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COPING WITH STRESS:Prologue, Functions of Coping, Distancing

<< HOW STRESS AFFECTS HEALTH:Stress, Behavior and Illness, Psychoneuroimmunology
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Health Psychology­ PSY408
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Lesson 20
COPING WITH STRESS
Prologue
One morning while taking a shower, David felt a small lump in his chest. He was sure it had not been there
before. It didn't hurt, but he was momentarily alarmed-- his father had had chest cancer a few years before.
It could be a pimple or some other benign growth." he thought. Still, it was very worrisome. He decided not
to tell his wife or his physician about it yet because as he thought, it may not be anything" Over the next
several days, he examined the lump daily. This was a very stressful time for him; and he slept poorly and
seemed preoccupied. After a week without the lump changing, he decided to take action. He told his wife
about the lump and made an appointment to see the physician.
Another man, Jack, had a similar experience. Finding a lump on his chest alarmed him, but he didn't deal
with the stress as rationally as David did. Jack's initial fright led him to reexamine his chest just once, and in
a cursory way. He told himself, "There isn't really a lump on my chest, it's just a rough spot: And he
convinced himself that he should not touch it because, he thought, "That will only make it worse." During
the next few months, Jack was quite worried about the "rough spot." He studiously avoided touching it,
even while washing. He became increasingly moody, slept poorly and developed many more headaches than
usual. He also told his wife that he didn't like his body to be touched. When she asked why he was acting so
differently in recent weeks, he denied that anything was wrong. Jack finally mentioned the "rough spot" to a
friend who convinced him to have his physician examine it.
People vary in the ways they deal with stress. Sometimes people confront a problem directly and rationally,
as David did, and sometimes they do not. For these two men, the way they dealt with their stress had the
potential for affecting their health. Because Jack did not face up to the reality of the lump, he delayed
seeking medical attention and experienced high levels of stress for a long time. If the lump were malignant,
delaying treatment would allow the cancer to progress and spread. As we have seen, prolonged stress can
have adverse health effects even in healthy people.
In this lecture we will discuss the ways people can and do deal with stress. Through this discussion, you will
find answers to questions you may have about the methods people use in handling stress. Are some
methods for coping with stress more effective than others? In the coming lectures we will discuss how
people can reduce the potential for stress in their lives. Also, when people encounter a stressor, how can
they manage and reduce the strain it produces?
Coping With Stress
Individuals of all ages experience stress and try to deal with it. During childhood years, people learn ways to
manage feelings of stress that arise from the many fearful situations they experience.
What is coping?
Because the emotional and physical strain that accompanies stress is uncomfortable, people are motivated
to do things to reduce their stress. These things" are what is involved in coping.
What is coping? Several definitions of coping exist. We will use a definition that is consistent with the way
we defined stress earlier. Earlier we saw that stress involves a perceived discrepancy between the demands
of the situation and the resources of the person. Since people engage in coping in an effort to neutralize or
reduce stress, coping activities are geared toward decreasing the person's appraisal of or concern for this
discrepancy.
Thus, coping is the process by which people try to manage the perceived discrepancy between the demands
and resources they appraise in a stressful situation.
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The word manage in this definition is important. It indicates that coping efforts can be quite varied and do
not necessarily lead to a solution of the problem. Coping efforts can--and, some would argue, should--be
aimed at correcting or mastering the problem. But they may also simply help the person alter his or her
perception of a discrepancy, tolerate or accept the harm or threat, or escape or avoid the situation.
For example, a child who faces a stressful exam in school might cope by feeling nauseated and staying
home. We cope with stress through our cognitive and behavioral transactions with the environment.
Suppose you are overweight and smoke cigarettes, and your physician has asked you to lose weight and stop
smoking because several factors place you at very high risk for developing heart disease. You have a threat:
you may become disabled or die. This is stressful, but you don't think you can change your behavior. How
might you cope with this? Some people would cope by seeking information about ways to improve their
ability to change. Other people would simply find another doctor who is not so directive. Others would
attribute their health to fate or the will of God," and leave the problem "in His hands." Still others may try
to deaden this and other worries with alcohol or other similar substances, which would add to the risk.
People use many different methods to try to manage the appraised discrepancy between the demands of the
situation and their resources. This is called the coping process.
The coping process is not a single event. Because coping involves ongoing transactions with the
environment, the process is best viewed as a dynamic series of continuous appraisals and reappraisals of the
shifting person--environment relationships. Shifts may be the result of coping efforts directed at changing
the environment, or coping directed inward that changes the meaning of the event or increases
understanding. They may also be the result of changes in the environment that are independent of the
person and his or her coping activity. Regardless of its source, any shift in the person-- environment
relationship will lead to a re-evaluation of what is happening, its significance, and what can be done. The re-
evaluation process, or reappraisal, in turn influences subsequent coping efforts.
