Coping With Stress PDF

CHAPTER 5 COPING WITH AND REDUCING STRESS CHAPTER OUTLINE I. Coping With Stress A. What is Coping? 1. Definition a. process by which people try to manage the perceived discrepancy between the demands and resources they...

CHAPTER 5 COPING WITH AND REDUCING STRESS CHAPTER OUTLINE I. Coping With Stress A. What is Coping? 1. Definition a. process by which people try to manage the perceived discrepancy between the demands and resources they appraise in a situation i. may manage by correcting or mastering the problem, or by changing perception of it ii. involves transactions with the environment 2. Coping process not a single event a. involves a dynamic series of appraisals and reappraisals of the person and the environment b. reevaluation influenced by transactions that preceded it and affect subsequent coping efforts B. Functions and Methods of Coping 1. Section introduction a. two main functions of coping i. altering the problem ii. regulating emotional response to problem 2. Functions of coping a. emotion-focused coping i. aim is to control emotional response to stress ii. two types of techniques 1) behavioral – using drugs/alcohol, seeking assistance, engaging in distracting activities 2) cognitive – changing how one thinks about the event through redefinition a) noting that things could be worse b) making comparisons with worse off others c) finding something positive in the situation iii. Freud’s defense mechanisms 1) involve distorting memory or reality in some way 2) example: denial a) denying the existence of the problem iv. avoidance strategies 1) most effective during first few weeks of prolonged stress experience  v. situations promoting the use of emotion-focused coping 1) situations that people believe there is little they can do to change 2) use of emotion-focused coping may interfere with seeking medical attention or promote unhealthy behaviors b. problem-focused coping i. used to reduce demands of stressful situation or expand resources for dealing with it ii. tend to be used when situations are perceived as changeable c. research on use of emotion-focused and problem-focused coping i. findings from Billings & Moos’ study on married couples 1) husbands & wives both use problem-focused coping more than emotion-focused coping 2) wives use emotion-focused coping more than husbands do 3) those with higher income and education use problem-focused coping more 4) persons use problem-focused coping less when stressful situation involves a death d. combining emotion-focused and problem-focused coping i. coping with stressful situations often involves using both types of coping strategies ii. if only one coping strategy used, it tends to be problem- focused coping 3. Coping methods and measurement a. over 400 coping methods have been identified by researchers b. efforts to develop instruments for measuring coping have not be successful so far i. often designed to correlate coping with mental or physical health which hasn’t been productive ii. tend to use retrospective methods which have been ineffective due to poor memory problem c. 4 promising directions of research on most important coping methods i. role of positive emotions 1) Folkman reports that positive emotions may sustain coping efforts ii. finding benefits or meaning 1) meta-analytic research indicates that finding benefits is associated with less depression, greater feelings of well-being  iii. engaging in emotional approach 1) involves emotional processing and expression iv. accommodating to a stressor 1) adapt or adjust to presence of stressor 2) Folkman & Moskowitz findings a) high levels of expression linked to improved perceived health, more vigor, fewer medical visits, and less distress b) high levels of processing linked to increased distress, poor health habits and health due to rumination that perpetuates stress 4. Using and developing methods of coping a. four issues about patterns in using different coping methods i. people tend to be consistent in coping method they use for a particular stressor ii. seldom use just one type of coping method with a stressor iii. coping methods used for short-term stressors tend to be different than those used for long-term stressors iv. both genetics and transactions influence coping styles b. coping probably changes over the lifespan, but the mechanism for how that occurs is unclear i. in children, coping depends on cognitive and language skills 1) learn to develop emotion-focused, cognitive strategies ii. middle-aged people tend to use problem-focused coping, whereas the elderly use more emotion-focused 1) differences probably influenced by what people must cope with 2) older people tend to view problems as less changeable 5. Gender and sociocultural differences in coping a. societal sex roles play important role in coping patterns of men and women i. men report using problem-focused and women report using emotion-focused coping 1) if statistically control for occupation and education, these differences disappear b. people with higher incomes and educational level report using problem-focused coping c. disadvantaged people more likely to experience stressful events and less likely to cope with stress effectively II. Reducing the Potential for Stress A. Enhancing Social Support 1. Social support is helpful after stressors appear and may even avert stress 2. Some segments of the population have less support a. men have larger social networks but women use theirs more effectively b. many elderly live in isolated conditions with few people to count on for support c. social network size is related to person’s prestige, income and education d. for people from lower socioeconomic classes, social networks tend to be less diverse, mostly kin e. greater reliance on social and helping organizations since family members have different roles and live further away 3. Needs for giving and receiving social support change over time a. high stress and deteriorating health may occur together at same time that social support may be dwindling 4. Receiving support from community organizations a. bring together people with similar problems and interests, which may be a new source for sharing, help, and friendship b. unknown which types of organizations work best for support c. people most likely to join a group