The relative efficacy of avoidant and nonavoidant coping strategies: a meta-analysis.

A casual review of the research literature on coping strategies suggests that strategies involving avoidant tactics are effective in reducing pain, stress, and anxiety in some cases, whereas nonavoidant strategies (called here attention), appear to be more effective in others. This article reports the results of a series of meta-analyses to ascertain whether there are systematic patterns in the empirical literature that describe when attention strategies are more or less effective than avoidant strategies. In particular, we consider the role of different kinds of attentional sets and also the role of time--whether some kinds of strategies work best in the early phases of the stress experience, and others are more efficacious in later phases of the stress experience. Results of an overall analysis of studies providing tests of attention versus avoidance indicated little evidence for one strategy's superiority. However, supplementary analyses, motivated by theoretical reasons, suggest there are boundary conditions that define the relative efficacy of a specific strategy. Overall, avoidance was associated with more positive adaptation in the short-run. However, attention was superior to avoidance if the former involved a focus on sensory schemata rather than emotional processing. If attention involved an emotional interpretational set or no explicit set, then it was associated with more negative outcomes than avoidance. In terms of long-term outcomes, avoidance indicates better outcomes initially, but with time, attention was associated with more positive outcomes. A final set of analyses found that both attention and avoidance facilitate adaptation as compared with no instruction controls. The meta-analyses suggest the important role of interpretational set and whether one looks at the immediate or at the long-term effects of coping. Limitations of the analyses and directions for future research are discussed.

Relationship between JAS- and FTAS-Type A behavior and non-CHD illness: a prospective study controlling for negative affectivity.

In addition to posing a risk for coronary heart disease (CHD), Type A behavior has been suggested as a risk factor for non-CHD illness. Past evidence, however, has relied chiefly on retrospective studies of self-reported illness that failed to control for the potentially confounding effects of negative affectivity. The present investigation was an 18-month prospective study of Type A behavior and medical records of illness in which chronic negative affectivity was also assessed. Negative affectivity was associated with retrospective self-reported illness, but only Type A, as measured by the Jenkins Activity Survey (JAS) and the Framingham Type A Scale (FTAS), predicted medical records of subsequent illness severity and number of illness-related medical visits. Controlling for negative affectivity did not reduce these significant relationships. It was concluded that persons scoring high on the JAS or the FTAS may be a greater risk of minor illness when objective measures of illness are assessed over a period of 1 year or more. Alternative explanations and future directions for research are discussed.

A multilevel data-analytic approach for evaluation of relationships between daily life stressors and symptomatology: patients with irritable bowel syndrome.

Four statistical strategies were used to evaluate whether occurrence of daily stressors increases lower gastrointestinal (GI) symptoms in irritable bowel syndrome (IBS) patients. Across-subject concurrent correlations between weekly stress and symptoms were positive but casually ambiguous and obscured between- and within-subject and occasion relationships. Multiple regressions assessing (weekly and daily) relations showed that prior symptoms predicted subsequent symptoms but that prior and concurrent daily stress had no consistent effects. Idiographic correlations also showed little evidence for a relationship between stress and symptoms. Daily stress did not appear to increase GI symptoms in IBS patients on a general basis. Daily recording methodology, in conjunction with within-subject analytic strategies, is proposed as an innovative approach to examine relations between stress and physical symptomatology.

Relationship of trait anger to resting blood pressure: a meta-analysis.

A series of meta-analyses were conducted to assess whether anger is related to essential hypertension. The present review also considered the relevance of the distinction between anger experience and anger expression, the effect of participant selection bias, and the white-coat hypertension effect for the anger-blood pressure (BP) association. Anger experience was correlated with elevated BP, but the relationship was small and highly variable. When positive effects emerged, both participant selection and the reliability of BP measurement posed interpretational problems. Persons high in anger are not merely exhibiting elevated BP in response to testing, so a white-coat effect is not evident. Being labeled as hypertensive may contribute to higher anger scores, however. The review suggests lines of future research concerning associations between trait anger and blood pressure.

