Coping and Social Support Flashcards
Describe the psychology and health link model (smith and cleland 2011)
when is stress experienced (generally)
- Stress experienced when perceived discrepancy in demands vs. ability to cope
Give 2 examples of key biological mediators of stress
- Age
- Gender
- Genetic susceptibility
- High reactivity to stress (i.e increases in blood pressure)
- Individual reactivity (e.g. cardiovascular reactivity)
- Weaknesses due to pre-existing pathology
- Medication
- Sleep
Give 2 examples of key psychological mediators of stress
- Personality e.g. Type A vs. B, hardiness, optimism
- Control beliefs, self-efficacy, helplessness
- Health-related behaviour e.g. exercise, diet
- Appraisal, perception, interpretation
- Altered response e.g. relaxation, biofeedback
- Coping strategies: thoughts and actions
- Social support, integration
Define coping
“Constantly changing cognitive and behavioural efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding resources” Lazarus & Folkman
How might we assess coping?
- Generic questionnaires where people respond in relation to chosen stressor (coping style)
- How they generally tend to cope in relation to a stressor
- Generic questionnaires where people respond in relation to specified stressor (coping strategies)
- e.g. Ways of Coping Questionnaire, COPE
- Specific questionnaires for particular stressors
What are similar actions for coping called?
- Similar actions grouped together as “ways of coping” or “coping strategies”
- Strategies labelled and assessed in different ways, little consistency, often confusing in literature
Give 4 examples/categories of coping strategies
- Problem solving: direct action, decision making, planning
- Support seeking: social support, comfort/help seeking- either practical or emotional
- Escape-avoidance: disengagement, denial, wishful thinking
- Distraction: alternative activities e.g. exercise or procrastination
- Cognitive restructuring: positive thinking, accommodation
- Rumination: -ve thinking, self-blame, worry, catastrophising
- Helplessness: inaction, passivity, giving up
- Social withdrawal: self-isolation, concealment, stoicism
- Emotional regulation: emotional expression, relaxation
- Information seeking: learning more, observation, monitoring of how to cope with the stressor
- Negotiation: compromising, prioritising, deal making
- Opposition: anger, blaming others, projection, reactance
- Delegation: maladaptive help seeking, complaining, self-pity
Describe emotion focused coping
- Emotion-focussed: aimed at modifying response (palliative coping, defensive processes, avoidance coping)
Describe problem focused coping
Problem-focussed: action to change, address stressor (problem solving, approach coping)
Is this more likely to be problem or emotion focused coping?
Setting goals for gradually building up activity after an accident
Problem
Is this more likely to be problem or emotion focused coping?
Self-discharging from hospital on insistence that well
Emotion
Is this more likely to be problem or emotion focused coping?
Refusing help from others despite difficulties with tasks
Emotion
Is this more likely to be problem or emotion focused coping?
Talking to other patients about stressful experience
Problem
Is this more likely to be problem or emotion focused coping?
Practising relaxation exercises prior to surgery
Emotion
Give 3 examples of areas of research which utilise ‘coping’ strategies
- Life events/changes
- Traumatic events
- Social issues
- Work issues
- Diagnosis/management of illness
- Injury
- Mental health problems:
- Caregiving & family/couples coping
Is problem or emotion focused coping better?
- Emotion-focussed traditionally viewed as negative
- In practice some coping strategies (e.g. seeking support) can be problem or emotion focussed, overlapping and co-dependent
- People not necessarily free to choose
- Usually range of coping strategies important to meet different challenges, at different times
In the acute phase of coping, is problem or emotion focused more prevalent
- Emotion-focussed coping unavoidable, helpful in short term to deal with emotions, only option as opportunities for problem-focussed may be limited
Why might long-term emotion focused coping be problematic
- Compromises self-management/self-care, taking responsibility, overcoming depression e.g. poorer outcomes if prolonged denial
Early problem-focussed coping needs to be what..?
