Researchers stated that 1/4 to 1/3 of the adult population in the Netherlands suffers from a chronic disease (1989). This is an irreversible disease that someone has to deal with for weeks, months or years. The most important chronic diseases affect many people, last for a long time, have a major impact on the health care system and have a high mortality level. Many chronic diseases affect the quality of life. Because of this a psychological intervention is desirable for this. Unfortunately, this often concerns the less common diseases, causing the focus being less on this.

Stress and coping with chronic illness

Researchers stated that 1/4 to 1/3 of the adult population in the Netherlands suffers from a chronic disease (1989). This is an irreversible disease that someone has to deal with for weeks, months or years. The most important chronic diseases affect many people, last for a long time, have a major impact on the health care system and have a high mortality level. Many chronic diseases affect the quality of life. Because of this a psychological intervention is desirable for this. Unfortunately, this often concerns the less common diseases, causing the focus being less on this.

The stage model of adaptation to the chronic disease

The relationship between stress and disease depends on various factors: biological factors, environmental factors and cognitive processes. These factors affect most diseases.

Learning to live with a chronic disease is important and at the same time difficult. To gain more insight into this, Morse and Johnson (1991) have developed the illness constellation model :

1. Uncertainty. Attempt to understand the symptoms.

2. Dislocation. High stress levels and high dependence on professionals and family members.

3. Recovery from the self. Try to gain control of the disease with the help of others and coping mechanisms.

4. Recovery of well-being. The patient has reached a new balance. The disease and its consequences are accepted.

The stress coping model for chronic disease of Lazarus and Folkman (1984)

Patients assign a value to a stressor or illness. This value determines the emotional or behavioral response that the patient experiences.

Research shows that when people experience unexpected changes in their chronic illness, they experience strong emotional responses (such as anxiety or depression). These feelings often disappear quickly. Other stressors (for example work-related) can then lead to an increased susceptibility to emotional reactions.

In the Lazarus and Folkman model, a distinction is made between emotion-oriented coping and problem-oriented coping. Any reaction from the patient can influence coping behavior in the future. Coping behavior also varies over time and per person. This also explains why one person adapts faster than the other person.

Limitations to the model of Lazarus and Folkman

• The model can be seen more as a frame of reference than as a model. The situation dimension is insufficiently represented in the model.

• Contextual interactions are neglected.

• The effects of the individual's life goals and his or her social relationships on the disease and coping mechanisms are ignored.

An extensive model of coping for chronic illness

Life events

View the model shown in figure 19.8 on page 614 of the article. It states that other important life events contribute to the assessment of disease-related events. The response to chronic illness can, for example, be influenced by violent life events.

Disease characteristics

The characteristics of a disease have a major influence on how someone deals with an event. There is a positive relationship between the observed severity of the disease and avoiding or passive forms of coping. When someone experiences less control, this leads to avoidance and emotion-oriented coping (rheumatism) or to problem-oriented coping (diabetes mellitus). Ambiguity leads to passive forms of emotion-focused coping in women with breast cancer.

Treatment characteristics

Hospital stays, medical examinations, operations and other forms of treatment (such as chemotherapy) lead to changes in the way the patient sees and experiences the disease.

Personal characteristics

Various stable personal characteristics (such as gender and origin) contribute to the way in which someone perceives the chronic disease. The coping style is also influenced by this. It seems that women, lower educated people and older people with a chronic illness use more often avoiding or emotion-oriented coping styles.

Estimation

The assessment that someone makes of an event depends on many different factors. The more goals threatened by a stressor and the more important such a goal is, the more stressful the event is.

External resources

Examples of external resources are money, time and distance to professional help. Social support is also an external means. There is a relationship between social support and adaptation to the chronic illness. In addition, there is also a link between social support and disease progression. The extent of the link varies per disease. The way in which social support works (as a buffer or more directly) is unclear.

Research shows that patients with rheumatoid arthritis showed more often maladaptive coping behavior when their spouse offered little support. When their spouse took a supportive approach, the coping style was more often problem-oriented.

Internal resources

When we speak of internal resources, it is about the physical strength of the patient, the energy that the patient has, personality characteristics and so on. There are different personality traits that can be related to estimation, coping and adaptation. For example, optimistic patients seem to adopt a more active and problem-solving coping style, while pessimistic patients adopt a more passive and avoiding approach. However, research shows that the influence of personality on coping is not enormously strong.

Coping behavior

There are many factors that influence the coping behavior of the patient. It is important to distinguish between actions related to coping or stress reactions and doping functions that relate to the goals that the actions must achieve. This can only be properly displayed in a hierarchical model:

1. Generalized coping goals, preferences and construction.

2. Coping strategies.

3. Specific coping acts.

Because research into coping behavior often did not recognize this hierarchy, many research results can be called variable. On the first level, it is important to distinguish between problem-oriented and emotion-focused coping.

The approach coping style means that the patient tends to approach and maximize the importance of the stressful event. The avoiding coping style means that the patient avoids, ignores or minimizes the importance of the event.

Effectiveness of coping

This is about the relationship between coping behavior and coping outcomes. Three types of outcomes can be distinguished:

1. Psychological outcomes.

2. Social outcomes.

3. Physical outcomes.

Emotion-oriented coping is often more passive and avoiding, while problem-oriented coping is more active. The use of one of these coping strategies is related to the psychological and physical adaptation of the patient. Patients who use more emotion-focused coping styles have more difficulty adapting to the chronic disease than patients with a problem-focused coping style.