4. Coping and Management

Question 1

Define coping

Answer 1

Lazarus and Folkman (1984) defined coping as constantly changing cognitive and behavioural efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person.

The goals of coping are:

• to reduce stressful environmental conditions and maximise the chance of recovery
• to adjust or tolerate negative events
• maintain a positive self-image
• maintain emotional equilibrium
• continue satisfying relationship with others

Question 2

Why is coping useful?

Answer 2

Coping is helpful at reducing the impact of stress on our well being. Ways in which we cope can explain this impact that stressors have on our health. Coping is a dynamic process which changes overtime in response to objective demands and subjective appraisals of the situation.

Question 3

Emergence of coping research

Answer 3

Coping research was epitomised by the work of Lazarus and Folkman (1984)
They reflected 2 higher order dimensions: problem-focused coping (strategic to solve.a problem) and emotion-focused coping (to manage emotions, let them out or reduce them) and including scales which assess the two dimensions.
Ruth and Cohen (1986) later added avoidance as a third coping dimension which is a social diversion/distraction.

Question 4

DunnGalvin et al (1999)

Avoidant Coping with FA

Answer 4

Conducted 15 focus groups with children aged 6-15.
6 themes identified: meanings of food, control and self-efficacy, peer relationships, risk and safety, self-identity and coping strategies.

• Younger children were more confident in social situations as they relied on their parents to choose safe foods.
• After the age of 8, social situations became a source of anxiety and uncertainty of what food is safe.
• older children took more control of events themselves
• coping strategies were cognitive, emotional and behavioural.

40% of children and teens used avoidance strategies to manage anxiety and risk
30% of children and teens used cognitive minimisation strategies, rejecting their allergic identity to prevent teasing and bullying (this increases risk)
30% of children and teens used adaptive strategies such as independence and self-management.

Question 5

Fenton et al (2011)

Coping with FA

Answer 5

Interviewed 10 children and 10 teens in Canada and found that:

• younger children relied heavily on parents to manage risk
• avoidance and educating others was used as a coping strategy
• adolescents were described as extremely vigilant, being more alert to overcome any risks and risk related anxiety and fear
• a few teens described feeling helpless and this was over-compensated by obsessive compulsive behaviour such as hand washing.

Question 6

Mackenzie et al 2009

Teens coping with FA

Answer 6

21 teens ages 13-18 with FA were interviewed.

• They reported having a food allergy as a burden but a way of life, not an impairment for them just something they prepare for.
• Coping involved assessing acceptable risk or using willpower to avoid the food they are allergic to and try to find alternatives.
• Some teens were very strict and they showed a high level of burden
• Those who reported more tolerance to risk and levels of precaution depending on the situation, perceived severity of their allergy and trust of food labels.
• A minority felt the least burden and they were the most tolerant towards risk, not always checking food labels etc

Question 7

Interventions should aim to …

Answer 7

• Change perceptions of illness identity
• Reduce emotional representations
• Promote beliefs in the effectiveness of both personal and treatment control
• Teach allergy sufferers new coping strategies such as positive reinterpretation of their allergy.

Question 8

Coping with Atopic Dermatitis

Answer 8

Much of the research looking at AD has used quantitative measures and looking and children and adolescents.

• Coping in children and adolescents has focused on itching/scratching cycle and negative beliefs/stress and catastrophising. Looking at how coping relates of illness beliefs, emotions, stress, QoL and severity.
• The coping behaviours of parents mostly include aggression with respect to scratching, protective behaviour, control of scratching

Question 9

Supporting evidence of Illness perceptions and distress coping with AD
Benyamini et al (2012); Wittowski et al (2007)

Answer 9

Illness perceptions such as higher belief and negative consequences of AD, a cyclical timeline, psychological causes of AD, low personal control, and strong illness identity have all correlated with a higher emotional impact of AD and poorer QoL.

Question 10

Schut et al (2014)

Illness perceptions and distress coping with AD

Answer 10

The goal of this cross‐sectional study was to investigate whether illness representations and coping strategies are correlated with the severity of AD and self‐rated physical impairment of the patients.
A total of 109 AD patients were examined at the beginning of their stay at a rehabilitation centre. They filled in validated questionnaires to measure illness perceptions (IPQ), coping strategies (EBS) and self‐rated physical well‐being (FEW). In addition, the severity of AD (SCORAD) was determined by a doctor.

Findings revealed that a considerable amount of the variance in self‐rated physical well‐being (51%) could be predicted by particular illness perceptions and coping.

Subsequent multiple mediation analyses indicated that certain coping strategies (active problem solving and depressive reactions) mediated the effect of illness representations on self‐rated physical well‐being. In contrast, only 7.4% of the SCORAD could be predicted by the IPQ scale illness identity.

This study showed that illness representations and coping are highly associated with self‐rated physical impairment in AD patients. Therefore, this patient group might profit from cognitive behavioural interventions designed to alter patients’ illness perceptions.