Programs for Coping with Stress and Promoting Health
413 Promoting Healthy Behavior 2. Contemplation. A problem behavior has been identiﬁed and the person is seriously thinking about changing it. 3. Preparation. The person has a strong intention to change and has made speciﬁc plans to do so. 4. Action. The person is engaging successfully in behavior change. 5. Maintenance. The healthy behavior has continued for at least six months, and the person is using newly learned skills to prevent relapse, or “backsliding.” The road from precontemplation through maintenance can be a bumpy one (Prochaska, 1994). Usually, people relapse and go through the stages repeatedly until they ﬁnally achieve stability in the healthy behavior they desire (Polivy & Herman, 2002). Smokers, for example, typically require three to four cycles through the stages over several years before they ﬁnally reach the maintenance stage (Piasecki, 2006). Programs for Coping with Stress and Promoting Health TAKING TIME OUT The workplace is the number one source of stress for many people. On January 1, 2000, Raymond Fowler, who was then chief executive ofﬁcer of the American Psychological Association, joined the ranks of those whose elevated blood pressure, heart problems, and other physical stress responses required a leave of absence from stressful jobs (Fowler, 2000). The National Institute for Occupational Safety and Health (1999) suggests a wide range of other behavioral coping options for stressed employees who cannot afford to take time off. You can view this advice online at http://www.cdc.gov/niosh/stresswk.html. LINKAGES How can people manage stress? (a link to Treatment of Psychology Disorders) An important part of health psychologists’ health promotion work has been to improve people’s stress-coping skills (e.g., Keogh, Bond, & Flaxman, 2006). Let’s consider a few speciﬁc procedures and programs associated with this effort. Just as people with extra money in the bank have a better chance of weathering a ﬁnancial crisis, those with effective coping skills have a better chance of escaping some of the more harmful effects of intense stress. Like family money, the ability to handle stress appears to come naturally to some people, but coping strategies can also be learned. Programs for teaching these strategies include several stages, which are summarized in Table 10.4. Bear in mind, though, that no single method of coping with stressors is right for everyone or every stressor. For example, denying the existence of an uncontrollable stressor may be ﬁne in the short run but may lead to problems if no other coping method is used. Similarly, people who rely entirely on active, problem-focused coping might handle controllable stressors well but ﬁnd themselves nearly helpless in the face of uncontrollable ones (Murray & Terry, 1999). The most successful stress managers may be those who can adjust their coping methods to the demands of changing situations and differing stressors (Taylor, 2002). Planning to Cope Developing Coping Strategies Strategies for coping with stress can be cognitive, emotional, behavioral, or physical. Cognitive coping strategies involve changing the way we think. These changes include thinking more calmly, rationally, and constructively in the face of stressors and may lead to a more hopeful emotional outlook. For example, students with heavy course loads may experience anxiety, confusion, discouragement, lack of motivation, and the desire to run away from it all. Frightening, catastrophizing thoughts (such as “What if I fail?”) magnify these stress responses. Cognitive coping strategies replace catastrophic thinking with thoughts in which stressors are seen as challenges, not threats. This substitution process is called cognitive restructuring (Lazarus, 1971; Meichenbaum, 1977). It involves first identifying upsetting thoughts (such as “I’ll never ﬁgure this out!”) and then developing and practicing more constructive thoughts to use when under stress (such as “All I can do is the best I can”). Cognitive coping doesn’t eliminate stressors, of course, but it can help us to perceive them as less threatening and therefore less disruptive (Antoni et al., 2000; Chesney et al., 2003). Seeking and finding social support are effective emotional coping strategies. As mentioned earlier, feeling that you are cared about and valued by others can be an 414 Chapter 10 Health, Stress, and Coping effective buffer against the ill effects of stressors, leading to enhanced immune functioning (Kiecolt-Glaser & Newton, 2001) and quicker recovery from illness (Taylor, 2002). Behavioral coping strategies involve changing behavior in order to minimize the negative impact of stressors. Time management is one example. If it seems that learn you are always pressed for time, consider developing a time management by doing plan. The ﬁrst step is to use a calendar or day planner to record how you spend each hour of each day in a typical week. Next, analyze the information to locate when and how you might be wasting time and how you might use your time more efﬁciently. Then set out a schedule for the coming week and stick to it. Make adjustments in subsequent weeks as you learn more realistic ways to manage your time. Time management can’t create more time, but it can help control catastrophizing thoughts by providing reassurance that there is enough time for everything and a plan for handling everything you have to do. Physical coping strategies can be used to alter the undesirable physical responses that occur before, during, or after the appearance of stressors. The most common physical coping strategy is some form of drug use. Prescription medications are sometimes an appropriate coping aid, especially when stressors are severe and acute, such as the sudden death of one’s child. However, people who rely on prescribed or nonprescription drugs, including alcohol, to help them face stressors may come to believe that their coping success is due to the drug, not to their own skill. This belief can make people more and more psychologically dependent on the drug. Furthermore, the drug effects that blunt stress responses may also interfere with the ability to apply coping strategies. The resulting loss of perceived control over stressors may make those stressors even more threatening and disruptive. Nonchemical methods of reducing physical stress reactions and improving stress coping include progressive relaxation training (Bernstein, Borkovec, & Hazlette-Stevens, 2000; Scheufele, 2000), physical exercise (Anshel, 1996), biofeedback (Saraﬁno & Goehring, 2000), and meditation and tai chi (Carlson et al., 2003; Davidson et al., 2003; Li et al., 2001), among others (Taylor, 2002). “In Review: Methods for Coping with Stress” summarizes our discussion of stresscoping methods. 2 DEALING WITH CHEMOTHERAPY in review Progressive relaxation training involves brieﬂy tensing groups of muscles throughout the body, one at a time, then releasing the tension and focusing on the resulting feelings of relaxation. It can be used to ease a variety of health-related problems, including the anxiety, physiological arousal, and nausea associated with cancer chemotherapy (Bernstein, Borkovec, & Hazlette-Stevens, 2000). METHODS FOR COPING WITH STRESS Type of Coping Method Examples Cognitive Thinking of stressors as challenges rather than as threats; avoiding perfectionism Emotional Seeking social support; getting advice Behavioral Implementing a time-management plan; where possible, making life changes to eliminate stressors Physical Progressive relaxation training; exercise; meditation ? 1. Catastrophizing thoughts are best overcome through coping strategies. 2. The ﬁrst step in coping with stress is to the sources and effects of your stressors. 3. True or false: It is best to rely on only one good coping strategy.