Motivation and emotion/Book/2013/Transactional model of stress and coping

Overview
In 1966, Dr Richard Lazarus first wrote about his transactional theory of stress and coping. He continued research into this field, publishing numerous books and research papers, some on his own, and some in collaboration with other scientists, especially Dr Susan Folkman. The model evaluates how major life events and daily hassles impact on emotions with the emphasis on cognitive appraisal and coping with stress. Cognitive appraisal consists of primary appraisal (to assess the harm or threat the situation may pose) and secondary appraisal (which evaluates what can be done and the individual's ability to manage and cope with it). Coping follows from this appraisal of threat and can influence either a change in the person-environment relationship or the level of emotional distress experienced. Personality traits, depressive symptomology and social support are some factors which influence coping skills and abilities. Cognitive behaviour therapies and approaches enable individuals to identify and become aware of thoughts and feelings that lead to inadequate coping, and learn new ways to problem solve and cope.

Background
In the late 17th century, stress, according to the study of physical (mechanical) sciences of the day, was used to describe the relationship between internal forces and the external force, or load (Lazarus & Folkman, 1984). That wasn't so far from today's truth. Stress is still considered to be the internal force or reaction resulting from any form of harmful stimuli. In 1932, Walter Cannon, observed that stress seemed to be related to an internal disturbance of homeostasis, possibly due to lack of oxygen, cold, low blood pressure or such (Lazarus and Folkman, 1984). Further investigation followed, with Hans Selye in 1936 describing a set of bodily defences against noxious stimuli and called this the General Adaption Syndrome (Lazarus and Folkman, 1984), noting that stress was the physiological reactions and processes resulting from some demand or stimuli.

What is the transactional model?
The Transactional Model of Stress and Coping Theory is a framework which emphasizes appraisal to evaluate harm, threat and challenges, which results in the process of coping with stressful events (Lazaurus, 1966; Lazarus & Folkman, 1984). The level of stress experienced in the form of thoughts, feelings, emotions and behaviours, as a result of external stressors, depends on appraisals of the situation which involves a judgement about whether internal or external demands exceed resources and ability to cope when demands exceed resources (Lazarus & Folkman, 1984).

Stress
This chapter discusses psychological stress as opposed to physical or mechanical stress. Psychological stress is the emotional response experienced when an environmental stimuli or event could endanger well-being, is perceived as exceeding a person's resources (Lazarus & Folkman, 1984) and can be defined by a stimulus-response relationship. This is based on the cognitive-relational theory of stress which emphasises that the person-environment interaction is continuous and reciprocal in nature (Lazarus & Folkman, 1987). The degree of stress experienced depends on how much of a stake a person has in the outcome of the event: if there is no relevance to the person, and no threat, there will be no stress; if their stake is high, the encounter will pose a threat or challenge, triggering a stress reaction (Lazarus & Folkman, 1984). Hobfòll (1989) believed that stress is a major factor which not only affects people's lives, but also has an impact on their mental and physical health.

Stress may result from internal processes or perceptions, or external environmental stimuli. Lazarus and Folkman (1984) attribute stress stimuli to two types of events: major life events, and daily hassles.

Life events
Major life events such as changes can be divided into two categories. The first are environmental (natural) events that are unforeseen and unpredictable and outside a person's control such as cataclysmic phenomena like earthquakes, floods or bush-fires that affect a large number of people, as well as other not naturally occurring disasters such as war, airplane disasters, and tragedies such as terrorist attacks on the World Trade Center. The second type of major life event are those which, although also outside of a person's individual control, affect only a few people, and can include events such as the death of a loved one, divorce, disability or a life-threatening illness (Lazarus & Folkman, 1984).

Life events cannot be considered as the sole measure of stress (Lazarus & Folkman 1984), and not all change is stressful. Lazarus and Folkman (1984) identified that the personal significance of the event is critical and depends on the affected person's history, life stage and circumstances and that each event, whether major or minor, leads to an individual experience with individual meaning in the way it is interpreted on a day-to-day basis.

Daily hassles
Lazarus and Folkman (1984) suggested that daily hassles, which often appear unimportant in relation to major life events, and therefore can often be taken for granted, which in itself can be stressful. Daily hassles are those experiences that can lead to annoyance, irritation and distress, and ultimately in feeling overwhelmed by responsibilities, and can include having an argument, money and family worries (Lazarus & Folkman, 1984).

