Coping and Social Support

Question 1

Describe the psychology and health link model (smith and cleland 2011)

Answer 1

Question 2

when is stress experienced (generally)

Answer 2

• Stress experienced when perceived discrepancy in demands vs. ability to cope

Question 3

Give 2 examples of key biological mediators of stress

Answer 3

• 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

Question 4

Give 2 examples of key psychological mediators of stress

Answer 4

• 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

Question 5

Define coping

Answer 5

“Constantly changing cognitive and behavioural efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding resources” Lazarus & Folkman

Question 6

How might we assess coping?

Answer 6

• 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

Question 7

What are similar actions for coping called?

Answer 7

• Similar actions grouped together as “ways of coping” or “coping strategies”
• Strategies labelled and assessed in different ways, little consistency, often confusing in literature

Question 8

Give 4 examples/categories of coping strategies

Answer 8

• 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

Question 9

Describe emotion focused coping

Answer 9

1. Emotion-focussed: aimed at modifying response (palliative coping, defensive processes, avoidance coping)

Question 10

Describe problem focused coping

Answer 10

Problem-focussed: action to change, address stressor (problem solving, approach coping)

Question 11

Is this more likely to be problem or emotion focused coping?

Setting goals for gradually building up activity after an accident

Answer 11

Problem

Question 12

Is this more likely to be problem or emotion focused coping?

Self-discharging from hospital on insistence that well

Answer 12

Emotion

Question 13

Is this more likely to be problem or emotion focused coping?

Refusing help from others despite difficulties with tasks

Answer 13

Emotion

Question 14

Is this more likely to be problem or emotion focused coping?

Talking to other patients about stressful experience

Answer 14

Problem

Question 15

Is this more likely to be problem or emotion focused coping?

Practising relaxation exercises prior to surgery

Answer 15

Emotion

Question 16

Give 3 examples of areas of research which utilise ‘coping’ strategies

Answer 16

• Life events/changes
• Traumatic events
• Social issues
• Work issues
• Diagnosis/management of illness
• Injury
• Mental health problems:
• Caregiving & family/couples coping

Question 17

Is problem or emotion focused coping better?

Answer 17

• 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

Question 18

In the acute phase of coping, is problem or emotion focused more prevalent

Answer 18

• Emotion-focussed coping unavoidable, helpful in short term to deal with emotions, only option as opportunities for problem-focussed may be limited

Question 19

Why might long-term emotion focused coping be problematic

Answer 19

• Compromises self-management/self-care, taking responsibility, overcoming depression e.g. poorer outcomes if prolonged denial

Question 20

Early problem-focussed coping needs to be what..?

Answer 20

• Early problem-focussed coping may need to be “cognitive problem-focussed” = rehearsal, planning
• Later opportunities for “behavioural problem-focussed” coping = active management

Question 21

What is adjustment indicated by?

Answer 21

• Usually indicated by absence of psychological distress, disorder; self-reported well-being

Question 22

Describe the stages of adjustment

Answer 22

• • not neccesarily a linear process

Question 23

Define coping flexibility

Answer 23

• 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

Question 24

Is there an association between coping flexibility and psychological adjustment

Answer 24

Small to moderate positive association between coping flexibility and psychological adjustment

Question 25

Define social support

Answer 25

Perceived comfort, caring, esteem or help a person receives from others

Question 26

Give 2 catgegories of social support

Answer 26

• 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

Question 27

True or False:

Social isolation/lack of support can decrease life expectancy by ~7 years?

Answer 27

True

Question 28

Social support consistently related to..

Answer 28

• Physiological markers (e.g. CV, neuroendocrine, immune),
• health status
• disease
• mortality

Question 29

Give 2 key challenges associated with severe ill health

Answer 29

• Treatment & hospitalisation
• Disruption to daily living
• Uncertainty, threat to future
• Burden of ongoing self-care, lifestyle changes

Question 30

What personal domains could sever illness effect?

Answer 30

• Perceived health
• Physical functioning
• Occupational/role functioning
• Social functioning
• Emotional functioning
• Cognitive functioning

Question 31

How can the impact of severe illnes be assessed for individuals

Answer 31

Can be assessed via generic (e.g. EQ5D, SF-36) or disease specific patient-reported outcome measures

Question 32

Give 2 common emotional responses to severe illness

Answer 32

• 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

Question 33

Why are controlling emotions important for health

Answer 33

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

Question 34

What is the prevalnce of depression with co-moribidities

Answer 34

Prevalence of depression: No chronic condition 3%, diabetes 9%, arthritis 11%, angina 15%, asthma 18%, 2+ chronic conditions 23%

Question 35

What % of all-cause mortalilty was experienced per SD increase in depression score?

Answer 35

22% increased risk of all-cause mortality, 13% increased risk of CV events per SD increase in standardised depression score

Question 36

What % of CVD mortalilty was experienced per SD increase in depression score?

Answer 36

13% increased risk of CV events per SD increase in standardised depression score

Question 37

What can impact cognitive functioning?

Answer 37

Some conditions (e.g. stroke) key impact on cognitive functioning (e.g. attention, memory, perception, communication), cognitive deficits also common following ICU stay

Question 38

Describe the ‘Self-regulatory Model’

Answer 38

Illness beliefs interact with emotional response to influence actions

Question 39

Why might someone be offered a psychological intervention

Answer 39

Patients may be offered/referred to rehab or other psychoeducational programmes to support coping, adjustment, recovery and improve quality of life

Question 40

What could interventions include?

Answer 40

• 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