Appraisals, Coping, and Stress in Breast Cancer Screening: A Longitudinal Investigation of Causal Structure

Article excerpt

Abstract

The cognitive-appraisal model of Lazarus and Folkman (1984) is one of the most prominent theories of stress. As integral elements in this model, Appraisal and Coping have both been proposed as mediators of the stress response. The purpose of this study was to test the predictive power of the theoretical model based on two competing formulations using structural equation modeling techniques. One conceptual model proposed that coping influences stress through appraisal; the other proposed that appraisals impact on stress via coping. Women (n = 506) undergoing breast cancer screening completed measures of appraisal, coping, and stress. Support was found for both hypothesized causal structures. The implications of these findings are discussed in terms of Lazarus' theoretical perspective.

Resume

Le modele d'evaluation cognitive de Lazarus et Folkman (1984) est une des principales theories sur le stress. Deux de ses elements propres, l'evaluation et l'adaptation, ont ete proposes comme mediateurs de la reaction au stress. La presente etude visait a tester l'efficacite predictive du modele theorique d'apres deux formulations differentes, au moyen de techniques de modelisation par equation structurelle. Un modele conceptuel proposait que l'adaptation influe sur le stress au moyen de l'evaluation; l'autre proposait que les evaluations influent sur le stress par l'entremise de l'adaptation. Les femmes (n = 506) subissant un test de depistage du cancer du sein ont repondu a des questions visant a mesurer l'evaluation, l'adaptation et le stress. Les resultats corroborent les deux structures causales hypothetiques. Les consequences de ces conclusions sont exposees dans le cadre de la perspective theorique de Lazarus.

As a core element in many theoretical models, the topic of stress remains the target of much academic debate. One area of particular interest involves the relationship between stress and health. Despite evidence to support the relationship, many questions remain unanswered as to the correlates and predictors of stress (Aldwin, 1994; Folkman, Lazarus, Gruen, & DeLongis, 1986), and among them, the sequential pattern of influences.

One of the most popular theories in the area of stress research, certainly in terms of citation, is the Cognitive Theory of Stress and Coping developed by Lazarus and Folkman (1984). For Lazarus and Folkman (1984), the interaction between the environment and the individual defines stress. Stress is experienced when demands from the environment exceed available resources, and the mediating processes of appraisal and coping therefore become crucial. Appraisal is also presented as a perpetual process, evolving in time as the individual re-appraises the stressor. Following a brief overview of the studies investigating the principle components of the cognitive-appraisal framework, two competing models are presented and tested.

The cognitive-appraisal model

Lazarus and Folkman (1984) argue that cognitive appraisals and coping are pivotal in our understanding of stress. More specifically, they present both these processes as mediators of the stress response (Folkman, 1984; Lazarus, 1993). Within this framework, cognitive appraisal is the "process of categorizing an encounter, and its various facets, with respect to its significance for well-being" (Lazarus & Folkman, 1984, p.31). According to Lazarus and Folkman (1984), appraisals are either primary, when the person evaluates the implications of the stressor, or secondary, when the evaluation entails what can be done to deal with the situation. Coping as a process involves some form of thought, action or feeling that is used, modified or eliminated to deal with an event that elicits some form of psychological stress (Lazarus & Folkman, 1984).

The relationship between coping and adaptation

Attempts to develop a parsimonious taxonomy of coping strategies have led to several classifications of these behaviours, thoughts and feelings. …