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A research study aimed at examining the Matching Hypothesis and Goodness-of-Fit Hypothesis in coping strategies and their relationship with appraised controllability of stressors. The study focuses on HIV-seropositive individuals and utilizes Lazarus and Folkman's Transactional Model of Stress and Coping. The document also discusses the importance of social support and coping self-efficacy in the context of stress management.
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A thesis presented to the faculty of the College of Arts and Sciences of Ohio University
In partial fulfillment of the requirements for the degree Master of Science
Dana Mitchell August 2004
This thesis entitled STRESS, COPING, AND APPRAISAL IN AN HIV-SEROPOSITIVE RURAL SAMPLE: A TEST OF THE GOODNESS-OF-FIT HYPOTHESIS BY DANA MITCHELL
has been approved for the Department of Psychology and the College of Arts and Sciences by
Timothy G. Heckman Associate Professor of Psychology
Leslie A. Flemming Dean, College of Arts and Sciences
Acknowledgements This thesis is dedicated to my family and loved ones for their support through my academic and professional endeavors. I would also like to thank Dr. Timothy G. Heckman for his guidance and mentoring, as well as my committee members, Dr. John Garske and Dr. Kenneth Holroyd.
Lazarus and Folkman’s (1984) Transactional Model of Stress and Coping provided the theoretical framework for the present study. The transactional model is built on the assumption that stress is a person-situation interaction, one that is dependent on the subjective cognitive judgment that arises from the interplay between the person and the environment (Zakowski, Hall, Klein, & Baum, 2001). No event or situation in itself is inherently stressful; instead, the stressor is defined by the subjective judgment of the situation that is appraised as threatening, harmful, or taxing of available resources (Lazarus & Folkman, 1984). Lazarus and Folkman (1984) suggest that coping will be most effective if there is a match between the changeability of the stressor currently confronting the individual and the appropriate form of coping applied to the stressor. Problem-focused coping applied to changeable stressors and emotion-focused coping applied to unchangeable stressors is proposed to be most adaptive; this proposal is also know as the goodness-of-fit hypothesis. The foundation for the present study was based on previous research that has tested the transactional model in various community samples. While the empirical literature in this area is limited and reports discrepant findings, several researchers have found full or partial support for the goodness-of-fit hypothesis (e.g., Zakowski et al., 2001; Park, Folkman, & Bostrom, 2001; Aldwin & Revenson, 1987). The unique contribution of this study to the field of psychology is that this investigation sought to clarify the associations among control appraisals, coping, and stress in a sample of HIV- seropositive persons living in rural communities.
This study addressed two basic hypotheses from the transactional model. First, the matching hypothesis examined whether control appraisals of life events influence a person’s choice of coping strategy. Second, the effectiveness of problem- versus emotion-focused coping as moderated by control appraisals (the goodness-of-fit hypothesis) was tested. Data collected in “Project Connect,” an NIMH-funded study evaluating the efficacy of a telephone-delivered coping improvement group intervention based at Ohio University, was utilized for the analyses. Self-administered questionnaires were completed by 337 people living with HIV in rural communities from the years of 1997-2002. Participants were presented with a list of psychosocial stressors common to HIV-infected persons (provided in the Results section) and were then asked to identify their most prominent life stressor, as well as their perceived controllability over the stressor. Hierarchical regression analyses were used to evaluate the relationship between the participants’ appraisal-coping fit and psychological health. These analyses expected to find (1) a significant and negative relationship between depression and problem- focused coping in persons who experienced changeable stressors and utilized more problem-focused coping relative to those who utilized more emotion-focused coping; and (2) lower levels of depression in individuals whose greatest stressor was unchangeable and who used more emotion-focused coping relative to those who used more problem- focused coping.