And so, in coping with the threat of serious illness, people who make efforts to change their lifestyles may
receive encouragement and better relationships with their physician and family. But individuals who ignore
the problem are likely to experience worse and worse health and relations with these people. Each shift in
one direction or the other is affected by the transactions that preceded it and affects subsequent
transactions.
Functions and Methods of Coping
You have probably realized by now that people have an enormous number of ways for coping with stress.
Because of this, researchers have attempted to organize coping approaches on the basis of their functions
and the methods they employ.
Functions of Coping
According to Richard Lazarus and his colleagues, coping can serve two main functions. It can alter the
problem causing the stress or it can regulate the emotional response to the problem.
Emotion-focused coping is aimed at controlling the emotional response to the stressful situation. People
can regulate their emotional responses through behavioral and cognitive approaches. Examples of
behavioral approaches include using alcohol or drugs, seeking emotional social support from friends or
relatives, and engaging in activities, such as sports or watching TV, that distract one's attention from the
problem.
Cognitive approaches involve how people think about the stressful situation. In one cognitive approach,
people change the meaning of the situation--for example, by deciding, "There are worse things in life than
having to change jobs because of my heart condition," or, "Now that my girlfriend has left me, I realize that
I really didn't need her." Another cognitive approach involves denying unpleasant facts, as Jack did with the
lump on his chest.
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People tend to use emotion-focused approaches when they believe they can do nothing to change the
stressful conditions. An example of this is when a loved one dies--in this situation, people often seek
emotional support and distract themselves with funeral arrangements and chores at home or at work. Other
examples can be seen in situations in which individuals believe their resources are not and cannot be
adequate to meet the demands of the stressor. A child who tries very hard to be the "straight A" student his
or her parents seem to want, but never succeeds, may reappraise the situation and decide, "I don't need
their love."
Problem-focused coping is aimed at reducing the demands of the stressful situation or expanding the
resources to deal with it. Everyday life provides many examples of problem-focused coping, including
quitting a stressful job, negotiating an extension for paying some bills, devising a new schedule for studying
(and sticking to it), choosing a different career to pursue, seeking medical or psychological treatment, and
learning new skills. People tend to use problem-focused approaches when they believe their resources or the
demands of the situation are changeable. For example, care-givers of terminally ill patients use problem-
focused coping more in the months prior to the death than during bereavement.
Methods of Coping: Skills and Strategies
What, types of skills and strategies do people use in altering the problem or regulating their emotional
response when they experience stress? The following list describes several commonly used ways of coping
that Susan Folkman, Richard Lazarus, and their colleagues (1986, 1988) identified from their research. The
strategies are labeled as serving problem- or emotion- focused coping functions and give examples of
cognitive or behavioral efforts a hospital patient might make when using each strategy. Coping methods
that focus on emotions are important because they sometimes interfere with getting medical treatment or
involve unhealthful behaviors, such as using cigarettes, alcohol, and drugs to reduce tension. People often
use these substances in their efforts toward emotion-focused coping.
Ways of Coping with Stressful Situations
Planful problem-solving (problem-focused): analyzing the situation to arrive at solutions and then taking
direct action to correct the problem. For instance, Roy, a hospital patient who needs to choose a specialist
for a serious illness, might seek and study information about different specialists before choosing.
Confrontive coping (problem-focused): taking assertive action, often involving anger or risk-taking, to
change the situation. For example, if Roy's medical insurance balks at paying for a desired treatment, he
might stand his ground and fight for payment.
Seeking social support (can be problem-or emotion-focused): trying to acquire informational or emotional
support. For instance, Roy might ask friends and nurses about different specialists (informational support
with a problem-focused function) and describe his worries to get comfort and encouragement from people
he loves (emotion-focused function).
Distancing (emotion-focused): making cognitive efforts to detach oneself from the situation or create a
positive outlook. As an example, Roy might try not to think about the health-related problems he's facing or
try to make light of them.
Escape-avoidance (emotion-focused): thinking wishfully about the situation or taking action to escape or
avoid it. For instance, Roy might engage in fantasies of miracles or other external happenings that would
make his problems go away, or he might try to avoid dealing with the problems by sleeping or using alcohol
a lot.
