Florence J. van Zuuren

Cancer patients’ coping styles and doctor–patient communication

Monitoring and blunting styles have become relevant concepts regarding their potential impact on patients’ and doctors’ behaviors. The present study aimed at investigating the relation between cancer patients’ coping styles and doctor–patient communication and global affect. Coping styles were assessed by means of the Threatening Medical Situations Inventory (TMSI). Since a shortened version of the TMSI was used, the validity of this instrument was also evaluated. First, it was examined whether the two factor structure of the original TMSI could be confirmed in our version. Then, the relation between coping style and patients’ preferences for information and participation in decision‐making was evaluated. Second, the relation between monitoring and blunting and patients’ age, sex, education, quality of life and prognosis was investigated. Finally, the relation between patients’ coping styles and communicative behaviors and global affect of both patients and physicians during the initial oncological consultation was examined.

The Process and the Meaning of Hope for Family Members of Traumatic Coma Patients in Intensive Care

In this study, the authors examined the process that family members go through when they are confronted with traumatic coma. They conducted 24 semistructured interviews with 22 family members of 16 coma patients and analyzed the data using the constant comparative method as proposed by grounded theory. Hope was the most prominent theme. It can be described as keeping a possible positive outcome in mind in an uncertain situation, knowing that this outcome is unlikely to happen. Hope was found to evolve stepwise up and down, dependent on further events and information: big steps at first, smaller later on. Hope helps family members to keep going and to manage care for the patient and for each other. Family members were found to protect themselves against false or unjustified hope by seeking valid information. They alternate their moments of despair, and in their interactions they respect each others hope.

Monitoring, blunting and situational anxiety: A laboratory study on coping with a quasi-medical stressor

Abstract In the past years, research has shown that monitoring (information seeking) and blunting (information avoiding) coping styles play a role in the adaptation to stressful medical situations. The present study examined 70 normal subjects who were threatened by a realistic medical film about brain surgery. Coping behaviour and subjective experience were investigated in relation to habitual coping style (as indexed by three monitoring/blunting questionnaires) and pre-existing medical fears. It was found that only the Threatening Medical Situation Inventory could to some extent predict coping behaviour in this experimental situation. Furthermore, subjective experience was predominantly determined by pre-existing medical fears. Implications of these findings will be discussed.

Preparing patients for gastrointestinal endoscopy: the influence of information in medical situations

The effects of the provision of information were tested in a sample of patients who underwent a gastrointestinal endoscopy for the first time (N=260). On the basis of their Threatening Medical Situation Inventory (TMSI)-monitoring score these patients were divided in high monitors versus low monitors. On the basis of the existing literature each group received the type of information that was considered most beneficial with regard to their coping style, and each group was compared with a control group receiving standard care (the usual information plus coaching by a nurse). Dependent variables were anxiety at different points in time, heart rate and skin conductance, pain, experience of the procedure, course of the procedure, duration of gagging, and satisfaction with the information provided. Unexpectedly, it turned out that high monitors did not profit by extensive information when compared with high monitors receiving standard care. Also for low monitors their minimal informational intervention did not exceed the effects of standard care. In the discussion, four factors possibly responsible for these results were elaborated. It is concluded that reservedness is required in providing (too) extensive information to patients who ask for this. Furthermore, considering the rather unpredictable and uncontrollable course of a gastrointestinal endoscopy, coaching by a nurse remains a valuable type of support.

Coping under experimental threat: Observable and cognitive correlates of dispositional monitoring and blunting

In order to investigate the relation between dispositional coping style and actual coping behaviour under threat, 53 undergraduate psychology students anticipated a mild stressor (bloody slides) in Part I of the experiment. Observable behaviour turned out to be unrelated to dispositional monitoring and blunting as measured by the Miller Behavioral Style Scale (MBSS; Miller, 1987) and the Threatening Medical Situations Inventory (TMSI; van Zuuren and Hanewald, 1993). However, when cognitions were also taken into account, some significant correlations emerged with the MBSS as well as with the TMSI. In Part II (N = 40), intrusive thinking after exposure to the experimental stressor was related to dispositional coping style. High monitors, as compared with low monitors (moderate monitors excluded) were found to elaborate the stressful experience in a more diffuse and extended way.

