedness, deficits in social skills and social support, and maladaptive perfec- tionism, individuals with insecure attachment may benefit from supportive counseling (Gnilka, Ashby, & Noble, 2013; Huprich, Rosen, & Kiss, 2013). Finally, employed individu- als with avoidant attachment may be vulnerable to unhealthy workplace adaptation and may benefit from counseling to address factors that underlie workaholic behavior.

The central tenets of hope theory comprise an accessible, action-oriented model. Hope-based assessment, conceptu- alization techniques, and interventions provide a pragmatic approach for working with consumers in rehabilitation set- tings (Coduti & Schoen, 2014; Snyder, Lehman, Kluck, & Monsson, 2006). The THS (Snyder et al., 1991) is a brief instrument that can be readily administered, scored, and interpreted in a rehabilitation setting. THS results indicate individuals’ hope profiles, which can be used to inform case conceptualization and intervention selection.

Individuals with high pathways/low agency are adept at generating routing thoughts; however, they often experi- ence frustration and anxiety because goal pursuit processes are hampered by impaired motivation. To increase capacity for agency, counselors should assess and explicitly rein- force incremental goal pursuit progress and help consumers develop skills for self-assessment and reinforcement. Agency is also enhanced through positive self-talk, reflec- tion on past positive outcomes, and framing prior negative outcomes as blocked goals rather than failures. Finally, suf- ficient self-care—including adequate exercise and sleep— is essential for the development of motivational energy (Snyder, 2002; Snyder et al., 2006).

Individuals with high agency/low pathways are profi- cient at generating motivational energy but have difficulty maintaining focus on pursuit of specific goals, and therefore often experience agitation and confusion about how to reach goals. Counselors working to assist low pathways individuals should focus on cognitive skills required to (a) generate and visualize goal paths, and (b) identify alternate

routes when primary goal paths are blocked. Guided lines of inquiry are useful for addressing specific obstacles dur- ing early stages of counseling and as a training intervention for increasing individuals’ internal capacity for pathway. Finally, counselors can help consumers internalize the role of pathways through explicitly and consistently framing the goal pursuit process in hope framework vernacular (Snyder, 2002; Snyder et al., 2006).

Individuals with low agency/low pathways experience a halting, inoperable goal pursuit process and may benefit from increased direction. In addition to working toward increased agency and pathways, counselors working with low total hope individuals should focus on (a) increased goal-directed thinking, (b) development of requisite coping skills for goal attainment, and (c) selection of specific goals and subgoals that are meaningful, incremental, measure- able, and ideally suited to individuals’ capacity for chal- lenge. Across hope profiles, successful implementation of the model hinges on exploring existing hope-related strengths and enhancing individuals’ internalized concepts of the goal-achievement process (Snyder, 2002; Snyder et al., 2006).

Limitations and Future Research

Several limitations inherent this study should be consid- ered in the interpretation of study findings. The present study used a convenience sample comprised of self- selected individuals who provided anonymous responses to an online, self-report survey. Self-report measures are susceptible to social desirability bias and response bias. Data were collected at a single point in time for each par- ticipant (i.e., cross-sectional). Therefore, causal direction in the model and in interpretation of results was primarily informed by theory. Most participants had an association with an SCI community organization (e.g., NSCIA, PVA). It is likely that individuals who participate in community organizations differ from the broader population of indi- viduals with SCI. Participants were relatively well edu- cated and reflected higher socioeconomic status. Most participants were White, and individuals from other racial/ ethnic backgrounds were underrepresented. This study did not investigate factors that may compound vulnerabilities experienced by individuals with SCI such as racial/ethnic minority group membership, socioeconomic status, or rural identity. Future research focused on sociocultural vulnerabilities could provide important information about detrimental effects of marginalization (Fyffe, Botticello, & Myaskovsky, 2013). We did not investigate post- employment factors such as workplace culture or worker adjustment. Research focused on relationships between the presently investigated constructs (i.e., attachment and hope) and post-employment factors could provide useful information about the process of work adjustment for

Blake et al. 85

individuals with SCI. Similarly, studies that operationalize medical and other contextual factors that influence employment would provide valuable information.

Research investigating the validity of attachment and hope measures for individuals with SCI and for the broader population of people with disabilities would contribute to the utility of the measures. Future research could assess the pre- dictive power of the investigated constructs for members of other disability groups. Longitudinal studies and randomized control trials (RCTs) focused on assessing effects of hope- based interventions would add value to the current findings.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Preparation of this manuscript was supported in part by the National Institute on Disability Rehabilitation Research through Grant #H133B13001 to Virginia Commonwealth University, Rehabilitation Research and Training Center on Employment of People with Physical Disabilities. The opinions expressed herein do not necessarily reflect the endorsement or position of the U.S. Department of Education.

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