Page 89 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Interactional Model of Stress 63

Table 3.1 Examples of psychological, biological and social factors
contributing to both stress and pain
Biological
Psychological factors factors Social factors
Negative emotional Fight or flight Availability and
associations response – quality of social
(e.g. anticipation of pain sympathetic support
at dressing change) arousal

Previous experience of Cortisol Quality of personal
pain and stress released relationships
Individual differences in Increase in Social comparisons
perception/appraisal of a heart rate, with other patients
stressful event breathing at different stages of
rate, blood recovery
pressure
Coping strategies Lowered Environmental
immune factors (e.g. hospital/
system clinic attendance vs.
functioning home visits)

Interactional Model of Stress

Within the interactional model of stress, Lazarus and Folkman
( 1984 , 1987 ) posited that stress and stress perception was
based upon a transaction between an individual and their
external world/environment. Hence, a stressful event would
only elicit a stress response if the individual actually per-
ceived the event to be stressful. In doing so, this model
accounts for the individual differences that may be evident in
perceiving an event stressful (E.g. while one patient may per-
ceive a dressing change to be highly stressful, another may
perceive it as a usual occurrence; see Fig. 3.3 ).
As can be seen in Fig. 3.3 this model proposes two types of
,
appraisal; primary and secondary. The primary appraisal,
whereby the event is appraised as to whether it is a threat or not

(see Rovira et al. 2010a , b ; Schlotz et al. 2011 ), is the initial