Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Coping with a stressful sigmoidoscopy: Evaluation of cognitive and relaxation preparations


Sigmoidoscopy involves the insertion of a small scope into the anal cavity to inspect for abnormalities in the colon. Although the procedure is not believed to be painful, it is often noxious for patients because it produces embarassment and discomfort. We examined the effectiveness of two brief interventions designed to enhance coping: self-instructional training and relaxation. In the self-instructional conditions patients were given brief training to focus their attention on either their own (internal) or the doctor's (external) ability to regulate the situation. A third (control) group received attention but did not experience self-instructional training. Half of each of these three groups also received relaxation training, while the other half did not. Planned comparisons demonstrated that subjects in the self-instructional strategies rated themselves as less anxious, had fewer body movements during the exam, and emitted fewer verbalizations than those in an attention control group. Patients in the external condition estimated that the exam took less time but tended to have elevated heart rates during the procedure. Those experiencing relaxation training tended to overestimate the duration of the exam, but made fewer requests to stop the exam and rated themselves as less anxious than patients who did not receive relaxation training.

This is a preview of subscription content, log in to check access.


  1. American Cancer Society (1979).Facts and Figures. ACS: New York.

  2. Averill, J. R. (1973). Personal control over aversive stimuli and its relationship to stress.Psychol Bull. 80: 286–303.

  3. Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change.Psychol. Rev. 84: 191–215.

  4. Bandura, A., Adams, N. E., and Beyer, J. (1977). Cognitive processes mediating behavioral change.J. Personal. Soc. Psychol. 35: 125–139.

  5. Bowers, K. S. (1968). Pain, anxiety, and perceived control.J. Consult. Clin. Psychol. 32: 596–602.

  6. Copeland, E., Miller, L., and Jones, R. (1968). Prognostic factors in carcinoma of the colon and rectum.Am. J. Surg. 116: 875–881.

  7. Davison, G. C., and Valins, S. (1969). Maintenance of self-attributed and drug-attributed behavior change.J. Personal. Soc. Psychol. 11: 25–33.

  8. Fuller, S. S., Endress, M. P., and Johnson, J. E. (1978). The effects of cognitive and behavioral control on coping with an aversive health examination.J. Hum. Stress, 4(4): 18–25.

  9. Gilbertson, V. (1974). Proctosigmoidoscopy and polypectomy in reducing the incidence of rectal cancer.Cancer 34: 936–939.

  10. Hertz, R., Deddish, M., and Day, E. (1960). Value of periodic examinations in detecting cancer of the rectum and colon.Postgrad. Med. 27: 290–294.

  11. Horan, J., Hackett, G., Buchanan, J., Stone, C., and Demchik-Stone, D. (1977). Coping with pain: A component analysis of stress-inoculation.Cog. Ther. Res. 1: 211–223.

  12. Johnson, J. E. (1973). The effects of accurate expectations about sensations on the sensory and distress components of pain.J. Personal. Soc. Psychol. 27: 261–275.

  13. Johnson, J. E. (1977). Information factors in coping with stressful events. Presented at the American Association of Behavior Therapy, Atlanta.

  14. Johnson, J. E., and Leventhal, H. (1974). Effects of accurate expectations and behavioral instructions on reactions during a noxious medical examination.J. Personal. Soc. Psychol. 29: 710–718.

  15. Johnson, J. E., Kirchhoff, K. T., and Endress, M. P. (1975). Altering children's distress behavior during orthopedic cast removal.Nurs. Res. 24: 404–410.

  16. Kaplan, R. M. (1982). Coping with stressful medical exams. In Friedman, H., and Di Matteo, M. R. (eds.),Interpersonal Issues in Health Care, Academic Press, New York, pp. 187–206.

  17. Kaplan, R. M., McCordick, S., and Twitchell, M. D. (1979). Is it cognitive or the behavioral component which makes cognitive behavior modification effective in test anxiety.J. Counsel. Psychol. 26: 371–377.

