How Do You Cope?

CrohnoGlass

Learning to cope with inflammatory bowel disease is crucial to living with the disease — but are some coping strategies better than others? Is there a ‘best’ way to cope with IBD?

It turns out there have been several studies of coping. Not surprisingly, some ways of coping are better than others. The most recent study along these lines was published last year in the Southern Journal of Medicine.*

The authors took 150 patients with IBD and gave them a survey that looked at their coping behaviors. The survey asks patients to note how often they do things like, “prayed or put your trust in God”, “waited to see what would happen”, or “tried to keep a sense of humor”.

The survey groups those responses into eight strategies: “evasive”, “confrontive”, “self-reliant”, “palliative”, “optimistic”, “emotive”, “supportant”, and “fatalistic” coping.

The study does not give much detail about the scale and what these strategies really mean, but after some Googling we found a book** that does:

CopingStrategiesPatients can use more than one strategy, of course, but the study found that  participants most often used “confrontive (46.7%), evasiveness (30%), optimistic (18.7%), and fatalistic (4.6%) coping.”

Patients rated confrontive (62.0%), optimistic (26.6%), and evasive (11.3%) coping styles as the most effective strategies.

But — study participants also took a survey of their quality of life, which the authors then compared to their coping strategies. And it turns out that patients with confrontive and optimistic styles of coping were better off than those who used evasive or fatalistic strategies.

This might be because patients who were sicker were more likely to use the less effective strategies, but there are good reasons to think that the wrong coping strategy can lead to worse health. If a person is ‘evasive’ and trying to ignore their disease, it stands to reason they are less likely to pay attention to important symptoms or changes in their health.

Across all measures — social function, bowel symptoms, emotional health — patients who were optimistic or confrontive were better off than patients who used other strategies. This is important because:

The way a patient copes with his or her disease has repercussions on adherence, perception of disease, functionality, and QOL.

Keep in mind that this isn’t the only study of coping in IBD patients. A review article in the Journal of Crohn’s & Colitis in 2013 looked at previous studies,*** and found slightly different results.

The review study divided coping strategies into two kinds: problem-solving and emotion-focused. This allowed them to assess studies that used a variety of measures of coping, including the JCS scale above. On the JCS scale, “confrontive” and “supportant” are problem-solving strategies, and the rest are emotion-focused.

In the review, 12 studies “showed a strong relationship between coping” and outcomes, while 13 had mixed results and two showed “little to no effect of coping”.

One thing the review found was that “emotion-focused coping has been associated with worse psychological outcomes”. But, the study points out, people with more active disease tend to adopt more emotion-focused strategies — especially because the disease is beyond their control.

The review authors suggest that “adaptive” coping means using a problem-solving strategy for things you can control, and an emotion-focused strategy for things you can’t control. “Maladaptive” — bad — coping is just the opposite.

What strategies do you use? Do they work for you?

*The study is Parekh, N.; et al. “Coping Strategies Used By Adult Patients With Inflammatory Bowel Disease”. Southern Medical Journal 108:6 (June 2015) pp. 337-342. Abstract online. A copy of the paper was provided by a friend of the blog.

**Jalowiec, Ann. “The Jalowiec Coping Scale.” Chapter 6 in Waltz, C.F.; Jenkins, L.S.; Strickland, O.;   Dilorio, C. Measurement of Nursing Outcomes 2nd Ed. , Vol. 3.: Self Care and Coping. (2003, Springer) pp. 71-86. Available Through Google Books

***The review study is McCombie, A.M; Mulder, R.T.; Gearry, R.B. “How IBD patients cope with IBD: A systematic review.” Journal of Crohn’s & Colitis 7 (2013), pp. 89-106 .

Photo “half full or half empty?” by Flickr user Ansy Wong used under Creative Commons license.

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