Journal of Behavioral Medicine

, Volume 36, Issue 4, pp 401–412 | Cite as

Matching intra-procedural information with coping style reduces psychophysiological arousal in women undergoing colposcopy

  • Susanna Kola
  • Jane C. Walsh
  • Brian M. Hughes
  • Siobhán Howard


This study assessed the combined effects of coping style and intra-procedural information on indices of distress (physiological measures, observed distress, self-report measures of anxiety and affect) among a group of patients undergoing colposcopy. High and low monitors were exposed to one of three interventions: high information (live video feed of colposcopy); low information (complete audiovisual distraction); and control. Results revealed a 2 (monitoring style) × 3 (information level) × 2 (time) interaction for systolic blood pressure (SBP), F(2, 111) = 3.55, p = .032. Among low monitors, patients in the low-information group exhibited significant SBP reductions during colposcopy, while those in the high-information group exhibited SBP increases. Among high monitors, patients in the high-information and control groups exhibited SBP reductions. Further, significant differences in observed signs of distress were found between groups with high monitors in the low-information group faring best overall, F(2, 111) = 4.41, p = .014. These findings indicate that tailoring information to suit individual coping style may maximize the apparent efficacy of interventions aimed at reducing stress during medical examinations.


Coping style Intervention Treatment matching Invasive medical procedure 


  1. Altekruse, S. F., Kosary, C. L., Krapcho, M., Neyman, N., Aminou, R., Waldron, W., et al. (2010, based on November 2009 SEER data submission, posted to the SEER web site, 2010). SEER cancer statistics review, 1975–2007. Retrieved from
  2. Boyle, P., & Levin, B. (Eds.). (2008). World cancer report 2008. Lyon: International Agency for Research on Cancer.Google Scholar
  3. Bradt, J., & Dileo, C. (2009). Music for stress and anxiety reduction in coronary heart disease patients. Cochrane Database of Systematic Reviews, Art. No.: CD006577. doi: 10.1002/14651858.CD006577.pub2
  4. Byrom, J., Clarke, T., Neale, J., Dunn, P. D., Hughes, G. M., Redman, C. W., et al. (2002). Can pre-colposcopy sessions reduce anxiety at the time of colposcopy? A prospective randomised study. Journal of Obstetrics and Gynaecology, 22, 415–420.PubMedCrossRefGoogle Scholar
  5. Chan, Y. M., Lee, P. W. H., Ng, T. Y., & Ngan, H. Y. S. (2004). Could precolposcopy information and counseling reduce women’s anxiety and improve knowledge and compliance to follow-up? Gynecologic Oncology, 95, 341–346.PubMedCrossRefGoogle Scholar
  6. Chan, Y. M., Lee, P. W. H., Ng, T. Y., Ngan, H. Y. S., & Wong, L. C. (2003). The use of music to reduce anxiety for patients undergoing colposcopy: A randomized trial. Gynecologic Oncology, 91, 213–217.PubMedCrossRefGoogle Scholar
  7. Christenfeld, N., Glynn, L. M., Kulik, J. A., & Gerin, W. (1998). The social construction of cardiovascular reactivity. Annals of Behavioral Medicine, 20, 317–325.PubMedCrossRefGoogle Scholar
  8. Dahlquist, L. M., McKenna, K. D., Jones, K. K., Dillinger, L., Weiss, K. E., & Sonntag Ackerman, C. (2007). Active and passive distraction using a head-mounted display helmet: Effects on cold pressor pain in children. Health Psychology, 26, 794–801.PubMedCrossRefGoogle Scholar
  9. Danhauer, S. C., Marler, B., Rutherford, C. A., Lovato, J. F., Asbury, D. Y., McQuellon, R. P., et al. (2007). Music or guided imagery for women undergoing colposcopy: A randomized controlled study of effects on anxiety, perceived pain, and patient satisfaction. Journal of Lower Genital Tract Disease, 11, 39–45.PubMedCrossRefGoogle Scholar
