Lazarus bib

Journal of Community & Applied Social Psychology, Vol. I , 57-70 (1991)
Stress and Coping in Mothers Caring for a Child with
Severe Learning Difficulties: A Test of Lazarus’
Transactional Model of Coping
LYN QUINE*
Institute of Social and Applied Psychology University of Kent at Canterbury CT2 7LZ, UK
JAN PAHL
National Institute of Social Work Tuvistock Pluce, London
ABSTRACT
The literature on psychological stress among women consistently points to the adverse effects
of child rearing on mothers, particularly those caring for children with physical or mental
handicaps. Early studies of the effects on family functioning of caring for a child with severe
learning difficulties adopted a pathological approach in which it was assumed that psychological
distress was inevitable among family members, particularly mothers. Recent research has
emphasised that many families cope with and adapt to the stress they experience, and seeks
to discover how they do so.
The paper reports on a study of 166 mothers caring for a child with severe learning difficulties.
The aim of the study was to investigate both the factors associated with maternal stress
and those which might mediate or buffer the effects of stress. The study used the Folkman
and Lazarus’ (1979) transactional model of stress. Stress is the condition that results when
persodenvironment transactions lead the individual to perceive a discrepancy between the
demands of a situation and hisher resources or ability to cope with those demands. The
nature and type of coping generated by a person will be determined by the coping resources
in the person’s environment. The model identifies five categories of coping resource: utilitarian
resources, healtWmorale, social networks, general and specific beliefs, and problem solving
skills. In our study, the five coping resources were represented by the mother’s social class
and appraisal of her financial worries, physical health, social support, acceptance of and
adjustment to the child, and assessment of coping skills. Stress was measured by the Malaise
Inventory (Rutter, 1970).
Four of the five coping resources were found to be significant contributors in a hierarchical
regression analysis of stress scores, contributing additional variance beyond that of behavioural
and other child characteristics. Altogether, 55% of the variance in stress scores was explained.
Key wordr: Stress, coping, severe learning difficulties, families.
XNTRODUCTION
In recent years a growing number of studies have examined the effect on family
* Lyn Quine is Senior Research Fellow at the Institute of Social and Applied Psychology, University
of Kent at Canterbury. Reprint requests to Lyii Quine please. Jan Pahl is Director of Research at the
National Institute of Social Work, Tavistock Place, London.
1052-928419 110 10057-14$07.00
0 1991 by John Wiley & Sons, Ltd.
Received I1 February 1991
Accepted 26 February 1991

Stress and Coping

The transactional model of stress and coping is a phenomenally dynamic concept to apply. Glazer’s text describes the model as “a framework for evaluating processes of coping with stressful events. Stressful experiences are construed as person-environment transactions, (213)” these transactions are then processed by the person under the management of the person’s mind and body. The ability of each person to interpret stress, and then act upon it, is seen in the case study and is researched here.

The case, "Stress, Coping, and Health: The Sandwich Generation," details the process for investigating the way women of the "sandwich generation" (those women responsible for caring for not only their children but their aging parents as well) cope with stress through the creation of an hour-long video segment and all the research questions involved. The case is one of great concern for all people who experience stress or eustress and their potential effects. Judging by most research on the subject, stress has a strong effect on any who experience it; the matter now up for question is how stress is coped with. The case touches on the many aspects of secondary appraisal process of coping with stress, and the purpose of this research paper is to describe that process and discuss the the mediating roles of social support and coping styles all involved in this coping process. More, research has been found to explore the ability of the five women in the 'sandwich study' to cope in broad terms. In that way, just as the study hoped, this research too may also be applicable to men and children.

Namely, the case defines stress as the following, "The term 'stress' is used liberally in lay discourse, at times referring to any event or interaction that prompts an individual to adapt or change. Stressors can be daily hassles or major life events (1)". Lazarus and Folkman defined it "as the outcome of an interaction between the person and the environment, where demands are appraised as taxing or exceeding the person's resources." With the double duty of caring for a parent and a child as the sandwiched generation is, there is a double load of stress. The question, that most of this research deals with then becomes how do these caregivers work with the potentially stressful events associated with that double duty.

The potentiality of the event being stressful relates to the appraisal process because as Park and Folkman point out, the interpretation of events is very personal. While primary appraisal deals with first line analysis of perceived susceptibility, perceived severity, and motivational relevance there is still much for an individual to do once they reach secondary appraisal, which is referred to as “an assessment of the resources available for coping,” (Quine 59). This simple definition relates to much of the hypothesizing done in the study. From the consideration of “attitudes and experiences of different cultural, racial and ethnic groups on the situations at hand,” identified on page 2 of the ‘sandwich study’, to the suggestion to “reflect upon whether an intergenerational approach to coping exists,” on page 6, resources for coping can be found in many parts of life. The women really need a tool for identifying their strongest coping assets and regimenting them. The secondary appraisal process being so dynamic it’s possible that anyone attempting to manage their resources may feel overwhelmed without such a tool.

