Chapter 12: Monitoring and blunting – From Fear to Flow

12

Monitoring and blunting

Introduction

Suddenly, you find yourself in a situation of threat. The threat is not immediate, like a gun pointed to your head or you gasping for air in ice-cold water – situations which evoke instinctive reactions rather than long cognitive processing – but a threat of a more slowly evolving nature. You have a birthmark that has changed color, and a medical check-up shows that you have developed melanoma. Your company’s economy has lately gone bad and you are called to your boss’s office to have a serious talk; within minutes you are laid off. Your daughter’s teacher calls you up to inform you about a drug problem they suspect she has. What would you do? Think about it for a minute. Your first reaction would probably be emotional: perhaps you would panic or deny. Perhaps you would stay strangely calm and non-reactive, or perhaps you would cry and shout and be angry. But things would eventually quieten down and you would need to move on and face a decision on how to proceed in the new and unwelcome situation. Now you have reached a point where seeking information may come in, if you need it, want it and allow it.

Research has shown that people in general tend to react in two basic ways to information in a threatening situation like the ones imagined. Both approaches – monitoring (information seeking) and blunting (information avoidance) – are a form of coping, and neither one is more productive than the other per se (Miller, 1987).

Intensive information seeking

The intensive information seeking of monitors is expressed in many contexts. Monitors, for instance, tend to be active internet users, frequently searching for information online (Osterman, 2004). Monitoring may also be a sign of concern for the well-being of others. For instance, those mothers who worry the most about a child’s surgery frequently use monitoring as their coping method (MacLaren and Kain, 2008). By investigating the situation from every angle, monitors try to discover ways to master it and attain a sense of control. Monitoring may also occur in a relational context, where a suspicious and jealous person searches for evidence of betrayal by constantly surveying and questioning their partner. However, as in a health context, more information is not always better, nor does it always reassure and calm. In fact it is often the suspicion, jealousy and ruminating over worst-case scenarios that break the relationship, rather than the possibly imagined betrayal (Ickes et al., 2003). Monitoring is thus a way of actively responding to a threat. Finding out more about the peril may provide a sense of being in charge – at least you are actively trying to find a solution. By reading and talking about the problem, you begin to understand the mechanisms behind it, and may consequently obtain clues on how to deal with it (Brashers et al., 2000). Focusing your attention so closely on the problem may nevertheless also increase anxiety, at times to such high levels that it would be detrimental and distracting in your attempts to withstand the situation. When this happens, you would perhaps be better off blunting, distracting yourself from the problem, trying to relax and digesting only a few bits of information.

Dispositional coping

Dispositional coping models such as repression-sensitization (Byrne, 1961), blunting-monitoring (Miller, 1987) and approach-avoidance (Cook, 1985) describe coping tendencies as stable cross-situational traits. The transactional view of coping, on the other hand, argues that the coping response in any given situation forms through dynamic interaction between the person and the environment (Lazarus and Folkman, 1984). In addition, the specific stage of the coping process would be decisive for the way in which a person responds (Ptacek et al., 2006). The two approaches of disposition versus transaction may be reconciled in the notion that styles and interactions operate on different levels. Styles may be found if we compare coping across a wide range of situations, but every specific situation also contains its own unique elements (ibid.).

Both attention and distraction are efficient coping methods, and neither is superior to the other (Suls and Fletcher, 1985). Blunting may be most functional in situations of uncontrollable threat, while monitoring is preferable when there is a possibility of influencing the perilous situation. The problem is that even in situations which require another style, some persons continue to use their own dispositional one. Rigid copers thus continuously employ a certain coping style in various contexts regardless of its suitability. This is not the case for adaptive copers, who can appraise the most appropriate reaction for any given situation and flexibly adjust their response to the specific elements that the context presents. This allows them to cope in an optimal way (Ptacek et al., 2006). Adaptive copers would hence employ monitoring strategies in controllable situations and blunting strategies in uncontrollable ones (Voss et al., 2006).

Arousal

Monitors are as a rule more anxious than blunters (Cohen and Lazarus, 1973; Miller and Mangan, 1983). One explanation for this may be the close attention they pay to signals of threat (Holmes and Houston, 1974). Monitors are hard-wired to scan their environment constantly for even the slightest hint of a hazard. They tend to interpret ambiguous messages as dangerous, and exaggerate both their importance and their risk (Miller, 1995). They also tend to overestimate the severity of physiological symptoms, such as those of a disease (Constant et al., 2005). With this constant focus on negativity and danger it is hardly surprising that a monitor would feel anxious and alert. Anxiety may not only be a consequence of monitoring, but also the very cause of it (e.g. Muris et al., 1995). As a result monitoring may additionally be seen as an attempt to reduce anxiety by looking for assurance of safety (Shiloh and Orgler-Shoob, 2006).

