Coping with Chronic Illness

Question 1

Define coping.

Answer 1

How we manage stress by adapting our thinking, emotions and behaviour.

Question 2

What is Folkman and Lazarus’ (1980) definition of coping?

Answer 2

A psychological mechanism for managing external stress which may be action oriented and thought based.

Question 3

Define chronic illness.

Answer 3

Illness lasting 3 months or more which cannot be prevented by vaccine or cured by medication or self resolve.

Question 4

What proportion of people aged over 65 have at least 1 chronic health condition?

Answer 4

80%.

Question 5

List 2 early models of coping.

Answer 5

1 - Cannon’s fight or flight model.

2 - Selye’s general adaptation syndrome.

Question 6

Summarise Cannon’s fight or flight model.

Answer 6

Threat leads to increased arousal in order to escape.

Question 7

Summarise Selye’s general adaptation syndrome.

Answer 7

• An alarm increases activity.
• Resistance is an attempt to cope.
• Exhaustion occurs when one can no longer resist.

Question 8

List 2 problems with early models of coping.

Answer 8

1 - They did not address individual variability or psychological factors.

2 - The described response was automatic and consistent, and therefore did not reflect clinical practice.

Question 9

Describe Lazarus and Folkman’s (1984) transactional model of coping.

Answer 9

Appraise the stressor:

• Primary appraisal (to determine whether a possible stressor is stressful).
• Secondary appraisal (to determine whether one can cope with the stressor by evaluating internal coping strategies).

Methods of coping:

• Problem focussed (to reduce the demands of the stressor or increase resources to manage it).
• Emotion focussed (to manage emotions)

Question 10

According to Lazarus and Folkman’s (1984) transactional model of coping, how might a stressor be assessed under a primary appraisal?

Answer 10

1 - Irrelevant.

2 - Benign and positive.

3 - Harmful and a threat.

4 - Harmful and a challenge.

Question 11

List 4 characteristics of problem focussed coping methods and 5 characteristics of emotion focussed coping methods according to Lazarus and Folkman’s (1984) transactional model of coping.

Answer 11

Problem focussed:

1 - Resolving the stressful event.
2 - Taking control.
3 - Seeking information.
4 - Removing oneself.

Emotion focussed:

1 - Disclaiming.
2 - Escaping or avoiding.
3 - Accepting responsibility.
4 - Self-control.
5 - Positive reappraisal.

Question 12

List 4 examples of problem focussed coping mechanisms.

Answer 12

1 - Revising to improve exam results.

2 - Gaining extra qualifications to enable a career change.

3 - Counselling for a failed relationship.

4 - Making a to-do list / agenda.

Question 13

List 4 examples of emotion focussed coping mechanisms.

Answer 13

1 - Seeking emotional support.

2 - Denial.

3 - Venting anger.

4 - Distraction.

Question 14

List 2 diseases for which stress is a risk factor.

Answer 14

1 - Atherosclerosis.

2 - Myocardial infarctions (in response to acute stress).

Question 15

List 5 behavioural responses to stress.

Answer 15

1 - Increased smoking.

2 - Increased alcohol intake.

3 - Poor diet.

4 - Lack of exercise.

5 - Increased accidents.

Question 16

List 6 factors which affect how people cope.

Answer 16

It is context dependent:

1 - Whether there is a practical solution.

2 - Available time.

3 - Available resources.

4 - Available money.

5 - Personality factors.

6 - Past experience.

Question 17

Give an example of an advantage of using Lazarus and Folkman’s (1984) transactional model of stress.

Answer 17

It has a focus on the interaction of the stressor with the external world.

Question 18

According to Lazarus and Folkman’s (1984) transactional model of coping, how can appraising stress produce positive and negative responses?

Answer 18

• Appraising stress as harmful and a challenge is a positive response, which focuses on
  growth and mastery.
• Appraising stress as harmful and a threat produces a negative emotional response,
  and vulnerability.

Question 19

According to Turk and Flor (1999), how do patients with chronic pain appraise stressors?

How does this reflect in their appraisal of their pain?

Answer 19

They have a tendency to make negative appraisals about the stressor and their ability to control pain.

• They therefore tend to appraise their pain as harmful and a threat.

Question 20

According to Smith and Wallston (1992), on which type of coping do people who make negative appraisals tend to rely?

Answer 20

Emotion focussed coping.

Question 21

According to Jensen et al. (1991), why is problem focussed coping thought to be better than emotion focussed coping?

Answer 21

• Problem focussed coping is associated with better physical and psychological functioning, whereas emotion focussed coping is the opposite.

Question 22

Define learned helplessness.

Answer 22

A state that occurs after a person has experienced a stressful situation repeatedly to the point where they come to believe that they’re unable to control or change the situation, causing them to stop trying (even when opportunities for change become available).

Question 23

Give an example of a quality which, according to Mruk (1999), predisposes people to problem focussed coping.

Answer 23

High self esteem.

Question 24

Define emotional stability.

Answer 24

A state where a person is continuously striving for a greater sense of emotional health, both intraphysically and intrapersonally.

Question 25

List 4 characteristics of an emotionally stable person.

Answer 25

1 - Able to tolerate a delay in satisfaction of needs.

2 - Able to tolerate frustration.

3 - Able to engage in long-term planning.

4 - Capable of revising their expectations in terms of demands.

Question 26

List 2 characteristics of an emotionally unstable person.

Answer 26

1 - Rapid and exaggerated changes in mood.

2 - Strong emotions.

Question 27

List 4 characteristics of resilience according to Rutter (2012).

Answer 27

1 - Resilience is not a general or stable characteristics, but nor is it solely an outcome of adaptation in individuals.

2 - Resilience is a complex process that manifests at specific moments in order to face circumstances.

3 - Resilience is inferred from the dynamic interactions of the components of risk and adaptation.

4 - Resilience varies among people with individual differences in response to environmental threats.

Question 28

List 7 impacts of chronic illness on lifestyle.

Answer 28

1 - Emotional distress.

2 - Restrictions to normal life.

3 - Learning how to manage the illness.

4 - New tasks.

5 - Changing risk factors to help prevent progression.

6 - Side effects of treatment.

7 - Loss of self.

Question 29

List 5 coping interventions (forms of support for coping).

Answer 29

1 - Information provision.,

2 - Social support.

3 - Self management training.

4 - Stress management training.

5 - Psychotropic medication.

Question 30

List 3 aims of coping interventions.

Answer 30

1 - To reduce distress.

2 - To help manage illness and its impact on daily life.

3 - To prevent progression of the illness.

Question 31

List 5 resources and qualities which can improve information provision.

Answer 31

1 - Good communication skills.

2 - Good interpersonal skills.

3 - Expert patients programme.

4 - Helplines.

5 - Leaflets.

Question 32

List 2 aims of social support.

Answer 32

1 - To increase self esteem.

2 - To provide companionship and prevent social isolation.

Question 33

List 3 aims of self management training.

Answer 33

1 - To help patients gain internal control over their illness.

2 - To increase self-efficacy and optimism.

3 - To provide adjunctive therapy (therapy given in addition to the main treatment to maximise its effectiveness).

Question 34

Define self-efficacy.

Answer 34

An individual’s belief in their capacity to execute behaviors necessary to produce specific performance attainments.

Question 35

List 5 management techniques.

Answer 35

1 - Problem-solving.

2 - Cognitive restructuring.

3 - Behavioural change plans.

4 - Relaxation and mindfulness.

5 - Positive self talk (a form of self instruction training).