  10. Domino, E. F., Ni, L., Xu, Y., Koeppe, R. A., Guthrie, S., & Zubieta, J.-K. (2004). Regional cerebral blood flow and plasma nicotine after smoking tobacco cigarettes. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 28, 319–327.CrossRefGoogle Scholar
  11. Edelmann, R. J. (1992). Anxiety—Theory, research, and intervention in clinical and health psychology. Chichester: Wiley.Google Scholar
  12. Forys, K. L., & Dahlquist, L. M. (2007). The influence of preferred coping style and cognitive strategy on laboratory-induced pain. Health Psychology, 26, 22–29.PubMedCrossRefGoogle Scholar
  13. Freeman-Wang, T., Walker, P., Linehan, J., Coffey, C., Glasser, B., & Sherr, L. (2001). Anxiety levels in women attending colposcopy clinics for treatment for cervical intraepithelial neoplasia: A randomised trial of written and video information. British Journal of Obstetrics and Gynaecology, 108, 482–484.PubMedCrossRefGoogle Scholar
  14. Galaal, K., Bryant, A., Deane, K. H. O., Al-Khaduri, M., & Lopes, A. D. (2011). Interventions for reducing anxiety in women undergoing colposcopy. Cochrane Database of Systematic Reviews, Art. No.: CD006013. doi: 10.1002/14651858.CD006013.pub3
  15. Gattuso, S. M., Litt, M. D., & Fitzgerald, T. E. (1992). Coping with gastrointestinal endoscopy: Self-efficacy enhancement and coping style. Journal of Consulting and Clinical Psychology, 60, 133–139.PubMedCrossRefGoogle Scholar
  16. Holowaty, P., Miller, A. B., Rohan, T., & To, T. (1999). Natural history of dysplasia of the uterine cervix. Journal of the National Cancer Institute, 91, 252–258.PubMedCrossRefGoogle Scholar
  17. Howells, R. E., Dunn, P. D., Isasi, T., Chenoy, R., Calvert, E., Jones, P. W., et al. (1999). Is the provision of information leaflets before colposcopy beneficial? A prospective randomised study. British Journal of Obstetrics and Gynaecology, 106, 528–534.PubMedCrossRefGoogle Scholar
  18. Khanna, N., & Phillips, M. D. (2001). Adherence to care plan in women with abnormal Papanicolaou smears: A review of barriers and interventions. Journal of the American Board of Family Practice, 14, 123–130.PubMedGoogle Scholar
  19. Kola, S., & Walsh, J. C. (2009). Patients’ psychological reactions to colposcopy and LLETZ treatment for further evaluation of cervical intraepithelial neoplasia. European Journal of Obstetrics, Gynecology and Reproductive Biology, 146, 96–99.CrossRefGoogle Scholar
  20. Le, T., Hopkins, L., Menard, C., Hicks-Boucher, W., Lefebvre, J., & Fung Kee Fung, M. (2006). Psychologic morbidities prior to loop electrosurgical excision procedure in the treatment of cervical intraepithelial neoplasia. International Journal of Gynecological Cancer, 16, 1089–1093.PubMedCrossRefGoogle Scholar
  21. Lester, H., & Wilson, S. (1999). Is default from colposcopy a problem, and if so what can we do? A systematic review of the literature. British Journal of General Practice, 49, 223–229.PubMedGoogle Scholar
  22. Ludwick-Rosenthal, R., & Neufeld, R. W. J. (1993). Preparation for undergoing an invasive medical procedure: Interacting effects of information and coping style. Journal of Consulting and Clinical Psychology, 61, 156–164.PubMedCrossRefGoogle Scholar
  23. Maguire, D., Walsh, J. C., & Little, C. L. (2004). The effect of information and behavioural training on endoscopy patients’ clinical outcomes. Patient Education and Counseling, 54, 61–65.PubMedCrossRefGoogle Scholar
  24. Marteau, T. M., Kidd, J., Cuddeford, L., & Walker, P. (1996). Reducing anxiety in women referred for colposcopy using an information booklet. British Journal of Health Psychology, 1, 181–189.CrossRefGoogle Scholar
