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1st appeared
14
July 2000
Focusing on the Positive During Dire Situations For all those who care for their dying loved ones it may comfort them to know that it is common, even healthful, to experience positive emotions in the midst of great stress, says a UCSF researcher.
Often fleeting, these positive emotions give caregivers a psychological time-out from the demands of dealing with a life-threatening illness, she says. "I believe that people have a need to feel good even while they’re feeling bad," says Folkman, co-director of the Center for AIDS Prevention Studies. For Folkman, who first conducted basic research on the coping process as a graduate student at UC Berkeley more than 20 years ago, her career has come full circle in her quest to know how people survive very difficult times. "I believe that positive emotions have adaptive functions in the stress process. They motivate and sustain coping. They provide breathers and restore one’s resources, energy and self-esteem," Folkman said at a recent lecture at Laurel Heights sponsored by the UCSF Comprehensive Cancer Center and the Center for Health and Community. Upon a suggestion from Tom Coates, now director of the UCSF AIDS Research Institute, Folkman decided to focus her investigation on a particular population: gay caregivers of men with AIDS in San Francisco. She began her study of 314 men, who were mostly in their late 30s and well-educated, in 1990 -- before the advent of protease inhibitors – when the prognosis for the disease was "bleak." Back then, caregivers worked around the clock to take care of their partners. Researchers followed the men up to five years, conducting bi-monthly interviews for the first two years and semi-annual interviews for the next three years, using clinical assessments and self-reports to measure moods, stress and coping processes and physical health. The research has yielded a wealth of information for Folkman and colleagues, who have published more than 40 articles and continue to gain new insights with analyses. Among the highlights of their findings:
It is this last finding that Folkman believes spawns a whole new area of investigation. For while the studies showed that caregivers experienced a "typical conjugal bereavement response in terms of depressed mood," researchers were surprised to discover that their caregivers’ positive feelings were just as frequent as the negative emotions except for the period immediately surrounding death. "Even when they were experiencing very high levels of depressed mood, they were still experiencing positive affect," Folkman says. This co-occurrence of positive and negative moods in life-threatening situations, Folkman says, has been reported in studies by other researchers although the finding has not been emphasized or explored in the literature. "To me, it’s not just a throwaway finding. To me it may be the clue to how people get through difficult times," Folkman says. Folkman and her colleagues found that the kinds of coping processes that sustain positive emotions seem to differ from those that regulate distress. The coping processes that sustain positive emotions seem to depend on meaning – on values and beliefs. "A whole classification of coping involves reaching down and drawing on those values and beliefs, which can include religious and spiritual beliefs. These values and beliefs are what sustains you. The positive moments might be just temporary, but they can be restorative." The research may have been less of an intrusion on participants’ lives than it was an intervention judging by low attrition rate. The interviews gave caregivers an opportunity to share their feelings during their partners’ dying process and after death. Most called to report their feelings within days after their partners died, Folkman said. Caregivers reported that amid the crisis, they discovered what’s really important in life, found new faith and gained personal strength. They found meaning and value in the caregiving, which many reported brought them closer to their partner and made them feel needed. Folkman also found that caregivers were even more positive when their partner showed appreciation. In the weeks just before their partners’ death, a study led by UCSF psychologist Judy Moskowitz found that caregivers turned to problem-focused coping, which means they tackled immediate tasks, such as changing the bed linen or going to the store, which helped take their minds off the dire circumstances. "It gave them an opportunity to be in control in an uncontrollable situation and by doing the task, they accomplished something useful that made them feel good." The findings from this research prompted Folkman to urge health care practitioners to emphasize the positive while acknowledging distress. "Clinicians should understand that people can feel good while feeling bad, and give as much attention to what makes patients feel good as they do to relieving their symptoms," she says. Source: Lisa Cisneros, Newsbreak Editor |
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In
fact, says Susan Folkman, an expert in coping, it’s the simple
things in life, such as making a nice meal, working in the garden
and enjoying a beautiful sunset, that can generate positive emotion
and help give people the strength to endure deep emotional trauma.