Coping with Stress

COPING WITH STRESS

Coping: (Lazarus & Folkman, 1984) a person’s efforts to manage stress, solve a problem, find a new way to look at the problem, or distract one’s self from it. Coping is not a one-time action; it’s a set of responses that you take over time. Example: Relationships are rarely strong one day and die the next; they die over the course of time. People cope with the dissolution of a relationship over time before it finally dies.

Problem-focused vs. Emotion-focused coping

Problem-focused coping is trying to confront and change the stressor. Basically, it’s trying to solve the problem. It includes actions such as seeking helping from others, taking direct action, and planning how to cope with the stressor. Attacking problems directly is better for your health than the second form of coping, emotion-focused.

Emotion-focused coping is when you try to cope with the emotional effects of a stressful situation. This includes not thinking about the problem (“Repress and deny”) or seeking social support to talk about it. You use this type of coping when you have to deal with a situation that has no real solution and just has to be accepted (like having terminal cancer). This type of coping is usually associated with negative adjustment, partly because denying or avoiding thinking about problems can lead to negative psychological and physical well-being. For instance, say you had leukemia as a child and had to undergo lots of painful procedures. If you avoid thinking about it as an adult, you will never be able to understand and accept the experience. It takes a lot of effort to keep a psychological pain bottled up (Ivory soap example), and eventually you become preoccupied with the effort to not think about it. Constantly exerting effort to avoid thinking about something upsetting leads to chronic physiological arousal. We know by now what happens when you have a sustained stress response—decreased immune functioning, high BP, increased heart rate.

Pennebaker found that writing about traumatic events in a journal predicted better health 4 months later. (p. 132 in your book). Writing about things is cathartic.

Problem-focused vs. emotion-focused—A Comparison

Problem-focused coping tends to emerge during childhood; emotion-focused coping emerges during later childhood or adolescence. People usually use both types of coping when dealing with stressors. Work-related stressors are more often dealt with by problem-focused coping; health-related issues are dealt with primarily by emotion-focused coping. There is some evidence that genetics plays a part in whether you deal with stressors primarily by problem-focused or by emotion-focused coping.

**When you have a problem that can be solved if confronted, it’s better to use problem-focused coping. If your problem is basically out of your control, relying on problem-focused coping could lead to frustration and disappointment. In this case, it’s better to use emotion-focused coping. Ex. Failed in-vitro attempts—better to use emotion-focused coping. MATCH THE COPING STYLE TO YOUR STRESSOR FOR BEST OUTCOMES.

Relaxation

Learning to relax is a major tool in coping with stress. In progressive muscle relaxation, people focus on tensing and then relaxing each part of their body on eat a time. Doing this tensing/relaxing pattern helps you learn to distinguish between a state of tension and state of relaxation so that you can learn to calm yourself down. Biofeedback is another technique that’s sometimes used. In this, you’re attached to a monitor that shows your heart rate, BP, tension, sweat, etc. (the physiological stress measures). You learn how your thoughts and feelings impact your physiological reactions. Meditation, hypnosis, and yoga are also effective stress reducers.

Systematic desensitization is a way of relaxing when facing phobias. (Describe).

Humor

Having a sense of humor about your stress is also effective. Studies have shown that after students watch funny videotapes, their immune system functioning is improved, and they have higher levels of NK cells and lower levels of cortisol. Humor is also associated with lower BP. Humor may distract people from their problems. So if you’re really sad, go watch a funny movie. Don’t watch a sad movie.

Exercise

Exercise is one of the most effective ways to combat stress. It relieves anxiety and depression and puts you in a better mood. It leads to physical and psychological health. We’ll be studying more about exercise in the next section of the course.

Religion

More than 90% of American adults consider themselves to be part of a formal religious tradition, and almost 96% believe in God or some other “universal spirit.” More than half of Americans report that prayer is an important part of their daily life, and women, African-Americans, older people, and those with lower incomes are particularly likely to see prayer as an important coping mechanism.

People who are involved in religion have better physical and psychological health. Study after study show that religious people are less depressed, less anxious, and have lower levels of cancer, heart disease, stroke, and suicide. Finally, religious involvement is associated with lower rates of mortality. In a study with 232 patients who had open-heart surgery, the ones who derived strength and comfort from their religion were less likely to die in the 6 months following surgery.

