Sensitizing effects of pretreatment measures on cancer chemotherapy nausea and vomiting

The association of having a monitoring or blunting coping style with psychological distress, health-related quality of life and satisfaction with healthcare in gastrointestinal stromal tumour (GIST) patients

BACKGROUND

There are two main coping styles regarding information seeking under medical threat; monitoring (information-seeking) and blunting (information-avoiding). The aim of this study is to (1) determine factors associated with a monitoring or blunting coping style in gastro-intestinal stromal tumour (GIST) patients and (2) investigate its association with psychological distress, cancer-related concerns, health-related quality of life and satisfaction with healthcare.

METHODS

In a cross-sectional study, Dutch GIST patients completed the shortened version of the Threatening Medical Situations Inventory to determine their coping style, the Hospital Anxiety and Depression Scale, Cancer Worry Scale, EORTC QLQ-C30 and part of the EORTC QLQ-INFO25.

RESULTS

A total of 307 patients were classified as blunters (n = 175, 57%) or monitors (n = 132, 43%). Coping style was not associated with tumour or treatment variables, but being a female (OR 2.5; 95%CI 1.5-4.1; p= <.001) and higher educated (OR 5.5; 95%CI 2.5-11.9, p= <.001) were associated with higher odds of being a monitor. Monitors scored significantly lower on emotional functioning (mean = 86.8 vs mean = 90.9, p=.044), which is considered a trivial difference, more often experienced severe fear of cancer recurrence or progression (53.0% vs 37.7%, p=.007), and had more concerns about dying from GIST in the future (60.6% vs 47.4%, p=.025). Compared to blunters, monitors were less satisfied with the received healthcare and information, and would have liked to receive more information.

CONCLUSION

GIST patients with a monitoring coping style experience a higher emotional burden. Additionally, monitors exhibit a greater need for information. Although this need for information could potentially result in fears and concerns, recognising it may also create an opening for tailored communication and information.

Coping under experimental threat: Observable and cognitive correlates of dispositional monitoring and blunting

In order to investigate the relation between dispositional coping style and actual coping behaviour under threat, 53 undergraduate psychology students anticipated a mild stressor (bloody slides) in Part I of the experiment. Observable behaviour turned out to be unrelated to dispositional monitoring and blunting as measured by the Miller Behavioral Style Scale (MBSS; Miller, 1987) and the Threatening Medical Situations Inventory (TMSI; van Zuuren and Hanewald, 1993). However, when cognitions were also taken into account, some significant correlations emerged with the MBSS as well as with the TMSI. In Part II (N = 40), intrusive thinking after exposure to the experimental stressor was related to dispositional coping style. High monitors, as compared with low monitors (moderate monitors excluded) were found to elaborate the stressful experience in a more diffuse and extended way.

Cognitive confrontation and avoidance during a naturalistic medical stressor

This study was undertaken to shed some light on problems that have arisen in measuring cognitive confrontation (monitoring) and cognitive avoidance (blunting) with a self‐report questionnaire, the Miller Behavioral Style Scale (MBSS; Miller, 1987). For this purpose, variants of both coping styles were studied in a naturalistic setting: 37 women who underwent prenatal diagnosis were interviewed at home about their ways of coping with different stages of the procedure, a few days before they expected the diagnostic results. Interview fragments pertaining to cognitive confrontation and avoidance were selected and analysed by two investigators in order to generate categories of avoidance and confrontation coping strategies. For some of the fragments, inter judge reliability was assessed using new judges. A comparison between the categories found and the kinds of items used in the MBSS shows that in real life more coping variants occur than those represented in the MBSS, in particular variants that involve a combination of cognitive confrontation and avoidance. Implications for the dimensionality of both concepts and for their measurement are discussed.

Effects of monitoring versus blunting on the public's preferences for information in a hypothetical cancer diagnosis scenario