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Self-control (emotion-focused): attempting to modulate one's own feelings or actions in relation to the
problem. Roy might hide his feelings to prevent emotional interactions with others or slow down the pace
of decision making to prevent impulsive choices.
Accepting responsibility (emotion-focused): acknowledging one's own role in the problem while also
trying to put things right. For example, Roy might lecture himself for not having gotten medical attention
sooner and promise to respond to symptoms more promptly in the future.
Positive reappraisal (emotion-focused): trying to create a positive meaning from the situation in terms of
personal growth, sometimes with a religious tone. For instance, Roy night become a better or stronger
person from the experience or feel that he has developed a stronger faith.
Each of these strategies is quite broad and can be applied in many ways and situations. To clarify how
people use emotion-focused methods, we can describe some variations on the strategies described above.
For instance, people may engage in a coping method called Emotional discharge, which involves
expressing or releasing their feelings about a stressful situation. This approach usually occurs in conjunction
with seeking social support, such as with friends or family or in support groups, and can also involve
using jokes or gallows humor. For instance, a man jokingly nicknamed himself "Semicolon" after part of his
cancerous colon was removed.
Cognitive redefinition is a strategy whereby people try to put a good face on a bad situation, such as by
noting that things could be worse, making comparisons with individuals who are less well off, or seeing
something good growing out of the problem.
People who want to redefine a stressful situation can generally find a way to do it since there is almost
always some aspect of one's life that can be viewed positively (Taylor, 1983). Optimistic individuals are
more likely than pessimists to use problem-focused methods and to redefine their situation in a positive
way.
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Table of Contents:
  1. INTRODUCTION TO HEALTH PSYCHOLOGY:Health and Wellness Defined
  2. INTRODUCTION TO HEALTH PSYCHOLOGY:Early Cultures, The Middle Ages
  3. INTRODUCTION TO HEALTH PSYCHOLOGY:Psychosomatic Medicine
  4. INTRODUCTION TO HEALTH PSYCHOLOGY:The Background to Biomedical Model
  5. INTRODUCTION TO HEALTH PSYCHOLOGY:THE LIFE-SPAN PERSPECTIVE
  6. HEALTH RELATED CAREERS:Nurses and Physician Assistants, Physical Therapists
  7. THE FUNCTION OF NERVOUS SYSTEM:Prologue, The Central Nervous System
  8. THE FUNCTION OF NERVOUS SYSTEM AND ENDOCRINE GLANDS:Other Glands
  9. DIGESTIVE AND RENAL SYSTEMS:THE DIGESTIVE SYSTEM, Digesting Food
  10. THE RESPIRATORY SYSTEM:The Heart and Blood Vessels, Blood Pressure
  11. BLOOD COMPOSITION:Formed Elements, Plasma, THE IMMUNE SYSTEM
  12. SOLDIERS OF THE IMMUNE SYSTEM:Less-Than-Optimal Defenses
  13. THE PHENOMENON OF STRESS:Experiencing Stress in our Lives, Primary Appraisal
  14. FACTORS THAT LEAD TO STRESSFUL APPRAISALS:Dimensions of Stress
  15. PSYCHOSOCIAL ASPECTS OF STRESS:Cognition and Stress, Emotions and Stress
  16. SOURCES OF STRESS:Sources in the Family, An Addition to the Family
  17. MEASURING STRESS:Environmental Stress, Physiological Arousal
  18. PSYCHOSOCIAL FACTORS THAT CAN MODIFY THE IMPACT OF STRESS ON HEALTH
  19. HOW STRESS AFFECTS HEALTH:Stress, Behavior and Illness, Psychoneuroimmunology
  20. COPING WITH STRESS:Prologue, Functions of Coping, Distancing
  21. REDUCING THE POTENTIAL FOR STRESS:Enhancing Social Support
  22. STRESS MANAGEMENT:Medication, Behavioral and Cognitive Methods
  23. THE PHENOMENON OF PAIN ITS NATURE AND TYPES:Perceiving Pain
  24. THE PHYSIOLOGY OF PAIN PERCEPTION:Phantom Limb Pain, Learning and Pain
  25. ASSESSING PAIN:Self-Report Methods, Behavioral Assessment Approaches
  26. DEALING WITH PAIN:Acute Clinical Pain, Chronic Clinical Pain
  27. ADJUSTING TO CHRONIC ILLNESSES:Shock, Encounter, Retreat
  28. THE COPING PROCESS IN PATIENTS OF CHRONIC ILLNESS:Asthma
  29. IMPACT OF DIFFERENT CHRONIC CONDITIONS:Psychosocial Factors in Epilepsy