The influence of social alienation on maintenance hemodialysis patients’ coping styles: chain mediating effects of family resilience and caregiver burden

This natural experiment provides substantial evidence for the following major themes, which are based on a cognitively oriented, process-centered theory of stress and coping: First, a stressful encounter should be viewed as a dynamic, unfolding process, not as a static, unitary event. Emotion and coping (including the use of social support) were assessed at three stages of a midterm examination: the anticipation stage before the exam, the waiting stage after the exam and before grades were announced, and after grades were posted. For the group as a whole there were significant changes in emotions and coping (including the use of social support) across the three stages. Second, people experience seemingly contradictory emotions and states of mind during every stage of an encounter. In this study, for example, subjects experienced both threat emotions and challege emotions. The complexity of emotions and their cognitive appraisals reflects ambiguity regarding the multifaceted nature of the exam and its meanings, especially during the anticipation stage. Third, coping is a complex process. On the average, subjects used combinations of most of the available forms of problem-focused coping and emotion-focused coping at every stage of the exam. Different forms of coping were salient during the anticipation and waiting stages. Problem-focused coping and emphasizing the positive were more prominent during the former, and distancing more prominent during the latter. Finally, despite normatively shared emotional reactions at each stage, substantial individual differences remained. Using selected appraisal and coping variables, and taking grade point averages (GPA) into account, approximately 48% of the variances in threat and challenge emotions at the anticipation stage was explained. Controlling for variance due to the grade received, appraisal, and coping variables accounted for 28% of the variance in positive and negative emotions at the outcome stage. Including grade, 57% of the variance in positive emotions at outcome and 61% of the negative emotions at outcome were explained.