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 Problem solving Cognitive restructuring 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 Moos and Schaefer 2. Taylor and colleagues (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 Cognitive appraisal Adaptive tasks 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 Dealing with pain and other symptoms Dealing with hospital environment and treatment process Developing and maintaining relationships with health professionals General Tasks Preserving an emotional balance Preserving self-image Sustaining relationships with family and friends Preparing for an uncertain future

Step 3 Coping Process Appraisal-focused (search for meaning) Logical analysis, mental preparation Cognitive redefinition Cognitive avoidance or denial Problem-focused (confronting and changing so it is manageable) 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? Demographic and personal factors (age, sex, class, religion) Physical and social/environmental factors (accessibility of social support and hospital environment) Illness-related factors (pain, stigma or disfigurement)

Implications of model What motivates coping? Two types of equilibrium 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 Search for meaning Search for mastery 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 self-knowledge, 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? Main Effect hypothesis Stress Buffering Hypothesis Research: Schwarzer et al. 1994) Pages 15-16

Investigating Control Psychological theories of control Attributions and control Self-efficacy and control Categories of control Reality of control Does control affect the stress response? Subjective experience Physiological changes

What is control? Attributions and control Self-Efficacy 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” Self-Efficacy and control Individual’s confidence to carry out a behavior Control is implicit to self-efficacy

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 …) 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…. 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 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) Design 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 Follow-up study to correct Results 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) Participants Job Strain Model Participants U.S. and Sweden: CHD Three Factors Workload (psychological demands) Autonomy of job (reflecting control) Job satisfaction Results (Increase in CHD) High demand/workload Low satisfaction 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