  18. Langer, E. J., and Rodin, J. (1976). The effects of choice and personal responsibility for the aged: A field experiment in an institutional setting.J. Personal. Soc. Psychol. 34: 191–198.

  19. Leventhal, H., and Everhard, D. (1979). Emotion, pain and physical illness. In Izard, C. E. (ed.),Emotions in Personality and Psychopathology, Plenum, New York, pp. 263–299.

  20. Lindman, H. R. (1974).Analysis of Variance in Complex Experimental Designs, Freeman, San Francisco.

  21. McCordick, S. M., Kaplan, R. M., Smith, S. H., and Finn, M. E. (1981). Variations in cognitive behavior modification for test anxiety.Psychother. Theory Res. Pract. 18: 170–177.

  22. Meichenbaum, D. (1977).Cognitive-Behavior Modification, Plenum Press, New York.

  23. Meichenbaum, D., and Turk, D. (1976).The Cognitive-Behavioral Management of Anxiety, Depression, and Pain, Bruner Mazel, New York.

  24. Rodin, J. (1976). Menstruation, reattribution and competence.J. Personal. Soc. Psychol. 33: 345–353.

  25. Rodin, J., and Langer, E. L. (1977). Long-term effects of a control-relevant intervention with the institutionalized aged.J. Personal. Soc. Psychol. 35: 897–902.

  26. Sarason, I. G., and Stopps, R. (1978). Test anxiety and the passage of time.J. Consult. Clin. Psychol. 46: 102–109.

  27. Schulz, R. (1976). Effects of control and predictability on the physical and psychological well-being of the institutionalized aged.J. Personal. Soc. Psychol. 33: 563–573.

  28. Seligman, M. E. P. (1975).Helplessness, Freeman, San Francisco.

  29. Smith, G., Chiang, H., and Regina, E. (1974). Acupuncture and experimental psychology. Paper presented at a symposium on pain and acupuncture, Philadelphia, April.

  30. Spanos, N., Horton, C., and Choves, J. (1975). The effect of two cognitive strategies on pain threshold.J. Abnorm. Psychol. 84: 677–681.

  31. Staub, E., and Kellett, D. S. (1972). Increasing pain tolerance by information about aversive stimuli.Journal of Personal. and Soc. Psychol. 21: 198–203.

  32. Strum, W. B., Landres, R. T., and Berry, C. C. (1976). Rates of detection of colon cancer by practosigmoidoscopy and barium enema.Ann. Intern. Med.

  33. Taylor, S. W. (1979). Hospital patient behavior: Reactance, helplessness, or control.J. Soc. Issues 35(1): 156–184.

  34. Turk, D. C. (1975). Cognitive control of pain: A skills training approach for the treatment of pain, Unpublished Masters thesis, University of Waterloo, Waterloo, Canada.

  35. Turk, D. C. (1978). Cognitive behavior techniques in the management of pain. In Foreyt, J. P., and Rathjen, D. P. (eds.),Cognitive Behavior Therapy: Research and Applications, Plenum Press, New York.

  36. Winawer, S., Sherlock, P., Schottenfeld, D., and Miller, D. (1976). Screeming for colon Cancer.Gastroenterology 70: 783–789.

Download references

Author information

Correspondence to Robert M. Kaplan.

Additional information

This research was supported by Grant R03MH30949 from the National Institutes of Mental Health to the first author.

Thanks are due to Gregg Pascoe and Gail Metzger for their assistance in various phases of this research project. The cooperation of the medical staff in the Division of Gastroenterology at Scripps Clinic and Research Foundation (La Jolla, California) is also gratefully acknowledged.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kaplan, R.M., Atkins, C.J. & Lenhard, L. Coping with a stressful sigmoidoscopy: Evaluation of cognitive and relaxation preparations. J Behav Med 5, 67–82 (1982).

Download citation

Key words

  • sigmoidoscopy
  • stressful medical exam
  • self-instruction
  • relaxation
  • cognitive-behavior modification