Monitoring and blunting are coping styles that characterize how people respond when faced with personally threatening situations. High monitors tend to pay more attention to, scan for, and amplify threatening cues; high blunters tend to avoid information and seek distractions when faced with a threatening event. This study sought to investigate possible differential effects of monitoring and blunting coping styles on information preferences in a hypothetical cancer diagnosis scenario in the adult general public of Minnesota. In a survey administered at a large public venue (2016 Minnesota State Fair), participants were asked to imagine they carried a gene mutation and were diagnosed with colon cancer. They indicated their information preference [modified Cassileth Information Styles Questionnaire (MCISQ)], completed two coping style measures [Miller Behavioral Style Scale (MBSS) and Threatening Medical Situations Inventory (TMSI)], rated their perceived severity of colon cancer (low, moderate, high), and answered demographic questions. Eight hundred fifty-five individuals provided usable data. Participants classified as monitors on the TMSI had significantly higher MCISQ scores (i.e., preferred more information) than those classified as blunters (p = .004). Those scoring high on monitoring and low on blunting on the MBSS preferred significantly more information than those scoring high on both monitoring and blunting (p = .04). Linear regression analysis revealed being a monitor (TMSI), scoring high on monitoring (MBSS), rating colon cancer as more severe, and having a higher education level were significant positive predictors of MCISQ scores. Results suggest individual differences in coping style, perceived severity, and education level affect desire for information. Genetic counselors should consider these patient characteristics (e.g., asking patients about their information preferences) and tailor their approaches accordingly.

Psychological Profile of Chinese with Cleft Lip and Palate Deformities

Objective:

To assess the psychological well-being of patients with cleft lip and palate (CLP).

Patients/setting:

Ninety-four Chinese CLP subjects between 10 and 40 years of age were recruited from the Discipline of Oral and Maxillofacial Surgery, The University of Hong Kong, between June and December 2003. They were divided into two groups for comparison: adolescents (10–16 years old) and adults (17– 40 years old). A control group of 116 healthy non-CLP patients was also recruited during the same period.

Interventions:

All CLP and non-CLP patients were asked to complete a set of four questionnaires to assess their psychological status. The questionnaires included the Social Avoidance and Distress Scale, the Satisfaction with Life Scale, the Culture-Free Self-Esteem Inventory, and the Chinese Miller Behavioral Style Scale.

Results:

Chinese CLP patients exhibited levels of subjective well-being and social anxiety that were similar to the published levels of a group of British CLP patients. They also had significantly lower general and social self-esteem but higher parental self-esteem than the non-CLP control group.

Conclusion:

CLP patients were generally satisfied with life and did not exhibit more social anxiety than the non-CLP control group. They also had a good relationship with their parents. Gender and educational level had no influence on their psychological profile. However, these CLP patients had lower self-esteem than non-CLP patients.

Optimism, coping style and emotional well-being in cardiac patients

OBJECTIVE

Optimism is associated with superior emotional well-being in people with chronic and acute health problems, possibly because optimists are more likely to implement problem-focused coping. Another interpretation posits that optimism can be a defensive response designed to diminish affective reactions to health problems. The study objective is to investigate this possibility.

DESIGN

A cross-sectional examination of relationships between dispositional and relative optimism, threat avoidance and emotional well-being in 85 cardiac patients.

RESULTS

Blunting, a measure of threat avoidance, was found to be associated with both optimism and emotional well-being, and the common variance was predictive of positive affect. As expected, this link was stronger in people with low self-efficacy for problem-focused coping.

CONCLUSION

These findings support a defensive interpretation of optimism amongst patients with recently-experienced cardiac disease, particularly as the effect was more pronounced in the low self-efficacy subsample. We discuss possible explanations for these findings and implications for the study of coping with serious illness.

Monitoring and blunting in palliative and curative radiotherapy consultations

OBJECTIVE

The present research paper investigates how cancer patients' monitoring and blunting coping styles are reflected in their communications during their initial radiotherapy consultations and in their evaluations of the consultation. Additionally, it is explored how a patient's disease status (curative versus palliative) influences the effects of his or her cognitive styles.

METHODS

The study included 116 oncology patients receiving treatment from eight radiation oncologists. For 56 patients treatment intent was palliative and for the remaining 60 curative. The patients' communicative behaviors were assessed using the Roter Interaction Analysis System (RIAS). Within three days the patients completed a monitoring and blunting inventory and after another six weeks they evaluated the treatment decision and treatment information by postal questionnaire.

RESULTS

Monitoring was positively and blunting negatively related to the patient's expression of questions, emotions and decision-making issues. After six weeks 'high monitors' as opposed to 'low monitors' reported having more doubts about the treatment decision and being less satisfied with the information received while 'high blunters' expressed fewer doubts and more satisfaction than 'low blunters' did. Significant associations were all attributable to the palliative treatment group.

CONCLUSION

Cancer patients' communicative behaviors vis-à-vis their oncologist hinge on their cognitive styles and an unfavorable disease status enhances the effects.