            Secondary appraisal is a dynamic process; It dynamism rest upon the number of ways to use resources. The coping effort rests upon what Taylor describes as Problem focused coping and Emotion focused coping, “Problem focused coping is aimed at changing the external world in some way, in an attempt to deal directly with the environmental source of stress (Conversations about Coping, 13).” Now because the TMSC states that the secondary appraisal process is mediated by these coping efforts, then the attempt to change the external world is the implementation of perceived control over outcomes: moving from perception to implementation.  Each woman has different resources and, for the most part, they cover a range of ages and lifespan stages. Depending on their resource level, cultural background, and experience dealing with stress (age) they will be either more or less confident in their ability to handle the stressor. On page 5 the study describes "several of the women share a common stressor, i.e., financial concerns, some of which result from or are exacerbated by the added stress of caregiving for their parent(s) or rising child care costs." But upon considering the stations of these women in life, the reader can hypothesize that based on the TMSC theory of self-efficacy the woman who is described as older, married, full-time career, affluent, stable childcare will have a greater belief in her ability to cope with the stress than the woman described as young, married, and indigent. Moreover, she may also have a greater chance in changing the external world because of her station in life.

            On the other hand though, self-efficacy rests on more than just financial resources. And unfortunately a full look at their self-efficacy isn’t possible because of the lack of information about the women’s seeking of information (explained in detail later). The case lays out no information about what their aging parents would need and what kind of assistance these needs might entitle them to. Self-efficacy hinges on this information because as Bandura’s study shows, “Other sources of discordance are at the performance locus. These include faulty assessment of performance and ambiguity about the performance undertakings. There is little basis for judging one’s self-efficacy for activities shrouded in ambiguity, (10)”. The self-efficacy of these women is such a mystery because there is no information on how each participant evaluated their confidence to performance the assumed tasks related to being a ‘sandwiched’ caregiver.

            Another part of the secondary appraisal process is the factor of perceived control over emotions. Glanz writes an example of this being, “perceived control over feelings, (217)” and the perceived social support has also been identified (Cash and Gardner 648) as influencing this perceived control over emotions. Taylor wrote of its extension into coping efforts as emotion focused coping in Conversations about Coping as it, “involves managing one’s emotional reactions to a stressful situation, (Conversations about Coping, 13)”. This management of emotional reactions has great mediating consequences on stress. Perhaps it can be assumed that one reason a woman would volunteer for a study of this sort is the potential emotional support they may receive from their peers in the study. Cash and Gardner explain it like this, “social support strategies are aimed at getting practical or emotional assistance from others,” (648). Certainly the different cultures identified in the study endeavor to give different levels of support whether practical or emotional. Further, Strine’s work on stressful disorders and social support as well, “our findings demonstrate a strong association among depression, impaired HRQOL, inadequate social and emotional support, dissatisfaction with life, and disability (63)”. Judging by these studies those people with social support will be most likely to cope.

            The TMSC also deals with stress as it relates to having knowledge of the source of stress and how that knowledge mediates it’s effects. Interestingly though, Information-seeking appears to be a double edged sword. While Case found that “Reducing uncertainty helps us not only maximize future outcomes but also guards against emotional stress,” (355) he also found that “much research has also noted that sometimes people avoid information, if paying attention to it will cause mental discomfort or dissonance” (354). In this way, depending on the woman in the study and her appraisal of resources, she may seek information about the sandwich generation and possible strategies to manage stress successfully or she may avoid that information totally so as to distance herself from the stress. I would imagine though that the sequence showing each woman hospitalizing her parent(s) “illustrates the women’s strength and resilience so vividly, (8)” that no woman would avoid information because they all appear to engage rather than disengage the stressor. Information seeking is, therefore, heavily influential in both engaging and disengaging with a stressful event.

            The majority of research on TMSC positions stress as bad, “The negative response

to stressors is commonly termed distress, and it is distress that is commonly studied for its relationship to adverse health outcomes. Distress, as such, is negative and dysfunctional (i.e., bad stress), (Nelson 2). On the other hand though, there is research that suggests that stress can have a positive effect; this kind of stress is known as eustress. “Eustress may improve health directly

through hormonal and biochemical changes or indirectly by facilitating effort and abilities  directed toward coping with existing stress,” (1449 Edwards, Cooper). Taking such research into consideration, perhaps the women in the sandwich generation study are better prepared to take care of their aging parents because they already have caregiving stressors (taking care of children, work, marriage, etc.) and are therefore hormonally and biochemically ready to take on this added responsibility. The question then becomes did any women in the study appraise the ‘sandwich’ stress positively? Did they believe that the parent moving in would enhance their well-being? Perhaps the richness of intergenerational familial dialogue is expected to be a resource rather than a tax on resources. More even, the woman who is described in the study as being young, single, and financially stable could use an aging parent who is still able-bodied to do some afterschool caregiving. If either of these cases were so, then the women might experience that positive appraisal and, therefore, not feel the kind of stress another woman in the study would feel.

            The Transactional Model of Stress and Coping is so dynamic that it moves throughout the case. Consider the potential initial stress of becoming a ‘sandwiched caregiver’, and then consider the stress of hospitalizing your aging parent, the process certainly doesn’t have a clear beginning or end. However, what can be seen through the case and the research detailed here is that stress cannot and should not be avoided. That kind of avoidance will only prolong the experience of distress. Instead, stress must be acted upon with preparation and flexibility: preparation in resources, and flexibility in mind. If the women in the study practiced this kind of dynamism themselves there is no doubt they were successful in adapting to the stress of being a ‘sandwiched caregiver’.