Proactive Approaches to Relieving Stress

It is interesting to think about proactive approaches to relieving stress, especially since our society, seems stress-provoking for many, perhaps most individuals. If social context, specifically having a social support system, is as important as many theoretical models propose, learning the benefits of social support as well as how to make the best use of it, seems an important part of intervening in populations who suffer the throes of isolation. An overwhelming amount of research suggests social support predisposes individuals to the most positive outcomes in a wide variety of circumstances (Jason, Witter, & Torres-Harding, 2003; Pakenham & Bursnall, 2006; Schroevers, Helgeson, Sanderman, & Ranchor, 2010). Of course, it would be important to identify cultural and other affects such as biological and neurological circumstances that preclude an individual from utilizing, or even understanding the benefits of social support systems.

Jason, L., Witter, E., & Torres-Harding, S. (2003). Chronic fatigue syndrome, coping, optimism and social support. Journal Of Mental Health, 12(2), 109-118.

Pakenham, K. I., & Bursnall, S. (2006). Relations between social support, appraisal and coping and both positive and negative outcomes for children of a parent with multiple sclerosis and comparisons with children of healthy parents. Clinical Rehabilitation, 20(8), 709-723. doi:10.1191/0269215506cre976oa

Schroevers, M. J., Helgeson, V. S., Sanderman, R., & Ranchor, A. V. (2010). Type of social support matters for prediction of posttraumatic growth among cancer survivors. Psycho-Oncology, 19(1), 46-53. doi:10.1002/pon.1501

Mothers of Developmentally Disabled Children

I find it interesting that 35% of mothers parenting children with developmental disabilities experience intense isolation (Gupta, 2007). Even if the isolation is only perceived, the effects are tremendous and have the potential to cause chronic stress and a plethora of deleterious effects. I also found it compelling that 65% of this population did not experience the isolation and negative effects of parenting children with developmental disabilities. One longitudinal study found no difference in the well being of parents raising children with intellectual disabilities, and that many parents maintain positive perceptions of raising children with developmental disabilities (Mailick Seltzer, Greenberg, Floyd, Pettee, & Hong, 2001). Because of the discrepancy in the experiences of these parents, it seems important to identify the underlying issues that may exist. For example, if lower socioeconomic status exacerbates the experiences of isolation, it would be important to determine what types of interventions may ameliorate these social effects in this particular segment of the population.

As always, when vastly different experiences are reported within a population, it becomes salient to examine the foundational influences. It seems to me that targeting these basic underlying factors may have the potential to produce a beneficial effect on the 35%.

References

Gupta, V. (2007). Comparison of parenting stress in different developmental disabilities. Journal Of Developmental & Physical Disabilities, 19(4), 417-425. doi:10.1007/s10882-007-9060-x

Mailick Seltzer, M., Greenberg, J. S., Floyd, F. J., Pettee, Y., & Hong, J. (2001). Life Course Impacts of Parenting a Child With a Disability. American Journal on Mental Retardation, 106(3), 265. doi: 10.1352/0895-8017(2001)1062.0.CO;2

More on Childhood Cancer

The psychological impact of isolation and separation are a critical part of the psychosocial effects of childhood cancer. Isolation and separation create a chronic stress, which has a definitive impact on the immune system as well as on the individual's psyche (Dhabar, 2011). I think these factors speak to the critical nature of providing these children with psychological support that includes friends and perhaps other children with cancer.

Excessive stress during childhood causes a dysregulation of leukocyes, which has the potential to add to the burden already placed on the immune system for children with cancer (Katz, Sprang, & Cooke, 2012). In healthy individuals, chronic stress can lead to increased mortality later in life as well as decreased cognitive functioning (Seeman, McEwen, Rowe, & Singer, 2001). This would place an additional tremendous burden on survivors of childhood cancer.

Because children tend to live in their own little worlds, it seems important to provide interventions that help them organize their world that suddenly includes cancer, which must be difficult for them to understand. This lack of understanding would likely contribute to the child's evaluation of their disease. Lazarus (1991) believed an experience is only as difficult or challenging as an individual evaluates it to be. Perhaps helping children to alter their perceptions - how they perceived their diagnosis would help them develop a more healthy emotional response. Lazarus found how individuals manage their emotional responses has a powerful effect on how they manage stress. The development of these skills seems critical for children with cancer and for survivors of childhood cancer.

References

Dhabhar, F. S. (2011). Effects of stress on immune function: Implications for immunoprotection
and immunopathology. In R. J. Contrada & A. Baum (Eds.), The handbook of stress science:
Biology, psychology, and health (pp. 47–63). New York, NY: Springer Publishing Company.

Katz, D., Sprang, G., & Cooke, C. (2012). The cost of chronic stress in childhood: understanding and applying the concept of allostatic load. Psychodynamic Psychiatry, 40(3), 469-480.

Lazarus, R. S. (1991). Progress on a cognitive-motivational-relational theory of emotion. American Psychologist, 46(8), 819-834. doi:10.1037/0003-066X.46.8.819

Seeman, T. E., McEwen, B. S., Rowe, J. W., & Singer, B. H. (2001). Allostatic load as a marker of cumulative biological risk: MacArthur studies of successful aging. Proceedings of the National Academy of Sciences of the United States of America, 98, 4770-4775.

Emotion and Problem-Focused Coping

Differences exist between emotion- and problem-focused coping and the situations in which they are effective. For example, as in the case of childhood disease, problem-focused coping can be ineffective because it is not possible to exert control over disease (Carver, 2011). Problem-focused coping can, however, be valuable in finding effective ways to cope. Emotion-focused coping strategies are effective when unchangeable stressors must be managed (Baldacchino & Draper, 2001).