Monitors tend to be more physiologically, behaviorally and subjectively aroused than blunters (Cohen and Lazarus, 1973; Miller and Mangan, 1983). In fact, monitoring may be such a strong impulse that it is difficult to switch off even in malfunctional circumstances. Rigid monitoring has for instance been linked to hypertension (Miller et al., 1989) and insomnia (Voss et al., 2006). Monitors frequently experience sleeping problems (73 per cent), while evidently not all sleeping problems (30 per cent) are related to monitoring (ibid.). Rigid monitors may be so highly wired to look for signals of threat that even when they try to relax this automatic surveillance mechanism remains alert, and they continue consciously and unconsciously to scan their sleep environment for possible danger. In addition, monitors tend to be bothered by intrusive rumination (Arikian, 2001). Worrying thoughts, often accompanied by strong negative emotionality, are difficult to switch off and may continuously bother the affected. Even when the person finally falls asleep, nightmares are common (Voss et al., 2006). When stress has exceeded the tolerable, the habitual monitor may turn to avoidance as a defense mechanism, actively trying to eliminate thoughts around the stressor. The ultimate reaction to overwhelming stress is often denial and disengagement – coping strategies which may be maladaptive in the long run (Miller et al., 1996). In sharp contrast, low monitors and high blunters find it easy to relax (Miller, 1987).

Monitors feel worried without information, while blunters find it unsettling when they cannot distract themselves (ibid.). When monitors are about to undergo medical procedures they tend to be agitated, ruminate and worry, and blame themselves for their condition. In addition they often experience pain and physiological discomfort. If a monitor in this situation is provided with useful information, this relieves not only psychological but also physical distress. Matching the amount of information with the coping style may for instance lower pulse rate and arousal (Miller, 1995; Miller and Mangan, 1983). Monitors and blunters thus cope optimally with the amount of information that best matches their respective style (Miller and Mangan, ibid.; Ludwick-Rosenthal and Neufeld, 1993). Forcing someone to deal with either more or less information than he/she wishes for tends to backfire. In a delivery situation it was shown that mothers who dealt with pain by paying close attention to processes in their bodies suffered less when they could watch their contractions on a monitor. But the opposite was true for mothers who relieved pain through distraction. If they were required to watch the monitor they became more aware of their bodily processes and their pain intensified (Shiloh et al., 1998). In other contexts it has also been shown that information may sensitize some patients to suffering, increase arousal and anxiety, and hinder recovery (Langer et al., 1975). Providing patients with large amounts of preparatory information before a medical procedure may cause anxiety, depression and discomfort (Miller and Mangan, 1983), particularly if the information relates to possible risks and complications (Kerrigan et al., 1993). This shows that interventions are most efficient when they correspond to the individual’s natural coping style, and may cause more harm than good if a patient is forced to ‘cope’ in a way that is not natural for her/him (Shiloh et al., 1998). Research has, however, also revaled that matching the amount of information with coping style is no guarantee for anxiety reduction (Ludwick-Rosenthal and Neufeld, 1993).

As we have seen, monitors generally do better when they can access a multitude of information. This may not apply to pessimistic monitors, who in fact may react destructively (Miller, 1995). They tend to exaggerate their health threats, expect the worst, have little faith in the future and doubt their ability to cope. In the worst-case scenario this creates a negative spiral. They encounter a threat; they seek information about it; what they find out increases their anxiety; they continue to seek; what they find escalates their anguish; they seek more… you get the picture. In the long run this may result in overload and denial. Monitoring could thus be a beneficial strategy if combined with self-efficacy, while the combination with pessimism may be detrimental (overview in Miller, ibid.).

