Psychological Stress and Coping in Adaptation and Illness

Research and thought in psychosomatic medicine must seek understanding of the psychological processes making a person's encounter with the environment stressful, and how these encounters lead to a variety of coping processes, emotional states, disease precursors, and stress disorders. One major theme of this paper is that every instance of adaptive commerce between a person and the environment is appraised cognitively as to its significance for the person's well-being. Such appraisals underlie the ebb and flow of emotional states, their quality and intensity. A second theme is an analysis of the debate about whether the bodily response to stress emotions is specific to the psychodynamics of the stressful encounter or general and non-specific. Third, it is argued that self-regulatory processes as well as cognitive appraisals are key mediators of the person's reactions to stressful transactions, and hence shape the somatic outcome. Two types of self-regulatory processes are distinguished: 1) direct action, which refers to any effort designed to alter the person's troubled relationship with the environment, and 2) palliative activities, including a) intrapsychic processes such as denial, detachment and attention deployment, and b) somatic-oriented devices such as drugs, relaxation training, biofeedback procedures, and so forth, which are employed in an effort to moderate the bodily concomitants of stress emotion.