Daily hassles are usually repeat occurrences, and are superior in predicting psychological and physical symptoms, accounting for almost all attributable stress, whereas life events have almost no impact (Lazarus & Folkman 1987). The distinction may be described by the differences between the sudden death of someone in a motor vehicle accident to that experienced from death after a long period due to a terminal illness (Lazarus & Folkman 1984). Even though the loss is equally stressful, the degree of the stress experience differs over time.

Stress can cause feelings of anxiety, depression, changes in behaviour and physiology, as well as acute and chronic illness (Lazarus & Folkman, 1984), increasing the likelihood of addictions such as drugs, alcohol and eating, and is particularly evident as a result of daily stresses. DeLongis, Coyne, Dakof, Folkman and Lazarus (1982) found that the frequency and intensity of daily hassles related to somatic illness, and this relationship was stronger than for life events. The meaning and significance of hassles depends on the individual's appraisal based on life experience, commitments and expectations, and how these interact with the actual event (DeLongis et al., 1982). Effectively daily stresses can be as damaging as major life events and can potentially leave an individual vulnerable to anxiety, depression and changes in behavior

Personal factors influencing the stress experience
Personal characteristics, society, gender, race, socioeconomic and marital status (to name a few) can all affect the way people experience stressful situations and reaction to stress. Folkman and Lazarus (1986) suggest that people with high depressive symptoms were more likely to be more vulnerable to threat and hostility, judging their situation as being more severe, which produces experiences of high stress levels. DeLongis, Folkman and Lazarus (1988) tested the impact of stress on health and mood and found that individuals with low self-esteem and unsupportive social relationships were more vulnerable to stress-related illness and mood disturbances than those with higher self-esteem and close social relationships.

Personality is closely related to formulation of goals, assumptions, beliefs and expectations and influences understanding of the past and the future, and ability to appraise and respond to stressful situations (Park & Folkman, 1997). According to trait theory, those high in neuroticism are more likely to see events as threatening, whilst those high in optimism will perceive the same as a challenge instead, indicating that personal dispositions contribute to how any given situation is perceived (Park & Folkman, 1997).

But a stressful situation, in itself, doesn't predict stress, or how an individual will react. The situation triggers a cognitive process whereby an individual assesses harm or threat to them, and their ability to deal or cope with it (Lazarus, 1993). Emotions are part of the stress reaction and allow better understanding of the person-environment interaction, as well as the environment itself (Lazarus, 1993).

Cognitive appraisal
Cognitive appraisal is the personal evaluative process which categorises a situation and focusses on the implications, meaning or significance of the changing relationship between the person and the environment (Lazarus & Folkman, 1984) which can elicit an emotional response. Individuals and groups differ in the degree and kind of reaction, as well as their sensitivity, vulnerability and interpretation of demanding pressures (Lazarus & Folkman, 1984). For example, divorce may represent a loss or failure for some, whilst for others it may be freedom and relief from an unsuitable or stressful relationship; job loss will possibly be viewed differently for a 20 year old than at 55. To any given situation, one person may respond with anger, aggression or frustration, another with anxiety and guilt, whilst another may ignore it. The significance of the encounter is influenced by personal beliefs, commitments and goals. The meaning of an event may not always be the same when experienced at different times (Park & Folkman, 1997). How each person construes an event will shape their emotional and behavioural response (Lazarus & Folkman, 1984).

For Lazarus and Folkman (1984), appraisal is a complex, high level cognitive activity and they posed that individuals evaluate a situation for relevance to their personal well-being (primary appraisal), and whether there is anything they can do to cope with possible benefits or threats (secondary appraisal).

Primary appraisal
Primary appraisal is the motivational significance of the situation and can be divided into three categories: irrelevant, where the stimuli has no implication for the person's well-being; benign-positive, where the outcome is deemed as positive with pleasurable emotions; and stressful, characterised by harm or loss, threat and challenge (Lazarus & Folkman, 1984). People who believe in their ability to control events, or believe in a benevolent world, will be more likely to view potentially threatening occurrences as challenges, rather than stressful (Park & Folkman, 1997), and are less likely to be overly affected by unexpected events. However, Park and Folkman (1997) identified that traumatic events such as serious illness or accidents, untimely death of a loved one, or disasters which people cannot control, can still be highly stressful even for these people.

Secondary appraisal
Secondary appraisal is the evaluative judgement of the situation in terms of the significance of the event for their well-being and what can be done to alleviate and manage the situation (Folkman & Lazarus, 1986) with regards to possible coping and expected outcome. Secondary appraisal depends on how much control a person feels they have, actions likely to improve the situation, and the stakes involved (Lazarus & Folkman, 1987), and shapes the degree of stress and emotional reaction. If a person feels they are inadequate to deal with the situation, or they have a high stake and commitment in the outcome, the resultant stress may be high due to the perception that the loss or harm cannot be prevented or overcome (Lazarus & Folkman, 1984).