cities (population less than 250,000) in Delaware, Florida, Georgia, and South Carolina. Results indicated that 65% of participants had lived away from their current county of residence for at least one month prior to becoming HIV-infected. Of those who had moved, the most commonly reported reason was to be closer to family. However, over a quarter (27%) of respondents indicated they had been infected locally, primarily via sexual acquisition. Rural HIV/AIDS Epidemiological Data. Berry (2000) surveyed four rural communities in the United States in 1993 and again in 1998. Data were collected from two areas with relatively low cumulative rural AIDS cases and limited access to HIV services (southeast Idaho and southeast New Mexico) and from two areas with relatively high AIDS prevalence and access to service (Edisto District, South Carolina and Treasure Coast, Florida). Results revealed that the cumulative number of AIDS cases in southeast Idaho grew less than in any of the other sites. While AIDS cases in southeast New Mexico more than doubled (from 35 to 92), particularly among injecting drug users, the cumulative number of cases remained comparatively low. Analyses in the remaining two sites, however, portrayed a different picture. Cases in the South Carolina grew from 99 to 342, and cases in Treasure Coast Florida rose from 605 to 1,432. The number of infections among IV drug users dropped considerably in South Carolina (from 31% in 1993 to 20% in 1998), however increases were recorded in heterosexual and female cases. In both South Carolina and Florida, Blacks accounted for the majority of the cases in 1993 and again in 1998.
Steinberg and Fleming (2000) conducted analyses on the Centers for Disease Control and Prevention’s 1996 national report of AIDS cases in adults and adolescents over 13 years of age. Communities of 500,000 or more residents were considered metropolitan statistical areas (MSAs), and areas with 50,000 or fewer residents were labeled as non-MSAs (i.e., rural communities). MSAs accounted for the majority (83%) of overall AIDS cases (containing 62% of overall population). Communities of 50,000 to 500,000 accounted for 10% of cases (18% of the population), and non-MSAs totaled 7% of cases (20% of the population). Analyses revealed that AIDS cases were disproportionately reported in the Northeast, totaling 32% of cases and only 20% of the overall U.S. population. While the South reported over four times as many non-MSA AIDS cases than any other region, it is important to note that these cases are spread over a large area (16 states) and population (35% of U.S. total). Hence, the resulting rate of infection in the South is relatively low (14 per 100,000), comparable to that found in the non-MSA Northeast (13 per 100,000). Nonetheless, these findings suggest the potential for small towns and communities to be severely affected by this disease. The Impact of HIV on Black and Southern Communities. HIV prevalence among black Americans living in both rural and urban communities is particularly high. Steinberg and Fleming (2000) found rates among black Americans were uniformly higher than any other racial group. Their analysis found that blacks accounted for 43% of total U.S. cases, yet only 11% of the population. Of the 40,000 new HIV infections per year in the U.S., 54% occur among Blacks; black women account for nearly 64% of the new annual infections among females, and black men account for approximately 50% of new
unprotected, receptive anal sex). Kelly and colleagues (1995) conducted a study from 1991-1992, sampling nearly 6,000 men at gay bars in 16 smaller cities (i.e., with populations between 50,000 to 180,000) throughout the U.S. Their analyses found that 27% of the non-partnered men in their sample reported having unprotected sexual contact in the previous two months. The Future of Rural AIDS. Heckman, Kim, Pinkerton, and Akers (2003) analyzed biannual data on AIDS cases diagnosed between 1993 and 2001 published by the Centers for Disease Control and Prevention. The authors compared AIDS cases in non- metropolitan areas (communities with 50,000 or fewer residents) to metropolitan statistical areas (populations of 500,000 or more). Results showed that between 1993 and 2001, large cities accounted for an average of 84.6% of all AIDS cases diagnosed in the United States, while non-metropolitan areas accounted for an average of 5.6% of all cases. During this period, AIDS diagnoses in non-metropolitan and metropolitan areas increased by 217% and 155%, respectively. However, the difference between urban and rural infection rates is expected to narrow. Based on polynomial regression analyses, the authors predict that by June 2006, 6.7% of all persons diagnosed with AIDS in the United States will be living in non-metropolitan areas. Between June 1993 and June 2006, the number of AIDS cases diagnosed in non-metropolitan areas will increase by 270%, compared to an increase of 167% in large cities. Finally, the ratio of large city to non- metropolitan AIDS diagnoses in 1993 was 17.2 to 1; however, in June 2006, this ratio is expected to decrease to 12.7 to 1.
