Screening Cognition, Distress, Coping and Social Factors

Mark argues that psychosocial information is often volunteered, for example when a patient answers a question about aggravating factors by describing how they feel, and clinicians need a framework to recognize it and to screen for it when it is not. Cognitive factors include the patient's understanding of the problem and its cause, beliefs about treatment, self-concept, openness, motivation, self-efficacy, expectations and the basis for those beliefs, probed with follow-up questions about what a diagnosis means to them. Unhelpful cognitions include catastrophizing, rumination, hypervigilance, negative self-concept and anger or blame. Distress, such as anxiety, frustration, fear or grief, should be judged for its behavioral and historical relationship to the problem, not assumed to drive it. Coping strategies such as medication, rest, activity modification and active strategies are each judged as adaptive or unhelpful, along with their effectiveness. Social factors cover health literacy, culture, living situation, work and above all perceived support, which is linked to better health and coping.