Primary and secondary appraisal cannot be considered as separate processes, but are interdependent and influence each other. Another form of appraisal is reappraisal, which, on the basis of new information, can sometimes mediate the evaluation of the situation (Lazarus & Folkman, 1984), resulting in the outcome being modified to be less, or more, threatening.

How does cognitive appraisal assist with stress?
In the 1960's, in an effort to understand more about cognitive appraisal in the stress and coping situation, Lazarus and colleagues used movies depicting horrific violent scenes to discover how cognitive appraisal plays a powerful role in mediating stress response levels (Lazarus & Folkman, 1984). During the 1970's, as reported by Lazarus and Folkman(1984), extensive studies and observations were conducted and reported by various scientist on cognitive appraisal, to identify what role, if any, it played in mediating stress in stressful situations. From these, and their own further research, Lazarus and Folkman (1984) concluded that the way a person appraises a situation directly influences the coping process and their emotional reaction, showing that cognitive appraisal is important in mediating thoughts, feelings and action and is central in identifying different coping styles.

Lazarus and Folkman (1984) identified that to explain success or failure, attribution theory, which attributes causality to events effecting behaviour, could be extended to include emotional and thought processes that lead to improved outcomes and behaviours.

Coping
Coping arises from appraisal that the demands of an event exceed personal resources and is motivated by the emotional response to harm and threat (Lazarus & Folkman, 1987). This appraisal serves two primary functions: to change the person-environment relationship and to influence the level of emotional distress. Coping comprises the cognitive and behavioural efforts required to manage the internal or external environment when a level of dissonance exists in a person's perception of their ability and resources to deal with the psychological stress (Lazarus & Folkman, 1984).

Coping can be defined by the relationship between the person and the environment (Lazarus & Folkman, 1984) and depends on subjective well-being, social functioning and somatic health, as well as the relevance placed on these by the individual at any given time. This relationship is constantly changing from one time to another, and can be seen in the complex stages of an examination, where students go through a prior warning period, a confrontational stage or exam, and a waiting period for results, all of which require different coping strategies (Lazarus, 1993).

Coping strategies
In their early research, Lazarus and Folkman (1987) found that the two most relevant and practical ways of coping that people used in almost all stressful encounters were directed at both altering the person-environment (problem-focus) and managing the emotional distress (emotion-focus). Emotion-focused coping attempts to either change the way the stressful environment is viewed, or to change the personal meaning of the situation resulting in distancing from the event, escape-avoidance or seeking social approval (Lazarus, 1993). Problem-focused coping seeks to change the relationship by acting on either the environment or the person (Lazarus, 1993) and is achieved by evaluating the stake in the encounter and using confrontive coping strategies, self-control, accepting responsibility, planful problem solving, and positive reappraisal (Lazarus & Folkman, 1987).

Some coping strategies, such as planful problem solving and positive reappraisal can result in positive emotional changes and provide satisfactory outcomes (Lazarus, 1993) whilst confrontive coping or distancing causes negative emotions, more distress and are associated with unsatisfactory outcomes.

Factors influencing coping skills and abilities
Lazarus (1993) also found that a coping strategy may not produce the same results across all situations or individuals. Lazarus and Folkman (1987) identified that those high in depressive symptoms appeared to judge their stakes to be in greater jeopardy in a stressful encounter, responding with high levels of worry and fear. Stress levels were also found to influence coping strategies: perception of increased stress decreased the likelihood of applying cognitive appraisal and coping strategies (Miller & McCool, 2003).

Individuals with personality Type A or Type B have been found to use differing coping strategies (Lazarus & Folkman, 1984). Type A personality is related to high values, excessive drive and competitiveness, are high achieving and ambitious, and cope with a high workload without high stress levels (Lazarus & Folkman, 1984); Type B individuals usually have a lower work level, are reflective, relaxed, social and easy going and cope less well with stress as they may not feel as in control.

The social environment can provide both stress and support to an individual (Lazarus & Folkman, 1984). People who feel geographically isolated or don't have close relationships are more likely to have lower coping strategies and negative emotional responses, whilst a strong social network can provide emotional support, direct aid and services, information and advice (Lazarus & Folkman, 1984), all of which can assist an individual to cope with both major life events and daily hassles.

For a test of your stress triggers try this: What are your stress triggers?

