Coping

Question 1

What is the definition of coping?

Answer 1

process by which people manage the perceived discrepancy between demands of the situation and the resources of the person that they appraise (stress) in a stressful situation

Question 2

What is the significance of coping?

Answer 2

• Link between coping and health status
• Failure to cope may have serious health consequences
• Important to understand how people cope with stress and illness

Question 3

What is used to appraise coping?

Answer 3

• ‘Stress - coping’ paradigm (Lazarus, 1980)
• Cognitive appraisal:
Primary appraisal (danger?)
Secondary appraisal (coping)

Question 4

Describe the impact of a good coping appraisal

Answer 4

• Relates to secondary appraisal
• ↓ effects of stressors
• Not necessarily associated with good outcomes
• Many different coping styles, strategies
• Individual/ situational differences
• May change over time – cognitive & behavioural transactions

Question 5

Should coping be considered a trait or a state?

Answer 5

• TRAIT - personality - style
- consistency
• STATE - response to time and situation - process or strategy
- different ways coping

Question 6

What are the main two types of coping?

Answer 6

• Alter the problem or regulate the emotional
response to the problem
– PROBLEM-FOCUSED
reduce demands of situation OR expand resources to deal with it
– EMOTION-FOCUSED
control emotional response to situation

Question 7

Describe problem-focussed coping

Answer 7

• Used when people believe their resources or demands of the situation are changeable

Examples
• Change from high to low stress job
• Change from an unhealthy diet to healthy diet

Question 8

Describe emotion-focussed coping

Answer 8

• Used when people feel they can do nothing to change the situation

Examples
• Using alcohol or drugs
• Seek emotional support from friends
• Use distraction
behavioural/ cognitive approaches... can interfere with health outcome

Question 9

Are med students stressed?

Answer 9

Ye

• Levels of stress are high in medical students
– long working hours
– work load
– feeling overwhelmed
– making mistakes
– serious treatment failures
– emotionally demanding (pts)
– relationship with consultants
– breaking bad news
– effects work on personal life
• Stress can lead to burnout (emotional exhaustion, cynicism) 
• Variety coping strategies used (+ve/-ve)

Question 10

What factors control differences in coping styles?

Answer 10

• Gender?
– women > emotion focused…
– men > problem focused…

• Social class
– high income, high education > problem focused 
– disadvantaged individuals > stress
< control over events 
< effective coping

Question 11

What are some coping strategies?

Answer 11

• Planning (PF)
• Active coping (PF)
• Seeking social support (PF/EF)
• Distancing (EF)
• Escape-avoidance (EF)
• Denial (EF)
• Distraction (EF)
• Self-control (EF)
• Substance use (EF)
• Accepting responsibility (EF)
• Positive reappraisal (PF/EF)

Question 12

Provide an example of coping strategies used when coping w illness

Answer 12

• Normalising – interpret symptom as normal experience
• Denial – denies existence of symptom
• Resignation – become consumed by illness
• Accommodation - acknowledges, deals with problem

Question 13

What are some coping resources?

Answer 13

• Money
• Health
• Sense of control (e.g. over situation)
• Personality (e.g. locus of control, optimism)
• Beliefs and attitudes (e.g. perfectionism)
• Become informed
• Exercise (e.g. vs antidepressants…)
• Social support…

Question 14

How is coping assessed?

Answer 14

Questionnaires, rating scales
• Ways of Coping checklist (Folkman & Lazarus 1988)
• COPE (Carver et al. 1989)

Question 15

What is COPE?

Answer 15

Assessment of coping: COPE (Carver et al., 1989)
• What individuals do and feel when they experience stressful events (rating scale)
• Coping strategies/ responses incorporated into 13 scales: – e.g. active coping, seeking instrumental social support, seeking
emotional social support, positive reinterpretation – measures situational/ dispositional coping
• Values of responses reflect coping style/ strategy

Question 16

Does coping moderate the association between stress and health?

Answer 16

•Well being, psychological adjustment
•Illness associated variables e.g. symptoms,
medication, survival
– e.g. post op: decreased anxiety, decreased hospital stay, increased recovery, decreased medication, cancer survival …

Question 17

Provide an example of the use of coping strategies and breast cancer survival

Answer 17

• ‘Fighting spirit’ – associated with better breast cancer survival (Greer et al., Lancet, 1979)
– prospective, multi-disciplinary 5 yr study
– 69 women with early breast cancer
– psychological responses, assessed 3 months post operatively, were related to outcome 5 yr later
• fighting spirit/ denial vs
• stoic acceptance/ helplessness or hopelessness
– follow up at 10, 15 years – same survival differences

Question 18

What two types of copers do Miller et all 1988 suggest?

Answer 18

• ‘Monitors’: seek information
• ‘Blunters’: avoidance
Preparation is best tailored to coping style
• ‘Monitors’ - high information
• ‘Blunters’ - low information

Question 19

Provide an example of personality and coping in gynaecological stress

Answer 19

• Women undergoing a gynaecological examination (n=40)
• Evidence that coping strategies can impact on the effects of procedural preparation
• Monitors: high/ low information
• Blunters: high/ low information
• Pulse rate measured pre-info, post-info, post exam (‘stress’ response)

Question 20

How should one prepare a patient to receive information and cope?

Answer 20

Stressful medical procedures e.g. surgery:
• Procedural information
– e.g. waking up in recovery room with drip and catheter
• Sensation information
– e.g. pre-medication may induce drowsiness
– e.g. post-operative pain may occur, controlled with medication
• Behavioural instruction
– e.g. coughing without pulling on wound incision
Dr-Pt discussion, pamphlet, video, family involvement

Question 21

What are some social support types?

Answer 21

• Networks
– size and frequency of contact – composition
– intimacy (confidant)
• Types
– emotional / esteem – informational
– tangible
– companionship
• Quantity
• Quality/ satisfaction – negative/ positive...

Question 22

How does social support influence health?

Answer 22

Buffering effect
• Protects individual against –ve effects on health – stressor is strong
– e.g. enhances resources, enables reappraisal, distraction Direct effect
• Beneficial to health and well-being
– regardless of the degree of stress
– e.g. belonging, self-esteem
– e.g. positive outlook, greater resistance to infection, healthier lifestyle

Question 23

When is social support not beneficial?

Answer 23

When not perceived as supportive Reduces self-esteem
Does not match needs Encourages damaging lifestyle
– poor role model
– not engaging in healthy behaviors
– overprotective (inactivity, disabling)