Integrating personality factors of successful coping and adaptation

As it was formerly introduced, coping with cancer is discussed in diverse theoretical frameworks. Several coping styles, personality characteristics and resources of stress tolerant patient and successful adaptation have been identified and studied separately with the evolution of positive psychological movement. As a Hungarian theoretical concept Oláh (2005a, 2005b) succeeded in integrating the empirically related resources of the personality types that help maintaining psychological health when dealing with stressful events. This one comprehensive model is the so called Psychological Immune System (PIS). The model is based upon positive psychological approaches which seek to emphasize human strengths and potential. The different protective personality factors fostering successful adaptation function in the same mode of action and have a high correlation. Therefore, it be considered as an integrated multidimensional system of personal capacities.

2.5.7.1 Psychological immunity

PIS involves coping strategies, protective personality resources and dimensions of resilience such as control capacity, learned resourcefulness, constructive thinking, hardiness, dispositional optimism, ego resiliency and emotional intelligence.

Psychological immunity plays an important role in maintaining and improving wellbeing – it grants a certain “immunity” during a stressful or traumatic event that provides immediate protection in situations that hinder development and the achievement of a personal goal. PIS integrates resources that enable the person to endure prolonged stress

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and cope efficiently with upcoming threats in such a way that personal integrity and developmental potential remains intact. It focuses on individual protective attributes and attributes that mediate the person’s orientation towards the protective resources of the environment (Oláh, 2005b).

2.5.7.2 Functioning of Psychological Immune System

PIS integrates, as a superordinate system, three mutually interactive subsystems. The first subsystem directs the person towards the exploration, understanding, and control of the physical and social environment, helps to monitor the possible positive outcomes, and to appraise the environment in a meaningful way. These so-called accommodative competencies like Positive Thinking, Sense of Control, Sense of Coherence, or Sense of Self Growth constitute the Approach-Belief Subsystem (ABS). The second subsystem helps to modify the difficult accommodation situation to guide the person towards the decided goal by changing the self or changing the environment. Utilising the necessary personal or environmental resources to generate new or alternative possibilities, these assimilative components of the Monitoring-Creating-Executing Subsystem (MCES) consist of creative self-concept, Change and Challenge Orientation, Social Monitoring Capacity, Problem Solving Capacity, creative self-concept, Self-Efficacy, Social Mobilizing Capacity, Social Creating Capacity and Goal-Orientation. The third subsystem, the Self-Regulating Subsystem (SRS), helps to stabilize the inner emotional state, especially negative emotions that interfere with planned actions, to help the person focus on the original goal by controlling the attentional focus and conscious operation. It provides for the stable operation of the first two subsystem through Impulse Control, Emotional Control, Irritability Control and Synchronicity (Oláh, 2005a) (Figure 1).

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Figure 1.: The components of Psychological Immune System according to Oláh (2005a, 2005b)

PIS as part of the individual protective apparatus functions both in the primary and secondary cognitive appraisal process of coping, and therefore allows for effective coping with stress. All three subsystems take part in the appraisal process, but with a time delay.

Immune traits of ABS have the most influence on the primary appraisal process, while MCES and SRS direct secondary appraisal. MCES functions mainly in problem-focused, task-oriented coping processes. Scales of MCES like Problem Solving Capacity, Social Creating Capacity, and Self- Efficacy correlate significantly with problem-focused ways of coping, while Social Monitoring and Social Mobilizing Capacity correlates with the Seeking Social Support preference. SRS, by regulating mainly the emotional aspects of personality, operates in emotion-focused behaviour. The three subsystems function in dynamic interaction with each other and with the environment. Biological, psychological and social components facilitate or inhibit the adaptative processes of the subsystems.

Giving an example for the functioning of PIS, in case of a stressor ABS initiates the exploration of the environment, while MCES handles and assimilates the result of the exploration. If ABS and MCES tendencies are balanced the person is capable of assimilating the approaching result and feels competence and other positive emotions. If

Approach-Belief Subsystem Positive Thinking Sense of Coherence Sense of Self-Growth

Sense of Control

Self-Regulating Subsystem Synchronicity Impulse Control Emotional Control

Irritability Psychological Immune System

Monitoring-Creating-Executing Subsystem Creative Self-Concept

Self-Efficacy Goal-Orientation Problem Solving Capacity Change and Challenge Orientation

Social Monitoring Capacity Social Mobilizing Capacity

Social Creating Capacity

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MCES is weak there is no competence to handle AB, the person feels anxiety and helplessness. If SRS is constantly low, a prolonged negative emotional state can be expected. At the same time, if AB has strong tendencies and SRS is weak it can describe sensational seekers or the maniac state. Optimal functioning requires on the one hand a great variety of elements of PIS within one system, and on the other hand a dynamic interactions of the inter-system units in synchrony with personal and environmental demands, so an optimal balance between the components can be achieved.(Oláh, 2005a).

2.5.7.3 Important correlates of psychological immunity

Psychological immunity seems to correlate with life-satisfaction and with factors of psychological wellbeing, such as environmental mastery, purpose in life, personal growth, self-acceptance, positive relations, and autonomy (Oláh, 2009). Mental and physical health is associated with higher Sense of Coherence, Sense of Self-Growth, Synchronicity, and Impulse, Emotion and Irritability Control, and almost all aspects of psychological immunity correlates negatively with burnout (Oláh, 2009). Furthermore, psychological immunity plays a role as the most important factor protecting against burnout among health care workers (Gombor, 2010). The personality resources of PIS, such as Positive Thinking, Sense of Control, Sense of Coherence, and Sense of Self- Growth have a mediating role in mental health and psychological adjustment to acute psychopathology (Mirnics et al., 2013). To our knowledge there is one published study examining the Psychological Immunity in cancer context. According to its findings, Hungarian oncology patients showed significantly lower scores on 12 out of 16 scales of the Psychological Immune Competence Inventory than the standard, healthy Hungarian population (Oláh, 2005b). Although PIS has been examined across different cultures, populations, and life situations (Gupta & Pandey, 2014; Magyaródi, Nagy, Soltész, Mózes & Oláh, 2014; Mirnics et al., 2013; H. Nagy & Oláh, 2014; Oláh, Nagy & Tóth, 2010; Szicsek, 2004; Voitkane, 2004), there is a need for more research on the psychological immune system of cancer patients. It is yet unknown whether it changes along the cancer continuum, or whether it can be improved by psychotherapeutic intervention. Research in this field can fill a scientific gap and integrate the knowledge of isolated models.

In summary, successful adjustment to cancer is a dynamic, interrelated process where coping plays an important role. Coping seems to change over time in the different phases

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of cancer treatment and survivorship as the stressors patients have to face also change.

Psychological immunity as a comprehensive model integrates resources that enable the person to endure prolonged stress and cope efficiently while personal developmental potential remains intact. Psychosocial interventions aim to improve adaptation processes to the illness. They have long term effects on coping processes. It remains a question, however, how psychological immunity as an integrated system changes over time and due to psychological interventions. Although there are methods that target especially the improvement of problem-solving and the coping repertoire, in general, it can be said that psychological interventions influence patients coping through the Sense of Control and personal growth, through Self-Efficacy and by effectively solving problems and the deeper understanding of the self and the underlying intrapsychic processes. In the next session the different psychosocial interventions used in oncological settings will be presented, with special focus on hypnosis and music.