- Coping is the attempt(s) to address demands perceived as taxing or exceeding one's personal resources.
- Coping is one way people maintain or recover wellness despite major life stressors (eg. cancer, trauma, bereavement)
- Alter either the stressor or how it is interpreted in order to make it appear more favourable.
- Anything a person does to reduce the impact of a perceived or actual stressor.
- Trying to achieve adaptation
Cohen and Lazarus (1979) 5 main coping functions
- Cohen and Lazarus (1979) described 5 main coping functions:
- 1. reducing harmful external conditions
- 2. tolerating or adjusting to negative events
- 3. maintaining a positive self image
- 4. maintaining emotional equilibrium and decreasing emotional stress
- 5. maintaining a satisfactory relationship with the environment or with others.
Problem vs emotion focused coping
- Problem: directed at the stressor to either reduce demands or increase resources.
- Strategies include: planning how to change stressor, how to behave to control it, seeking practical or info support to alter stressor, confronting source of stress
- Emotion: mainly cognitive efforts direct at managing the emotional response to stressor.
- Eg. positively reappraising the stressor to see it more positively, acceptance, seeking emotional support, venting anger, praying.
Approach vs avoidant coping
- Approach: concerned with attending to source of stress and trying to deal with the problem
- Avoidant: avoiding or minimising the threat of the stressor.
- Can be emotion focused or avoiding the actual situation.
- eg. substance abuse, keeping mind off stressor.
Coping styles or strategies
- Coping style generally considered trait-like and unrelated to the stressor.
- Monitoring vs Blunting (Miller, 1987):
- Monitoring: approach style of coping, threat-relevant info is sought and processed. Eg. asking about treatments and side effects.
- Blunting: general tendency to avoid or distract oneself from threat relevant info. eg. sleeping, day dreaming, doing other things.
- Studies showed Monitoring associated with protective behaviour.
- BUT in women with cancer, monitoring increased distress.
- Highlights importance of context- person's coping style may not fit the situation.
What is adaptive coping?
- Generally, problem/attentional coping is more likely to be adaptive when stressor can be altered or controlled.
- Emotion is likely more adaptive where individual has little control or resources are low.
- Problem focused can be counter productive (eg. stressing about surgery)
Coping strategies of young adults with cancer (Miedema et al., 2007)
- Interviewed 15 patients
- Qualitative study that explored coping strategies.
- Found that Coping strategies evolved from diagnosis to treatment.
- Also used different approaches, strategies and at different times.
- Coping intentions or goals are likely to influence the coping strategies employed and their success.
- Choose based on anticipated outcomes ie. coping is purposeful.
- Unless we know 'why' a person chooses to cope in particular way, cannot determine whether it is effective.
- Different simultaneous coping strategies may be for different goals.
Stress, personality and illness
- Personality: the dynamic organisation within the individual of those psychophysical systems that determine his characteristic behaviour and thought.
- This is trait approach to personality- stable and enduring.
- Means to typify behaviour patterns.
- POssible models of association b/w personality and health/illness, with differing degrees of 'directness':
- 1. Personality may promote unhealthy behaviour (eg. smoking) thereby having indirect effect on disease risk.
- 2. Personality may influence coping (eg. pessimistic may not seek support), indirect effect on health.
- 3. Personality may be predictive of disease onset. 'Disease-prone personality'
- Personality traits may predispose to specific illnesses. Influence seen in encountering stress, subsequent appraisal and coping therefore indirect route.
Big 5 personality dimensions and coping
- Neuroticism: Employ more coping strategies (maybe finding right one) and tend to be maladaptive and emotion focused.
- Negative affectivity: many stress measurements are self reported therefore N's may not be in more stressful situations, just appraise it that way.
- Physiological explanations is associated in inc cortisol.
- Agreeableness: adaptive response to stressors
- Extroversion: positive in appraisal and coping but more exposure to health risk behaviours
- Dispositional optimism is 'protective.
- More likely to see stressor as changeable thus using more problem focused coping.
- Optimistic beliefs work in different way- more self care if controllable and better mood if uncontrollable.
- Associated with coping, reduced symptom reporting and reduced negative mood or depression.
- More important than self care in diseases you cannot control like MS.
- View that unpleasant events more likely to happen to others than to self and pleasant things more likely to happen to self.
- Sometimes referred to as 'defensive optimism'
- May operate as an emotional buffer against recognition or acceptance of possible negative outcomes. (ie may protect people form depressing reality)
- Aspect of a person arising from having experienced rich, varied and rewarding experiences in childhood, manifest in feelings of:
- 1. commitment: sense of purpose, view potentially stressful situations as meaningful and interesting
- 2. Control: a person's belief that they can influence events in their lives. Sees stressors as changeable.
- 3. Challenge: tendency to view change as a normal aspect of life and opportunity for growth.
- These characteristics buffer them against stress.
- Hardiness has more effect in situations of high stress than low.
- Effects of negative life events less for females higher in hardiness.
- Some have suggested lack of hardiness (rather than presence) is more what affects appraisal and could be underlying trait in neuroticism.