for serious illness if it involves embarrassment or stigma 5. Community role in enhancing social support networks a. creating programs to help people develop social networks b. providing facilities for meetings, recreation, fitness c. arranging social events d. providing counseling services 6. Factors that contribute to ineffective social support a. recipient interprets support as sign of personal inadequacy b. recipient believes that personal control is limited by support B. Improving One's Personal Control 1. Developing a "what's the use" attitude a. seen in people with chronic illnesses who stop trying to improve situation b. a signal that they need help to bolster sense of self-efficacy and reduce feelings of passivity/helplessness 2. Enhancing personal control a. in children i. provide a stimulating environment, encouragement and praise, reasonable standards of conduct and performance. b. in adults i. employees having more control over some aspects of their jobs ii. elderly people doing more things for themselves c. assisting chronically ill persons by training them in effective ways to cope C. Organizing One's World Better  1. Organization reduces frustration, wasted time, and stress 2. Three elements of time management a. setting goals b. making daily "to do" lists c. making daily schedules D. Exercising: Links to Stress and Health 1. Correlational evidence relates fitness to decreases in depression, anxiety and tension a. problems in interpreting the correlation i. reduction may be due to placebo effect ii. correlation doesn't clarify causal pattern 2. Research providing evidence of benefits a. comparing moderate v. vigorous exercise found that young men who vigorously exercise show reduction in anxiety b. regular exercise lowers cardiovascular reactivity and decreases likelihood of hypertension c. experimental research provides evidence of exercise reducing heart rate and blood pressure 3. Protective effects of exercise a. less illness noted in those who exercised more b. stress has less impact on the health of fit people E. Preparing for Stressful Events 1. Enhancing feelings of control is an effective preparation for surgery a. behavioral control methods teach patients how to reduce discomfort or promotes rehabilitation by learning specific actions b. cognitive control helps patient concentrate on beneficial aspects of surgery c. informational control involves details about procedures or sensations they’ll experience i. too much information may increase stress unless focus is on what sensory experiences to expect III. Reducing Stress Reactions: Stress Management A. Section Introduction 1. Definition of stress management a. any program of behavioral and cognitive techniques that is designed to reduce psychological and physical reactions to stress 2. Pharmacological approaches a. use of medications to reduce emotions accompanying stress B. Medication 1. Drugs used to reduce physiological arousal and anxiety a. benzodiazepines (e.g., Valium, Librium) i. decrease central nervous system transmission b. beta-blockers (e.g., Inderol) i. block sympathetic activity in the peripheral nervous system ii. may cause less drowsiness than benzodiazepines 2. Using drugs for stress should be on temporary basis a. used following acute crisis b. also may be used while person is learning new psychological methods for coping C. Behavioral and Cognitive Methods 1. Section introduction a. methods for coping with stress developed by psychologists focus on changing behavior or thinking processes 2. Relaxation a. since relaxation is opposite of arousal, relaxation techniques should be good way to reduce stress b. progressive muscle relaxation i. proposed by Jacobson (1938) ii. works by getting people to pay attention to how their muscles feel when tense and relaxed iii. involves a sequence of tightening and relaxing muscles while directing person to pay attention to how sensation feels 1) tensing technique used training and eliminated once person has mastered the process iv. sessions last 20-30 minute and work best in quiet, nondistracting setting with person lying down or sitting in comfortable furniture c. relaxation process used mostly with adults but may be taught to children i. problems in using technique with children 1) may not actually relax muscles when told to do so 2) may tense more muscles than told to do d. quick version i. once full version mastered, shortened form may be used in stressful situations 1) involves deep breathing, relaxing self-talk, thinking about something pleasant e. effects of relaxation on stress reduction i. people who receive training show less cardiovascular reactivity to stress & stronger immune functioning 3. Systematic desensitization a. process pairs a stimulus hierarchy with relaxation b. assumes that fears are acquired by classical conditioning and this relationship may be counterconditioned with a calm response c. systematic desensitization may use in vivo, imagined, or symbolic stimuli d. effects of systematic desensitization on stress reduction i. one study found fear in adults was reduced in six 1 1/2 hr. sessions ii. technique may be used with children but may need to shorten session length 4. Biofeedback a. electromechanical device monitors physiological processes and reports the information i. process allows person to gain voluntary control over arousal level via operant conditioning b. effectiveness of biofeedback i. has been found as effective as progressive muscle relaxation treatment of stress-related headaches ii. no more effective than progressive muscle relaxation for reducing stress itself and is more costly c. children may be better candidates for biofeedback than adults. i. more enthusiastic, regarding it as a game ii. less skeptical that intervention will work iii. more likely to practice iv. problems = may have shorter attention span or be disruptive during session 5. Modeling a. modeling (also called social or observational learning) involves learning by observing the behaviors and consequences of that behavior of a model b. stress and fears may be acquired and reduced by modeling i. symbolic or in vivo models may be used c. method used similar to that in systematic desensitization i. person relaxes while watching calm model, either in vivo or symbolically d. research on effects