Problem-Solving Training for Effective Stress Management and Prevention
D'Zurilla, Thomas J., Journal of Cognitive Psychotherapy
According to recent theoretical and research developments in the area of stress and coping, social problem solving (i.e., real-life problem solving) appears to be an important general coping strategy that can have a significant effect on a person's ability to reduce, control, and prevent the experience of stress in everyday living. Although an increasing number of studies have been providing support for this viewpoint, current stress-management programs still provide little or no training in general problem-solving principles. A new stress-management program is described that focuses on training in the application of a general problem-solving coping strategy. The results of three recent outcome studies are reported which, taken together, strongly suggest that problem-solving training is a viable and promising approach to stress management which increases positive psychological resources (problem-solving ability, self-esteem, life satisfaction), while reducing stress and its negative effects (psychological symptomatology, health problems).
Research support has been growing in recent years for the view that stress is often a major factor in the etiology and/or maintenance of both psychological and somatic disorders (Bloom, 1985; Dohrenwend & Dohrenwend, 1985; Lazarus & Folkman, 1984). In terms of psychological disorders, Barlow (1985) has sug gested that the average practicing clinician probably sees more stress-related conditions than all other clinical problems combined. With regard to somatic disorders, it has been estimated that as many as 80% of individuals seeking medical care do so because of stress-related illnesses (Pelletier, 1977). These disorders include many anxiety and phobic conditions, depressions, anger and abuse problems, headaches, backaches, chronic fatigue, asthmatic conditions, insomnia, hypertension, bruxism, and gastrointestinal problems (Woolfolk & Lehrer, 1984).
In view of the prevalence of stress-related disorders in recent years, it is not surprising that the demand for effective stress-management treatments has increased dramatically. While stress-management techniques include pharmacological methods and other passive anxiety-reduction treatments (e.g., hypnosis, biofeedback methods; Woolfolk & Lehrer, 1984), the present article will focus on stress-management training, which involves instruction in the application of active coping skills and techniques that enable the client to reduce, minimize, control, tolerate, and/or prevent stress in everyday living. The coping-skills training approach is emphasized here because it seems to hold the most promise for the maintenance and generalization of stress-reduction effects, as well as for prevention (Meichenbaum, 1985; Meichenbaum & Jaremko, 1983).
RECENT DEVELOPMENTS IN STRESS THEORY
After more than 50 years of stress theory and research, there is still no universally accepted definition or conceptualization of stress. However, in recent years an interactional model of stress has emerged that has been gaining widespread acceptance (Lazarus, 1981; Lazarus & Cohen, 1977; Lazarus & Folkman, 1984; McGrath, 1982; Sarason, 1980). According to this view, stress is a multifaceted, dynamic process which involves a complex, reciprocal interaction among a number of different variables related to both the environment and the person (external/internal adaptive demands, cognitive appraisals, coping activities, physiological-emotional responses). Depending on the specific person and environment variables, the nature of the stressful experience may vary considerably between persons and across situations. Indeed, the particular combination of person and environment variables in many situations might be quite unique to the particular individual (Lazarus & Folkman, 1984). The major implication of this interactional view for clinical stress management is that the requirements for effective coping are likely to vary from one situation to another, depending on specific characteristics of both the situation (e. …