5 Lifestyle factors
3. Existential death anxiety
2.3. Section three: Coping Mechanism 1 Introduction
A diagnosis of breast cancer is a great shock. Women report that they fear breast cancer more than heart disease, even though they have a better chance of surviving breast cancer, and later dying of stroke or heart failure. Fear of this disease as well as the treatments for it, seem to be inherent in women all across the world (Pam, 2012) In order to adapt/cope, the patient ought to employ certain coping mechanisms. Individuals with terminal illness who utilize coping strategies have better quality of life compared to those who do not (Kearny, 2006).
Coping is the major determinant in the process from stressful events to adaptational outcomes such as psychological symptoms and somatic illness (Lazarus, 1993). Coping has two main functions: dealing with the problem that is causing the distress (problem-focused coping) and regulating stressful emotions (emotion-focused coping) (Folkman and Lazarus, 1986).
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According to Johnson‘s stress-coping model, coping strategies are efforts directed toward managing or dealing with a stressor. Depending upon how effectively individuals cope with their stressors, they may experience either desired emotional states of acceptance, peace, and equanimity, or undesired emotional consequences such as depression, anxiety, and anger. Coping does not imply successbut efforts to resolve a stressful situation. Several factors influence the stress-coping response. Some factors are related to the stressor such as, intensity, scope, duration, number, and nature of concurrent stressors and predictability. Those related to the individual experiencing the stressor include level of personal control, feeling of competence, availability of social support, information and guidance, and access to resources (equipment and supplies). Others are age at the time of stress and cognitive appraisal (Elshtawawy, 2014)
Although death anxiety is common in breast cancer and worsen the disease course, coping style, and treatment outcomes, these psychiatric disorders are ignored and left untreated. Understanding these common psychiatric disorders and associated psychosocial factors can help to plan for treatment and may result in more treatment success (Elshtawawy, 2014).
Coping is a complex mental process by which a person deals with stress, solves problems, and makes decisions. It is an emotional, cognitive and behavioral response of a patient to an illness. Coping process involves at least two stages: confronting and managing with different aspects of illness or disability. Since every patient is a unique person, an emotional, cognitive and behavioral response can vary a lot and can occasionally be quite unpredictable in the same patient (Oncol, 2004).
Undoubtedly, cancer causes considerable psychological distress in patents, families, and often those health professionals who care for them. Some socially determined problems often augment distress in patients as well in addition to the unpleasant symptoms such as pain, nausea, fatigue and the distress, financial problems and problems concerning employment, housing, childcare, family worries and existential doubts (Oncol, 2004).
Although there is no clear scientific evidence for the association between coping strategies and the cancer initiation, the progression or the recurrence, the therapeutic window for the psychosocial intervention is still wide and shows an important effect on the quality of lives of many cancer patients (Sprah and Sostaric, 2004).
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2.3.2. Coping mechanisms of women with breast cancer
Appropriate coping and adjustment is important in facing chronic diseases, especially during the treatment period such as chemotherapy. Coping strategies refer to the specific efforts, both behavioral and events (John and MacArthur, 1999). Payne, (1990) stated that chemotherapy recipients employed four predominant styles in coping with the treatment crisis - think positively/fighter, acceptance, fearfulness and hopelessness. Women, who underwent chemotherapy treatment and had ―confrontive‖ element in coping style, were found to experience less psychological and physical symptoms, as compared to the patients who had ―avoidant‖ element in the coping strategy used(Shapiro,1997). Another researcher pointed out that behavioral escape avoidance and cognitive escape-avoidance as the most important coping mechanisms which contribute to the psychological distress of the cancer patients receiving chemotherapy. Thus, the coping style with a fighting spirit has been observed to associate with a greater adherence to the chemotherapy regimen (Saniah&Zainal, 2010).
A diagnosis of breast cancer regardless of the stage can be stressful, impact multiple spheres of life, and disrupt physical status, emotional and spiritual well-being, and personal relationships for the patient and family. In order to adapt, the patient ought to employ certain coping mechanisms. Individuals with terminal illness who utilize coping strategies have better quality of life compared to those who do not. Coping is the major determinant in the process from stressful events to adaptational outcomes such as psychological symptoms and somatic illness. Coping has two main functions: dealing with the problem that is causing the distress (problem-focused coping) and regulating stressful emotions (emotion-focused coping (Lazarus, 1993).
According to Johnson‘s stress-coping model, coping strategies are efforts directed toward managing or dealing with a stressor. Depending upon how effectively individuals cope with their stressors, they may experience either desired emotional states of acceptance, peace, and equanimity, or undesired emotional consequences such as depression, anxiety, and anger (Mukwato et al., 2010).
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There are two forms of coping strategies; Problem- focused and emotional-focused coping. Problem-focused coping attempts to find solutions to resolve the problem causing the stress. Problem -focused coping strategies functions to alter the stressor by direct action, used when conditions are appraised as amenable. Strategies include learning new skills or developing new standards of behavior. Emotion-focused coping involves managing the emotions that an individual feels when a stressful event occurs. Emotional focused coping mostly occurs when an appraisal has been made that nothing can be done to modify the stressor. Emotion-focused strategies include wishful thinking, minimization, or avoidance (Mukwato et al., 2010).
There are other coping mechanism forms such as self-distraction which is a pattern of behavior or a collection of actions where in all apparent self-inflicted harm or abuse toward oneself , and active coping refers which is the utilization of those psychological or behavioral coping efforts that are characterized by an attempt to use one‘s own resources to deal with a problem situation (Zeidner& Endler, 1996). Denial which is the denying the happening of an event or the reliability of information, and can lead to a feeling of aloofness and to the ignoring of possibly beneficial information, substance userefers to the overuse of, or dependence on which lead to the effects that are detrimental to the individual's physical and mental health, and the use of emotional supporthas which been described as behavior which assures the individual is loved and valued as a person regardless of achievement (Bloom, 1982). Further coping mechanisms include the use of instrumental support is which is the perception and actuality that one is cared for has assistance available from other people, and that one is part of a supportive social network. These supportive resources can be emotional, financial, assistance, advice, or companionship and intangible; Another coping mechanisms are behavioral disengagement which is fail to follow the rules or expectations for the activity, and engaging instead in behaviors outside of the norms orexpectations, venting which is the process of releasing stress or get rid of emotions, positive reframingmeans which is the try to reconsider things in a positive light, humoris which is the tendency of particular cognitive experiences to provoke laughter and provide amusement , and acceptance which is a person's assent to the reality of a situation, recognizing a process or condition (often a negative or uncomfortable situation) without attempting to change it or protest it. Religion is one of the coping mechanisms that deal with the inevitability of stressful situation
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such as death in addition to self-blame which is a cognitive process in which an individual attributes the occurrence of a stressful event to oneself. (Carver, 2007)
Several factors influence the stress-coping response. Some factors are related to the stressor such as, intensity, scope, duration, number, and nature of concurrent stressors and predictability. Those related to the individual experiencing the stressor include level of personal control, feeling of competence, availability of social support, information and guidance, and access to resources (equipment and supplies). Others are age at the time of stress and cognitive appraisal (Fredette, 1995).