Stress, Coping and Hope LE July 2024.pptx

Stress, coping and hope

1. Stress, Coping and Hope

2. What is Stress? Stress can be defined as a state of worry or mental tension caused by a difficult situation. (WHO, 2023) Stress as a physical response to “threat” Activation of biological systems Flee or fight response Health behaviors Vigilance Anxiety or worry Interaction between environmental stimuli and a person Long-term, inescapable issues activate a “general adaptation syndrome” which is harmful to health over time.

3. Stress and Coping Stress is contextual i.e. it involves a transaction between the person and the environment, It is a process, meaning that it changes over time. Stress is a situation that is appraised by the individual as personally significant, and as having demands that exceed the person’s resources for coping

4. Cognitive Appraisal Appraisals are negotiations between demands and our goals and personal beliefs. Primary appraisal - personal significance of a situation what’s happening and whether it matters and why. Primary appraisal is shaped by the person’s beliefs, values, and goals. Secondary appraisal refers to the person’s evaluation of options for coping. determined by the situation whether there are opportunities for controlling the outcome by the person’s physical, psychological, material, and spiritual resources for coping.

5. Cognitive Appraisal The two forms of appraisal determine the extent to which the situation is appraised as a harm or loss, a threat, or a challenge. We classify events as familiar or unfamiliar, threatening or nonthreatening. We generate strategies behavioral strategies to deal with events. Motivation and existing cognitions come into play. The appraisal process generates emotions. Anger or sadness, for example, are associated with loss appraisals; anxiety and fear are associated with threat appraisals; and anxiety mixed with excitement are associated with challenge appraisals. The personal quality of the appraisal process explains why a given event can have different meanings for individuals

6. Definitions of Coping An ever changing process involving both cognitive means and behavioral actions, in order to manage internal or external situations that are perceived as difficult and/or beyond the individual’s current resources (Lazarus and Folkman 1984) The changing thoughts and behaviors that people use to manage distress and the problem underlying the distress in the context of a specific stressful encounter or situation (Folkman, n.d.) Adapting to and managing change, stress, or opportunity, such as those associated with acute or chronic illness, disability, pain, death, relocations, work, changes in family structure, new relationships, or new ideas ( Tabers , 2021)

7. Reflective Exercise Describe a stressor that you’ve experienced? How did you respond? Rate your coping ability on a scale of 1-10. What would have helped you cope better?

8. Cognitive Styles Influence Coping Strategies The way we think about the world influences how we perceive and interpret events. Stressors, then are approached based on our interpretations of the situation. Cognitive Styles can influence coping and ultimately well-being.

9. Dimensions of Coping Problem-focused A ddresses the problem causing the distress. Examples of this style include active coping, planning, restraint coping, suppression of competing activities. P roblem focused coping strategies: taking control, information seeking, and evaluating the pros and cons.

10. Emotion-focused

11. Meaning/Appraisal-focused Individual uses cognitive strategies to derive and manage the meaning of the situation Directed towards challenging one's own assumptions, adaptive cognitive. Occurs when the person modifies the way they think for example: Goal revision Focusing on strengths gained from life experiences Reordering priorities

12. Coping is a dynamic and interactive process

13. Key Points of Coping Coping can apply to an individual, a family, or an entire community The focus coping mechanisms is to change the meaning of the stressor or transfer attention away from it Coping occurs along a spectrum from effective/adaptive responses to ineffective/maladaptive responses All strategies are NOT created equally! Some may bring temporary relief but may be maladaptive Others may bring more extensive relief and be more adaptive. Different approaches work for different individuals in different situations Outcomes of coping range from resolution to acceptance

14. Antecedents of Coping Individual perceptions Insight and honesty Individual boundaries Life experiences Anticipation Positive defense mechanisms Ability to cognitively and emotionally appraise and manage internal and/or external situations Available resources and support systems Relationships with people Relationships with environment

15. Risk Factors For Poor Coping Impaired cognition Inability to accurately assess the stressor Denial or avoidance of the stressor (negative defense mechanisms) An actual or perceived lack of control over the situation An actual or perceived lack of support/resources No experience or poor past experiences handling stressful situations Age Deterioration in Health or Chronic Health Conditions

16. Consequences of Poor Coping Maladaptive coping can lead to physical and/or psychosocial problems Decline in physical health Peptic ulcer disease Hypertension Decline in mental health Isolation Depression Anxiety Alteration in functional ability Job loss Poor hygiene Substance abuse/addictions Alteration in family dynamics Separation/divorce Poor communication

17. Clinical Significance Helps in choosing the best approach to the patient & build an effective relationship with the healthcare team P atients who adopt maladaptive mechanisms are more likely to perceive the healthcare team as less supportive. Maladaptive coping mechanisms have been linked to health-risk behaviors, non-adherence and substance abuse. Coping influences compliance to therapy and lifestyle changes. In disorders where non-medicinal treatment plays a role in the progression, coping mechanisms are important in determining the severity of such conditions. C oping styles may be helpful in patients' educational programs or psychotherapy, and could contribute to the prevention of sequelae . Stanislawski (2019)

18. Assessment General assessment (observable) General description and appearance Behaviors and defense mechanisms Communication/Speech Content of thought Mood, affect and feelings Judgment/Insight

19. Assessment History Perception of stressor Past Coping Patterns Social Family dynamics/friends Work/recreation Living environment Financial

20. Interventions

21. Cognitive Styles, Coping and Stress One’s disposition and cognitive style can affect the ability to cope with stress. Optimistic style as a buffer (adaptive) Looming cognitive style (maladaptive) How we think about and approach (appraisals) a stressor affects our coping ability. Understanding how we approach stressors will enable us to find a strategy to cope with stress.

