Health Psychology Summary of Smith (Week 5): Coping and adjustment to rheumatoid arthritis. In J. Suls and K.A. Wallston
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Course
Health Psychology (PSMSB11)
Institution
Rijksuniversiteit Groningen (RuG)
Summary of: Smith, C.A., Wallston, K.A. & Dwyer, K.A. (2003 ). Coping and adjustment to rheumatoid arthritis.
In J. Suls and K.A. Wallston (Eds.). Social psychological foundations of health and illness (pp. 458-
494). Oxford: Blackwell Publishing Ltd.
Coping: person’s cognitive and behavioral efforts to manage the stress producing aspects of
one’s circumstances (including illness-related ones) → central for adjustment
individual differences in adjustment to chronic illness, might be due to…
◦ self-efficacy
◦ control-related beliefs
◦ self-esteem
◦ optimism
◦ social support
→ coping is central among these constructs because coping represents behavioral
interface where these beliefs and resources are translated into thoughts and behaviors
that impact directly on health, well-being and adjustment
coping research is in crisis:
◦ usually quantitative measures are applied to measure the degree to which individuals
employ various coping strategies, which are than compared across groups of individuals
→ exclusive use of coping inventories is limited and new alternatives should be
developed
Broad dimension vs Narrow Strategies
one issue confronting the coping research concerns the level of specificity at which to assess
coping
usually when using coping checklists, coping tended to be analyzed, and assessed, in terms
of broad coping dimensions (problem-focused vs. emotion-focused; active vs. passive)
broad dimensions have drawbacks:
◦ combining strategies (active vs. passive) into a single score, broad coping scales may
obscure and underestimate the relations between coping and adjustment (e.g. use
different strategies in different situations) and important strategies might be overlooked,
ignored, or dropped from consideration if they fail to contribute cleanly to a simple
factor structure
recently move from broad summary scale to examination of specific coping strategies
◦ finding → different forms of emotion-focused coping (i.e. attempts to manage the
distress resulting from stressful circumstances) differ in their relations to psychological
adjustment (e.g. positive reappraisal associated with good psychological adjustment;
wishful thinking, distancing, avoidance associated with poor adjustment)
◦ multidimensional approach should be used to assess coping
▪ drawback:
assessment instruments can quickly become unwieldy → would have to use
coping inventory with at least 60 and up to 100 items which is costly in time and
participants good will (especially because patients might have limited attention)
▪ alternative:
using shorter measure assessing broader subscales (systematically including
items representative of each of the multidimensional subsclaes) → same
drawbacks when using original broad subscale (mentioned above)
adopt individual subscales but be selective in the subscales that are assessed →
only one which are relevant to situation which includes careful consideration of
problem area
Assessing Strategies vs Functions
, Health Psychology – Smith (lecture 5) 2
concern whether one should directly assess the specific strategies used by individual or the
coping functions served by those strategies
→ most of the subscales assessed in multidimensional coping inventories do not refer to
overarching coping functions (emotion-focused and problem-focus coping refer directly to
coping functions served by strategy: e.g. emotion-focused coping leads to reappraise
circumstances in more positive light), but rather refer to the specific behavioral and
cognitive strategies in which persons might engage (seeking social support, avoidance,
positive reappraisal)
→assessing coping should be directed at measuring the specific coping strategies in which a
person engages rather than in attempting to directly assess the coping functions served by
those strategies because…
1. respondents are likely to be better able to report on which specific strategies they
engaged in rather than on which functions those strategies served, as the specific
strategies represent concrete behaviors and cognitions in a way that the more abstract
functions served by those behaviors and cognitions do not
▪ self-report limited: patients re sometimes unaware of their coping activities (e.g.
denial) and awareness of it might reduce strategies effectiveness
▪ however, some strategies more accessible to patients and their assessment via self-
reports is less limited
→ should focus more on assessment of concrete behaviors and thoughts
2. not necessarily a one-to-one mapping between coping strategies and the functions they
serve, sometimes strategy can serve problem-focused and emotion-focused functions
simultaneously (e.g. when seeking social support) & function of strategy often depends
on the context in which it is used (e.g. distraction – avoidant emotion-focused strategy
which is mostly associated with poor adaptational outcomes but can be helpful for pain
patients)
▪ further examples:
denial found to be positively associated with positive adjustment in persons with
end-stage renal failure and cancer
catastrophizing usually seen as passive and maladaptive emotion focused coping
strategy, however, in children found to be more active than passive → might that
it is an effective problem-focused way of getting attention and assistance for
persons who are otherwise relatively powerless to exert control over their health
condition or circumstances
→ recommend that investigators attempt to assess the actual coping strategies used in as direct and
concrete a manner as possible, and then to use those data to infer the coping functions being served,
rather than attempting to assess those functions directly
Specificity Imbalance in Current Inventories vis-a-vis Emotion- vs. Problem-focused
Strategies
coping inventories assessing strategies regarding emotion-focused coping work better than
for problem-focused coping and are far more developed
Emotion-focused strategies are largely intra-personal, representing variety of ways that
person can adjust or adapt to stressful conditions without actually changing those conditions
problem-focused strategies, reflecting efforts to change the actual conditions to make them
less stressful, are inherently context/task specific → might be relevant and effective in one
context but not in another
◦ mostly used is a single subscale assessing something akin to “active problem-solving,”
which assesses the degree to which the respondent attempted to do anything (without
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