Psychosocial factors associated with perceived disease severity in patients with chronic hepatitis C: relationship with information sources and attentional coping styles

The aim of this study was to investigate psychosocial factors associated with perceived disease severity, with emphasis on informational processing, in 185 consecutive patients with chronic hepatitis C. Medical data, information sources regarding chronic hepatitis C, and attentional coping styles were assessed. The patients considered their hepatitis C a severe disease and gave it a mean rating of 74 (SD = 19) on a 100-mm visual analogue scale, but this perception was not related to liver histological severity. In multivariate analysis, age, coping styles (monitoring, blunting), and having a hepatologist as an information source accounted for 23% of the variance of perceived severity. These results suggest that information processing and psychological features play a key role in the way patients with chronic hepatitis C perceive their disease.

Satisfaction with information and quality of life in patients undergoing chemotherapy for cancer. The role of individual differences in information preference

Earlier studies have shown that patients are dissatisfied with the information they receive from doctors and nurses. The purpose of this study was to analyze satisfaction with information and quality of life in patients with cancer undergoing chemotherapy, considering the patient's information preference. Data were collected during interviews with 30 consecutive patients undergoing chemotherapy for cancer. The subject of the interviews was the satisfaction of patients with the information they received, and additional measures used were the Miller Behavioral Styles Scale and EORTC-QLQ-30. The results showed that 21 of 30 patients were satisfied with the information they received from health care. Married patients or cohabitants were satisfied more often than single patients. No significant differences in quality of life could be found between satisfied and dissatisfied patients. Regarding information preferences, the dissatisfied patients reported more information-avoiding behavior than those who were satisfied. The results must be interpreted cautiously because of the study's limitations, but one clinical implication can be stated: There is value in being aware of patients' information-seeking/avoiding behavior before starting to inform them.

Effect of distraction and coping style on in vivo exposure for specific phobia of spiders

Recent studies have generated mixed findings regarding the effects of distraction on exposure-based treatments. Results have also been inconsistent regarding the effects of monitoring and blunting coping styles on outcome. The present study attempted to integrate these two areas of research. We hypothesized that the effect of distraction on treatment outcome might depend on coping style. Specifically, we predicted that for blunters (i.e.. individuals who tend to avoid threat-related information), distraction would interfere with the effects of exposure. However, we predicted that distraction might benefit monitors (i.e., individuals who tend to seek out threat-related information). Sixty individuals with a specific phobia of spiders underwent a single, two-hour session of exposure treatment. During the first hour, half of the participants were distracted by listening to an audiotape and the other half underwent exposure without distraction. In the second hour, all participants underwent focused exposure. Based on measures of heart rate, subjective fear, and behavioral testing, participants improved after one hour of treatment, and improved further during the second hour. However, neither distraction, coping style, nor their interaction had a significant effect on outcome. The present study provides support for the benefits of behavioral treatment for specific phobias. However, our hypotheses regarding distraction and coping style were not confirmed.

Breaking bad news about cancer: patients' preferences for communication

PURPOSE

The goal of this study was to assess patients' preferences regarding the way in which physicians deliver news about their cancer diagnosis and management.

PATIENTS AND METHODS

A sample of 351 patients with a variety of cancers completed a measure assessing their preferences for how they would like to be told news about their cancer. Patients rated characteristics of the context and content of the conversation as well as physician characteristics.

RESULTS

Factor analysis indicated that patients' preferences for how they would like to be told news regarding their cancer can be grouped into the following three categories: (1) content (what and how much information is told); (2) facilitation (setting and context variables); and (3) support (emotional support during the interaction). Women (P =.02) and patients with higher education (P =.05) had significantly higher scores on the Content scale, women (P =.02) had higher scores on the Support scale, and younger patients (P =.001) and those with more education (P =.02) had higher scores on the Message Facilitation scale. Medical variables were not associated with patients' ratings of the importance of the three subscales.

CONCLUSION

Patients rated items addressing the message content as most important, though the supportive and facilitative dimensions were also rated highly. Understanding what is important to patients when told news about their cancer provides valuable information that may help refine how this challenging task is best performed.

