Coping with Stress
Objectives:
Evaluate strategies for coping with stress.
Mediating the Stress-illness
link
• Exercise
– Decrease in stress
• Gender
– Men respond greater to stress
• Life events
• Type-A personality/behavior
– Competitiveness, impatience
• Social support
– Decrease in illness and stress
• Actual or perceived control
– Control decreases stress
Two types of coping
1. Approaches
2. Avoidance
• Problem solving
– Forming a plan of action
• Problem avoidance
– Refusing to think about the
problem
• Wishful thinking
– Dreaming about better times
• Emotional social support
– Talking to people about
feelings
• Instrumental social support
– Talking to people and getting
advice
• Cognitive restructuring
– Redefining the problem
• Distraction
– Link to addictive behavior
FOUR Models
1. Moos and Schaefer
(Crisis of Illness Theory)
2. Taylor and colleagues
(Cognitive Adaptation Theory)
3. Social Support Theory
4. Control Theory
Coping with Illness (stress)
• Moos and Schaefer
– Three processes that make up the coping
process
1. Cognitive appraisal
2. Adaptive tasks
3. Coping skills
Step 1 Cognitive Appraisal
• Appraise the situation
–How will this influence my life?
–Factors
• Knowledge
• Previous experience
• Social support
Step 2 Adaptive Tasks
• Illness tasks
• General Tasks
1. Dealing with pain and
other symptoms
2. Dealing with hospital
environment and
treatment process
3. Developing and
maintaining
relationships with health
professionals
1. Preserving an emotional
balance
2. Preserving self-image
3. Sustaining relationships
with family and friends
4. Preparing for an
uncertain future
Step 3 Coping Process
1.
Appraisal-focused (search for meaning)
–
–
–
2.
Logical analysis, mental preparation
Cognitive redefinition
Cognitive avoidance or denial
Problem-focused (confronting and changing so it is
manageable)
–
–
–
3.
Seeking information and support
Taking action to solve problem
Identifying rewards (Short Term satisfaction)
Emotion-focused
–
–
–
Affective regulation (maintain hope)
Emotional discharge (venting feelings)
Resigned acceptance
Not everyone responds to
illness the same way
•
What determines if the tasks and skills
are used?
1. Demographic and personal factors
– (age, sex, class, religion)
2. Physical and social/environmental factors
– (accessibility of social support and hospital
environment)
3. Illness-related factors
– (pain, stigma or disfigurement)
Implications of model
• What motivates coping?
– Maintain equilibrium and normality
– Desired outcome of coping is reality orientation
• How?
– Short-term or long-term goals
• Two types of equilibrium
– Healthy adaptation
• Maturation (positive adjustment to the situation)
– Maladaptive response
• Deterioration
• Does this model work for non-illness stress?
– No
Taylor et al.
•
•
Move beyond illness-stress coping only
Coping with crisis/stress has three
processes
1. Search for meaning
2. Search for mastery
3. Search for self-enhancement
•
Motivated to maintain a status quo
–
Maintaining illusions
•
•
cognitive adaptation
Based on research with women who have
breast cancer
1. Search for meaning
• Search for causality (why did it happen
to me?)
– 95% of those interviewed gave a cause
• Understanding the implications (what
effect has it had on my life?)
– Over 50% mentioned improved selfknowledge, self-change and reprioritization
• Attributing meaning leads to cognitive
adaptation
2. Search for mastery
• Mastery achieved through believing another
occurrence can be prevented or the illness
can be controlled
– 66% believed they could influence course or
reoccurrence of cancer
• Remainder believed that doctors would
• Two types
– Psychological: positive thinking, meditation
– Behavioral techniques: change medications, diet
or finding out information
3. Search for Self-enhancement
• Build self-esteem
– 17% reported only negative changes
– 53% reported only positive changes
• Comparison
– Up: compare with those that are better off
– Down: compare with those that are worse
off
– Most showed downward comparisons
Role of Illusions
• Illusions are necessary for cognitive
adaptation
– “I can control whether my cancer comes back”
• Illusions
– Positive interpretations of reality
– “I know what caused my cancer, I can control
whether it comes back”
• Better than reality orientation (Moos and
Schaefer)
How does Social Support
mediate Stress?