Type A behaviour and personality (TAB)
- Time-urgent behaviour (trying to do too much in too little time)
- Easily annoyed/hostility/anger
- Achievement oriented behaviour
- A vigorous speech pattern
60-70's, TAB found to modestly but consistently increase risk of coronary heart disease (CHD) compared to type b.
Later research found no significant relationship.
- Some evidence type As respond more quickly and in a stronger emotional manner to stress & exhibit greater need for control than non-type A.
- This increases likelihood of encountering stress.
- Greater physiological reactivity in competitive tasks.
- Cardiovascular activity during stress implicated in various disease processes,.
Hostility and anger (part of type A personality)
- Hostility: trait anger is central emotional component. experienced and manifested in aggressive actions or expressions. Cynical view of world & negative expectations of motives of others. May appear overtly aggressive or angry.
- Likely risk factor for development of CHD
- -> engage in health risk behaviour, lower benefit from psychosocial resources or interpersonal support, more stress reactive.
- May be less of a trait than a coping response.
Type C personality
- A cluster of personality characteristics manifested in stoic, passive, non-emotionally expressive coping responses.
- Cooperative and appeasing
- Unassertive and passive
- Thought to be associated with elevated risk of cancer.
- Mixed evidence
Type D personality
- A personality type characterised by high negative affectivity and social inhibition.
- "Distressed" personality
- May affect cardiovascular heart disease prognosis and outcomes
Locus of control (LoC)
- Generalised belief that would influence behaviour because greater reinforcements (eg. rewarding outcomes) were expected when responsibility for events was placed internally rather than externally.
- Only predicts behaviour where rewards/outcomes valued.
- Internal: take responsibility for events. Problem focused coping efforts.
- Not always adaptive can lead to unrealistic optimism
- External: believe outside forces affect.
- Accepting reality of no control may lead to more adaptive emotion focused responses.
Different types of controls
- Behavioural: belief that one can perform behaviours likely to reduce the negative impact of a stressor.
- Cognitive: belief that one has certain thought processes or strategies available that will reduce the negative impact of a stressor.
- Decisional: having the opportunity to choose between two options
- Informational: having opportunity to find out about stressor (why, what, where) allows for preparation
- Retrospective: attributions of cause or control after the event- giving meaning.
Where a person attributes the case of an event, feeling or action to themselves, to others, to chance or some other causal agent.
- Social class influences belief in personal control.
- A review found no particular attribution strongly associated with achieving better outcome.
- Characterological self blame (something about my nature i can't change) associated with negative outcomes like depression.
- Person's belief than they can set, plan and attain goals.
- About goal directed thinking and believed to have both trait and state like aspects.
- Can be seen as something that can be 'given' to patients by doctors but not optimism or self efficacy.
- Similar to optimism, self efficacy
Depression and anxiety
- Depression role in illness: controversial. Some found no association, some with hypertension, and breast cancer in elderly sample.
- Pathways depression can affect health:
- Influences appraisals (eg. threat v challenge) thus influencing coping actions.
- Reduces likelihood of healthy behaviour or cessation of unhealthy behaviour.
- Adherence to treatment lower.
- Interfere with person's ability to seek or benefit from social support.
- The disclosure of emotional experiences as a means of reducing stress;
- often achieved by describing the experience in writing.
- Contradictory findings.
- Thought that venting emotions may maintain the emotion by paying more attention to it.
- Can also interfere with potential to receive social support.
- However-> may assist in emotional self regulation by allowing person to develop greater mental control over stressor, facilitate closure and reduce distress.
- Evidence that the style of expression (antagonistic vs construction expression of anger) influence outcome of whether expression is positive or not.
- Social support can be actual or perceived.
- People with social support believe they are loved and cared ford, esteemed and valued, part of a social network of communication and mutual obligation.
- Social support affects appraisal and acts as a buffer against stress
Types and function of social support
- Emotional support: provider- empathy, caring, concern. Recipient- reassurance, sense of comfort, belongingness
- Esteem support: provider- positive regard, encouraging person, positively comparing. Recipient- builds self worth, sense of competence, being valued.
- Tangible/instrumental support: provider- direct assistance, financial/practical aid. Recipient- reduces strain/worry.
- Informational support: provider- advice, suggestions, feedback. Recipient- communication, self efficacy/selfworth
- Network support: provider- welcoming shared experiences. Recipient- sense of belonging, affiliation
Social support and mortality
- Social network strongly predicted mortality in heart disease, cancer stroke.
- However source of support may influence whether it influences health.
- Old people with more friends had higher mortality.
- May be from loss of friends and loss of hope.
Social support and disease
- Social support acted as moderator for disease.
- Particularly important in diseases where physical dependence and decreased social activity from disease are present.
- May also buffer impact of depression.
Two broad theories on how social support might operate
- Direct effects hypothesis: Lack of social support is detrimental to health. Provides sense of belonging, self esteem, positive outlook and healthier lifestyle. Also physiological route- reduced blood pressure reactivity.
- Buffering hypothesis: protects the person against negative effects of high stress. Through influencing cognitive appraisal (perceive resource as greater to meet threat) and modifying coping response (they do not cope alone)
Can social support be bad for you?
- Can lead to poor adaptation for pain patients.
- Become over dependent and passive with recovery.
- Help may not always be perceived as supportive.
- Support may not match the needs
- Limitation: self report