of modeling in children i. depending on child's age and previous surgical experiences, stress/anxiety related to surgery may be reduced 1) anxiety may actually increase in younger children a) may need to use distraction techniques to reduce stress in these children 6. Approaches focusing on cognitive processes a. stress results from cognitive appraisals based on lack of information, misinformation or irrational belief b. cognitive restructuring i. involves replacing stressful thoughts with more constructive or realistic thoughts that reduce appraisals of threat or harm c. types of irrational beliefs related to stress i. Ellis' common irrational beliefs 1) can't-stand-itis 2) musterbating ii. Beck’s beliefs 1) arbitrary inference = drawing a specific conclusion from insufficient, ambiguous, or contrary evidence 2) magnification = greatly exaggerating the meaning or impact of an event iii. these kinds of irrational thinking affect cognitive appraisal of threat or harm due extreme perspective- taking d. use of cognitive therapy to change maladaptive thinking patterns i. therapy originally developed by Beck for treating depression ii. emphasis is on changing maladaptive thought pattern iii. helps clients see 1) they are not responsible for all the problems they encounter 2) negative events are not necessarily catastrophes 3) maladaptive beliefs are not logically valid iv. uses hypothesis testing strategy e. problem-solving training i. clients learn strategies for identifying, discovering, or inventing effective/adaptive ways to address problems 1) watch for problems that arise 2) define problem clearly 3) generate variety of possible solutions 4) decide on best course of action f. stress-inoculation training i. developed by Meichenbaum, involves variety of methods designed to teach skills to alleviate stress ii. three phases of training 1) learning about stress and how it affects people 2) acquiring behavioral and cognitive skills to fight stress 3) practicing skills with real or imagined stressors iii. training program is well thought out using well established techniques against stress 7. Multidimensional approaches  a. assumes both problems and solutions are multifaceted; therefore require multi-faceted intervention i. effective approaches incorporate many stress-reduction techniques ii. programs can be tailored to person's specific problems D. Massage, meditation, and hypnosis 1. Three additional techniques related to relaxation 2. Massage a. variety of massage techniques use various degrees of pressure applied to muscles/joints i. preferred pressure varies with age of person. b. Deep tissue massage is effective in i. reducing anxiety and depression ii. reducing hypertension, pain, or asthma symptoms iii. bolstering immune function 3. Meditation a. transcendental meditation i. a form of yoga in which a relaxed person closes their eyes and repeats a mantra ii. purpose of meditation is to increase ability to create relaxation response when confronted with stressor iii. broader purpose may be “mindful awareness” 1) developing insight regarding essence of experiences, unencumbered by cognitive or emotional distortions 2) learn to detach from cognitive and emotional distortions about pain b. research support for effectiveness i. quasi-experimental designs find lower anxiety and blood pressure in meditators v. non-meditators ii. monks who meditate can lower body metabolism and brain electrical activity iii. meditators show decrease in blood pressure iv. those who practice meditation regularly show reduction in blood pressure and enhanced immune function 4. Hypnosis a. an altered state of consciousness induced by suggestion leading to responsiveness to directions for changes in perception, memory, and behavior b. suggestibility is greatest in children and then declines to a stable level in adulthood c. suggestible people can learn to induce hypnotic state in themselves through self-hypnosis d. research findings of effectiveness i. may be helpful in stress management programs but not more effective than other relaxation techniques ii. people who use either hypnosis or relaxation regularly show improved immune function IV. Using Stress Management to Reduce Coronary Risk A. Section Introduction 1. Many risk factors for CHD have been identified, including age, family history, and people’s experiences and behaviors a. experiences and behaviors should be modifiable B. Modifying Type A Behavior 1. When Type A was identified as a risk factor, efforts began to discover ways to modify it 2. Empirical efforts to reduce Type A a. multidimensional approaches i. Type A men randomly assigned to multidimensional intervention group or exercise groups 1) hostility component was reduced more in multidimensional group b. stress inoculation/relaxation study i. method involved learning about role of arousal and cognitive processes in development of anger as well as relaxation techniques and using soothing comments 1) program was effective in reducing anger 3. Evidence of decreasing Type A resulting in decreased incidence of CHD a. 3 group study including traditional treatment, cardiac counseling group and Type A/cardiac counseling group i. Type A/cardiac counseling group showed biggest decrease in Type A behavior 4. Pharmacological approaches in modification of Type A behavior a. Findings indicated that use of beta-blockers related to less Type A behavior i. suggests that beta-blockers may be good alternative treatment for those at coronary risk who have not responded well to behavioral or cognitive interventions C. Treating Hypertension 1. Typical treatment regimen for hypertension involves medication, weight control, exercise, and reducing intake of cholesterol, sodium, caffeine and alcohol 2. Use of stress management techniques in treating hypertension a. findings i. use of single techniques produce limited results ii. multidimensional programs are highly effective in reducing blood pressure 3. Occupational use of stress management programs a. most studies find improvements in psychological and physiological stress b. programs still not widely applied i. evidence of effectiveness is new ii. interventions are costly iii. people who really need to be in these programs may not join, may drop out even if do join, or not adhere to program recommendations