1. Objectives: Evaluate strategies for coping with stress.

3. 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

4. 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

5. 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

6. Coping with Illness (stress)
Moos and Schaefer
Three processes that make up the coping process
Cognitive appraisal
Adaptive tasks
Coping skills

7. Step 1 Cognitive Appraisal
Appraise the situation
How will this influence my life?
Factors
Knowledge
Previous experience
Social support

8. 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

9. 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

10. 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)

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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)

17. How does Social Support mediate Stress?
Main Effect hypothesis
Stress Buffering Hypothesis
Research: Schwarzer et al. 1994)
Pages 15-16

18. 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

20. 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

21. 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) ***

22. …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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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