The 'cues' to diagnosis: describing the monitoring activities of women undergoing diagnostic investigations for breast disease

Waiting to ascertain the nature of an undiagnosed breast abnormality is an intensely stressful experience for many women. Uncertainty surrounding the aetiology of symptoms is underpinned by the threat of malignancy, and the 'need to know' the diagnosis is of primary concern at this time. Seeking out threat-relevant information through a process known as 'monitoring' attempts to fulfil this need. This paper details the qualitative phase of a multimethod research study that investigated the psychological impact of diagnosing breast disease. This involved focus interviews with a subset of 40 women from the original study cohort. Several types of threat-related cues were identified by respondents and were categorized as temporal, interpersonal, procedural and spatial. In the context of uncertainty (and in some cases suspicion) these cues were interpreted as 'indicators' of the pending diagnosis. The manner in which particular aspects of the environment are identified, interpreted and designated as 'threat-relevant' cues is discussed. Furthermore, the implications for health professionals working with patients during this stage of 'pre-diagnosis' are considered.

Perspectives on cancer patient education

OBJECTIVES

To provide an overview on cancer patient education.

DATA SOURCES

Literature related to demographic and health care trends, patient education, health literacy, and cancer patient information needs.

CONCLUSIONS

Cancer patients need information related to diagnosis, treatment, side effects, self-care needs, and effects on work and relationships. Planned patient teaching includes a variety of teaching strategies and written materials, and contributes to better patient outcomes. Inadequate health literacy and other barriers present challenges to providing effective patient education.

IMPLICATIONS FOR NURSING PRACTICE

More research is warranted in developing assessment tools and effective health education techniques and in measuring outcomes and costs related to patient education. The education needs of cancer patients will not drastically change in the next century. How nurses meet those needs, however, will change as we apply new learning theories and technologies of teaching.

Changes in clinical measures of autonomic nervous system function related to cancer chemotherapy-induced nausea

Individual cancer patients differ in their nausea/vomiting response to chemotherapy. It is not known why patients receiving the same chemotherapy have different severity of side effects. Several lines of research implicate the autonomic nervous system (ANS) in the development of chemotherapy-induced nausea. We examined the association between autonomic reactivity and the level of nausea experienced following chemotherapy in 20 patients with ovarian cancer treated with cisplatin or carboplatin who received the same antiemetic. We applied eight common non-invasive clinical tests of autonomic function prior to inpatient chemotherapy treatment, 2 h after treatment and again 24 h following treatment. Two hours after chemotherapy and before any nausea was reported by the patients, the nine patients who subsequently experienced high levels of nausea had a greater overall percentage of abnormal clinical ANS tests than the 11 patients who subsequently developed low levels of nausea (P < 0.01). Twenty-four hours after treatment, the overall number of abnormal autonomic tests remained non-significantly higher than at the pretreatment baseline for the high nausea group. Demographic and clinical characteristics were not related to chemotherapy-induced nausea in this sample. Autonomic reactivity appears to be related to the development of nausea following chemotherapy. Further investigation of ANS involvement in chemotherapy-induced nausea could increase understanding of nausea etiology and potentially lead to the prediction of susceptible patients.

The effect on coping of monitoring, blunting, and the ability to achieve cognitive structure

The effects of monitoring and blunting on individuals' choices of coping strategies and their effectiveness were examined. In addition, the authors explored the effect of the ability to achieve cognitive structure (AACS), defined as either or both of the following: (a) the ability to avoid information that either cannot be categorized or clashes with the individual's existing knowledge; (b) the ability to organize knowledge to fit an already existing cognitive structure. The results showed that in addition to the main effects of monitoring on problem-focused coping and social support seeking behaviors and of blunting on the use of wishful thinking, AACS was found to moderate blunting's influence on problem-focused coping as well as the effectiveness of distancing and avoidance coping. Finally, the results showed that the combination of high monitoring and high blunting sometimes contributes to coping effectiveness.

