Transactional Model Constructs

After understanding how PA and SB patterns change over the course of survivorship, the next logical step is to determine important demographic, clinical, and treatment-related

characteristics, as well as psychosocial variables, that may be associated with them. Demographic, clinical, and treatment-related characteristics are important for identifying subgroups of women in need of intervention. Psychosocial variables from the Transactional Model of Stress and Coping that prove to be mediators may be mutable intervention targets in the future.

Theories, such as the Transactional Model of Stress and Coping, are useful in several ways for identifying intervention targets for future research. Theory is helpful for selecting

light of the functions that psychosocial constructs may be playing in important health-related processes. Psychosocial variables are an important component of the Transactional Model of Stress and Coping, in that they describe how cognitive and affective perceptions predict the coping process.

The central tenets of the Transactional Model are four-fold: 1) Perception of a stressor is considered to be “transactional" because it is formed by an individual’s cognitive and emotional appraisal of the stressor and the environmental context in which it occurs; 2) Individuals vary in their perception of stressors and availability of coping resources; 3) Coping strategies are a process determined by how threatening the situation is perceived to be and what coping options are perceived to be available; and 4) Coping is conceptualized as dynamic in that it varies by situational context, even within individuals (Lazarus & Folkman, 1987; Lazarus, 1999; Hill Rice, 2000). The Transactional Model makes no a priori assumptions about what constitutes “good” or “bad” coping strategies (e.g., Folkman & Lazarus, 1985). Coping is simply an individual’s efforts to manage a stressor when demands exceed coping resources.

Figure 1.8 shows the 1987 version of the Transactional Model that represents Lazarus and Folkman’s later thinking. In the diagram, a stressor is assumed to be occurring in order for appraisal processes to be initiated (but does not appear in the diagram itself). A stressor is a danger or demand originating from the internal or external environment that upsets homeostasis and requires action to restore balance (Glanz & Schwartz, 2008; Lazarus & Laupier, 1978). Lazarus and Folkman (1987) make a distinction between an objective, versus a perceived, threat (e.g., perceived risk for breast cancer recurrence may or may not align with objective risk). Their model assumes that perceptions of a stressor are better predictors of coping strategies than more

Figure 1.8. Transactional model of stress and coping.

Lazarus and Folkman describe two types of cognitive and emotional appraisals that impact coping behavior: primary and secondary appraisal. They argue that, before emotion occurs, individuals make a primary appraisal, which is an automatic, often unconscious, assessment of what is happening and what it may mean for them personally or for loved ones. In primary appraisal, a situation or stressor is judged on whether it is germane to well-being, i.e., whether the stressor is irrelevant, stressful, or benign-positive (lower left corner of Figure 1.8). If the situation is judged to be benign or positive, it has the potential for a positive outcome (labeled “benefit” in the Transactional Model literature but not shown in Figure 1.8). A situation perceived to be stressful is broken down further into three parts: harm/loss, future threat, and challenge (Lazarus & Folkman, 1987). “Harm or loss” is conceptualized as negative

consequences attributed to the stressor that have occurred to date; “threat” is anticipated harm for the future; and “challenge” is the potential for mastery or gain.

A secondary appraisal also occurs. This appraisal relates to the perception of whether any action(s) can be taken to reduce or eliminate the stressor, and if so, which coping strategies might be effective (Lazarus & Folkman, 1987; Lazarus, 1999). Coping strategies are the cognitive, affective, and behavioral efforts to manage a situation perceived to be a stressor (Lazarus & Folkman, 1987).

Primary and secondary appraisals are explicitly described as influencing each other but not having a temporal dimension. In other words, the appraisal that something (or nothing) can be done about a stressor may be made before the individual has determined what is personally at stake. The Transactional Model predicts that when stakes are perceived to be high, mobilization of coping resources will occur. When the stake is substantial and coping resources are judged to be inadequate, a negative emotional response is predicted to occur. The greater the imbalance between stakes and coping resources, the greater the negative emotional response is predicted to be.

The Transactional Model of Stress and Coping suggests that breast cancer survivors who perceive recurrence to be an important future threat, and who appraise their coping resources as adequate to manage future recurrence risk, will change their behavior as a coping strategy. For instance, breast cancer survivors may increase their PA or change their diet to increase overall health and reduce future health threats. Breast cancer survivors may choose to change PA (instead of, or in conjunction with, other health behaviors) because of media reports on PA and cancer, a clinician’s recommendation to increase PA, or other sources of information.

Because few researchers have explicitly framed PA and SB as coping strategies, virtually no research exists about when they are used to deal with a stressor and when they are due to

as proxies for coping strategies after a breast cancer diagnosis. These ideas will be covered more fully in Section 1.2.4. In the next section, I discuss the strengths and weaknesses of the

Transactional Model in relation to my dissertation.