In addition to the several demographic or developmental factors that influence the magnitude and patterning of the acute physiological stress response, numerous psychological variables have been shown to affect stress responses that are presumably learned throughout life and therefore more amenable to change. Foremost among these variables is a group of behaviors that might best be referred to as coping skills. We all know people who seem to possess the ability to cope with life's most challenging stressors (like becoming quadriplegic or losing the family home in a hurricane) without apparent distress; we also know others who experience extreme distress if they are five minutes late for an appointment. Clearly, these individuals differ regarding the sorts of coping skills they have learned throughout life. Lazurus and Folkman (1984) used the term 'coping' to refer to the cognitive and behavioral efforts that a person made to manage the specific stressors that were appraised as taxing or exceeding their resources. They categorized these groups of skills into two types: emotion-focused coping and problem-focused coping. Problem-focused coping involves cognitive and behavioral efforts on the part of the person to deal directly with the source of the stress. For example, a person with considerable job-related stress might generate strategies to become more efficient on the job or make suggestions to the employer regarding steps to make the company operate more smoothly. Quitting the job and finding a better position would also be an example of problem-focused coping. Emotion-focused coping, in contrast, is aimed at regulating the individual's emotional stress response. Using emotion-focused coping to deal with job stress might involve learning how to mediate or engage in positive self-talk to reduce the negative effects related to the acute stress response associated with the job. In general, problem-focused coping works better when an individual has some control over the situation and emotion-focused coping may be preferred when the situation cannot be controlled. For example, if you were diagnosed with heart disease and informed that your quitting smoking and eating a low-fat diet would greatly assist in treating your condition, developing a problem-focused plan to do so would definitely be in your best interest. In contrast, if you were diagnosed with a rare chronic viral condition for which there is no known treatment and your actions would not influence the outcome, emotion-focused coping might prove more beneficial in regulating your stress response.
In contrast to persons with few coping skills, persons with excellent problem-focused and emotion-focused coping skills are likely to exhibit less severe acute stress reactions, and by so doing will experience lesser risk for stress-related disease outcomes (Lazurus and Folk-man, 1984). Even persons with adequate skills in both areas, however, need to know when best to use them. Integrating the findings from the literature on styles of coping with the Defense-Defeat Reaction Model presented above, one could speculate that problem-focused coping might be preferred for situations eliciting a defense reaction and emotion-focused coping might be preferred for situations eliciting defeat reactions. Although this hypothesis makes intuitive sense, empirical support is needed before final conclusions can be drawn.
Several attitudes and behavior patterns have also been shown to influence the magnitude and pattern of the physiological stress response. For example, persons who exhibit high scores on measures of cynical hostility or the Type A behavior pattern have been shown to exhibit significantly greater physiological stress reactions and risk for stress-related illnesses than their respective low-hostile or Type B counterparts (Harbin, 1989; Smith, 1992). Like coping skills, these 'personality' variables are presumably learned throughout life as individuals interact with their environments and are thus amenable to change, provided the individual is adequately motivated and provided efficacious interventions to alter these behavioral features. Interestingly, these behavioral parameters appear to evoke a greater physiological stress reaction only when the stressor chosen involves confrontation, anger recall, or harassment by an experimenter (Harbin, 1989; Smith, 1992). Therefore, high-hostile and Type A persons are not uniformly more reactive than low-hostile or Type B persons during all types of stressors; rather, their exaggerated responses appear to occur only when the stressors they encounter elicit anger.
In recent years, an increasing number of studies have examined the relation between spirituality and health outcomes (Thoreson, Harris, and Oman, 2001). The vast majority of these studies have shown that being religious or spiritual is associated with positive health benefits. One common behavior associated with spirituality, forgiveness for transgressions or betrayal, has been examined with respect to physiological stress responses and found to be associated with smaller stress responses (Witvliet, Ludwig, and VanderLaan, 2001).
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