Journal of Behavioral Medicine

, Volume 5, Issue 1, pp 67–82 | Cite as

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

  • Robert M. Kaplan
  • Cathie J. Atkins
  • Linda Lenhard


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.

Key words

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


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. American Cancer Society (1979).Facts and Figures. ACS: New York.Google Scholar
  2. Averill, J. R. (1973). Personal control over aversive stimuli and its relationship to stress.Psychol Bull. 80: 286–303.Google Scholar
  3. Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change.Psychol. Rev. 84: 191–215.Google Scholar
  4. Bandura, A., Adams, N. E., and Beyer, J. (1977). Cognitive processes mediating behavioral change.J. Personal. Soc. Psychol. 35: 125–139.Google Scholar
  5. Bowers, K. S. (1968). Pain, anxiety, and perceived control.J. Consult. Clin. Psychol. 32: 596–602.Google Scholar
  6. Copeland, E., Miller, L., and Jones, R. (1968). Prognostic factors in carcinoma of the colon and rectum.Am. J. Surg. 116: 875–881.Google Scholar
  7. Davison, G. C., and Valins, S. (1969). Maintenance of self-attributed and drug-attributed behavior change.J. Personal. Soc. Psychol. 11: 25–33.Google Scholar
  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.Google Scholar
  9. Gilbertson, V. (1974). Proctosigmoidoscopy and polypectomy in reducing the incidence of rectal cancer.Cancer 34: 936–939.Google Scholar
  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.Google Scholar
  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.Google Scholar
  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.Google Scholar
  13. Johnson, J. E. (1977). Information factors in coping with stressful events. Presented at the American Association of Behavior Therapy, Atlanta.Google Scholar
  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.Google Scholar
  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.Google Scholar
  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.Google Scholar
  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.Google Scholar
  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.Google Scholar
  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.Google Scholar
  20. Lindman, H. R. (1974).Analysis of Variance in Complex Experimental Designs, Freeman, San Francisco.Google Scholar
  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.Google Scholar
  22. Meichenbaum, D. (1977).Cognitive-Behavior Modification, Plenum Press, New York.Google Scholar
  23. Meichenbaum, D., and Turk, D. (1976).The Cognitive-Behavioral Management of Anxiety, Depression, and Pain, Bruner Mazel, New York.Google Scholar
  24. Rodin, J. (1976). Menstruation, reattribution and competence.J. Personal. Soc. Psychol. 33: 345–353.Google Scholar
  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.Google Scholar
  26. Sarason, I. G., and Stopps, R. (1978). Test anxiety and the passage of time.J. Consult. Clin. Psychol. 46: 102–109.Google Scholar
  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.Google Scholar
  28. Seligman, M. E. P. (1975).Helplessness, Freeman, San Francisco.Google Scholar
  29. Smith, G., Chiang, H., and Regina, E. (1974). Acupuncture and experimental psychology. Paper presented at a symposium on pain and acupuncture, Philadelphia, April.Google Scholar
  30. Spanos, N., Horton, C., and Choves, J. (1975). The effect of two cognitive strategies on pain threshold.J. Abnorm. Psychol. 84: 677–681.Google Scholar
  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.Google Scholar
  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. Google Scholar
  33. Taylor, S. W. (1979). Hospital patient behavior: Reactance, helplessness, or control.J. Soc. Issues 35(1): 156–184.Google Scholar
  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.Google Scholar
  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.Google Scholar
  36. Winawer, S., Sherlock, P., Schottenfeld, D., and Miller, D. (1976). Screeming for colon Cancer.Gastroenterology 70: 783–789.Google Scholar

Copyright information

© Plenum Publishing Corporation 1982

Authors and Affiliations

  • Robert M. Kaplan
    • 1
  • Cathie J. Atkins
    • 1
  • Linda Lenhard
    • 2
  1. 1.Psychology ClinicSan Diego State UniversitySan Diego
  2. 2.La Jolla Veterans Administration Medical CenterLa Jolla

Personalised recommendations