Monitoring and trait anxiety

Whether or not there is a connection between monitoring and trait anxiety is controversial. Intuitively it would appear that the two traits are related. Monitoring shares many similarities with trait anxiety, such as heightened arousal, vulnerability to state anxiety and an exaggerated tendency to interpret new stimuli as threatening. With respect to information interaction, we find an additional similarity in the usually active information seeking that both dimensions share. The relation between the two, however, is not straightforward but has instead been subject to much debate. It has been demonstrated that monitoring shows no relation to trait-like depression, trait anxiety or Type A, all of which are characteristics that share features with monitoring (overview in Miller, 1995, 1987). Although high monitoring has been linked to a chronic tendency to worry, this appears unrelated to trait anxiety (Davey et al., 1992). In the five-factor tradition, monitoring and negative affectivity as well as monitoring and introversion have been found to be unrelated (Muris et al., 1993). But some studies have revealed a connection. Monitors have been found to score higher on negative affectivity than blunters (Voss et al., 2006), to display higher trait anxiety than blunters and to have a negative perception bias (Russell and Davey, 1993; Stoddard et al., 2005). In other words, research findings are contradictory and puzzling. Future research will clarify the controversy.

Further adding to the confusion, it is not only the trait-anxiety dimension that resembles monitoring. There also appear to be similarities between blunting and repression, and monitoring and sensitization, respectively. Repressors try to avoid or distract their attention away from threatening stimuli, in the same way as blunters would. Sensitizers again continuously scan their environment for such cues. Both monitoring and sensitizing have been correlated with trait anxiety (Holmes, 1974; Miller and Mangan, 1983). Sensitizers, moreover, often interpret neutral or ambiguous stimuli as being threatening, just as monitors do. Monitors have indeed been called consistent vigilants or sensitizers, while blunters have been named consistent avoiders or repressors (Hock et al., 1996). It has nevertheless been demonstrated that monitoring and blunting show no relation to repression-sensitization (overview in Miller, 1995, 1987). One explanation may be that the monitoring-blunting scale does not capture as profound an individual difference as the repressor-sensitizer scale. It seems that monitors can learn to blunt, and vice versa (Miller and Mangan, 1983). Again, further investigation is needed for a final resolution of the puzzle.

Information avoidance

When it comes to information interaction, is the more the merrier or may ignorance be bliss?

Although monitors by definition are vigilant to threats in their environment, their focus on hazards may become unbearable under extreme circumstances. As anxiety rises it will at some point cross a border to overload, resulting in information avoidance rather than active information seeking. Consequently, under uncontrollable, chronic or severe threat, habitual monitors may turn into blunters (Miller et al., 1996). Typical for high monitors are intrusive negative thoughts and worries which are difficult to master or escape. They constantly occupy the mind, and result in strong negative emotionality as well as sleep disturbances. In an attempt to quiet the mind, monitors may therefore resort to denial or mental disengagement. As an example, a worried person may be constantly vigilant to bodily symptoms suggesting illness. As this feeds rather than reduces anxiety, the person may eventually escape into denial of symptoms and messages suggesting unwanted news. The monitoring tendency is also sensitive to the potential benefit of the obtained information. When the outcome of a genetic test would be uncertain and there would be no way to influence the possible development of a disease, monitors may not be interested in testing (Shiloh et al., 1999). These reactions are understandable and adaptive in that they temporarily reduce stress, but eventually suppression may be counterproductive as it interferes with acceptance and attempts to move on.

Despite the documented link between anxiety and active information seeking, high anxiety may also induce information avoidance. The theory of affective intelligence argues that emotional arousal, particularly anxiety, alerts the organism to gather information that may be useful for self-protection (Marcus et al., 2000). This is supported by the control model of information seeking, which states that we seek information to minimize uncertainty, gain control and prepare for responses that will lower or eliminate threat (Miller, 1981). Terror management theory, on the other hand, argues that anxious persons strive to protect themselves from information they perceive to be threatening (Solomon et al., 1991). It seems that both theories are on to something, as the decision to seek out or avoid information often depends on how severe the anguish is. At manageable levels anxiety often prompts information seeking, while if it is too strong it may result in avoidance.

Persons with high trait anxiety and low self-esteem may experience complex and new situations as overwhelming and therefore be less likely to seek out related information (Schaninger, 1976). A typical reaction to unbearable fear and anxiety is thus avoidance, denial and repression, often accompanied by feelings of anger, guilt and hopelessness (Johnson, 1997; Myers and Derakshan, 2000; Spielberger and Starr, 1994; Watson and Clark, 1984). Suppression of thoughts or memories may also act as a form of information avoidance (Wenzlaff and Wegner, 2000; Golding and MacLeod, 1998). Another indirect form may be to discredit the information source (Cohen, 1993). These reactions are particularly common if a person doubts that he/she will manage the situation (Johnson, 1997). Avoiding information may thus be a deliberate attempt to cope (Brashers, 2001). It is a defense against a certainty that is too threatening to bear (Case et al., 2005). As long as explicit and negative predictions are unknown, there is, after all, hope (Leydon et al., 2000). Some patients, for example those diagnosed with cancer, consequently shun information about their condition as it makes them too anxious (Hinds et al., 1995; Struewing et al., 1995).

