Crisis theory 🧠 proposes that coping 💪 begins with the patient's cognitive appraisal 🤔 of the meaning 💭 or significance 🎯 of the health problem 🏥 to his or her life 🌍. The outcome 🎯 of this appraisal 🤔 leads the individual to formulate an array of adaptive tasks 📋 and to apply various coping skills 💪 to deal with these tasks ✅. Let's see what these tasks and skills are 🔍.
The Tasks and Skills of Coping 💪📋
According to Moos 👨🔬 (1982), people who are ill 🤒 need to address two types 2️⃣ of adaptive tasks 📋 in the coping process 💪:
Tasks Related to the Illness or Treatment 🏥💊
Tasks related to the illness or treatment 🏥, which involve learning to:
- (1) Cope with the symptoms 🤕 or disability ♿ the health problem causes.
- (2) Adjust to the hospital environment 🏥 and medical procedures 💉 needed to treat the problem.
- (3) Develop and maintain good relationships 🤝 with their practitioners 👨⚕️.
Tasks Related to General Psychosocial Functioning 🧠👥
Tasks related to general psychosocial functioning 🧠, which involve striving to:
- (1) Control negative feelings 😔 and retain a positive outlook 🌟 for the future 🔮.
- (2) Maintain a satisfactory self-image 🪞 and sense of competence 💪.
- (3) Preserve good relationships 👥 with family 👨👩👧👦 and friends 🤝.
- (4) Prepare for an uncertain future 🔮.
These tasks can be very difficult 😔 for patients 🤒, particularly when their health problems 🏥 may lead to disability ♿, disfigurement 😰, or death 💀. Still, many people with poor prognoses 📉 for their health manage to adapt successfully ✅ and make the most 🎯 of their new life circumstances 🌍.
Crisis theory 🧠 proposes that patients encounter these adaptive tasks 📋 in any health problem 🏥 they experience. But the relative importance 📊 or salience of each task 📋 for each illness 🤒 or injury 🤕 depends on the nature of the condition 🏥 and the patient's personality 🧠 and environmental circumstances 🌍. A person who becomes blind 👁️❌ may have little physical discomfort 😌, but may experience difficulty 😔 maintaining a job 💼 or social relations 👥. A woman 👩 who has a mastectomy 🏥 may need to focus on adapting 🔄 to her new self-image 🪞. A professional athlete 🏃♂️, construction worker 👷, or other physically active individual 💪 is likely to experience more difficulty 😔 adapting to a wheelchair ♿ than a more sedentary person 🛋️.
Family members 👨👩👧👦 must make similar adjustments 🔄, and these individuals are critically important 🎯 in helping patients 🤒 achieve each goal 🏆. Patients are likely to adapt well ✅ to a chronic condition ⏳ if their family members 👨👩👧👦 participate actively 🏃♂️ in their treatment regimens 💊, encourage them to be self-sufficient 💪, and respond to their needs 🤝 in a caring 💝 and sensitive manner 🥰.
What coping skills 💪 do patients 🤒 and their families 👨👩👧👦 employ to deal with these adaptive tasks 📋? The next section describes several useful strategies 🛠️ that they commonly use ✅.
Coping Strategies for Chronic Health Problems 🛠️⏳
1. Denying or Minimizing the Seriousness 🙈📉
Denying or minimizing 🙈 the seriousness of the situation 📉. As we have seen, this approach can be beneficial ✅ in the early phases 🏁 of adjusting to a health problem 🏥. Patients may benefit from this approach 💡 by using it selectively 🎯 to put aside their emotions 😢 temporarily ⏱️, thereby saving them from feeling overwhelmed 🌊 and giving them time ⏰ to organize other personal coping resources 💪.
2. Seeking Information 📚🔍
Seeking information 📚 about the health problem 🏥 and treatment procedures 💊.
3. Learning Self-Care 💉🎓
Learning to provide one's own medical care 💉 such as self-administering insulin shots 💉. With this approach, patients gain a sense of control 🎮 and personal effectiveness 💪 with respect to their conditions 🏥.
4. Setting Goals 🎯📋
Setting concrete, limited goals 🎯 such as in exercising 🏃♀️ or in going to shows 🎭 or social gatherings 👥, and maintaining regular routines 🔄 as well as possible. By doing this, patients 🤒 and their families 👨👩👧👦 have things to look forward to 🌟 and opportunities to achieve goals 🏆 they consider meaningful 💫.
5. Recruiting Support 🤝💬
Recruiting instrumental and emotional support 🤝 from family 👨👩👧👦, friends 👥, and practitioners 👨⚕️ by expressing needs 🗣️ and feelings 😢.
