Stress & Coping 2

Question 1

Coping Definition - Lazarus and Folkman, 1984

Answer 1

• Coping is defined as “constantly changing cognitive and behavioural efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person”
• Actual coping efforts, aimed at problem management and emotional regulation, give rise to outcomes of the coping process (for example, psychological well-being, functional status (e.g. health status, disease progression, and so forth), and health behaviours (e.g. adherence)

Question 2

Coping Dimensions

Answer 2

Active coping efforts are conceptualised along two dimensions:
1. Problem–focused coping (problem management strategies)
2. Emotional–focused coping (emotion regulation strategies)
There is also an avoidant coping category

Question 3

Problem-Focused Coping: Part 1

Answer 3

“Problem-focused coping refers to efforts to improve the troubled person-environment relationship by changing things, for example, by seeking information about what to do, by holding back from impulsive and premature actions, and by confronting the person or persons responsible for one’s difficulty.” (Monat & Lazarus, 1991, p. 6)
•e.g., Cancer = consult experts, determine best course of action

Question 4

Problem-Focused Coping: Part 2

Answer 4

• Tends to increase attention to the stressful situation
• Suggested to be more adaptive when something can be done about the situation
• Types of problem-focused coping:
• Problem-Solving: analysing situation and taking direct action
• Confrontational Coping: taking assertive action
• Seeking Social Support: seeking information

Question 5

Emotion-Focused Coping: Part 1

Answer 5

•“Emotion-focused (or palliative) coping refers to thoughts or actions whose goal is to relieve the emotional impact of stress. These are apt to be mainly palliative in the sense that such strategies of coping do
not actually alter the threatening or damaging conditions but make the person feel better.” (Monat & Lazarus, 1991, p. 6)
•e.g., Cancer = focus on reducing emotional responses

Question 6

Emotion-Focused Coping: Part 2

Answer 6

•Can increase attention to the stressful situation, but can also be a
distraction
•Suggested to be more adaptive when nothing can be done about the
situation
•Types of emotion-focused coping
• Seeking Social Support: emotional support
• Distancing: making cognitive efforts to detach from the situation or create a positive outlook
• Self-Control: attempts to modulate feelings or actions regarding the problem
• Accepting Responsibility: acknowledging role in the problem
• Positive Reappraisal: creating a positive meaning in terms of personal growth

Question 7

Avoidant Coping

Answer 7

• Refers to a set of strategies used (deliberately or not) to distract from the stressful situation or delay dealing with the stressor
• Types of avoidant coping:
• Venting
• Blaming
• Self-distraction
• Distancing
• Escape Avoidance
• Defence mechanisms (denial, intellectualisation)

Question 8

Other Ways to Conceptualise Coping

Answer 8

• Brown and Nicassio(1987) -active versus passive coping
• Jensen, Turner, Romano, and Strom (1995) cognitive versus behavioural types
• Compas and colleagues (2001,2006)
• primary-control engagement(e.g., problem solving, changing the situation, and emotion regulation),
• secondary-control engagement(e.g., positive thinking, acceptance, and distraction)
• disengagement coping
• Aim for a balance between approach and avoidance

Question 9

Coping Styles

Answer 9

•What we have talked about so far is situation-specific coping efforts
•Coping styles are conceptualized as stable dispositional
characteristics that reflect generalized tendencies to interpret and respond to stress in particular ways (Lazarus, 1993)
• Coping efforts = mediator
• Coping Styles = moderator
•Coping styles are believed to drive appraisal and coping efforts (Lazarus, 1993).

Question 10

Coping Style –Information Seeking: Part 1

Answer 10

• Healthcare setting has a lot of uncertainty, information seeking common
• Evidence that seeking information is helpful (↓ distress ↑ adaptive health behaviours)
• BUT we differ on how much information we find helpful
• Monitor versus Blunter

Question 11

Coping Style –Information Seeking: Part 2

Answer 11

• Monitor versus Blunter
• Monitoring better than blunting when stressor is short-term and need for information can be satisfied
• Monitors may be more inclined to seek health-related information that could have significant medical benefits
• Monitors play a more active role in medical decision making
• Monitors maybe less likely to experience regret following difficult medical decisions
• BUT
• Monitoring may be associated with more threatening primary appraisals of health threats. Monitors exhibit more physical distress and arousal during invasive medical procedures than blunters (Miller and Mangan, 1983)

Question 12

Coping Style -Optimism: Part 1

Answer 12

•The tendency to have positive rather than negative generalized expectancies for outcomes.
•Dispositional optimism appears to exert effects on each of the key processes of the Transactional Model.
• Among gay men at risk for AIDS, dispositional optimism was associated with perceived lower risk of AIDS (primary appraisal), higher perceived control over AIDS (secondary appraisal), more active coping strategies, less distress,
and more risk-reducing health behaviors(Taylor et al., 1992).

Question 13

Coping Style -Optimism: Part 2

Answer 13

•Studies show link between optimism and psychological adjustment across a variety of illness (Kung et al., 2006; Carver et al., 1993)
•Studies show link between optimism and disease outcomes
(mortality) across a variety of illness (Kim et al., 2017)

Question 14

Coping Style –Control

Answer 14

• Locus of control = the extent to which people feel that they have control over the events that influence their lives.
• Internal versus external
• Passive (not in control) vs Active (in control)

Question 15

Social Support: Part 1

Answer 15

• Social support plays a key role in coping
• By influencing key processes posited in the Transactional Model, social support can influence how people adapt to stressful events.
• For example, availability of confidants could affect a person’s perceptions of personal risk or the severity of illness (primary appraisal).
• These interactions could also bolster beliefs about one’s ability to cope with situations and manage difficult emotions (secondary appraisal)

Question 16

Social Support: Part 2

Answer 16

• Also need to consider the impact of a non-supportive environment
• Active discouragement of disclosure of feelings can lead to avoidant coping and poor psychosocial outcomes. E.g. Breast cancer patients who reported being socially constrained reported ↑depression and ↓ QOL
• Outcome consistent across different health conditions

Question 17

Social Support: Part 3

Answer 17

• Social support has been conceptualized in a variety of ways (Heitzmannand Kaplan, 1988).
• Quantitative and tangible dimensions (the number of friendships)
• Qualitative and nontangible dimensions involving subjective appraisals of adequacy of support networks or feelings of interconnectedness
• 4 types of Social Support:
• Esteem support
• Advice support
• Companionship
• Instrumental or physical help

Question 18

What is the link between social support and health?

