Chronic Embitterment in the NHS

Chronic Embitterment is a persistent and disabling negative reaction to an event perceived as unjust and is a frequent presentation in NHS Occupational Health settings. It is associated with distress and impairment and is difficult to treat. A lack of research on the psychological processes which underpin Chronic Embitterment has led to a lack of clarity about why some people become embittered while others, facing the same circumstances, do not. Certain psychological variables were proposed as potentially relevant. While rumination has been named as a characteristic feature of Chronic Embitterment, no published study had explored this association. In other studies, Positive beliefs about rumination have been indicated to underpin rumination. It was hypothesised that this may also be the case in Chronic Embitterment. Sense of Coherence describes a cognitive approach to problems which has been repeatedly linked to resilience following negative life events. The relationship of Sense of Coherence to rumination and Chronic Embitterment was unexplored. As both low Sense of Coherence and excessive rumination have evidence based treatments, exploring the roles of these factors in Chronic Embitterment was suggested as a useful direction for research. Seventy nine NHS staff attending two Occupational Health departments in greater London completed a cross sectional survey in relation to the psychological correlates of embitterment. Correlations with the severity of embitterment were found in Affective Rumination and Sense of Coherence, but not Positive beliefs about rumination. Moreover it was found that the relationship been embitterment and Affective Rumination was mediated by Sense of Coherence. The implications of this finding for the understanding, prevention and treatment of Chronic Embitterment are discussed.