The transactional process of coping
The transactional process integrates separate person and environmental issues (Lazarus & Folkman, 1984) and emphasises cognitive appraisal to evaluate the harm, threat or challenge presented by the encounter. The process is the flow of events between a constantly changing environment and the individual's reaction and emotional state, where the shift in emotions reflects changes in the meaning of the relationship (Lazarus & Folkman, 1984).

Measurement
In the late 1970s, Lazarus developed the Ways of Coping scale (Lazarus, 1993) and its use produced a number of important findings about the coping process: people use most of the strategies identified by the scale as ways to cope; some coping strategies are more stable and consistent, whilst others are more inconsistent, across stressful encounters; coping changes across time in any given situation; emotion-focussed coping was used when the situation appeared difficult to change, and problem-focused coping was used if the encounter was controllable by action; and coping mediated the emotional response from beginning to end of the encounter.

Treatment approaches to stress
Many theories have been developed over the years to understanding the stress, appraisal and coping strategies that people apply. From the Freudian method of uncovering childhood fears and wishes that are perpetuated in adult life (Lazarus & Folkman, 1984), to dynamic theories that combined the Freudian beliefs with understanding how these conflicts are maintained in adult life despite providing unsatisfactory resolution. Affective theorists following the classical conditioning of Pavlov (Lazarus & Folkman, 1984) believed that the use of habitual avoidant coping responses prevent an individual from learning alternative ways of coping. Whactel, according to Lazarus and Folkman (1984), attempted to integrate psychoanalytical and behavioural therapies, identifying that dysfunctional behaviours learned from childhood are sustained into adulthood, becoming self-perpetuating and interfering with adaptation. Both the avoidance and psychodynamic approaches to treatment involve identifying and exposing the causes of anxiety and learning new ways to cope to reinforce desirable behaviour (Lazarus & Folkman, 1984).

Cognitive-behaviour approaches recognise that cognitive processes have a role in determining emotion and behaviour and can either sustain or eliminate inappropriate coping strategies (Lazarus & Folkman, 1984), and are most compatible with Lazarus and Folkman's theory of stress and coping. The goal of cognitive restructuring, and cognitive behaviour therapy (Lazarus & Folkman, 1984) is to enable an individual to identify and become aware of negative self-statements which result in emotional distress, and to learn new ways to problem solve and cope.



The transactional theory of stress and coping (Lazarus and Folkman, 1984) identified that stress is the result of interplay between the individual and the environment, so for therapy to be effective it must consider both and must attune the individual with the environment. Stress reactions and coping are contextual and can change for different types of encounters, as the encounter unfolds and when experienced at different times. Effective therapy centres on a person's emotional life and is built around their vulnerabilities and coping mechanisms as well as their strengths (Lazarus & Folkman, 1984). For those who notice that they are just not coping with stress, or are experiencing mental health illness associated with stress, cognitive behaviour therapy can assist.

The aim of cognitive behavioural therapy using the transactional stress and coping model views the appraisal processes, emotions and coping strategies as intertwined and is used to assist an individual to make more favourable appraisals about their reactions and to assess the outcome in a more positive way (Lazarus & Folkman, 1984). Therapy consists of both cognitive and behavioural techniques to change a person's beliefs and thoughts and to teach new skills and techniques to change their behaviour (Lazarus & Folkman, 1984), and can include exposure therapy, cognitive processing therapy and relaxation training, including meditation, mindfulness and yoga.

Lazarus and Folkman (1984) realised that the solution may not be a one-size-fits-all approach to addressing the cognitive, behavioural and emotional processes that an individual experiences and ongoing research is needed.

Table 1 Transactional model of stress and coping process (derived from Lazarus & Folkman, 1984)

Conclusion
The transactional model integrates personal and environmental issues and focuses on cognitive appraisal to evaluate the threat posed by the encounter which can result in stress. It looks at how major life events and daily hassles impact on a person's emotions, how they may view the encounter based on their personal well-being and appraise their ability to cope and deal with any resultant harm or threat. Some people are more vulnerable to stressful situations than others, especially those with high depressive symptoms, or have certain personality traits, such as high neuroticism or low optimism. Stress can cause biological and psychological changes leading to chronic illness and addictions as well as anxiety and depression. The coping ability of any person is mediated by their characteristics, previous experiences, beliefs and values and is defined by the relationship between the person and the event, and may not always be the same when experienced at different times or by different people. Coping strategies involve either altering the person-environment relationship, or managing the emotional distress resulting from the encounter, or both. Lazarus and Folkman (1984) advocate cognitive behaviour therapy to assist an individual to identify and become aware of inappropriate coping strategies which lead to emotional distress, and learn new ways to problem solve and cope with stressful situations.