22. Cognitive Styles and Emotions Emotions are made up of cognitive, neurobiological and behavioral components. Positive emotions have been linked to positive health. Negative emotions have been linked to cardiovascular disease in varying degrees. Negative emotions and cognitive styles hopelessness, pessimism, anxiety, rumination and anger

23. Pessimistic Cognitive Style A pessimistic style reflects a tendency to expect negative outcomes as a general rule. A pessimistic person would attribute bad events to himself. A pessimistic person would discount a good event; would be discounted and linked to an external cause.

24. Hope

25. Hope

26. Hope Hope has a cognitive base that contains information and goals it generates an energy Often described as ‘will’, that has a motivational quality it has both negative and positive emotional tones due to the possibility that what is hoped for might not come to pass for many people hope has a basis in religion or spirituality whereby it is equivalent to faith. Folkman (2010)

27. Coping and Hope The revival of hope in intensely stressful situations depends in part on cognitive coping processes. Coping with uncertainty Uncertainty travels with psychological stress. May be emotion focused – downplay severity or avoidance May be problem-focused – information seeking Information may be favorable – hope Unfavorable information – reappraisal, second opinion, faith Folkman (2010)

28. Uncertainty And Distortion Of Reality L iterature shows that people tend to have unrealistic optimism about their ability to manage traumatic events, but also that these illusions are associated with effective coping and psychological adjustment and a sense of agency (Taylor and Amor 1996, Snyder et al 2002). Unrealistic hope may be what the patient needs at the outset in order to have any hope at all. Over time, as the patient and the patient’s family caregivers absorb more information and its meaning, more realistic expectations shift from hoping for unrealistic outcomes e.g. cure, to more plausible outcomes hope of living longer than expected, being well cared for and supported, having good pain and symptom control and hope of getting to certain events Folkman (2010)

29. Managing Uncertainty Over Time Uncertainty can provide a fertile ground for doubts based on what one hears, sees, reads, or imagines. hope provides a counter-balance hope (e.g., as faith) or hoping (e.g., actively focusing on reasons for feeling hopeful) act as emotion-focused coping strategies. other kinds of emotion-focused coping strategies are appropriate for managing anxiety in waiting situations, e.g., distracting one’s self Hope allows us to hold conflicting expectations simultaneously. The concept of hope legitimizes holding conflicting expectations. Holding both possibilities also facilitates adaptive problem-focused and emotion-focused coping. Folkman (2010)

30. Dealing With a Changing Reality When circumstances change with time, previous expectations and hopes may no longer be relevant. G iving up hope with respect to what had been does not necessarily mean that hope itself is quashed. Generalized hope, such as hope that is based on faith, personality disposition, or history can act as a reserve that supports the efforts to revise expectations . religious faith can support hope by providing a sense of ultimate control through the sacred through affirming beliefs about the sacred such as ‘God will be by my side’. “I did it before, I can do it again”

31. Goal adjustment Letting go of goals that are no longer tenable identifying meaningful, realistic goals for coping in the present meaning-focused coping sense of control, Creates a renewed sense of purpose Hope with respect to new goals Situational hope

32. Factors that Influence Situational Hope Beliefs Personality Disposition Previous experiences with stress The meaning of what is now at stake What else is going on in the person’s life Interactions with close others The quality and sensitivity of patient–physician communications during this transition Folkman 2010

33. Hope, Goals and Existential Distress What do patients hope for? Meaning and purpose Higher order goals ‘maintain my dignity’ ‘be at peace with my God’ ‘avoid suffering’ Proximal goals ‘to find the best doctor’ ‘to attend my grandson’s graduation’ ‘to have a successful conversation with my insurance carrier’

34. Interventions Accept patients where they are Provide an environment of acceptance Quiet and safe environment Utilize therapeutic communication – Acknowledge, Validate, Name Encourage verbalization of feelings, perceptions, and fears Validate their feelings Assist patient to recognize his or her own worries

35. Interventions Identify stressors related to the present condition Assist in the development of effective coping skills Acknowledge the patient’s spiritual/cultural background and its role in their coping Explore situational hope

36. Concluding Comments Stress can be adaptive, but it can also be maladaptive. How we assess and perceive stressors can affect our well-being. Developing healthy and appropriate strategies for coping with stressors is related to healthier outcomes. Coping strategies representing different coping modes can coexist and complement each other. hope is not a perpetually self-renewing resource; it has peaks and valleys and is at times absent altogether. The relationship between hope and coping is dynamic and reciprocal; each in turn supports and is supported by the other.

37. References Clayton JM, Butow PN, Arnold RM, Tattersall MH. Fostering coping and nurturing hope when discussing the future with terminally ill cancer patients and their caregivers. Cancer 2005;103:1965–1975. Folkman, S. (2010). Stress, coping, and hope. In Psychological aspects of cancer (pp. 119-127). Boston, MA: Springer US. Lazarus RS, Folkman S. Stress, Appraisal, and Coping. Springer: New York, 1984. Penley , J. A., Tomaka, J., & Wiebe, J. S. (2002). The association of coping to physical and psychological health outcomes: A meta-analytic review. Journal of behavioral medicine, 25, 551-603. Snyder CR, Rand KL, King EA, Feldman DB, Woodward JT. ‘False’ hope. Journal Clinical Psychology 2002;58: 1003–1022. Stanisławski , K. (2019). The coping circumplex model: An integrative model of the structure of coping with stress. Frontiers in psychology, 10, 694. “Stress.” World Health Organization. Accessed July 7, 2024. https://www.who.int/news-room/questions-and-answers/item/stress. Taber’s Cyclopedic Medical Dictionary (2021). (2021). F.A. Davis Company/Publishers. Taylor SE, Armor DA. Positive illusions and coping with adversity. Journal of Personality 1996;64:873–898.