- Early problem-focussed coping may need to be “cognitive problem-focussed” = rehearsal, planning
- Later opportunities for “behavioural problem-focussed” coping = active management
What is adjustment indicated by?
- Usually indicated by absence of psychological distress, disorder; self-reported well-being
Describe the stages of adjustment
- not neccesarily a linear process
Define coping flexibility
- Variously defined as: perceived ability to cope, good strategy situation fit, having broad coping repertoire, well-balanced coping profile, cross-situational variability in strategy deployment
Is there an association between coping flexibility and psychological adjustment
Small to moderate positive association between coping flexibility and psychological adjustment
Define social support
Perceived comfort, caring, esteem or help a person receives from others
Give 2 catgegories of social support
- Emotional: empathy, caring, concern, reassurance
- Esteem: encouragement, self-worth, being valued
- Instrumental: practical assistance e.g. money, help
- Informational: advice, suggestions, feedback
- Network: sense of belonging, shared interests
True or False:
Social isolation/lack of support can decrease life expectancy by ~7 years?
True
Social support consistently related to..
- Physiological markers (e.g. CV, neuroendocrine, immune),
- health status
- disease
- mortality
Give 2 key challenges associated with severe ill health
- Treatment & hospitalisation
- Disruption to daily living
- Uncertainty, threat to future
- Burden of ongoing self-care, lifestyle changes
What personal domains could sever illness effect?
- Perceived health
- Physical functioning
- Occupational/role functioning
- Social functioning
- Emotional functioning
- Cognitive functioning
How can the impact of severe illnes be assessed for individuals
Can be assessed via generic (e.g. EQ5D, SF-36) or disease specific patient-reported outcome measures
Give 2 common emotional responses to severe illness
- Emotionalism/emotional lability/instability: e.g. 25% after stroke
- Anger, frustration: normal, understandable & common reaction
- Anxiety, fear, worry: unavoidable, motivating, but problematic if prolonged (e.g. 25-33% stoke patients experience clinical anxiety)
- Depression (persistent low mood, loss of interest/pleasure): e.g. ~1 in 3 patients with stroke or CHD experience at some point
Why are controlling emotions important for health
Research suggests anxiety & depression across a range of diseases may result in a vicious circle:
- Poor adherence & self-care, self-destructive behaviours
- Detrimental effects on disease processes
Leading to…
- Increased symptoms, disability, reduced quality of life
- Prolonged recovery, poorer outcomes from treatment
- Increased risk of further acute events & complications
- Increased costs of care
- Reduced survival
What is the prevalnce of depression with co-moribidities
Prevalence of depression: No chronic condition 3%, diabetes 9%, arthritis 11%, angina 15%, asthma 18%, 2+ chronic conditions 23%
What % of all-cause mortalilty was experienced per SD increase in depression score?
22% increased risk of all-cause mortality, 13% increased risk of CV events per SD increase in standardised depression score
What % of CVD mortalilty was experienced per SD increase in depression score?
13% increased risk of CV events per SD increase in standardised depression score
What can impact cognitive functioning?
Some conditions (e.g. stroke) key impact on cognitive functioning (e.g. attention, memory, perception, communication), cognitive deficits also common following ICU stay
Describe the ‘Self-regulatory Model’
Illness beliefs interact with emotional response to influence actions
Why might someone be offered a psychological intervention
Patients may be offered/referred to rehab or other psychoeducational programmes to support coping, adjustment, recovery and improve quality of life
What could interventions include?
- Often include:
- Exercise to improve functioning, reduce anxiety about exertion, reduce risks
- Usually include…
- Education re: disease, treatment, self-management, lifestyle changes
- Social support via group classes, involvement of carers
- Sometimes include…
- Behaviour change techniques e.g. enhancing self-efficacy, goal-setting
- Stress management, relaxation training
- Psychological assessment, treatment, referral for emotional problems
- Support with cognitive deficits, consideration of health & illness cognitions