  25. Miller, S. M. (1987). Monitoring and blunting: Validation of a questionnaire to assess styles of information seeking under threat. Journal of Personality and Social Psychology, 52, 345–353.PubMedCrossRefGoogle Scholar
  26. Miller, S. M. (1992). Individual differences in the coping process: What to know and when to know it. In B. N. Carpenter (Ed.), Personal coping: Theory, research, and application (pp. 77–92). Westport: Praeger.Google Scholar
  27. Miller, S. M., Buzaglo, J. S., Simms, S. L., Green, V., Bales, C., Mangan, C. E., et al. (1999). Monitoring styles in women at risk for cervical cancer: Implications for the framing of health-relevant messages. Annals of Behavioral Medicine, 21, 27–34.PubMedCrossRefGoogle Scholar
  28. Miller, S. M., Combs, C., & Kruus, L. (1993). Tuning in and tuning out: Confronting the effects of confrontation. In H. W. Krohne (Ed.), Attention and avoidance (pp. 51–69). Seattle: Hogrefe & Huber.Google Scholar
  29. Miller, S. M., & Diefenbach, M. A. (1998). The cognitive-social health information processing (C-SHIP) model: A theoretical framework for research in behavioral oncology. In D. S. Krantz & A. Baum (Eds.), Technology and methods in behavioral medicine (pp. 219–243). London: Lawrence Erlbaum.Google Scholar
  30. Miller, S. M., Fang, C. Y., Diefenbach, M. A., & Bales, C. B. (2001). Tailoring psychosocial interventions to the individual’s health information-processing style: The influence of monitoring versus blunting in cancer risk and disease. In A. Baum & B. L. Andersen (Eds.), Psychosocial interventions for cancer (pp. 343–362). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  31. Miller, S. M., Leinbach, A., & Brody, D. S. (1989). Coping in hypertensive patients: Nature and consequences. Journal of Consulting and Clinical Psychology, 57, 333–337.PubMedCrossRefGoogle Scholar
  32. Miller, S. M., & Mangan, C. E. (1983). The interacting effects of information and coping style in adapting to gynecologic stress: Should the doctor tell all. Journal of Personality and Social Psychology, 45, 223–236.PubMedCrossRefGoogle Scholar
  33. Miller, S. M., Rodoletz, M., Schroeder, C. M., Mangan, C. E., & Sedlacek, T. V. (1996). Applications of the monitoring process model to coping with severe long-term medical threats. Health Psychology, 15, 216–225.PubMedCrossRefGoogle Scholar
  34. Miller, S. M., Roussi, P., Altman, D., Helm, W., & Steinberg, A. (1994). Effects of coping style on psychological reactions of low-income, minority women to colposcopy. Journal of Reproductive Medicine, 39, 711–718. (PMID 7807485).Google Scholar
  35. Miró, J. (1997). Translation, validation, and adaptation of an instrument to assess the information-seeking style of coping with stress: The Spanish version of the Miller Behavioral Style Scale. Personality and Individual Differences, 23, 909–912.CrossRefGoogle Scholar
  36. Miró, J., & Raich, R. M. (1999). Effects of a brief and economical intervention in preparing patients for surgery: Does coping style matter? Pain, 83, 471–475.PubMedCrossRefGoogle Scholar
  37. Morgan, J., Roufeil, L., Kaushik, S., & Bassett, M. (1998). Influence of coping style and precolonoscopy information on pain and anxiety of colonoscopy. Gastrointestinal Endoscopy, 48, 119–127.PubMedCrossRefGoogle Scholar
  38. Muris, P., Merckelbach, H., & de Jong, P. J. (1995). Exposure therapy outcome in spider phobics: Effects of monitoring and blunting coping styles. Behaviour Research and Therapy, 33, 461–464.PubMedCrossRefGoogle Scholar
  39. Parkin, D. M., Bray, F. I., & Devesa, S. S. (2001). Cancer burden in the year, 2000. The global picture. European Journal of Cancer, 37, S4–66.PubMedCrossRefGoogle Scholar
  40. Phillips, A. C., & Hughes, B. M. (2011). Cardiovascular reactivity at a crossroads—Where are we now? Biological Psychology, 86, 95–97.PubMedCrossRefGoogle Scholar