Psychologists point to the following factors as accounting for the positive effects of religion (and none of them involve divine intervention, of course):

1. People who are religious may have stronger and more extensive social networks. Social support has long been associated with good health outcomes.
2. Many religions directly encourage healthy behavior, such as abstaining from drugs, alcohol, and risky sexual behaviors.
3. Religious commitment may lead people to rely on adaptive coping mechanisms. For example, people who lose a baby to SIDS engage in more “cognitive processing” (thinking) about the event if they’re religious than if they’re not. More cognitive processing leads to acceptance and better well-being later on.
4. People who have strong spiritual beliefs may benefit in terms of health because their religion provides some type of meaning for even seemingly senseless tragedies. Religious people are more likely to focus on the positive aspects of the tragedy, which can lead to greater psychological and physical well-being.

Psychologists would say that prayer and worship have a positive impact on physical and psychological health because it encourages relaxation and optimism and lowers the physiological response to stress. (Stress is known to produce all sorts of illness, both physical and psychological, and even death.) Meditation works in the same way.

BUT, for a more religious take on it, there was an interesting study done in Korea recently (2001) to examine whether prayer can actually impact physical health: 199 women who were undergoing infertility treatment were randomly assigned to prayer vs. no-prayer groups. Pictures of the women in the “prayer group” were given to people who attended churches in the U.S., Canada, and Australia. These people were asked to pray that these women would get pregnant. Neither the women who were trying to get pregnant nor the medical staff caring for them knew about the study. Researchers then assessed whether women who were prayed for got pregnant more than the women without prayers did. To their astonishment, the women were prayed for were much more likely to get pregnant—50% in the prayer group vs. 26% in the no-prayer group. The rate of pregnancy in the prayer group was also much higher than the standard rate of pregnancy in this clinic, which was 33%.

I remember about 2 years ago, another study had similar results. People prayed for cancer patients (I think) who were strangers to them. The patients didn’t know they were being prayed for, and neither did their doctors. The ones who were prayed for had much greater survival rates than the ones who weren’t.

Psychological control. Having a sense of control over stressful events is a key aspect of coping. Perceived control is the belief that you can determine your own behavior, influence your environment, and bring about desired outcomes. Control benefits children and adolescents as well as adults. It’s especially important for vulnerable populations such as the elderly, medical patients, and children. Psychological control is so powerful that it’s been used extensively in interventions to promote good health habits and help people cope with medical procedures and surgeries. Example: Giving women in labor control over how much medicine is administered in their epidural; giving post-surgery patients control over their pain medication.

SOCIAL SUPPORT

Social support is critical in dealing with stress. Social support has been defined as information from others that one is loved, cared for, and esteemed. Even pets can provide social support. It was first identified as a crucial part of coping in the Alameda County study, in which the researchers found four different types of social support: marriage, extended family and friends, church/temple membership, and other formal and informal group affiliations. Other people serve several functions for us during times of stress. They can provide us with information needed to cope with the stressor, tangible support (e.g., financial assistance or help moving, etc.), and emotional support (just listening to us cry).

Research shows that having social support during times of stress reduces depression and anxiety. The lack of social support during stress, especially for people who have a high need for such support, can make the stressor even harder to deal with. The elderly, recently widowed, and victims of sudden & severe life events are particularly at risk. Social isolation is a major risk factor for death for both humans and animals. Having social contacts helps women live an average of 2.8 years longer and men an average of 2.3 years longer. The impact on health of having low levels of support is similar in magnitude to the effect of smoking.

People with high levels of social support have fewer complications during pregnancy and childbirth, are less susceptible to herpes attacks, have lower rates of heart attacks, and show better adjustment to CAD, diabetes, lung disease, arthritis, and cancer. Having social support also helps one recover from illness or surgery faster, and people with high levels of support are more likely to adhere to the medical regimens and use health s

services.

One of the main focuses of social support research these days is to identify the biopsychosocial pathways by which social support impacts health. What we know so far is that social support can lower blood pressure and is strongly related to levels of urinary norepinepherine, epinephrine, and cortisol in men but not really in women. Social support is associated with reduced sympathetic and cortisol responses to stress and with better immune functioning for support recipients.