Answer 18

• Alameda County, California Study –Berkman and Syme(1979)
• 7000 men and women studied in 1965
• Index based on four types of social ties: marital status, number contacts with friends and relatives, and church and group membership
• Persons with low scores (lack of social ties) had 9-year mortality rates 1.9 to 3 times greater than those with high scores (more social ties)
• Results have been replicated in U.S. and Europe
• Assoc with mortality independent of self-reported physical health, year of death, socioeconomic status, smoking, alcohol use, obesity, physical activity, utilization of preventative health services, and cumulative index of health practices.

Question 19

Who benefits from what support?

Answer 19

•People in different situations benefit from having different types of support –matching hypothesis –depends on type of problem
• In the case of ‘controllable’ events (e.g., new parents, victims of natural disaster, breakdown), people benefit from practical support.
• In the case of uncontrollable events (e.g., loss of spouse), people benefit from emotional support.
• Receiving social support from persons with similar problem has benefits –Kulik et al. (1996) –matching hospital roommates who had heart surgery,
lower anxiety, more mobile post op, left hospital earlier: 8.04 days v. 9.17 days for those patients who did not have roommates who previously had the surgery

Question 20

Health Theory of Coping: Part 1

Answer 20

• Coping is reimagined as the cognitive and behavioural reactions to reduce unpleasant emotions (e.g., sadness, fear, anger), irrespective of emotional intensity.
• Consider within the context of a broader biopsychosocial model of health and wellbeing (Stallman, 2018)
• Healthy behaviours (sleep, nutrition, exercise) and healthy coping strategies are the proximal components of emotional regulation.
• Healthy behaviours reduce emotional reactivity and healthy coping strategies in reaction to unpleasant emotions minimise the likelihood of negative consequences from coping behaviours.

Question 21

Health Theory of Coping: Part 2

Answer 21

• All coping strategies are considered adaptive and often helpful in the short-term in reducing distress.
• However, the theory conceptualises cognitive and behavioural coping activities into either healthy or unhealthy categories based on their likelihood for potential unwanted and unintended negative physical, psychological, or social consequences (Stallman, 2018)

Question 22

Health Theory of Coping: Part 3

Answer 22

• Within the Health Theory of Coping, the focus is on how to reduce unpleasant emotions or distress
• The focus is not on how to address problems that trigger distress.
• Studies show stress-related impairments on a range of tasks requiring flexible, goal-directed cognitions, such as solving problems. This highlights the importance of delaying problem-solving until the resolution of acute distress.

Question 23

Coping in the context of Illnesses: Part 1

Answer 23

• Unpleasant emotions and psychological distress are key components of many physical illnesses or the treatments of illnesses.
• Furthermore, emotional and coping problems are associated with:
• Poor treatment adherence post-discharge from hospital
• Significantly higher rates of death
• Secondary adverse events

Question 24

Coping in the context of Illnesses: Part 2

Answer 24

• Increased health care use, e.g. higher rates of readmission and emergency department visits
•A treatment goal in all mental health settings is for people to function
better, which includes developing and using a range of healthy coping
strategies..

Question 25

Measuring Coping: Part 1

Answer 25

• The most widely used subscales address problem-focused coping and emotion-focused coping.
• Ways of Coping Inventory (WOC) (Folkman and Lazarus, 1988),
• The Multidimensional Coping Inventory (Endlerand Parker, 1990),
• The Coping Orientations to Problems Experienced (COPE) scale (Carver, Scheier, and Weintraub, 1989, Carver et al., 1993).

Question 26

Measuring Coping: Part 2

Answer 26

• The COPE questionnaire has twelve subscales, including active coping, suppression of competing activities, planning, restraint, social support, positive reframing, religion, acceptance, denial, disengagement, use of humor, and self-distraction.
• Cope –60 items  Brief Cope 28 –still long..• Carver, C. S. (1997). You want to measure coping but your protocol’s too long: Consider the Brief COPE. International Journal of Behavioral Medicine, 4, 92-100.

Question 27

Application -Assessing

Answer 27

• Appraisal of illness:
• primary appraisals (such as perceptions of risk of recurrence)
• secondary appraisals (for example, self-efficacy in adopting health behaviour recommendations)
• Specific coping strategies:
• problem-focused coping
• emotion-focused coping
• Avoidance
• Dispositional coping styles
• Information seeking
• Need for control
• Level of optimism versus pessimism.

Question 28

Application –Coping Planning

Answer 28

• Coping Planning assesses all coping strategies—healthy and unhealthy—and supports clients to identify more healthy strategies they can use when they are upset or distressed before resorting to habitual unhealthy coping strategies (Stallman, 2017, 2018).
• It aims to strengthen current healthy coping rather than chastise or criticise existing unhealthy strategies in the absence of alternatives.
• Disclosing suicidality and other unhealthy strategies within this framework is considered a healthy coping strategy (professional support).