1. Main Effect hypothesis
2. Stress Buffering Hypothesis
Research: Schwarzer et al. 1994)
Pages 15-16
Investigating Control
•
Psychological theories of control
1.
2.
3.
4.
•
Attributions and control
Self-efficacy and control
Categories of control
Reality of control
Does control affect the stress response?
1. Subjective experience
2. Physiological changes
What is control?
1. Attributions and control
 Is the cause of the stress controlled by the
individual or not
•
•
Controllable cause “I should have prepared
better”
Uncontrollable cause “the interviewer was
biased”
2. Self-Efficacy and control
– Individual’s confidence to carry out a
behavior
– Control is implicit to self-efficacy
3. Categories of Control (5)
–
–
–
–
–
Behavioral control (avoidance)
Cognitive control (reappraisal)
Decisional control (choice over possible outcome)
Information control (access information)
Retrospective control (could I have prevented …)
4. Reality of Control
– Perceived control (I believe…)  Most Control
– Actual control (I can … )
*** discrepancy is illusory control (I control whether the plane
crashed by counting throughout the journey) ***
…Stress Response….
1. Subjective Response
(Corah and Boffa, 1970)
–
–
–
–
Stimulus  Loud Noise
IV: predictable or nonpredictable
DV: Level of Stress
Preparation for stress diminishes
subjective response to stress
2. Physiological Changes
– Uncontrollable  increase in
corticosteroids
Animal Research on Control
• Seligman and Visintainer
– IV: uncontrollable and
controllable shocks
– DV: tumor growth (injection
of tumor cells)
– Results:
• uncontrollable  Tumor
Growth
– Implications:
• controllability  stress
response  promote health
• Manuk et al. 1986 (CHD in Monkeys)
• Natural Environment (Submissive
or dominant)
– Design
• IV: New members = unstable
environment
• DV: Rate of CHD
• Results
– Dominant/unstable/more CHD
• Implications
– Control and expectations of control
conflict  CHD
Brady 1958
• Control reduces stress (conflicts
with Manuk)
– Executive Monkey…i.e. human
executives
• Design
– IV: ability to avoid (control) shock
– DV: ulcers and death rate
• Results
– Executive monkeys dies or
became incapacitated
• Implications
– Constant vigilance (control)
illness
Weiss, 1968
• Evaluation of Brady
– Sampling error: Selected by learning speed
• More emotional  learn quicker
– High emotion  high susceptibility to stress
• Follow-up study to correct
– Used rats (3 groups)
• Results contradicted Brady
• Results
– Executive  negative consequences
– No control  Severe consequences (increased
corticosteroids)
– No-shock  little deterioration
Human Research
•
Stress-Illness link (Karasek et al 1981)
–
•
Job Strain Model
Participants
–
–
U.S. and Sweden: CHD
Three Factors
1. Workload (psychological demands)
2. Autonomy of job (reflecting control)
3. Job satisfaction
–
Results (Increase in CHD)
1. High demand/workload
2. Low satisfaction
3. Low control
Control and Stress-illness link
• Control and preventative behavior
– High control  maintain healthy lifestyle
• Control and behavior following illness
– High control  change lifestyle
• Control and physiology
– Control directly influences health via physiological
processes
• Control and personal responsibility
– High control leads to personal responsibility
• No behavior change OR
• Unhealthy behaviors  illness
Benefits to LOW control?
• Most theories
– High control  less stress  less illness
• BUT…some situations the perception of
helplessness leads to less stress
– Flying in a plane
• Low control  low stress
• Implications:
– Less stressful than trying to control an
uncontrollable situation