Coping with cancer: novel methods of stress management
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Coping with cancer: novel methods of stress management
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[post_content] => Practice Passage (Question 1-5)
*This passage is the property of Khan Academy and has been reformatted into an AAMC-style interface in their entirety by MedLife Mastery. MedLife Mastery does not endorse and is not an affiliate of Khan Academy.
Individuals diagnosed with cancer often experience significant amounts of stress. Some patients cope with stress by adopting unhealthy habits (like drinking, smoking, or withdrawing from social relationships), which can increase symptom severity and result in poor quality of life both during and after cancer treatment. Conversely, individuals who manage stress with healthy techniques can experience symptom relief and improved quality of life. A group of oncologists hope to promote healthy stress reduction and decide to focus their efforts on deep breathing. They postulate that a deep breathing exercise will induce the relaxation response, a physical state of deep rest that is the physiological opposite of a stress response (or fight or flight). They believe that when patients learn to breathe more slowly and deeply, their muscles will relax, blood pressure will decrease, and heart rates will slow down (all characteristics of the relaxation response). When testing the exercise with two patients they notice significant decreases in blood pressure, muscle tension, and heart rate. They conclude that the exercise could decrease select physical symptoms of stress.
The oncologists decide to expand their testing, and develop several deep-breathing exercises to be delivered in a group format. They believe that the combined exercises will help patients cope during times of stress. The program consists of 30-minute guided group breathing classes that occur biweekly for 8 weeks. Patients are also asked to complete home deep breathing practices. To test their theory, they recruit 10 adult cancer patients to participate in their program. The patient group is homogenous in type and stage of cancer. All patients have recently received their cancer diagnosis. The patients are all between 45 and 55 years old (mean age 48.6) and there are equal numbers of men and women in the group. Each patient completes a stress symptom checklist both before and after the intervention. The stress symptoms checklist can be found in Table 1. The symptom checklist is divided into four categories, with six possible symptoms in each category. Patients are instructed to circle any and all symptoms they are currently experiencing. The results from the study can be found in Figure 1.
Table 1
Figure 1
[post_title] => Coping with cancer: novel methods of stress management
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[question] => Given the information in the passage and the results from Figure 1, which of the following is the least problematic aspect of the study?
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[description] => Reason for the Correct Answer:
The behavioral and physical symptoms of stress outlined in the symptom checklist all could be side effects of chemotherapy or other cancer treatments. The oncologists should have asked patients to list their current treatment regimens so that they could control for those symptoms in their analysis.
The checklist could also be problematic because it was not a sensitive measure of stress (meaning if a person is stressed, the might not accurately document it). The terms used in the checklist were also confusing and could be difficult to interpret. The checklists lack of validity could be a significant problem.
Social support is incredibly important for individuals coping with stress, and because the program was delivered in a group format, it is entirely possible that emotional and cognitive benefits were the result of the group, not the program. This is also a significant confounding variable.
Homogeneity in a sample can be helpful in preliminary research because it helps to control for extraneous variables. This is the least problematic aspect of the study.
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[each_answer] => A. The oncologists recruited patients from a sample that was too homogenous, which makes the results of the program difficult to generalize.
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[each_answer] => B. The oncologists did not control for group social support, which could lead to decreases in some of the emotional and cognitive symptoms of stress on the checklist.
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[each_answer] => C. The oncologists used the stress checklist to measure stress, which did not provide a sensitive measurement of stress and had overlap between and within categories of symptoms.
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[each_answer] => D. The oncologists did not control for side effects of cancer treatment, which could lead to increases in some of the behavioral and physical symptoms of stress on the checklist.
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[1] => Array
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[quiz_unique_key] => 3873426850
[question] => For most individuals, a cancer diagnosis would be classified as what type of stressor?
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[description] => Reason for the Correct Answer:
Catastrophic stressors refer to events that happen that are out of the control of groups of individuals (which refers more to wars, environmental disasters, or acts of terrorism).