Transactional Model of Stress, Appraisal, and Coping Conway and Terry (1992) suggest that theoretical approaches to the study of coping have historically taken one of three forms. The first of these approaches conceptualizes coping as an ego process that operates to reduce emotional tension. As argued by Folkman and Lazarus (1980), this conceptualization is considered problematic, as it equates coping with mastery over stressful demands; and hence the process of coping is confounded with its outcome. The second theoretical approach conceptualizes coping as a trait (Conway & Terry, 1992). This approach, however, fails to take into account that stressful situations are not static events, nor that individuals do not respond similarly to all stressful events (Lazarus & Folkman, 1984). The final conceptualization, proposed by Lazarus and Folkman (1984), views coping as a dynamic process, specific not only to the presenting situation but also to the stage of the encounter. According to Folkman and Lazarus (1988), coping is not merely a response to tension. Instead, coping is influenced by an individual’s cognitive appraisal of an event; and one’s cognitive appraisal subsequently influences emotional arousal (Folkman & Lazarus, 1988). Lazarus and Folkman (1984) view psychological stress as a relationship between the person and the environment that is appraised as potentially endangering to one’s well- being. Two critical processes mediate this person-environment relationship: (a) the cognitive appraisal , which is an evaluative process that determines why and to what extent a particular transaction between the person and environment is stressful; and (b) coping , the process through which the individual manages the demands of the person- environment relationship and the ensuing emotions generated from the situation.
states, rather than on external situations that trigger emotional responses. Emotion- focused coping is most likely to occur when an appraisal has been made that nothing can be done to modify the harmful, threatening, or challenging environmental conditions. This form of coping is directed towards altering the individual’s emotional response to the problem and includes strategies such as wishful thinking, minimization, or avoidance. Contrarily, problem-focused coping functions to alter the stressor by direct action. This form of coping is more probable when conditions are appraised as amenable to change. Problem-focused strategies include learning new skills, finding alternative channels of gratification, or developing new standards of behavior. Some coping strategies, such as seeking social support, may serve both emotion- and problem -focused functions simultaneously (Vitaliano, Maiuro, Russo, & Becker, 1987). Both emotion- and problem-focused forms of coping are used by most individuals in response to stressful events (Folkman & Lazarus, 1980). Prior research (e.g., Schmitz & Crystal 2000; Fleishman & Fogel, 1994) has found no significant correlation between problem- and emotion-focused coping, suggesting that the two dimensions are distinct constructs and not simply opposite poles on a single continuum. An increase in one dimension of coping does not imply a decrease in the other. An individual’s cognitive appraisal of the stressful circumstance plays an influential role in coping selection. While neither problem-focused nor emotion-focused coping is inherently adaptive or maladaptive, Folkman, Lazarus, Gruen, & DeLongis (1986) suggest that coping may need to be considered as it interacts with the appraisal of the situation in order to reliably predict psychological adjustment. According to the
goodness-of-fit hypothesis, the effectiveness of a coping strategy in reducing distress depends on the degree to which it matches the appraised situation. Perceived control is particularly important in determining the appropriate fit. Controllable stressors may be best dealt with by focusing on the problem itself, whereas such efforts may be ineffective or detrimental in the face of an uncontrollable stressor. On the other hand, in the situation of an uncontrollable problem, coping strategies that are more emotion-focused may be more advantageous in reducing stress, as one’s internal state may be more amenable to change than the situation itself. As Zakowski et al. (2001) explain, a ‘good fit’ between appraisal and coping consists predominately of emotion-focused coping when dealing with an uncontrollable stressor and predominately problem-focused coping for a controllable stressor. Empirical Findings on the Goodness-of-Fit Hypothesis Previous research on the goodness-of-fit hypothesis has found contradictory results. Below is a summary of studies that have found either full, partial, or no support for the hypothesis. Research Finding Full Support of the Goodness-of-Fit. Only one study, Forsythe and Compas (1987), has fully supported the goodness-of-fit hypothesis. In this study, a sample of 84 college students reported the type of coping strategy used in response to both major (e.g., death of a relative) and minor distressing events (e.g., receiving a poor grade on a paper). Results indicated a significant coping by control interaction for major life events. In other words, psychological symptoms were highest when there was a poor fit between appraisals and coping, such as trying to directly change an event that was
