Chapter 4- Coping

approach coping, meaning changing how one thinks about a problem, can help reduce the negative effects of stress

The use of positive reappraisal, meaning finding some beneficial aspects of even negative events, can even be effective for people who are coping with the considerable stress of managing a chronic disease

Researchers in one study examined whether HIV-positive men who had lost a partner or close friend were able to find some meaning in that loss, such as showing a shift in values, priorities, or perspective

As predicted, men who found meaning showed less rapid declines in T-cell levels and lower rates of AIDS-related mortality at the 2- to 3-year follow-up, even controlling for health status at baseline, health behaviors, and other potential confounding variables

reappraisal- is a useful way of coping with emotions in general

For example, HIV positive men who see some positive aspects of their diagnosis, such as shifting their values and priorities, show a slower rate of progression of the disease and survive longer

On the other hand, while emotion-focused coping can be detrimental if you simply refuse to try to fix a manageable problem, this approach may be very effective when there is little that can be done to change a negative situation

For example, emotion-focused coping is most effective in dealing with failed in vitro fertilization attempts, a situation over which couples have virtually no control.

According to the reserve capacity model, people with low SES experience more frequent stressful situations—by living in more crowded, noisy, and dangerous environments—and have a smaller supply of resources—tangible, interpersonal, intrapersonal—to manage stressful events.

For example, people who are low in SES may be less able to borrow money for emergencies, less able to rely on stable friendship networks, and not have jobs with flexibility in work schedules.

Finally, stress can influence behavior in a number of ways. People who experience severe stressors may suffer from continuing behavioral problems

For example, war veterans often experience severe behavioral symptoms, including sleeplessness, nightmares, and startle reactions Stress can also lead to negative interpersonal behavior. After the devastating Hurricane Andrew hit south Florida in 1992, causing high levels of stress in the many people who experienced the destruction of their home and/or other possessions, reports of domestic violence increased dramatically Sexual drive is also affected by stress. It decreases in men and women during times of stress: Women are less likely to ovulate, and men are more likely to have difficulty achieving and maintaining an erection

In sum, because different types of situations call for different types of coping, individuals who are comfortable using a number of different coping styles have a higher likelihood of minimizing their stress in a variety of challenging situations.

For example, you may need to use problem-focused coping when trying to constructively resolve a conflict with your dating partner, but you must use emotion-focused coping if your efforts to solve the problem fail, and the relationship ultimately ends.

Importantly, this type of written expression of emotion is especially beneficial for people who don't have supportive environments in which to confide feelings

However, the benefits of writing about one's problems may not be seen in all cultures.

On the other hand, people who have negative expectations about their illness or disease, meaning they have accepted their worsening condition and eventual death, show worse physical health—even in cases in which such expectations are realistic

In one study, researchers examined negative HIV-related expectancies in HIV-positive men, including an acceptance of their diagnosis, an awareness of the likely disease progression, and an acknowledgement that they lacked control over the disease outcome Follow-ups with these men over 21/2 to 31/2 years revealed that these negative expectancies about their HIV infection were associated with greater development of HIV-related symptoms (e.g., diarrhea, weight loss, high fever, night sweats), even controlling for immune measures, drug adherence, substance use, and depression.

avoidance coping, such as trying to withdraw from the situation and focusing on other things to take your mind off it, can be adaptive for short-term stressors

In the case of short-term stressors, such as an anxiety-provoking job interview, distracting oneself can be effective.

Progressive muscle relaxation can be an effective strategy for managing stress.

In this technique, people focus on consciously tensing and then releasing each part of their body (hands, shoulders, legs, etc.) one at a time This helps patients learn to distinguish states of tension from states of relaxation, thereby helping them learn how to calm themselves down in virtually any stressful situation

Employed women also show lower levels of cholesterol than homemakers. Why do women benefit from having multiple roles?

Negative experiences in one domain can be buffered by experiencing positive effects in another—days in which work projects aren't going well may be improved by spending quality time with one's family, and days full of family-related stress may be improved by accomplishing valued projects at work. In sum, for women, being employed outside the home may help buffer the effects of stressful conditions in the home, and vice versa.

Simply avoiding thinking about a traumatic event prevents individuals from understanding and ultimately coming to terms with the experience

One study of breast-cancer patients found that those who reported bottling up emotions instead of expressing them were more likely to experience depression and anxiety

The technique of biofeedback also helps people distinguish between states of tension and relaxation but with a particular focus on how these psychological states influence their physiological reactions.