6. Considering Future Events 🔮⚠️
Considering possible future events 🔮 and stressful circumstances 😰 in order to know what lies ahead 🛤️ and to be prepared ✅ for unexpected difficulties ⚠️.
7. Gaining Perspective 🌟💭
Gaining a manageable perspective 👁️ on the health problem 🏥 and its treatment 💊 by finding a long-term "purpose 🎯" or "meaning 💭" for the experience 🌟. Patients often do this by applying religious beliefs 🙏 or by recognizing how they have been changed in positive ways ✨ by the experience 🌈.
As we can see, each of these skills 💪 can help in achieving the goals 🎯 of adaptive tasks 📋 and in leading to a positive outcome ✅ of the crisis 🚨. Is one approach best 🏆? Generally speaking, although moderate or temporary use 📊 of any specific skill 💪 can be beneficial ✅, using any single skill exclusively ❌ may undermine the coping process 💪. Some coping skills 🛠️ may be more appropriate ✅ for dealing with some tasks 📋 than with others. As a result 🎯, people generally use these skills selectively 🎯, often in combination 🔗.
For instance, seeking information 📚 may help patients deal with the symptoms 🤕, and setting reasonable goals 🎯 may help them do exercises 🏃♀️ and reduce their incapacitation ♿📉. Individuals who have adjusted successfully ✅ to each phase 🔄 of the crises 🚨 are ready to deal effectively 💪 with subsequent phases 📈 in their adjustment 🔄 to their health problems 🏥.
Long-Term Adaptation to Chronic Health Problems ⏳🔄
Chronic disorders ⏳ last for a very long time ⏰—and patients 🤒 and their families 👨👩👧👦 need to adapt 🔄 to the illnesses whether they worsen 📉, stay the same ➡️, or improve over time 📈. The term adaptation 🔄 refers to "the process of making changes 🔄 in order to adjust constructively ✅ to life's circumstances 🌍." For chronically ill individuals ⏳ and their families 👨👩👧👦, the adaptive changes 🔄 they make can enhance their quality of life ✨ by promoting their effective physical 💪, psychological 🧠, and social functioning 👥.
What Does "Quality of Life" Mean? 🌟❓
Quality of life ✨ refers to the degree of excellence 🏆 people appraise 🤔 their lives to contain. People around the world 🌍 appraise excellence 🏆 with similar criteria 📊, such as performing daily activities 📅, energy ⚡ or discomfort 😣, positive 😊 and negative feelings 😢, personal control 🎮, interpersonal relations 👥, pleasant activities 🎉, personal and intellectual growth 🌱, and material possessions 💰.
When chronically ill people ⏳ can expect to live for many years 📆, they need to make many decisions 🤔, such as career selections 💼, that involve examining their options 🔍 based on realistic assessments ⚖️ of their conditions 🏥. People who continue to rely heavily 📈 on avoidance coping strategies 🙈, such as denial ❌, are less likely to adapt effectively 💪 than those who use strategies that allow them to consider their situations more carefully 🔍 and objectively 📊.
Impacts of Different Chronic Conditions 🏥🔍
What is it like to live 🌍 with a chronic health problem ⏳? To some extent, the answer depends on the illness 🏥. Beginning with this section, we will consider the impact 💥 of specific chronic medical conditions 🏥 and treatments 💊 on patients 🤒 and their families 👨👩👧👦. The particular health problems 🏥 we will examine were selected to illustrate disorders of different body systems 🧬 and widely different adjustment difficulties 😔. Some of the health problems 🏥 tend to develop at much earlier ages 👶 than others 👴; some require much more complex treatment regimens 💊 than others; and some produce more pain 🤕 and disability ♿ than others.
People who are disabled ♿ by illness 🏥 are more likely than others to adjust poorly 📉 to their condition and become clinically depressed 😢. After we discuss these disorders 🏥, we will consider psychosocial approaches 🧠 to help chronically ill people ⏳ adapt to their condition ✅.
Although the medical problems 🏥 we will discuss here include some that can be life-threatening 💀, none of these chronic conditions ⏳ is among the most deadly illnesses 💀 people around the world 🌍 develop— particularly heart disease ❤️, cancer 🎗️, stroke 🧠, and AIDS 🦠.
We will use a life-span perspective 👶👴 to organize the health problems 🏥: illnesses that generally begin in childhood 👶 will be presented first 1️⃣, and illnesses that usually begin in old age 👴 will be considered last 🔚. As we have seen, the impact 💥 of a health problem 🏥 and the way people cope 💪 with it depend partly on the patient's age 📆. We will start by considering the impact 💥 of asthma 😮💨, a chronic respiratory disorder 🫁 that generally begins in the early childhood years 👶.