Cancer patients' coping styles and doctor-patient communication

Monitoring and blunting styles have become relevant concepts regarding their potential impact on patients' and doctors' behaviors. The present study aimed at investigating the relation between cancer patients' coping styles and doctor-patient communication and global affect. Coping styles were assessed by means of the Threatening Medical Situations Inventory (TMSI). Since a shortened version of the TMSI was used, the validity of this instrument was also evaluated. First, it was examined whether the two factor structure of the original TMSI could be confirmed in our version. Then, the relation between coping style and patients' preferences for information and participation in decision-making was evaluated. Second, the relation between monitoring and blunting and patients' age, sex, education, quality of life and prognosis was investigated. Finally, the relation between patients' coping styles and communicative behaviors and global affect of both patients and physicians during the initial oncological consultation was examined. Patients (N = 123) visited their gynaecologist or medical oncologist for an initial discussion of possible treatment. Patients' coping styles, socio-demographics, preference for information and participation in decision-making, quality of life and prognosis were assessed by postal questionnaire prior to the visit to the outpatient clinic. The consultation was audiotaped and analysed according to Roter's Interaction Analysis System, to identify instrumental and affective communicative behaviors of both patients and physicians. The two factor structure of the TMSI could be confirmed. A monitoring style was related to a preference for detailed information (r = 0.23) and participation in medical decision-making (r = 0.23). A monitoring style was also related to patient question-asking (r = 0.25) and patient dominance (r = 0.23). To conclude, the validity of the shortened TMSI is satisfactory. Also, cancer patients' coping styles are not related to other personal and disease characteristics. Further, a monitoring style seems to have an impact on patients' question-asking and dominance during the oncological consultation.

Patient satisfaction with cancer chemotherapy nursing: a review of the literature

Assessments of patient satisfaction have become widely accepted as a legitimate and worthwhile approach to improvement of service quality. Satisfaction studies are common in areas such as general practice or midwifery, but the approach has hardly been applied to assessments of care for persons with cancer. This paper first provides an historical background to satisfaction research in Western countries, then goes on to introduce conceptual issues in this field. Literature relevant to patient satisfaction with cancer chemotherapy services is then examined, with the review structured by four aspects of care: treatment accessibility and environment, technical aspects of care, interpersonal aspects of care, and patient information and education. The literature clearly suggest two areas which need urgent attention: assessments and management of adverse effects, and provision of patient information.

Side effects of adjuvant chemotherapy: perceptions of node-negative breast cancer patients

Twenty-one node-negative breast cancer patients were interviewed shortly after completing adjuvant chemotherapy and asked about side effects they had experienced, expectation of side effects, and strategies for coping with the side effects. Eighteen of the women were interviewed 6 months later to determine their feelings about the chemotherapy experience and ending treatment and what side effects persisted or developed after chemotherapy. Hair loss, fatigue, treatment-related problems, nausea and infections/low blood counts were the most frequently described problems during the first interviews. Patients used coping strategies suggested by physicians and nurses. Six months later, hair problems, fatigue, weight gain, menopausal problems, emotional problems and nail problems were most often reported. Most patients (16/18) did not expect to be experiencing chemotherapy-related problems 6 months after ending treatment. Fatigue interfered with daily lives and weight gain caused concern. A total of 35% of participants experienced fear or anxiety at the end of chemotherapy, but most (62%) recalled at least some positive feelings 6 months later. Given the same circumstances, all but two would make the same decision to undergo adjuvant chemotherapy. Support groups would be especially useful for patients completing chemotherapy who would lose continued frequent support from clinic personnel.

Psychometric evaluation of a questionnaire to document side-effects of chemotherapy

This paper reports the psychometric testing of the Worthing Chemotherapy Questionnaire (WCQ). The WCQ is a patient self-report instrument to document side-effects of chemotherapy. Literature review of relevant studies shows that psychometric testing of similar instruments is rarely rigorous. Content validity for the WCQ was established in five ways: literature review, Delphi review among oncology staff, pre-pilot unstructured interviews, pilot study and amendment of the instrument and items for spontaneous reporting of problems on the questionnaire. A three-stage approach to construct validity was used. The hypothesis adopted was that as certain cytotoxic agents cause stomatitis, incidence and severity of stomatitis will decrease following cessation of treatment. Stage 1: factor analysis confirmed the presence of a sole factor, with an eigenvalue of 5.3, for mouth problems which explained 65.5% of the variance. Stage 2: the hypothesis was confirmed using research findings. Stage 3: the Wilcoxon test showed highly significant results for during and post chemotherapy stomatitis scores. Reliability of the questionnaire was assessed using the test-retest method. Weighted kappa was chosen as the test statistic. A median value of wk = 0.87 was obtained. The results indicate that the WCQ is a reliable and valid instrument.

