repressors need to be distinguishable from those who are simply not anxious.
Weinberger, Schwartz and Davidson (1979) have developed a method of measuring
repression using a measure of anxiety together with a measure of defensiveness. This
is the most frequently used approach. To be defined as a repressor a person must have
a low score on anxiety and a high score on defensiveness. The measure of defensive -
ness often used is the Marlowe–Crowne measure of social desirability (Crowne and
Marlowe, 1960).
Repression has been linked to poorer immune functioning (e.g. Esterling et al.,
1993) and to increased coronary heart disease risk factors such as high cholesterol
(Niaura et al., 1992). A recent meta-analysis (Mund and Mitte, 2012) looked at 22
studies of repressive coping and somatic illness and found that repressive coping was
associated with cancer and heart disease. However, the findings for cancer suggest that
repressive coping does not precede cancer diagnosis, but is likely to develop
subsequently in order to cope with the diagnosis. Furthermore, it was not possible to
draw any conclusions about the relationship between repression and cancer progression.
Mund and Mitte (2012) also found that repressors were at increased risk of hypertension
and cardiovascular disease, however, this result was based on only a single study and
remains to be confirmed. Thus exact implications of this coping style for health remain
unclear.
Monitoring and blunting
Monitoring and blunting coping styles refer to the information-processing style of
people facing threats. It has typically been studied in medical situations with a view
to ascertaining the appropriate type of information to give to patients to help them
cope with impending medical or surgical interventions. Those with a monitoring style
will tend to seek out information about the threat and amplify or worry about it (e.g.
Miller, Summerton and Brody, 1988) whereas those with a predominantly blunting
style will actively avoid it. Typically, these two dimensions are treated as independent
(rather than being opposite poles of a single dimension) so that individuals are divided
into high and low monitors and high and low blunters.
Research suggests that monitors and blunters react differently to medical stressors.
For example, high monitors go to the doctor with less severe medical problems and
demand more tests and information than low monitors (Miller et al., 1988). Miller et al.
(1988) suggest that this is not accompanied by any greater wish for control, rather it
is to reduce uncertainty and lower arousal.
Miller and Mangan (1983) suggested that a patient’s level of arousal was lower if
the level of information given was matched to their coping style (i.e. monitors require
much more detailed information). This theory has been used to inform the design of
appropriate health messages (see also Chapter 8). Williams-Piehota et al. (2005)
matched messages about mammography to women’s coping styles. They hypothesized
that matched messages would be more effective in persuading women to attend for
mammography. The leaflet designed for those classified as blunters was short and to
the point. It gave basic facts such as ‘the key to finding breast cancer is early detection
and the key to early detection is getting regular screening mammograms’. In contrast,
the leaflet for monitors gave details of symptoms and risk factors for cancer and
explanations of mammography procedures, e.g. ‘for some women early detection may
prevent the need to remove the entire breast or to receive chemotherapy’. Both leaflets
COPING AND SOCIAL SUPPORT 97