Specificity in social support: perceptions of helpful and unhelpful provider behaviors among irritable bowel syndrome, headache, and cancer patients.

Perceived social support was assessed among 53 patients suffering from non-life-threatening chronic illnesses (i.e., irritable bowel syndrome or recurrent headache). Subjects recalled predominantly helpful support interactions and reported the three major types of social support as equally helpful. In addition, irritable bowel syndrome patients, who experience embarrassing physical symptoms, reported fewer instances of tangible assistance than chronic headache patients. Comparisons to cancer patients studied by Dakof and Taylor (1990) revealed differences in perceived social support as a function of diagnosis. These results offer insight into the needs of patients with noncatastrophic illnesses and suggest that the challenges and tasks confronting these individuals are unique from those encountered by patients with catastrophic diseases.

Effects of sensory and procedural information on coping with stressful medical procedures and pain: a meta-analysis.

A meta-analysis of studies on preparation for medical procedures and pain evaluated the relative effects of sensory; procedural, and combined sensory-procedural preoperational information on coping outcomes. Results indicated that, in contrast to sensory information, procedural information provided no significant benefits over control group instruction. Combined sensory-procedural preparation, however, yielded the strongest and most consistent benefits in terms of reducing negative affect, pain reports, and other-rated distress. The meta-analytic results are consistent with the dual process preparation hypothesis, which proposes that the information combination is optimal because procedural details provide a map of specific events while sensory information facilitates their interpretation as nonthreatening. It is concluded that a combined preparation is the preferred clinical option.

Daily stress and the trajectory of mood: spillover, response assimilation, contrast, and chronic negative affectivity.

Experience sampling methodology was used to examine the effects of current and prior problems on negative mood within and across days. Forty male community residents wore signal watches and kept dairy records of problem occurrence and mood 8 times a day for 8 consecutive days. Trait negative affectivity (NA), prior mood, and concurrent stress were related to mood during the day. Mood in response to a current problem was worse if the prior time had been problem free than if the prior time had been stressful. High NA Ss were more reactive to concurrent stressors than were low NAs, but the effect was small. NA and current-day stress were the major influences of mood across days. High NAs were more distressed by current-day problems and recovered more slowly from problems of the preceding day. The benefits of conceptualizing the effects of daily stressors on mood in terms of spillover, response assimilation, habituation, and contrast are discussed.

In search of the false-uniqueness phenomenon: fear and estimates of social consensus.

An examination of the social perception literature yields little evidence for the false-uniqueness phenomenon (Valins & Nisbett, 1972), the perception that one's attributes are more unique than is the case. In contrast, the tendency for individuals to project their own characteristics onto other people and assume that more people are like themselves is a robust phenomenon. One reason researchers may not have found false uniqueness is that they have not looked at the accuracy of consensus estimates. A close look at the results of Tabachnik, Crocker, and Alloy (1983) and Sanders and Mullen (1983), who did assess accuracy, suggests that people possessing undesirable attributes over-estimate consensus, whereas people holding desirable attributes underestimate consensus. The latter pattern is a form of false uniqueness. In this study we looked at the accuracy of social consensus estimates in the context of psychological fears. A sample of subjects filled out an abbreviated version of a fear survey and made estimates of consensus. The results showed that both high- and low-fear respondents overestimated the incidence of high fear among their peers, but high-fear subjects were more inaccurate in their estimates. A false-uniqueness effect was found on the part of low-fear subjects, as they tended to underestimate the incidence of low fear among their peers. These findings are consistent with a motivational interpretation that emphasizes the individual's need to justify or normalize stigmatized behavior and to bolster perceived self-competence.

The relation between type A behavior and chronic emotional distress: a meta-analysis.