A study of patients' experiences of side-effects associated with chemotherapy: pilot stage report

This paper reports findings from the pilot stage of a longitudinal descriptive study of problems experienced by day-patients undergoing chemotherapy treatment with the Day Ward, Worthing Hospital. Unlike the majority of studies in this field, this study allows documentation of all side-effects perceived by the patient as important, and is designed to follow the progress in incidence and severity of each problem through the treatment course. Preliminary findings show some 100 side-effects have been identified, with different problems being most troublesome for each treatment regime. Full data are provided. The study emphasises the importance of regime-specific data both in formulating clinical practice and in the provision of patient education.

Monitoring versus blunting styles of coping with cancer influence the information patients want and need about their disease. Implications for cancer screening and management

BACKGROUND

Two main psychologic coping styles for dealing with cancer and other health threats have been identified: monitoring (attending to) or blunting (avoiding) potentially threatening information. This article reviews results and implications from this research relevant to cancer screening and management.

METHODS

The Monitor-Blunter Style Scale has been used extensively to assess and categorize patients with regard to these coping styles to predict their differential responses to various cancer-related screening and management regimens.

RESULTS

Patients characterized by a monitoring coping style generally are more concerned and distressed about their cancer risk, experience greater treatment side effects, are more knowledgeable about their medical situation, and are less satisfied with and more demanding about the psychosocial aspects of their care. They also prefer a more passive role in clinical decision making, are more adherent to medical recommendations, and manifest greater psychologic morbidity in response to cancer-related threats.

CONCLUSIONS

Patients fare better (psychologically, behaviorally, and physiologically) when the information they receive about their medical condition is tailored to their own coping styles: generally those with a monitoring style tend to do better when given more information, and those with a blunting style do better with less information. However, patients with a monitoring style who are pessimistic about their future or who face long term, intensely threatening, and uncontrollable medical situations may require not just more information, but also, more emotional support to help them deal with their disease.

MONITORING COPING STYLE, FEAR OF AIDS, AND ATTITUDES TOWARDS AIDS PREVENTION

The present study indicated that subjects with a high monitoring coping style are more fearful of AIDS than subjects with a low monitoring coping style. In addition, it was found that high monitors have a more preventive attitude towards AIDS than low monitors.

The relationship between information-seeking and information-avoiding coping styles and the reporting of psychological and physical symptoms

The present paper describes a prospective study of the relationship between information-seeking and information-avoiding coping styles ('monitoring' and 'blunting') and the reporting of both psychological and physical symptoms. The results suggested that blunting was directly associated with the reporting of both psychological symptoms and symptoms associated with opportunistic infections (such as colds, 'flu etc.). Furthermore, this association between blunting and symptom report was independent of initial symptom levels and of some other factors which have been shown to influence health status (i.e. the frequency of negative life experiences, the frequency of daily hassles and levels of trait anxiety). No significant relationships were found between monitoring and symptom report. It is argued that the most likely explanation of these results is that high blunters report more illness symptoms as a result of failing to respond to initial illness cues or seeking remedial treatment only at a later stage in the development of a disorder.

Satisfaction with communication, medical knowledge, and coping style in patients with metastatic cancer

Interviews were conducted with 77 patients aged 19-84, admitted to a medical oncology ward for assessment and modification of treatment. Satisfaction with information provided about tests, symptoms and treatment was assessed, together with satisfaction with care in general, factual knowledge concerning cancer and other medical conditions, and anxiety. Habitual style of coping with stress by information-seeking vs avoidance was measured using the Miller Behavioral Style Scale. Satisfaction levels were generally high. Patients reporting the highest level of satisfaction with information were more avoidant in their coping style than the remainder, and were also less anxious. Factual knowledge about cancer was in contrast greater among patients who were less satisfied with communication. These patterns were not dependent on age or education. It is argued that satisfaction with communication in medical settings is not a simple function of communication skills and the provision of adequately structured information, but that patients' tendencies to cope with stress by seeking out or avoiding information need to be taken into account.

Coping styles, paradox, and the cold pressor task

The study investigated how coping style differences affected performance on the cold pressor task. Reactions of "monitors" (individuals who prefer having information about stressors) and "blunters" (individuals who avoid cues connected with stressors) were compared, using different instructional sets. The study also assessed the effectiveness of paradoxical intention compared to more traditional cognitive strategies. Monitors and blunters were identified using Miller's recently developed Behavioral Style Scale. All instructional sets improved performance in comparison to a control condition, and individuals generally did better when an instructional set supported their preferred coping style. Paradoxical intention did not show any decided advantage over other strategies. The desirability of designing stress management programs to fit individual coping style patterns is discussed.