Information seeking has often been described as a means to decrease cognitive uncertainty and mend the accompanying feelings of insecurity (Kuhlthau, 2004). But more information may increase uncertainty and cause anxiety rather than calm an uneasy mind. In fact there are situations where people may be better off with more uncertainty than less (Brashers et al., 2000). One study found that 52 per cent of respondents felt that information reduced their anxiety about a health concern, but 10 per cent felt that the information they got actually made them more anxious (Pifalo et al., 1997). Awareness of a genetic risk for cancer may for instance lead to psychological problems (Giarelli, 1999). Genetic testing may thus not evidently be something positive, but instead a cause of anxiety and depression (Chaliki et al., 1995; Lerman et al., 1995; Smith and Croyle, 1995). Avoiding certainty may in this context be a conscious decision. Positive illusions, such as unrealistic optimism, could be an effective means to cope with a too-stressful reality (Taylor and Armor, 1996). The decisive factor is how the uncertainty is conceived. When not knowing equals danger, it evokes anxiety and fear and the response generally consists of information seeking. But when uncertainty represents hope and optimism, information that brings (perhaps negative) certainty is best avoided. In stressful contexts like a health concern or disease one may attempt to increase uncertainty and hope by learning more about cures and research advances. After being diagnosed with a terminal disease such as AIDS it may be reassuring to find out more about treatment alternatives and self-care, while knowing more about likely symptoms may be frightening. In this situation sharing the experience with others in the same boat may be comforting and therapeutic, but listening to others’ stressful experiences, symptoms and pain may cause more damage than gain (Brashers et al., 2000). The way people approach uncertainty may also change over time. For instance, living with a terminal disease requires adjustment (ibid.). In fact what is certain is that life itself is uncertain, fragile and impermanent. We need to accept and even embrace this constant change (Mishel, 1990). It has been shown that persons who consider themselves happy often tend to be blunters. This does not imply that they ignore problems, but rather that they have the capacity to escape momentarily the emotional stress they cause. In a relationship context, for instance, it has been shown that blunting potentially threatening information, such as ignoring your partner’s innocent attraction to another person, may be beneficial to the relationship (Ickes et al., 2003). For cancer patients the feeling of hope, often obtained by avoiding negative and detailed information, might in fact be essential for their capacity to carry on a fairly normal everyday life (Leydon et al., 2000).

Preventive medicine naturally has benefits and our biomedical advancements have been of immense value, but there are also situations where not knowing is preferable (Brashers, 2001). In today’s society, when options for instance for genetic testing are increasingly available, more and more people are faced with such choices. Our society has become somewhat of a ‘culture of chronic illness’ where increased awareness and vigilance about health risks cause unnecessary worry, confusion and anxiety for those who are in fact healthy (ibid.). Encouragement to have check-ups and tests may not inspire the healthier living intended, but instead an unhealthy preoccupation with illness (Woloshin and Schwartz, 1999). As much as people have the right to know, they also have the right to choose not to know (Alpert, 2003). Improved devices for screening and frequent health check-ups increase the likelihood of discovering something malfunctioning in every individual, causing what Brashers (2001) calls ‘a society divided into the chronically ill, and the worried well’. Avoiding information allows a leeway from confronting a troubling reality, for instance avoiding being HIV tested despite symptoms (Brashers et al., 2000). Yet research has shown that avoidance of tests and diagnoses causes more anxiety than finding out, even if the news is bad (Kash et al., 2000; Conley et al., 1999). Denial and avoidance coping have repeatedly been related to high anxiety, depression and worries (Deimling et al., 2006). Women who avoid genetic testing for cancer have been shown to be more likely to become depressed, even compared to those who learn that they carry a possibly cancer-inducing gene (Kash et al., 2000). Not knowing may thus cause worry and anxiety, at times at an unconscious level. In this context it is difficult to say what is the cause and effect. Does information avoidance increase anxiety in an uncertain context, or do anxious persons consciously try to avoid information in order to protect themselves from disturbing news? Likely both mechanisms may be active, at times simultaneously feeding each other.