A meta-analysis was conducted of studies examining the relation between Type A behavior and chronic emotional distress as measured by standard psychological scales. Aggregating across all studies, the average effect size was .27, indicating a positive association between Type A and chronic dysphoria; however, there was considerable variability in the size of the relation among studies. Partitioning by Type A measure revealed that Structured Interview-assessed Type A was unrelated to chronic dysphoric emotions; however, most of the self-report measures of Type A behavior were moderately correlated with upset. The Framingham Type A Scale and the Bortner Scale showed the strongest relations. Thus, contrary to the traditional view, Type A measured by self-report does have some emotional concomitants, although they are not in the pathological range. Also discussed are how the results bear on the proposal that the maladjusted personality confers coronary risk, the implications for reported associations between Type A and illness complaints, and for the study of the Type A as a social psychological construct.

Type A coronary-prone behavior pattern and social facilitation.

A laboratory study was conducted to investigate the task performance of Type A coronary-prone individuals relative to Type B's in three types of social situations: alone, with a similarly performing coactor, or with a better-performing coactor. The results indicate that Type A's performance on a simple task was facilitated by the presence of either a similar or superior coactor, whereas the presence of coactors impaired performance on a complex task. Type B's showed weak and nonsignificant facilitation effects that occurred only in the presence of similar coactors. The results are discussed in terms of the Type A's concern about evaluation, achievement, and social comparison, and Sanders and Baron's distraction-conflict theory of social facilitation.

Differential roles of neuroticism, extraversion, and event desirability for mood in daily life: an integrative model of top-down and bottom-up influences.

Top-down and bottom-up approaches were combined to assess the relative impact of extraversion, neuroticism, and daily events on daily mood. Ninety-six community-residing men completed diaries for 8 consecutive nights. Extraversion predicted positive mood, whereas neuroticism predicted positive and negative mood. Undesirable events predicted negative mood and, more modestly, positive mood. Desirable events predicted positive mood. Negative dispositional and situational factors play a larger role in daily positive affect than positive factors do in daily negative affect.

The effectiveness of attention and rejection as coping styles: a meta-analysis of temporal differences.

The purpose of this study was to conduct a meta-analysis [16] of research comparing the effects on physical adaptation of two cognitive strategies for coping with stressors: attention and rejection. Attention refers to focusing attention on the stressor and/or on one's rejection to it; rejection refers to focusing attention away from the stressor and/or one's reaction to it. For studies examining the immediate effects of attention and rejection, rejection produced better physical adaptation (i.e. fewer symptoms, reduced physiological responses) than attention. For studies looking at the long term effects of attention and rejection, attention produced better physical adaptation than rejection. Mechanisms which could produce these effects, and their implications, are discussed.

Test performance as a function of the hard-driving and speed components of the type A coronary-prone behavior pattern.

Male and female students in an undergraduate psychology class completed a student version of the Jenkins Activity Survey (JAS) and several weeks later performed on the first course test of the semester. Test-completion times and test scores were unobtrusively recorded and a series of Pearson product-moment correlations were subsequently performed. These revealed the following: (1) The time urgency component of the Type A coronary-prone behavior pattern was negatively related to the amount of time that students spent working on the test (p less than 0.05) but unrelated to the obtained tests scores. (2) The hard-driving and competitive component of the Type A coronary-prone behavior pattern bore a marginal positive relationship with time-on-test (p less than 0.10) and a strong positive relationship with obtained test scores (p less than 0.002). (3) Global JAS scores and time were not correlated. However, global JAS scores were found to be positively related to the scores that students obtained on the test (p less than 0.05). It is suggested that the failure of previous research to reach any definite conclusions concerning the relationship between Type A/B behavior and task performance may be due to their utilization of global measures of Type A behavior while ignoring the effects of the component behavioral tendencies. When time urgency and hard-drivingness do not interfere with one another and when the nature of the task makes at least one of these components salient, performance differences should emerge between Type A's and Type B's.

The role of anxiety and depression in the irritable bowel syndrome.