Patients are attached to a monitor that shows their physiological response (heart rate, muscle tension, sweat), and they are able to learn how their thoughts and feelings influence their physiological reactions. This is an effective way to help people learn strategies of decreasing stress as well as the impact of stress on their physical reactions

In sum, the type of coping people use must match the type of situation they are coping with for them to experience the greatest benefits.

People who cope with events using the ''right'' type of strategy experience fewer symptoms of anxiety and depression, and subjects who cope using the ''wrong'' type of strategy experience more symptoms

some research suggests that simply affirming another part of one's identity can reduce stress.

Researchers in one study randomly assigned participants to either a self-affirmation condition—in which they wrote about values that were important to them—or a control condition—in which they wrote about values that were not particularly important to them Next, participants completed various stressful tasks, such as giving a 5-minute speech and counting backwards by 13 from 2,083. As predicted, participants in the control condition showed significantly greater increases in cortisol—a measure of stress—than those in the self-affirmation condition.

The use of denial or distraction can even lead people to delay seeking medical care in response to various health symptoms

Second, deliberately trying to avoid thinking about negative events is very difficult and thus requires considerable effort

breast-cancer patients who write about their deepest thoughts and feelings regarding breast cancer report significantly fewer physical symptoms three months later

Similarly, HIV-positive people who write about traumatic events show lower levels of the HIV virus in their blood than those who write about their activities over the past 24 hours and people with chronic illnesses who write about their deepest thoughts and feelings about the more stressful event they had ever undergone show better health later on than those who wrote about their plans for the day

Other researchers believe that both problem-focused and emotion-focused coping can be effective, depending on the situation

Specifically, while problem-focused coping is very effective in the case of stressors that you can change by actively confronting them- in cases in which you have no opportunity for improving the situation, the use of problem-focused coping may lead to feelings of frustration and disappointment

selfaffirmation can reduce the stress of midterm exams, thereby leading to lower levels of epinephrine.

The benefits of self-affirmation for reducing stress, and thereby improving health, may help explain why employed men and employed women have similar levels of illnesses, whereas women who are homemakers experience higher levels of illnesses

Although one possibility is that men who were in better health were more likely to see meaning in their illness than those who were in worse health at the initial baseline, this research controlled for men's baseline health, meaning they included or took into account initial health for all men when predicting later health.

This approach puts greater confidence in the causal link between finding meaning and better health outcomes. These results suggest that responding in a positive way to stressful events may be associated with better immune response, which leads to better physical well-being

Is tackling a problem directly beneficial in terms of health?

Yes: Most research suggests that people who use problem-focused coping show better adjustment

found that women who watched sad films and were asked to conceal their feelings while watching showed

a greater cardiovascular reaction than those who were allowed to openly express their feelings

among gay men who were HIV positive, those who were ''in the closet'' had

a more rapid spread of infection—and faster death—than those who were open about their sexual orientation

problem-focused coping example

a person who is feeling stress because of too much work could ask for an extension on a paper or make an effort to stop procrastinating and finish one project each day.

Active coping (Strategy of problem-focused coping)

active coping (removing the stressor- example by dropping a class) planning how to cope with the stressor (ex- structuring specific times for studying each day) suppressing other activities to focus on the stressor (eliminating participation in athletic events) seeking advice or assistance with coping (talking to one's advisor about how to balance work projects

Progressive muscle relaxation can also be paired with systematic desensitization

an approach that helps people build up tolerance to a particular stressful object or event. In this technique, the person is asked to describe the specific causes of his or her anxiety and then to create a hierarchy of different stimuli associated with that anxiety these fears are ranked so that relatively low-anxiety-causing stimuli fall at the bottom of the hierarchy, and higher-anxietyprovoking stimuli set at the top of the hierarchy. The therapist then asks the patient to focus on the least-anxiety-provoking image, while encouraging the person to relax. Whenever the patient experiences anxiety, the therapist asks him or her to focus on a less-stressful stimulus. Gradually, as the patient is able to think about a low-level stimulus without feeling anxiety, the therapist continues to higher-level (more anxiety-provoking) stimuli; this process, over time, enables people to build up their tolerance to the stressful situation.

coping

an individual's efforts to manage the stressful demands of a specific situation, such as working to solve a problem, finding a new way to look at the situation, or distracting oneself from the problem

