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Part 3- L6.docx

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Gareth Treharne

Part 3- L6 Coping with chronic illnesses- stress and intervention Q: Is stress only due to things that happen to us? A: yes, without stressors in the environment life would be easy No, there are always stressors in life and stressors only become meaningful through appraisal Normal to experience stress If stress is chronic it can be damaging to your health Stress - Stress traditionally conceptualised as major life event o Death of a spouse o divorce o Marital separation chronic (physical) illness o Jail term o Death of a relative Acute stress disorder criteria - Anxiety following a traumatic stressor o I.e. earthquake, car accident - Intrusive memories or dissociation (surreal or amnesia) and hyper vigilance or avoidance (place and thought) - Lasting for 3 days to 1 month after the traumatic event (>1 month = possible POST-traumatic stress disorder) - Clinically significant distress or impairment - Not due to substance, head injury or brief psychosis The transactional model - Lazarus and Folkman (1984) proposed that life events cause chronic daily “hassles” = minor unpleasant events (acute) - Modelled stress as an on-going process of transaction between the individual and their environment - The individual males appraisals of o The situation = primary appraisal  Harm: the negative outcomes experienced so far  Threat: potential negative outcomes  Challenge: potential positive outcome o How able they are to cope = secondary appraisal  Self: how can I cope?  Help: who can help me cope? The transactional model - Stress and coping when sick o Primary stress appraisal  Harm: This symptom has been unbearable  Threat: Maybe something is really wrong  Challenge: I have shed loads of sick days I can use o Secondary appraisal  Self: I don’t know if I can cope, I’ve never felt this ill  Potential help: I’ll ask mum  Professional help: Maybe I should see my GF or Google it - Coping with HIV o Earvin “Magic” Johnson o Three main types of coping efforts  Problem focused  Usually active and approach in nature  Emotional focused  Often passive and avoidant in nature  Meaning focused  Also passive but approach > growth o Hard to categorise a specific coping activity  What about seeking advice from a close friend?  May involve focusing on the problem  May also involve help dealing with emotions o Study  Active problem focused efforts are said to be best when personal control s high  Coping control fit among gay men (mean age 38) living with a male partner in San Francisco (1990-1992)  162 were HIV- but was/is a caregiver for HIV+ partner  82 were HIV+ and acting as a caregiver (partner had HIV+)  61 were HIV+ not a caregiver (partner was HIV-)  Method  Participants has assessments every 2 months (1-13 times; mean 8.1)  Controllability of their single most stressful event of the past week: “to what extent was this situation one that you could change or do something about?”  Also answered the Ways of Coping Scale o Planful problem solving  Problem focused  E.g. making a plan of action o Distancing  Emotion focused  E.g. refusing to think about it o Positive appraisal  Meaning focused  E.g. trying to look on the bright side  Coping scored as a proportion of their total reported coping efforts across all subscales (for the one persons’ coping efforts) o Planful problem solving = 6 = 25% o Distancing = 18 = 75% o Positive appraisal = 0 = 0%  Depressed moods over the past week was assessed on the Center of Epidemiology Studies Depression Scale  Physical symptoms of HIV/AIDS recorded on a checklist (e.g. recent infections)  Results  On the stressors that were described o 63% related to caring giving (80% were caregivers) o 28% related to the participants own life and HIV  Regardless of caregiving status, men who were HIV+ reported higher levels of positive appraisal = meaning focused coping  Regardless of the HIV status the men who were caregivers reported more depressed moods  Controllability and problem focused coping interacted to predict depressed mood (over the multiple time-points)  When the stressor was considered more controllable, greater use of problem focused coping was rela
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