Wk 4: Managing Stress CH 12

• 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) 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: 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: 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 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.

• 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)

• 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.

• 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.

• 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.

• Show:
• Competitiveness
• Time-urgent behaviour (trying to do too much in too little time)
• Easily annoyed/hostility/anger
• Impatience
• 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: 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.

• 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

• A personality type characterised by high negative affectivity and social inhibition.
• "Distressed" personality
• May affect cardiovascular heart disease prognosis and outcomes

• 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.

• 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 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

• 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 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 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.

• 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 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