It consists of simply paying attention to ongoing events and experiences

and thereby avoiding letting one's mind become preoccupied with other thoughts or concerns. So, while talking with a friend, you would focus intensely on this interaction, and not allow yourself to think about what you will do later on or how stressful your day has been

However, these other factors do not fully explain this association: The association between low SES and negative health outcomes exists even when researchers take into account the frequency of specific health behaviors

as well as in countries with nationally funded health care programs

asking people to not think of something can actually lead them to become preoccupied with the event.

because constantly exerting effort to avoid thinking about something upsetting leads to chronic physiological arousal, relying on this coping strategy can lead to decreases in immune cell activity as well as higher blood pressure and heart rate

mindfulness

can be described as a state of concentrated awareness in terms of what is happening in the present moment

In some cases, however, the stress can't simply be removed or eliminated, meaning that problem-focused coping can't be used to manage stress. In these cases, changing how you think about the stress can be helpful in reducing its negative effects, which is a strategy called

emotion-focused coping

The link between low SES and poor health can be explained in part due to

health behaviors and access to health care—in other words, people who are low in SES tend to have poorer health habits and less access to health care

Emotion-focused coping is often associated with negative adjustment

in part because denying or avoiding thinking about problems can actually lead to negative psychological and physical well-being

People who are low in SES also have more difficulty quitting smoking,

in part because they live in more stressful environments and receive lower levels of social support

There are many strategies for activating the relaxation response,

including imagery, hypnosis, and progressive muscle relaxation

relaxation response

is a coordinated set of physiological changes that support rest and restoration, which are characterized by greater activation of the parasympathetic nervous system, leading to lower heart rate, blood pressure, and breathing rate.

problem-focused coping

managing challenging situations: is trying to confront and change the stressor can include a number of different approaches, such as seeking assistance from others, taking direct action, and planning This type of coping is often used when something constructive can be done to help solve the problem or at least make the situation better

emotion-focused coping can also involve approach coping

meaning changing how one thinks about the problem or venting about the problem to others (seeking social support)

This type of emotion-focused coping can involve either avoidance coping

meaning denying or avoiding the problem

Other relaxation strategies that are effective in decreasing physiological arousal in response to stressful situations include

meditation, hypnosis, and yoga.

roles of resources on how someone manages stress- Specifically, considerable research reveals that individuals who are low in SES experience

more negative health outcomes, including higher rates of cardiovascular disease, diabetes, arthritis, and cancer as well as higher overall mortality rates

people who receive a massage show higher levels of

neuroendocrine and immune functioning

Some of the strongest evidence for the benefits of emotion-focused coping, and in particular, even thinking about or reflecting on one's problems, comes from

research on writing about emotional experiences Although writing about traumatic events can initially lead to larger increases in blood pressure and more negative moods, individuals who write about such events show signs of better health later on, including fewer illnesses and minor health problems (e.g., headaches, acne, diarrhea).

emotion-focused coping example

someone who has a fight with a close friend could simply try to put it out of his mind as a way of avoiding feeling sad or could discuss these feelings with another person to try to make sense of the sadness.

For example, college students are more likely to use problem-focused coping when preparing for an exam, but they are less likely

to use this approach when they are nervously waiting for their grades after taking the exams

Yet another approach to managing stress is to change one's physiological responses to stress,

which in turn can reduce its harmful effects on physical health

However, most work suggests that in the case of longer-term and more severe stresses, avoidance coping can be detrimental

women who have breast cancer and rely on avoidance coping prior to their surgery show higher levels of negative effect after their surgery than those who use other coping strategies In this case, emotion-focused strategies such as wishful thinking (e.g., ''hoped a miracle would happen'') are detrimental, perhaps because their use interferes with effective cognitive processing and problem solving directed toward those decisions and/or requires significant cognitive energy, which in turn can even lead to more intensive (and intrusive) thoughts

In line with this view, people who are low in SES show lower levels of optimism, self-esteem, and social support, which are associated with

worse health outcomes

even feeling low in SES—regardless of the objective SES status—is associated with

worse health, including greater likelihood of becoming infected with a cold

For example, if you are struggling to come to terms with your parents' divorce, trying to use problem-focused coping will be ineffective because this situation is out of your control

you aren't going to be able to fix the problems in their relationship

Most importantly, HIVpositive people who have accepted their condition die on average 9 months sooner than those who resist the fatality of their diagnosis

—providing powerful evidence that one's attitude after receiving a diagnosis of a terminal disease influences life expectancy