Asthma 😮💨🫁
We all experience respiratory disorders 😷 at one time or another. If we are fortunate 🍀, these disorders are limited to occasional bouts with colds 🤧 and the flu 🤒. But millions of people are not so fortunate 😔— they suffer from chronic respiratory problems 🫁⏳. In some cases, these problems involve constant breathing impairments 😮💨 that vary in intensity 📊 from one day to the next 📅. In other cases, the victims breathe normally 😊 most of the time ⏰ but suffer recurrent episodes 🔄 of impaired breathing 😮💨. Some chronic respiratory disorders ⏳ become severe enough 📈 to disable their victims ♿ and may even claim their lives 💀. This can happen with asthma 😮💨.
What Is Asthma? 😮💨❓
Imagine being at home 🏡 reading 📖 one evening 🌙 and noticing that a slight whistling 🎵, wheezing sound 😮💨 starts to accompany each breath 🫁 you take. Soon the sound becomes louder 📢 and your breathing becomes labored 😰. You try opening your mouth 👄 to breathe, but very little air 💨 goes in or out ❌. When your chest 🫁 begins to contract from the effort 💪 and your heart 💓 pounds rapidly 📈 you are quite frightened 😨 and worry 😰. "Will my next gasp for air 💨 be my last 💀?" This is what a major asthma attack 😮💨 is like. Victims of extreme attacks 😱 may begin to turn blue 🔵 and look as if they are about to die 💀 and some do die ⚰️.
Asthma 😮💨 is a respiratory disorder 🫁 involving recurrent episodes 🔄 of impaired breathing 😮💨 when the airways become obstructed 🚫. This disease is very prevalent 📊 around the world 🌍; in the United States 🇺🇸 alone, about 17 million people 👥 (6% of the population 📊) suffer from asthma 😮💨. Prevalence rates 📈 are much higher for children 👶 than adults 🧑. Although the disorder may emerge at any age 👶👴, it is most likely to develop by age 5 5️⃣ in children 👶 and between the ages of 30 and 40 📆 among adults 🧑.
Fortunately 🍀, most childhood cases 👶 of asthma 😮💨 become less severe 📉 over time ⏰, and 25 to 50% 📊 of the children 👶 who develop asthma 😮💨 no longer have symptoms ✅ by the time they reach adulthood 🧑. Each year 📅, over 5,400 asthmatics 😮💨 in the United States 🇺🇸 die 💀 from asthma attacks 😮💨; the death rates 📈 from attacks have increased since 1980 📆 and are higher among African Americans ⬛ than white individuals ⬜.
Because African Americans ⬛ have lower incomes 💰📉 than whites ⬜ and are less likely to have regular physicians 👨⚕️❌, they tend to use hospital emergency rooms 🚑 as their main source 🏥 of treatment for asthma 😮💨 and seek help 🆘 mainly when attacks are severe 😱.
Asthma 😮💨 is clearly a major health problem 🏥. Let's see what causes asthma attacks 🔍.
The Physiology, Causes and Effects of Asthma 🧬😮💨
Asthma episodes 😮💨 typically begin when the immune system 🛡️ is activated to react in an allergic manner 🤧, producing antibodies 🧬 that cause the bronchial tubes 🫁 and other affected body tissues 🧬 to release a chemical called histamine. This chemical causes irritation 🔴 to those tissues 🧬. In an asthma attack 😮💨, these events cause the bronchial tubes 🫁 to become obstructed 🚫 as their smooth muscles 💪 become inflamed 🔴, develop spasms 😣, and produce mucus 🤢. These events last, perhaps, an hour or two ⏰ and can lead to tissue damage 🧬❌, thereby increasing 📈 the likelihood of more frequent 🔄 and severe future attacks 😱. For some asthmatics 😮💨, airway inflammation 🔴 becomes constant ⏳.
What Causes Asthma Attacks to Happen? 💥❓
We do not have a full answer ❌ to this question ❓, but we do know that attacks usually occur in the presence of certain conditions 🔍, called triggers 💥. Asthma triggers 💥 can include personal factors 👤, such as having a respiratory infection 🤧 or feelings of anger 😠 or anxiety 😰; environmental conditions 🌍, such as air pollution 🏭, pollen 🌸, or cold temperature ❄️; and physical activities 🏃♀️, such as strenuous exercise 💪. The triggers 💥 that lead to attacks are different for different asthmatics 😮💨, and some individuals have attacks only when two or more triggers 💥💥 occur at the same time ⏰.
