Changes in the future: a future involving children, career or travel can become
uncertain.
In addition, the crisis nature of illness may be exacerbated by factors that are often
specific to illness such as:
Illness is often unpredicted: if an illness is not expected then the individual will not have
had the opportunity to consider possible coping strategies.
Information about the illness is unclear: much of the information about illness is
ambiguous and unclear, particularly in terms of causality and outcome.
A decision is needed quickly: illness frequently requires decisions about action to be
made quickly (e.g. should we operate, should we take medicines, should we take time
off from work, should we tell our friends).
Ambiguous meaning: because of uncertainties about causality and outcome, the
meaning of the illness for an individual will often be ambiguous (e.g. is it serious?
how long will it effect me?).
Limited prior experience: most individuals are healthy most of the time. Therefore,
illness is infrequent and may occur to individuals with limited prior experience. This
lack of experience has implications for the development of coping strategies and
efficacy based on other similar situations (e.g. ‘I’ve never had cancer before, what
should I do next?’).
Many other crises may be easier to predict, have clearer meanings and occur to indi-
viduals with a greater degree of relevant previous experience. Within this framework,
Moos and Schaefer considered illness a particular kind of crisis, and applied crisis theory
to illness in an attempt to examine how individuals cope with this crisis.
The coping process
Once confronted with the crisis of physical illness, Moos and Schaefer (1984) described
three processes that constitute the coping process: (1) cognitive appraisal; (2) adaptive
tasks; and (3) coping skills. These processes are illustrated in Figure 3.2.
Process 1: Cognitive appraisal At the stage of disequilibrium triggered by the
illness, an individual initially appraises the seriousness and significance of the illness
(e.g. Is my cancer serious? How will my cancer influence my life in the long run?).
Factors such as knowledge, previous experience and social support may influence this
appraisal process. In addition, it is possible to integrate Leventhal’s illness cognitions at
this stage in the coping process as such illness beliefs are related to how an illness will
be appraised.
Process 2: Adaptive tasks Following cognitive appraisal, Moos and Schaefer
describe seven adaptive tasks that are used as part of the coping process. These can be
divided into three illness specific tasks and four general tasks. These are illustrated in
Table 3.1.
ILLNESS COGNITIONS 63