  41. Rees, C., & Bath, P. A. (2000). The psychometric properties of the Miller Behavioral Style Scale with adult daughters of women with early breast cancer: A literature review and empirical study. Journal of Advanced Nursing, 32, 366–374.PubMedCrossRefGoogle Scholar
  42. Rickert, V. I., Kozlowski, K. J., Warren, A. M., Hendon, A., & Davis, P. (1994). Adolescents and colposcopy: The use of different procedures to reduce anxiety. American Journal of Obstetrics and Gynecology, 170, 504–508.PubMedCrossRefGoogle Scholar
  43. Rogstad, K. E. (2002). The psychological impact of abnormal cytology and colposcopy. British Journal of Obstetrics and Gynaecology, 109, 364–368.PubMedCrossRefGoogle Scholar
  44. Schwartz, M. D., Lerman, C., Miller, S. M., Daly, M., & Masny, A. (1995). Coping disposition, perceived risk, and psychological distress among women at increased risk for ovarian cancer. Health Psychology, 14, 232–235.PubMedCrossRefGoogle Scholar
  45. Sparks, G. G., & Spirek, M. M. (1988). Individual differences in coping with stressful mass media: An activation-arousal view. Human Communication Research, 15, 195–216.CrossRefGoogle Scholar
  46. Spielberger, C. B., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). State-trait anxiety inventory. Palo Alto: Consulting Psychologists Press.Google Scholar
  47. Suls, J., & Fletcher, B. (1985). The relative efficacy of avoidant and nonavoidant coping strategies: A meta-analysis. Health Psychology, 4, 249–288.PubMedCrossRefGoogle Scholar
  48. Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5th ed.). USA: Pearson.Google Scholar
  49. Tiltman, A. J. (2005). The pathology of cervical tumours. Best Practice & Research Clinical Obstetrics and Gynaecology, 19, 485–500.CrossRefGoogle Scholar
  50. Tomaino-Brunner, C., Freda, M. C., Damus, K., & Runowicz, C. D. (1998). Can precolposcopy education increase knowledge and decrease anxiety? Journal of Obstetric, Gynecologic, & Neonatal Nursing, 27, 636–645.CrossRefGoogle Scholar
  51. Tsuda, A., Steptoe, A., West, R., Fieldman, G., & Kirschbaum, C. (1996). Cigarette smoking and psychophysiological stress responsiveness: Effects of recent smoking and temporary abstinence. Psychopharmacology (Berlin), 126, 226–233.CrossRefGoogle Scholar
  52. Walsh, J. C., Curtis, R., & Mylotte, M. (2004). Anxiety levels in women attending a colposcopy clinic: A randomised trial of an educational intervention using video colposcopy. Patient Education and Counseling, 55, 247–251.PubMedCrossRefGoogle Scholar
  53. Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063–1070.PubMedCrossRefGoogle Scholar
  54. Williams-Piehota, P., Pizarro, J., Schneider, T. R., Mowad, L., & Salovey, P. (2005). Matching health messages to monitor-blunter coping styles to motivate screening mammography. Health Psychology, 24, 228–245.CrossRefGoogle Scholar
  55. Wolf-Maier, K., Cooper, R. S., Banegas, J. R., Giampaoli, S., Hense, H.-W., Joffres, M., et al. (2003). Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. Journal of the American Medical Association, 289, 2363–2369.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Susanna Kola
    • 1
    • 4
  • Jane C. Walsh
    • 1
  • Brian M. Hughes
    • 2
  • Siobhán Howard
    • 3
  1. 1.School of PsychologyNational University of Ireland, GalwayGalwayIreland
  2. 2.Centre for Research on Occupational and Life StressNational University of Ireland, GalwayGalwayIreland
  3. 3.Department of PsychologyMary Immaculate College, University of LimerickLimerickIreland
  4. 4.Department of Behavioural and Social SciencesUniversity of HuddersfieldHuddersfieldUK

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