Ambient stressors refer to events that are in the background of most individual’s lives (like pollution, noise, or traffic). Because a cancer diagnosis is a salient, personal event, it would not be classified as an ambient stressor.
A cancer diagnosis is a major life event stressor, as it is potentially negative, chronically problematic, and relatively rare in a person’s life.
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[each_answer] => A. Major life event stressor, because a cancer diagnosis is a rare, negative event with lasting impact.
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[each_answer] => B. Micro-stressor, because a cancer diagnosis can be a small, relatively minor hassle for some individuals.
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[each_answer] => C. Ambient stressor, because a cancer diagnosis can negatively impact an individual without their awareness.
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[each_answer] => D. Catastrophic stressor, because a cancer diagnosis is unforeseen and completely out of the control of the individual.
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[question] => The oncologists decide to redesign the study. Which of the following strategies would be the best option to help them to increase power and strengthen the study?
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[description] => Reason for the Correct Answer:
All of these strategies would strengthen the research in different ways. Adding additional measurement components may strengthen the researcher’s ability to understand how and why patients are experiencing stress, but it would not necessarily increase the study’s power.
Recruiting a larger number of patients to the study would theoretically increase power, but without controlling for extraneous variables, a larger, more heterogeneous sample means more variability within the sample, which could increase the chance of random error and decrease the power of the study.
If the oncologists recruit a larger sample of patients and randomly assign them to the active condition (the program) or a control (the waitlist), they will increase their power and strengthen their ability to control for error.
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[each_answer] => A. Recruit a larger number of patients with different types and stages of cancer to expand the breadth of the research
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[each_answer] => B. Strengthen assessment of stress by adding salivary cortisol measurements before and after each program session
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[each_answer] => C. Strengthen assessment of stress by adding a qualitative component in which patients are interviewed regularly
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[each_answer] => D. Recruit a larger number of patients and randomly assign them to the deep breathing program or a waitlist control group
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[question] => The moment after a person receives a cancer diagnosis, she experiences an immediate spike in her stress levels. She appraises the situation as dangerous and her body reacts accordingly. Which of the following body responses is associated with sympathetic nervous system activation and could be a physiological reaction she experiences?
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[description] => Reason for the Correct Answer:
The sympathetic nervous system is activated during fight or flight responses, so look for body responses consistent with sympathetic nervous system activation.
During fight or flight, there are increases in heart and respiration rates, as well as increased secretions of hormones from the adrenal glands like cortisol.
During fight or flight, the body dilates blood vessels to increase blood flow to organs such as the lungs and skeletal muscle. Other blood vessels, such as those to the intestines, are constricted.
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[each_answer] => A. Decreased cortisol
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[each_answer] => B. Constriction of vessels in skeletal muscle tissue
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[each_answer] => C. Dilation of vessels in skeletal muscle tissue
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[each_answer] => D. Decreased heart rate
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[question] => Which coping strategy best describes the deep breathing program?
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[description] => Reason for the Correct Answer:
Problem focused coping (in regards to cancer) could involve learning more about the causes of cancer, evaluating the pros and cons of different types of treatment, or taking control of a treatment plan.
Appraisal focused coping (in regards to cancer) could involve denying or distancing from the reality of the disease or the situation and is similar to avoidance focused coping. Appraisal focused coping methods may also involve altering goals and values.
Emotion focused coping (in regards to cancer) would involve a focus on restructuring or managing emotions that accompany stress. One method for managing or restructuring emotions could be meditation, or using relaxation based exercises like deep breathing.
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[each_answer] => A. Appraisal focused coping because it challenges patient’s assumptions about cancer and relaxation.
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[each_answer] => B. Emotion focused coping because it teaches patients to manage emotions that accompany perception of stress.
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[each_answer] => C. Problem focused coping because the program is aimed at learning more about stress and taking control.
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[each_answer] => D. Avoidance focused coping because patients distance themselves from their physiological reaction to stressful experiences.
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