Coping style and self reported health promotion and disease detection behaviour

Objectives. In the present study we investigate the relevance of the monitoring-blunting concept to the realm of health behaviour, and to health promotion and disease detection behaviour in particular. Design. The study is correlational in character, supplemented with some qualitative data. Methods. Sixty participants of varying sex, age and educational level filled out the Threatening Medical Situations Inventory, measuring the monitoring and blunting coping style, and the newly developed Health Promotion-Detection Questionnaire, intended to measure the tendencies to exhibit health promotion and disease detection behaviours. In addition, they answered a few open questions concerning their health. Results. It emerged that disease detection behaviour is positively related to age, and it is more often carried out for health reasons than health promotion behaviour. The monitoring coping style is significantly, though modestly, related to both health promotion and disease detection. The latter relation still holds when we controlled for age and gender. No relations with blunting were found, except for individual health behaviours. Conclusion. The results of the present study encourage further investigation of the role of coping styles in the performance of different types of health behaviours. Hereby, the further distinction between health strivings of the approach and the avoidance type may prove useful.

Cognitive confrontation and avoidance during a naturalistic medical stressor

This study was undertaken to shed some light on problems that have arisen in measuring cognitive confrontation (monitoring) and cognitive avoidance (blunting) with a self‐report questionnaire, the Miller Behavioral Style Scale (MBSS; Miller, 1987). For this purpose, variants of both coping styles were studied in a naturalistic setting: 37 women who underwent prenatal diagnosis were interviewed at home about their ways of coping with different stages of the procedure, a few days before they expected the diagnostic results. Interview fragments pertaining to cognitive confrontation and avoidance were selected and analysed by two investigators in order to generate categories of avoidance and confrontation coping strategies. For some of the fragments, inter judge reliability was assessed using new judges. A comparison between the categories found and the kinds of items used in the MBSS shows that in real life more coping variants occur than those represented in the MBSS, in particular variants that involve a combination of cognitive confrontation and avoidance. Implications for the dimensionality of both concepts and for their measurement are discussed.

Is exposure therapy outcome affected by a monitoring coping style

Abstract In the present study, 36 spider phobics received a one-session exposure in vivo treatment. It was investigated whether a monitoring (information seeking) coping style affected treatment outcome. In general, therapy appeared to be very successful. Yet, monitoring was found to be related to larger relapse at one week follow-up. This finding is in conflict with an earlier study of Steketee, Bransfield, Miller, and Foa (1989) that showed a favorable treatment outcome for monitors (information seekers) as compared to blunters (information avoiders). Potential explanations for the seemingly conflicting results are discussed.

Perceived need for information among patients with a haematological malignancy: associations with information satisfaction and treatment decision-making preferences

For patients with haematological malignancies, information on disease, prognosis, treatment and impact on quality of life is of the utmost importance. To gain insight into the perceived need for information in relation to sociodemographic and clinical parameters, comorbidity, quality of life (QoL) and information satisfaction, we compiled a questionnaire based on existing validated questionnaires. A total of 458 patients diagnosed with a haematological malignancy participated. The perceived need for information was moderate to high (40–70%). Multivariate regression analyses showed that a higher need for information was related to younger age, worse QoL, being member of a patient society and moderate comorbidity. The need for disease and treatment‐related information was higher than the need for psychosocial information. A higher need for disease and treatment‐related information was associated to being diagnosed with multiple myeloma. A higher need for psychosocial information was related to a lower educational level. The information provision could be improved according to 41% of the patients. Higher satisfaction with provided information was associated with better QoL. Most patients (62%) reported that they wanted to be fully informed about their illness and actively involved in treatment decision‐making. The results contribute to improving patient‐tailored information provision and shared decision‐making in clinical practice. Copyright

Monitoring-blunting coping styles and cognitive symptoms of dental fear

The present study investigates whether monitoring (i.e. vigilant) and blunting (i.e. avoidant) coping styles are associated with cognitive symptoms of dental fear. Results show that monitoring is positively related to the frequency and believability of negative thoughts about dental treatment, and negatively with the ability to control such thoughts. The opposite pattern is found for blunting. That is, blunting correlates negatively with the frequency and believability of negative thoughts, whereas a positive association emerges with cognitive control. These findings are in line with the Monitoring Process Model which proposes that ‘monitors’ (compared to ‘blunters’) generally show greater distress and arousal because of the way in which they cognitively elaborate threat.