Coping with the risk for cervical cancer: The mediating role of dispositional monitoring in the stress response

• Main Author: Rodoletz, Michelle Carol
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01-01-1995
• Subjects: Clinical psychology; Gynecology; Obstetrics; Obstetrics and gynecology; Psychobiology; Psychotherapy; Womens studies
• ISBN: 9798209380054

Early detection and management of cervical cancer and precancerous gynecologic conditions associated with the sexually-transmitted Human Papilloma Virus (HPV) can dramatically increase survival rates from cervical cancer. It is therefore necessary for women with precancerous cervical conditions, such as carcinoma in situ (CIS), Condyloma (CLA) or Cervical Intraepithelial Neoplasia (CIN) to adhere to screening and treatment protocols in order to prevent disease progression. While an accumulating body of evidence exists on how women cope with invasive cancerous disease, far less has been documented on how women adjust to the diagnosis and long-term management of preinvasive conditions. Dispositional attentional style has been found to predict psychological distress in response to such threats. High monitors--who cognitively scan for and attend to threatening cues--generally have been found to show greater distress than low monitors--who cognitively avoid threat-relevant cues. According to the Monitoring Process Model (MPM), high monitors who overestimate threat, experience greater intrusive ideation about their medical condition, which triggers (unsuccessful) attempts to avoid such thoughts. When distress becomes too extreme, high monitors ultimately resort to more extreme defensive strategies, such as denial. This coping process can be maladaptive when faced with the emotional and practical management of a long-term medical stressor such as HPV. This research extended work on attentional styles and coping strategies to predominately white, middle-class women (N = 101) who had been previously screened for and diagnosed with CIN, and who were undergoing repeat follow-up screening (colposcopy). Results show significantly higher health-related subjective distress in women "at risk" for cervical cancer as compared to women presenting for routine gynecologic examinations. Indeed, the degree of intrusive and avoidant ideation experienced by these women was comparable to that evidenced in patients in other stressful medical contexts, such as cancer and trauma injured patients. Results of a structural modeling analysis supported the MPM, showing that high monitors are in fact, more vulnerable to repetitive intrusive and avoidant ideation with respect to their "at risk" status and, in turn, defend against this spiraling anxiety through the use of potentially maladaptive coping strategies such as denial and mental disengagement. Moreover, these effects held while controlling for global levels of depression. All findings were independent of relevant sociodemographic and medical confounders. The MPM has implications for the management of patients at risk for cervical cancer and other long-term medical stressors. By tailoring psychosocial interventions to the patient's coping style, emotional adjustment can be enhanced. This may facilitate adherence to stressful medical regimens over time and deter the progression of HPV.