Cognitive appraisal processes and health: from bench to bedside

Background/objectives: After two decades of cognitive-appraisal research in spine surgery and other medically ill patients, the present work reviewed the published literature on cognitive-appraisal processes and health outcomes to determine key findings and considerations, and how they point to appraisal-assessment based interventions to improve clinical outcomes. Methods: The present work reviewed the published literature on cognitive-appraisal processes and health outcomes to determine key findings and considerations, and how they point to interventions to improve clinical outcomes. These implications were further examined in terms of when such appraisal processes should be addressed and how individual differences should be explicitly considered. Results: The literature review identified 53 articles, of which 26 were retained for further review and 27 were excluded because they either (1) used a different definition of cognitive appraisal or (2) focused solely on measurement development; methodological or statistical development; or theory development. The findings from the retained studies highlighted the following cognitive-appraisal processes in order of frequency of mention: Sampling of Experience, Standards of Comparison, Frame of Reference, and Combinatory Algorithm. Empirical findings also generally supported more interventions on appraisal processes after surgery rather than before. An appraisal-assessment based intervention is proposed that builds on the empirical evidence. Conclusion: It is our hope that the present work has provided the next logical step in response-shift research, moving from basic, foundational findings to implications for clinical interventions that can help medically ill patients recover in more lasting and deeper ways from surgery and other health state changes.