Coping

Question 1

Define coping

Answer 1

‘process by which people manage the perceived discrepancy between demands of the situation and the resources of the person that they appraise in a stressful situation’

Question 2

Analyse how coping is associated with primary and secondary appraisals of stress.

Answer 2

As a result of a stimulus:

PRIMARY APPRAISAL
1) First undergo primary appraisal in which we determine whether it represents a harm, loss or threat.
Possible conclusions include
a) Benign appraisal (leading to no further coping)
b) Irrelevant appraisal (leading to no further coping)
c) Positive appraisal (leading to no further coping)
d) Stimulus appraised as harm, loss or threat

SECONDARY APPRAISAL
2) If the stimulus is appraised as harm, loss, or threat, it is then perceived as a stressor, triggering the need for secondary appraisal (=coping).
Four actions may be reached as a result of this appraisal:
a) Seeking information
b) Taking direct action;
c) Doing nothing
d) Worrying

Hence, coping:
• Relates to secondary appraisal
• ↓effects of stressors
• Not necessarily associated with good outcomes
• Many different coping styles, strategies (Individual/ situational differences)
• May change overtime

Question 3

Compare coping style with coping strategies

Answer 3

Coping may be described as trait or state.

STYLE

• associated with notion of TRAIT
• linked with personality of individual
• consistent

PROCESS/STRATEGY

• associated with notion STATE
• responsive to time and situation
• different ways coping

Question 4

Contrast between emotion and problem-focused coping.

Answer 4

PROBLEM-FOCUSED
-reduce demands of situation OR expand resources to deal with it
-Used when people believe their resources or demands of the situation are changeable
-Examples
• Change from high to low stress job
• Change from an unhealthy diet to healthy diet

EMOTION-FOCUSED
-control emotional response to situation
-Used when people feel they can do nothing to change the situation
-Examples
• Using alcohol or drugs
• Seek emotional support from friends 
• Use distraction

Question 5

Identify gender and social class differences in coping styles.

Answer 5

GENDER
– women > emotion focused
– men > problem focused

SOCIAL CLASS
– high income, high education > problem focused
– disadvantaged individuals have > stress,
< control over events, and < effective coping

Question 6

List coping strategies, identifying whether they are problem-focused or emotion focused.

Answer 6

• Planning (PF)
• Active coping (PF)
• Seeking social support (PF/EF)
• Distancing (EF)
• Escape-avoidance (EF)
• Denial (EF)
• Distraction (EF)
• Self-control (EF)
• Substance use (EF)
• Accepting responsibility (EF)
• Positive reappraisal (PF/EF)

Question 7

Define normalising, denial, resignation, and accommodation in the context of coping.

Answer 7

• Normalising – interpret symptom as normal experience
• Denial – denies existence of symptom
• Resignation – become consumed by illness
• Accommodation - acknowledges, deals with problem

Question 8

Give four examples of coping resources.

Answer 8

• Money
• Health
• Sense of control (e.g. over situation)
• Personality (e.g. locus of control, optimism)

Question 9

Outline the major methods of assessing coping.

Answer 9

Through questionnaires, rating scales

1) COPE
• Rating scale
• Looks at what individuals do and feel when they experience stressful events
• Coping strategies/ responses incorporated into 13 scales: e.g. active coping, seeking instrumental social support, seeking emotional social support, positive reinterpretation • Measures situational/ dispositional coping
• Values of responses reflect coping style/ strategy
• Example in Seeking Instrumental Support:
- I try to get advice from someone about what to do
(4 possible answers, usually do this a lot to usually don’t to this at all)

2) WAYS OF COPING CHECKLIST

Question 10

Understand how coping with illness can affect patient health outcome.

Answer 10

2 outcomes used to measure this

1) Psychological dimension
2) Symptoms associated with illness (symptoms, medication, survival)

-Examples, post op: decreased anxiety, decreased hospital stay, increased recovery, decreased medication, cancer survival

1) FIGHTING SPIRIT (studies measuring cancer survival)
– associated with better breast cancer survival (Greer et al., Lancet, 1979)
• fighting spirit/ denial vs
• stoic acceptance/ helplessness or hopelessness
– psychological responses, assessed 3 months post operatively, were related to outcome 5 yr later
– follow up at 10, 15 years – same survival differences

-In a second study, EF coping strategies significantly associated with survival for invasive breast cancer

2) GYNECOLOGICAL STRESS (studies measuring stress)
- Evidence that coping strategies can impact on the effects of procedural preparation
- Monitors (patients who seek information) had a much lower pulse rate when given a lot of info than when given little info
- Blunters (patients who avoid overload of information) had a much lower pulse rate when given a low amount of information than when given a high amount

3) PREPARED PATIENTS HAVE BETTER HEALTH OUTCOMES (studies measuring stress)
-Useful to prepare the patient through,
• Procedural information
– e.g. waking up in recovery room with drip and catheter
• Sensation information
– e.g. pre-medication may induce drowsiness
– e.g. post-operative pain may occur, controlled with medication
• Behavioural instruction
– e.g. coughing without pulling on wound incision

E.G. Family-centered preparation for surgery improves perioperative outcomes in children:

• outcomes: child anxiety, parental anxiety
• Variables:
  1) Control standard care (no pre-med, no parental presence anesthesia)
  2) Parental presence (standard+ parents present anesthesia)
  3) ADVANCE behavioural prep (standard+ decreased anxiety, distraction, modelling & education, parents, no excessive reassurance, coaching, exposure)
  4) Midazolam (inducing drowsiness, relieving anxiety)

4 had lower child anxiety results, followed by 3, followed by 2 presence, followed by 1
ADVANCE group exhibited the lowest severe emergence delirium

Question 11

Identify some of the varying factors between kinds of social support and describe how social support affects coping.

Answer 11

They differ in size, composition, frequency and intimacy of contact, type of support (emotional, informational, tangible, companionship), quantity, quality.

1. Buffering effect on health:
   • Protects individual against negative effects on health
   – when the stressor is strong
   – e.g. enhances resources, enables reappraisal, distraction

2. Direct effect on health:
• Beneficial to health and well-being
– regardless of the degree of stress
– e.g. belonging, self-esteem
– e.g. positive outlook, increased resistance to infection, healthier lifestyle

3. Negative effect on health: 
• When not perceived as supportive
-- Leads to reduced self-esteem
-- Does not match needs
-- Encourages damaging lifestyle (if poor role model support, if overprotective support leading to inactivity, if support not engaging in health behaviors)