Coping Flashcards
What is the definition of coping?
process by which people manage the perceived discrepancy between demands of the situation and the resources of the person that they appraise (stress) in a stressful situation
What is the significance of coping?
- Link between coping and health status
- Failure to cope may have serious health consequences
- Important to understand how people cope with stress and illness
What is used to appraise coping?
• ‘Stress - coping’ paradigm (Lazarus, 1980)
• Cognitive appraisal:
Primary appraisal (danger?)
Secondary appraisal (coping)
Describe the impact of a good coping appraisal
- Relates to secondary appraisal
- ↓ effects of stressors
- Not necessarily associated with good outcomes
- Many different coping styles, strategies
- Individual/ situational differences
- May change over time – cognitive & behavioural transactions
Should coping be considered a trait or a state?
• TRAIT - personality - style
- consistency
• STATE - response to time and situation - process or strategy
- different ways coping
What are the main two types of coping?
• Alter the problem or regulate the emotional
response to the problem
– PROBLEM-FOCUSED
reduce demands of situation OR expand resources to deal with it
– EMOTION-FOCUSED
control emotional response to situation
Describe problem-focussed coping
• 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
Describe emotion-focussed coping
• Used when people feel they can do nothing to change the situation
Examples • Using alcohol or drugs • Seek emotional support from friends • Use distraction behavioural/ cognitive approaches... can interfere with health outcome
Are med students stressed?
Ye
• Levels of stress are high in medical students – long working hours – work load – feeling overwhelmed – making mistakes – serious treatment failures – emotionally demanding (pts) – relationship with consultants – breaking bad news – effects work on personal life • Stress can lead to burnout (emotional exhaustion, cynicism) • Variety coping strategies used (+ve/-ve)
What factors control differences in coping styles?
• Gender?
– women > emotion focused…
– men > problem focused…
• Social class – high income, high education > problem focused – disadvantaged individuals > stress < control over events < effective coping
What are some coping strategies?
- 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)
Provide an example of coping strategies used when coping w illness
- Normalising – interpret symptom as normal experience
- Denial – denies existence of symptom
- Resignation – become consumed by illness
- Accommodation - acknowledges, deals with problem
What are some coping resources?
- Money
- Health
- Sense of control (e.g. over situation)
- Personality (e.g. locus of control, optimism)
- Beliefs and attitudes (e.g. perfectionism)
- Become informed
- Exercise (e.g. vs antidepressants…)
- Social support…
How is coping assessed?
Questionnaires, rating scales
• Ways of Coping checklist (Folkman & Lazarus 1988)
• COPE (Carver et al. 1989)
What is COPE?
Assessment of coping: COPE (Carver et al., 1989)
• What individuals do and feel when they experience stressful events (rating scale)
• 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
Does coping moderate the association between stress and health?
•Well being, psychological adjustment
•Illness associated variables e.g. symptoms,
medication, survival
– e.g. post op: decreased anxiety, decreased hospital stay, increased recovery, decreased medication, cancer survival …
Provide an example of the use of coping strategies and breast cancer survival
• ‘Fighting spirit’ – associated with better breast cancer survival (Greer et al., Lancet, 1979)
– prospective, multi-disciplinary 5 yr study
– 69 women with early breast cancer
– psychological responses, assessed 3 months post operatively, were related to outcome 5 yr later
• fighting spirit/ denial vs
• stoic acceptance/ helplessness or hopelessness
– follow up at 10, 15 years – same survival differences
What two types of copers do Miller et all 1988 suggest?
• ‘Monitors’: seek information • ‘Blunters’: avoidance Preparation is best tailored to coping style • ‘Monitors’ - high information • ‘Blunters’ - low information
Provide an example of personality and coping in gynaecological stress
- Women undergoing a gynaecological examination (n=40)
- Evidence that coping strategies can impact on the effects of procedural preparation
- Monitors: high/ low information
- Blunters: high/ low information
- Pulse rate measured pre-info, post-info, post exam (‘stress’ response)
How should one prepare a patient to receive information and cope?
Stressful medical procedures e.g. surgery:
• 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
Dr-Pt discussion, pamphlet, video, family involvement
What are some social support types?
• Networks – size and frequency of contact – composition – intimacy (confidant) • Types – emotional / esteem – informational – tangible – companionship • Quantity • Quality/ satisfaction – negative/ positive...
How does social support influence health?
Buffering effect
• Protects individual against –ve effects on health – stressor is strong
– e.g. enhances resources, enables reappraisal, distraction Direct effect
• Beneficial to health and well-being
– regardless of the degree of stress
– e.g. belonging, self-esteem
– e.g. positive outlook, greater resistance to infection, healthier lifestyle
When is social support not beneficial?
When not perceived as supportive Reduces self-esteem
Does not match needs Encourages damaging lifestyle
– poor role model
– not engaging in healthy behaviors
– overprotective (inactivity, disabling)