Using a reliable and valid structured diagnostic interview scale (ADIS-R), and patients with careful medical characterization, we found significantly more diagnosable psychopathology, particularly anxiety disorders, among treatment seeking patients with irritable bowel syndrome than among comparable age and sex samples of treatment seeking patients with Inflammatory Bowel Disease. Significant differences were also found on the Hamilton Anxiety Rating Scale and Hamilton Rating Scale for Depression between IBS patients and the IBD patients and controls, who did not differ. Comparable levels of psychiatric disorder among parents of probands were found in all three groups. The results are consistent with Latimer's (1983) notion of IBS patients being a subclass of 'neurotics'.

Prediction of outcome from cognitive-behavioral treatment of irritable bowel syndrome.

The presence of a diagnosable Axis I psychiatric disorder predicted significantly (P less than 0.001) lower likelihood of significant improvement among 90 irritable bowel syndrome patients given cognitive and behavioral treatments to help the disorder. Other psychological tests, including the MMPI, BDI, STAI, as well as demographic variables, failed to yield significant prediction.

Psychological aspects of irritable bowel syndrome: comparisons with inflammatory bowel disease and nonpatient controls.

Patients with irritable bowel syndrome (IBS) (n = 121) were compared to 46 patients with inflammatory bowel disease (IBD), and to 45 nonpatient controls on a variety of psychological tests and on symptomatology. The most consistent finding was the ordering of group psychological test means such that, on 11 of 14 measures, IBS patients scored higher than IBD patients, who in turn scored higher than the nonpatient controls. The two patient groups differed significantly only on measures of anxiety with the IBS patients scoring significantly higher on all three measures. IBS patients also reported significantly more severity of abdominal pain than the IBD patients; while IBD patients reported more episodes of diarrhea, they did not rate them as significantly more severe than did the IBS patients. Various other parameters of the IBS population are also explored and implications for treatment and future study are discussed.

Two controlled evaluations of multicomponent psychological treatment of irritable bowel syndrome.

We report two controlled comparisons of a previously validated multicomponent (relaxation, thermal biofeedback, and cognitive therapy) treatment for irritable bowel syndrome (IBS) to an ostensible attention-placebo control (pseudo-meditation and EEG alpha suppression biofeedback) and to a symptom-monitoring control. In Study 1 (n = 10 per condition) there were nonsignificant trends for the multicomponent treatment to be superior to the attention-placebo condition. In Study 2 (n = 30 per condition), we found no advantage for the multicomponent treatment over the attention-placebo condition. Subjects in both treatment conditions showed significant reductions in GI symptoms, as measured by daily symptom diaries, and significant reductions in trait anxiety and depression. The GI symptom reductions held up over a 6 month follow-up. Possible explanations for the results are explored.

A disposable urea sensor for continuous monitoring of hemodialysis efficiency.

A new sensor for the on-line measurement of urea in the dialysate output is described. The sensor is based on a differential measurement of conductivity changes induced by the urease-catalyzed hydrolysis of urea. The use of screen printing for the batch-fabrication of the basic transducers results in cheap disposable devices. In addition, the sensor has been designed to fit into a standard male luer-adapter, and can be plugged directly into the dialysate line. The in vitro response is linear to urea concentrations exceeding 6620mM. A resolution of 20020 microM has been achieved with a baseline stability of 50 microM/hr. Interferences caused by fluctuations in the ionic strength and the consequent conductivity changes are effectively suppressed by the differential sensor pair. The efficiency of this suppression is expressed in a common mode rejection ratio of typically 40 to 50. Preliminary ex vivo results show the feasibility of the concept. The sensor principle is not restricted to urea but can be extended to other molecules of interest for hemodialysis monitoring, such as creatinine and L- and D-amino acids.

Multiple role juggling and daily mood states in working mothers: an experience sampling study.

The effects of multiple role juggling (i.e., simultaneously attending to demands of different roles) on daily mood states of employed mothers were examined. Ss completed activity and mood questionnaires 8 times a day for 8 days. Multiple role juggling had immediate negative effects on task enjoyment and mood. However, contrast effects and habituation to role juggling occurred when mood and satisfaction were examined over time. Furthermore, mood states tended to spill over from one episode to the next within a day, but contrast effects were found across days. These results reflect the complex nature of psychological adjustment to multiple role occupancy.