THEORETIC FRAMEWORK
This study is guided by Lazarus’s cognitive-motivational-
relational theory, supplemented with theory on coping with chronic illness. In our model of coping in patients with COPD (Fig 1) it is assumed that there is a continual interplay between mediators such as subjective appraisals of stressful events, coping strategies, and short-term outcomes such as psychological distress reactions. Antecedents such as demographic characteristics and disease factors are influencing these processes. Coping consists of cognitive and behavioral efforts to manage specific external and internal demands and any conflicts between them that are appraised as
taxing or exceeding the patient’s resources. Although
coping is directed at the regulation of psychological
distress, coping also directly follows the patient’s cognitive appraisal of the situation. Lazarus defines cognitive appraisal as an “evaluative process,” by which people ascribe meaning to an encounter or event with respect to their wellbeing. Lazarus and colleagues identify two basic kinds of appraisal, primary and secondary, that rep-resent the process whereby people ascribe and evaluate this meaning. Primary appraisal is the evaluation of what is at stake for a person’s well-being. Here a person reflects: Am I in trouble or being
benefited now and in the future, and in what way?
Stress appraisals include threat, harm, loss, or challenge.
14 Secondary appraisal concerns the perceived coping options available to an individual in managing a specific event.14 The essential question for a person is what might and can be done to manage the situation and what is the likelihood that a given coping option will accomplish what it is supposed to in the context of other internal and/or external demands. Coping has two major functions: to deal directly with the problem and attempt to actively manage or alter the problem causing the distress
(problem-focused coping), and to regulate the emotional
response to the problem (emotion-focused coping). According to our model, coping is viewed as a reciprocal process. Appraisals and coping processes are assumed to influence resulting psychological distress reactions, both of which in turn can influence and change appraisal and coping processes reciprocally. Appraisal and coping processes are considered to be mediators because they are not present as variables at the onset, but arise out
of the transactional context. Thus, they are regarded
as tentative and changeable cognitive constructs
that emerge and reemerge out of ongoing transactions
on the basis of conditions in the environment and within the person.