Stress management in the health care setting: Matching interventions with patient coping styles.

Abstract

Forty-six patients about to undergo preprosthetic oral surgery were presented with either a problemfocused, emotion-focused, or mixed-focus stress management intervention. The mixed-focus intervention produced the best overall response to surgery; the emotion-focused intervention produced the lowest adjustment levels. The Krantz Health Opinion Survey Information scale was the best overall predictor of response to surgery in conjunction with treatments. Better adjustment and satisfaction and lower self-reported pain were obtained when high information-preference subjects were given a problem-focused intervention and when low information-preference subjects were given an emotion-focused intervention; responses were relatively poor when mismatches occurred. Differences in relative use of problem-to emotion-focused coping as measured by the Ways of Coping Checklist were unrelated to adjustment or satisfaction, but differences in problem-focused coping were the best predictors of pain response in conjunction with treatments. Preoperative anxiety level was inversely related to adjustment and satisfaction and was directly related to pain, with the affective-unpleasantness component of pain primarily accounting for this association.A growing number of studies are examining the effectiveness of interventions designed to enhance the coping stalls of persons exposed to stressful medical and surgical procedures. In a metaanalysis of the overall efficacy of attention coping strategies versus avoidant coping strategies, Suls and Fletcher (1985) concluded that both attention and avoidance facilitated adaptation as compared with a no instruction condition but that there was no evidence for the superiority of one strategy over the other (see also Thompson, 1981) and that, given the size of the literature on stress and coping, relatively few studies had directly compared attention with avoidance strategies. In some studies, attention and avoidance strategies have been combined in multiple component treatment packages with experimental designs that have not allowed one to separate out the effects of each component (Auerbach & Kilmann, 1977). It has further been noted (Anderson & Masur, 1983;Auerbach, Martelli, & Mercuri, 1983) that in health care settings, patients in the typical standard-care-only or attention-placebo control groups receive unknown and unmeasured components of problem-focused intervention (typically through provision of varying degrees and types of information by the medical staff) and nonspecific This article is based on a dissertation by the first author that was supervised by the second author and submitted in partial fulfillment for the requirements of the PhD in clinical psychology at Virginia Commonweahh University.

Problem‐Solving Appraisal, Health Complaints, and Health‐Related Expectancies

“…It is notable that people differ in their desire for information about health-related issues and in the degree to which they want to be directly involved in their own health care (Krantz, Baum, & Wideman, 1980). These preferences can exert a substantial impact on individual distress prior to and during medical procedures, and interventions that are congruent with patient preferences for information and involvement are more effective than are strategies that are insensitive to these individual differences (Auerbach, Martelli, & Mercuri, 1983;Martelli, Auerbach, Alexander, & Mercuri, 1987).…”

Psychological preparation for patients undergoing day surgery

“…Moreover, detailed medical information provided by the anaesthetist only served to increase anxiety for some patients. Martelli et al (1987) studied 46 patients undergoing oral surgery and local anaesthesia and concluded emotional focused coping strategies was the most effective method for patients who were very anxious and in a situation where there was little possibility for personal choice. Anderson (1987), utilising emotional and behavioural measures when surveying patients prior to cardiac surgery concluded information alone did not reduce anxiety although it did help to increase feelings of control.…”

“…stress results from the physical trauma of surgery (Wolfer and Davies 1970, Ramsay 1972, Wallace 1984, Martelli et al 1987, O`Hara et al 1989. Wallace (1984) discovered even minor surgery to be stressful.…”

Educational needs of patients undergoing coronary artery bypass graft

“…It seems that such interventions would be more effective if they are designed based on coping style of each patient (10). Nurses need to personally assess their patients and establish an open relation with them (11).…”