Lecture notes
Lecture notes the psychology of chronic illness (PSYC3077)
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- De Montfort University (DMU)
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Week 2Monday 12th of October
Lecture 1
Coping
Session aims:
By the end of this session, you should be able to demonstrate an understanding of:
- Factors that affect how individuals respond to a chronic illness
- How individuals adjust to chronic illness over time ( & individual differences in
responses)
- Some social and environmental factors involved
- And be able to evaluate relevant theories, models and empirical research
Seminar 1: how we consider chronic illness across the lifespan
Intro and definitions
Developing a chronic condition places a number of demands on an individual and often on
their family will touch on this as well. These demands can differ in condition as well as in
other factors. There may be practical aspects, there may be emotion factors, cognitive,
financial considerations and these can all vary depending on where these individuals are in
life stage and socioeconomic factors and what the condition is.
But often, the person with the chronic condition is no longer invincible. The illness may take
away any plans, hopes and dreams that they had, and it can introduce uncertainty.
Someone who is living with a chronic illness has to adapt and adjust and this is usually
permanent.
When we are talking about a chronic condition, we are normally referring to something that
does not have a cure (although that does snot refers to some types of cancer), and generally
lasts six months.
Living with a chronic condition demands change does not normally only involve only the
individual that has the disease.
Generally coping is viewed as situational rather than dispositional, and the meaning of this is
that how an individual copes with one particular situation, might be very different to how
they cope with another situation. It is not necessarily a personality trait so we don’t
necessarily think of people as good copers or bad copers, but more than someone may cope
well in situation A but not so well in situation B.
Morse and Johnson (1991), proposed a generic model of emotional and coping response, so
that is from the onset of symptoms to actually living with the chronic illness. And they
proposed that: when individuals are facing illness they have to deal with uncertainty: trying to
understand the meaning of the symptoms that they have, and also dealing with disruption: so
,they’re experiencing a crisis which may be characterised by intense stress and a level of
dependence (??).
What we see when people are addressing these issues is: striving, so they’re attempting to
gain control of their illness by means of active coping, so trying to do something. And
also through restoration, so they propose that an individual achieves a new emotion-
based on accepting the illness and its consequences → equilibrium.
When thinking about factors that can affect coping:
2 key ones
1. Illness related factors
2. Treatment-related factors
Illness related factors
● Individual’s perception of ‘threat’ determines the difficulty in coping (Cohen &
Lazarus, 1979)
● Some health problems are more difficult to deal with e.g.:
● Disfigurement - especially to face (Hagedoorn & Molleman, 2006)
● Self-efficacy in dealing with the responses of others
● Self-consciousness or stigma can lead to avoidance of others
● Changes in bodily function (Bekkers et al., 1995)
● E.g. seizures or having an ostomy
Treatment-related factors
People find that the treatment is actually worse than the illness it is supposed to be treating.
Treatment regimens can be difficult
Pain associated with the treatment rather than illness
Side effects - medication or treatments
Schedules that make everyday life changes e.g. giving up work
Schedules that mean changing lifestyles e.g. giving up smoking
Visible treatments – e.g. ointments with odours
Think about coping through a lifespan approach. Coping isnt static it does change through
time.
Definitions of coping & Adjustment
● “Constantly changing cognitive and behavioural efforts to manage specific external and/or
internal demands that are appraised as taxing or exceeding the resources of the person”
(Lazarus & Folkman, 1984, p.141) ---> this is about coping in general not coping with
chronic illness.
- Coping is not an outcome, we don’t do things to get to a bad or good coping, it is a
process where we do various tasks to get the good outcome or good quality of life.
, ● Adjustment often defined in terms of outcomes e.g. preserving functional status and low
negative affect (Stanton et al., 2007)
● An essential “stabilizing factor that can help individuals maintain psychosocial adaptation
during stressful periods” (Holahan et al., 1996; Moos & Moos, 1986) (in White et al., 2018
p.2)
Stages and models
Stages of adjustment (Kubler-Ross, 1969; Shontz, 1975)
Kubler-Ross’ stages of grief; Denial. Anger. Bargaining. Depression.
Acceptance.
Shontz: Initial reactions in 3 stages; shock, encounter, retreat → similar to denial but shouldnt last
a long time.
Move away from stage-based to task-based approaches
Criticisms: Too prescriptive, rigid linearity, creating expectations of responses, categorises people
But can be a good starting point
Some people feel relieved after being diagnosed, it is like it is a relief, you’re not imagining your
symptoms
Not evyerone reachers the last stage, not everyone reaches acceptance or equilibrium.
Elements from different stages may cooccur
Transactional Model of Coping (Lazarus & Folkman, 1984)
, Highly influential model because it changed the way people looked at coping. What theys ay
is that coping is our attempt to change a stressor
This is a generic model, it is not about coping with a specific chrinicl illness or any illnesses
whatsoever.
They place cognitions in a central role and there is a relationship between cognition and
emotions and coping, and this is dynamic and variable. So reflective changing situation.
This was viewed as a novel model because unlike previous models, which saw coping as a
reaction to emotion, this one has a reciprocal relationship between coping and emotion.
Emotion can activate coping, coping can activate emotion.
These emotion and behaioural responses can kind of remain fluid until the situation is
resolved.
Crisis theory (Moos & Schaefer, 1984)
Specifically related to illness and they conceptualised physical illness as a crisis.
Physical illness as a crisis
Three processes:
Cognitive appraisal, adaptive tasks, coping skills
Self-regulation – individuals are motivated to re-establish a state of equilibrium and normality
Two new types of equilibrium:
Healthy adaptation: involves reality orientation, not being in a state of denial, adaptive tasks and
constructive coping skills.
Maladaptive response: can result in deterioration
Coping with a Chronic Illness (Moos & Holahan, 2007)
Adaptive tasks: (related to health or general)
● Managing symptoms
● Managing treatment
● Forming relationships with healthcare providers
•
● Managing emotions
● Maintaining a positive self-image
● Relating to family and friends
● Preparing for an uncertain future
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