I work with children and adolescents with developmental and intellectual disabilities and their parents. I have found that even though problem solving has an important place in helping parents develop a working strategy, it is the emotion-focused coping strategies that enable them to change the negative and isolating thoughts associated with their stress (their child's condition).

Emotion-focused coping can be instrumental in the process of reevaluating unchangeable stressors, such as disease (Stanton, Kirk, Cameron, & Danoff-Burg, 2000). I find it interesting that children naturally utilize this form of coping. From Clark's (2003) perspective, though, it is not simply that they choose emotion-focused coping, but that it is likely their use of imaginal play that is foundational in their natural coping mechanisms.

References

Baldacchino, D., & Draper, P. (2001). Spiritual coping strategies: A review of the nursing research literature. Journal of Advanced Nursing, 34, 833-841.

Clark, C. D. (2003). Imaginal coping. In In sickness and in play: Children coping with chronic illness (pp. 91–138). New Brunswick, NJ: Rutgers University.

Carver, C. S. (2011). Coping. In R. J. Contrada & Baum (Eds.), The handbook of stress science: Biology, psychology, and health (pp. 221–229). New York, NY: Springer Publishing Company.

Stanton, A. L., Kirk, S. B., Cameron, C. L., & Danoff-Burg, S. (2000). Coping through emotional approach: Scale construction and validation. Journal of Personality and Social Psychology, 78(6), 1150-1169. doi: 10.1037//0022-3514.78.6.1150

Latino Youth in America

Acculturative stress is the consequence of functioning within two cultural groups, which creates a dissonance because of the conflicting beliefs and attitudes within each group. Adolescents may be caught between two groups. For example, for Latino youth in America, stress may be the result of culture-related stress: acculturative stress, bicultural experiences, such as the difference between the adolescent's school and home life, and discrimination, all of which place the adolescent at a higher risk for substance abuse, domestic violence, and mental illness (Bridges, De Arelano, Rheingold, Danielson, & Silcott, 2010). In addition, the adolescent may struggle with participating within the American culture, which conflicts with his home life and his parents who want him to maintain their culture of origin and to maintain their cultural lifestyle, beliefs, and attitudes (Hays & Erford, 2010).

According to Lazarus (2006), stress is the result of the cognitive appraisal of a situation, and the extent to which the individual feels threatened and has the ability to influence the situation. Further, Lazarus (1991) believed the cognitive appraisal of a circumstance is a combination of mediating and moderating variables, which include the individual's cultural beliefs, attitudes, and lifestyle. For Latino youth, other variables may include low self-esteem, which can potentially alter the development of peer relationships, the inability to access resources, and facing discrimination.

                                              Stress Related Intervention
Cultural sensitivity must be central in any intervention, but especially when culture-related stress is an issue. Interventions should be flexible and address cultural values that pertain to religion, family values, and identity development, which is different in Latino youth than in non-Latino white adolescents (Hays & Erford, 2010). For these reasons, Cultural Adaptation of Cognitive Behavioral Therapy (CBT) could be effective for this population. This intervention, like other forms of CBT teach how thoughts, activities, and interactions with other people, influence mood. It challenges negative thinking, and embraces the natural family support system, which is central in Latino culture (Duarté-Vélez, Bernal, & Bonilla, 2010).

The Influences of Personal Bias

Cultural adaptation for an intervention should be developed in such a way that "increase(s) the congruence between the client's experience of a treatment and the properties of the treatment assumed by the therapist" (Duarté-Vélez et al., 2010, p. 896). Psychology professionals must be aware of the cultural values of the adolescent and his family, since family is a primary cultural value in Latino culture and maintaining emotional closeness to parents is a cultural ideal (Duarté-Vélez et al., 2010). Certainly, the Euro-centric aspects of psychology do not serve a broad segment of populations (Sue & Sue, 2008). It would be important for any professional working in culturally sensitive environments to acknowledge the effects of his or her personal views and realize that those views are not necessarily neutral.

References

Bridges, A. J., de Arellano, M. A., Rheingold, A. A., Danielson, C., & Silcott, L. (2010). Trauma exposure, mental health, and service utilization rates among immigrant and United States-born Hispanic youth: Results from the Hispanic family study. Psychological Trauma: Theory, Research, Practice, And Policy, 2(1), 40-48. doi:10.1037/a0019021

Duarté-Vélez, Y., Bernal, G., & Bonilla, K. (2010). Culturally adapted cognitive-behavior therapy: integrating sexual, spiritual, and family identities in an evidence-based treatment of a depressed Latino adolescent. Journal Of Clinical Psychology, 66(8), 895-906.

Hays, D. G., & Erford, B. T. (2010). Developing multicultural counseling competence: A systems approach (Reprint ed.). Boston: Pearson.

Lazarus, R. S. (1991). Progress on a cognitive-motivational-relational theory of emotion. American Psychologist, 46(8), 819-834. doi:10.1037/0003-066X.46.8.819

Lazarus, R. S. (2006). Emotions and interpersonal relationships: Toward a person-centered conceptualization of emotions and coping. Journal of Personality, 74(1), 9-46. doi: 10.1111/j.1467-6494.2005.00368.x

Sue, D. W., & Sue, D. (2008). Counseling the culturally diverse: Theory and practice (5th ed.). Hoboken, NJ: John Wiley & Sons.