The main triggers 💥 for many asthmatics 😮💨 are allergens 🤧— substances, such as pollens 🌸 or molds 🍄, that are known to cause allergic reactions 🤧. But other asthmatics 😮💨 do not have any known allergies ❌, and other factors, such as physical exercise 🏃♀️ or cold air ❄️, are the main triggers 💥 for them. Tests 🧪 for allergic reactions 🤧 usually involve injecting a small amount 💉 of the allergen under the skin 🧴 and checking to see if the skin 🧴 in that area becomes inflamed 🔴.
Medical Regimens for Asthma 💊😮💨
Medical approaches 🏥 provide the cornerstone 🏛️ of treatment for asthma 😮💨. Asthma regimens 💊 consist of three components 3️⃣, the first being to avoid known triggers 🚫💥 of attacks. The second component 2️⃣ involves medication 💊. To treat an acute attack ⚡, patients mainly use bronchodilators 💨, which open up constricted airways 🫁. To prevent attacks 🛡️, patients can use anti-inflammatories 💊, such as inhaled or oral corticosteroids 💉 and cromolyn, which reduce bronchial inflammation 🔴📉 or block the release of histamine 🧬 and other chemicals that cause inflammation 🔴.
The third component 3️⃣ of asthma regimens 💊 involves exercise 🏃♀️. In the past ⏮️, physicians 👨⚕️ advised many asthmatics 😮💨 to avoid exercise 🏃♀️❌ because it could induce an attack 💥. But it now appears that the less 📉 these people exercise 🏃♀️, the worse 📈 their conditions get. Many physicians 👨⚕️ today recommend treatment regimens 💊 that carefully combine fitness training 🏋️ and the use of medication 💊.
Asthma's potential 💥 for producing disability ♿ and, sometimes, death 💀 makes it important ⚠️ that patients adhere ✅ to their regimens 💊. Although adhering to asthma regimens 💊✅ reduces attacks 📉 and incidents of wheezing 😮💨, many asthmatics 😮💨 fail to take medication 💊❌ to prevent attacks and use medication during an attack incorrectly ❌.
Psychosocial Factors in Asthma 🧠😮💨
Many people with asthma 😮💨 report that the triggers 💥 of their attacks often involve their emotional states 😢, such as being worried 😟, angry 😠, or excited 😄. Experimental research 🔬 has shown that emotional arousal 😰; such as when watching an exciting movie 🎬, can trigger attacks 💥 in some children 👶. Studies 📊 have also found that suggestion 💭 can induce symptoms 😮💨 in some asthmatics.
In one study 🔬, researchers 👨🔬 had asthmatics 😮💨 inhale several doses 💨 of a placebo solution 💊, with each succeeding dose labeled as containing an increasingly strong level 📈 of an allergen 🤧. Nearly half 📊 of the subjects developed symptoms 😮💨, either as full asthmatic attacks 😱 or as spasms of the bronchial muscles 💪. Another study 🔬 confirmed the effect of suggestion 💭, but also showed that the asthmatic reaction 😮💨 could be negated ❌ if the subjects were first given another placebo 💊 that was described as a new asthma drug 💉. In other words, the first suggestion 💭 blocked the second one 🚫.
For example, studies 📊 have shown that false feedback 📊❌ indicating that the airways are becoming obstructed 🚫 increases breathlessness 😮💨 in people with asthma 😮💨.
Although there is little question ❓ that psychosocial factors 🧠 can influence asthma attacks 😮💨, we do not know how these factors work 🤔 and which asthmatics 😮💨 are more affected by them. It is possible that psychosocial factors 🧠 make asthmatics 😮💨 more sensitive 📊 to allergens 🤧 or other conditions that trigger 💥 their attacks.
Asthma attacks 😮💨 are frightening 😨 for the patient 🤒 and family 👨👩👧👦 alike; and frequent episodes 🔄 are costly 💰 to the family and disrupt these people's lives 🌍 and functioning 📉. Living with this disorder 😮💨 adds to the stress 😰 that asthmatics 😮💨 and their families' 👨👩👧👦 experience, and studies 📊 have found that asthma 😮💨 is sometimes related to maladjustment 😔 in patients 🤒 and their families 👨👩👧👦.
Summary 📋
Understanding the coping process 💪 in chronic illness ⏳ involves recognizing the adaptive tasks 📋 patients face—both illness-related 🏥 and psychosocial 🧠—and the various coping strategies 🛠️ they employ, from seeking information 📚 to gaining perspective 🌟. Long-term adaptation ⏳ requires balancing multiple approaches 🔄 to maintain quality of life ✨. Asthma 😮💨 exemplifies how chronic conditions affect patients physically 💪, emotionally 😢, and socially 👥, highlighting the importance of comprehensive treatment 💊 that addresses both medical 🏥 and psychosocial factors 🧠.