Which type of social support appears to be the strongest in terms of psychological functioning? Family relationships. But different types of support may be more effective coming from different sources. Emotional support is most important from intimate others, whereas information and advice may be more valuable from experts. If you expect emotional support from a family member and get advice instead, you may perceive that your stressor has been made worse.

Support early in life. There is interesting evidence that receiving social support from your parents early in life and/or living in a stable and supportive environment as a child has long-term effects on coping and health. **Experiencing the divorce of one’s parents in childhood predicts premature death in midlife. A 1994 study of college students found that students who perceived themselves as having a lot of support from their parents coped more easily with stressors. A longitudinal study of men at Harvard showed that those who said they’d had warm, close relationships with their parents had better health 35 years later; in contrast, men who didn’t perceive that they had a warm relationship with their parents were more likely to be diagnosed in midlife with CAD, hypertension, ulcers, and alcoholism.

When is social support beneficial to health?

Direct effects hypothesis: maintains that social support is beneficial during nonstressful times as well as stressful times. So, then, having social support is ALWAYS beneficial to health—in times of low stress and high stress. How? Because having people who care about you and your health around can encourage you to eat healthy, exercise, go to the doctor, etc. Maintain your health habits, in other words.

Buffering hypothesis: social support is mainly beneficial when a person is under high stress. Research has found that the benefits of social support are greatest when a person is experiencing high levels of stress—e.g., those in military combat, fighting AIDS, experiencing natural disasters, and unemployed people. Knowing that you have social support may help you looking at a stressor differently since you know that others will be there to help you. Things may not look so bleak.

Social support vs. social companionship (Rook). The absence of social companionship (marriage or friendship) leads to loneliness, which is associated with anxiety, depression, and negative physical symptoms. Social support is having people to talk to about personal problems, having help with household tasks, and having people to ask advice from. Social companionship is having someone to do things with (eat, go to movies, etc.) ***Social support helps people in times of stress (buffering hypothesis); social companionship leads to well-being regardless of stress (direct effects hypothesis).

Matching hypothesis—you have to match the particular type of social support to the particular problem. Example: You need a babysitter for an emergency. Talking about your need for a sitter with your mother and having her commiserate with you is not helpful. What you need is for her to volunteer to keep your child.

*If you have a problem that can be solved/fixed, you benefit most from getting practical types of social support. If the problem can’t be solved, you need emotional support. Implication: What is more helpful for someone who has just experienced the loss of her husband? Bringing her food, or sitting and talking with her about her loss?

What kinds of support are effective?

Having a confidant, such as a spouse or partner, may be the most effective social support, especially for men. Men usually rely on their wives or girlfriends for support; women often rely on a best female friend. Why?

1. A man’s sense of self is defined through his ability to achieve results. Men are problem-focused copers.
2. To offer a man unsolicited advice is to presume that he doesn’t know what to do or that he can’t do it on his own.
3. A woman’s sense of self is defined through her feelings and the quality of her relationships.
4. Many times, a woman just wants to share her feelings about her day, and her husband, thinking that he’s helping, interrupts her by offering a steady flow of solutions to her problems.
5. A woman under stress is not immediately concerned with finding solutions to her problems but rather seeks relief by expressing herself and being understood.
6. Just as a man is fulfilled through working out the intricate details of solving a problem, a woman is fulfilled through talking about the details of her problems.

The beneficial effects of social support are not necessarily cumulative. The critical factor is to have at least one close friend. Having a dozen close friends may be no more beneficial than having 2 or 3. In fact, too much or overly intrusive social support may make stress worse. People who belong to “dense” social networks (friendship or family groups that are highly interactive and in which everyone knows everyone else) may find themselves getting too much advice and interference in times of stress.

Women typically have more of a social network—broader and denser—than men do. Women tend to receive more support than men, and they’re more likely than men to have a “best friend” (66% of women vs. 25% of men). Women tend to benefit more, both physically and psychologically, from friendships. Those with fewer friends tend to suffer more from depression and anxiety. Women benefit more in terms of life expectancy than men do from having a large social network. Interestingly, though, men benefit more from being marriage. Losing a spouse is much more detrimental to men than it is to women. Widowed men are more likely to die themselves after losing a spouse than widowed women are. Why the difference? Probably because of women’s broad social networks, which enable them to receive more social support.