COPING WITH STRESS:Prologue, Functions of Coping, Distancing

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Health Psychology PSY408

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.

Health Psychology PSY408

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.

Health Psychology PSY408

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.

Health Psychology PSY408

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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