نقش اضطراب، سبکهای مقابله با استرس و فاز سیکل قاعدگی در پریشانی

Using three samples, researchers investigated the relation between various anxiety levels, coping strategy use, and menstrual cycle phase to menstrual distress. In Studies 1 and 2, women low in anxiety sensitivity used more acceptance coping strategies and women high in anxiety sensitivity reported using more maladaptive coping strategies. In Study 2, women with medium anxiety sensitivity reported similar coping strategies to women low in anxiety. Menstrual cycle phase did not differentially affect coping strategy use in women varying in anxiety sensitivity levels in Studies 1 and 2. In addition to depressed mood emerging as a significant predictor of premenstrual distress in these two studies for all participants, avoidance coping for women high in anxiety sensitivity and problem-focused coping for women low in anxiety sensitivity were also significant predictors of premenstrual distress. In Study 3, during the premenstrual phase, women with panic disorder, compared to controls, reported using more avoidance coping whereas controls reported used more active coping and seeking social support for emotional and instrumental reasons. Results are discussed within a continuity model from high anxiety sensitivity to anxiety disorder for maladaptive coping and menstrual distress.

The menstrual literature is replete with equivocal findings as to whether specific menstrual cycle phases are associated with increased symptomatology (see Gallant & Derry, 1995). Recent studies suggest that anxiety sensitivity and panic attack history may greatly affect the experience and reporting of menstrual symptoms. In these studies, women high in anxiety sensitivity reported more severe menstrual symptoms relative to low and medium anxiety sensitivity women irrespective of current menstrual cycle phase (Sigmon, Dorhofer, Rohan, & Boulard, 2000a; Sigmon, Fink, Rohan, & Hotovoty, 1996). Similarly, women with panic disorder endorsed more intense menstrual symptoms than controls across the menstrual cycle (Sigmon et al., 2000b). To account for these findings, the authors proposed the menstrual reactivity hypothesis (i.e., women high in anxiety, especially those with panic disorder, may be more vigilant about physical sensations associated with the menstrual cycle and develop negative expectancies about them). In addition to anxiety sensitivity level, coping style represents another variable to consider in explaining menstrual distress. In the general population, men tend to use more active, problem-focused coping strategies (e.g., active planning) and women tend to use more emotion-focused coping strategies (e.g., seeking social support, focus on and venting of feelings; Ptacek, Smith, & Dodge, 1994; Vingerhoets & Van Heck, 1990) to cope with stressful situations. Preliminary research on coping and panic suggests that individuals with panic disorder use fewer problem-focused coping strategies and more wishful thinking strategies than controls (Cowley & Roy-Byrne, 1988 and Vitaliano et al., 1987). Although no research has been published that directly examines coping strategy use in individuals varying in anxiety sensitivity levels, researchers have hypothesized that individuals high in anxiety sensitivity engage in more anxious rumination and avoidant behaviors when coping with anxiety-provoking situations (Reiss, Peterson, Gursky, & McNally, 1986). However, coping styles related to menstrual cycle phase have not been specifically explored among high anxiety sensitivity women or among women with panic disorder. Comparing high anxiety and panic populations to controls across the menstrual cycle would highlight whether specific coping styles may contribute to heightened menstrual distress in these groups. For example, the ways in which a woman copes with stressful events (e.g., avoidance or emotion-focused coping) may influence the experience and reporting of menstrual symptoms. The relation between coping styles and the menstrual cycle has received some attention in the menstrual literature. In a survey to determine how women naturally cope with menstrual symptoms, Choi and Salmon (1995) found that women with more severe premenstrual symptoms were more likely than controls to use avoidance coping strategies (e.g., substance use) and were more likely to rate them as effective compared to active strategies (e.g., socialization, exercise). The majority of the research in this area, however, has focused on investigating coping style use in women who have been characterized as suffering from premenstrual syndrome (e.g., Fontana & Badawy, 1997 and Fontana & Palfai, 1994). During the premenstrual phase, Fontana and Palfai (1994) found that women with premenstrual dysphoria reported using more situational redefinition and social support coping strategies than controls. However, it does not appear that these differences are related to increases in perceived stress level during the premenstrual phase of the menstrual cycle. For example, Beck, Gevirtz, and Mortola (1990) found that level of psychosocial stress did not determine symptom severity in women with premenstrual syndrome. Although stress levels may be comparable across the menstrual cycle in women varying in premenstrual symptomatology, coping strategy use may vary according to menstrual cycle phase. However, the menstrual cycle itself could be conceptualized as a stressor (Sabin & Slade, 1999). If a woman reacts to aspects of the menstrual cycle (e.g., experiences discomfort) with maladaptive coping strategies (e.g., uses drugs or alcohol), she may experience more negative mood and perceive changes in her physical status as more severe. This possibility would be particularly salient for women high in anxiety sensitivity and for women with panic disorder. Due to increased self-focus regarding somatic changes (e.g., Clark et al., 1997; Schmidt, Lerew, & Trakowski, 1997), these women may be more likely to misinterpret and catastrophize the bodily sensations associated with aspects of the menstrual cycle (Sigmon et al., 2000b; Sigmon, Rohan, Boulard, Dorhofer, & Whitcomb, 2000c). Coping strategy use could be examined in relation to how individuals cope with social/environmental stressors, various menstrual cycle phases, and increased levels of anxiety and panic. Preliminary research has found that individuals with panic disorder report using more maladaptive coping strategies (e.g., wishful thinking, avoidance, blaming self) than controls (e.g., Katerndahl, 1999 and Roy-Byrne et al., 1992). The importance of coping strategy use in panic disorder has been conceptualized as representing “useful indicators of co-morbidity and care-seeking” (Katerndahl, 1999, p. 564). There is a need within anxiety populations to examine the specific types of coping strategies that are used across the menstrual cycle and how this impacts self-reports of menstrual distress. One goal of this paper was to investigate how women of varying anxiety sensitivity levels and women with panic disorder coped with general stress during specific menstrual cycle phases. We were interested in investigating this relation along a continuum, in individuals who varied in their experience of anxiety symptoms from women with high anxiety, who are at risk for developing panic disorder (e.g., Maller & Reiss, 1992), to women with panic disorder. The second goal of this effort was to explore whether specific coping styles are associated with increased menstrual distress in these groups. We analyzed the data from three successive samples of women varying in anxiety levels (Sigmon et al., 2000a, Sigmon et al., 2000b and Sigmon et al., 2000c). In each of these studies, coping strategy use, menstrual distress, and current menstrual cycle phase data were obtained. In addition, measures of negative affect were utilized to rule out negative bias effects on reporting coping strategy use and menstrual distress. We hypothesized that women high in anxiety sensitivity levels and women with panic disorder would report using more maladaptive coping strategies than controls, especially during the premenstrual phase. Because of the preliminary nature of the second research question, we made no a priori hypotheses about which coping strategies might best predict premenstrual distress.