Cognitive confrontation and avoidance during a naturalistic medical stressor

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Abstract
This study was undertaken to shed some light on problems that have arisen in measuring cognitive confrontation (monitoring) and cognitive avoidance (blunting) with a self‐report questionnaire, the Miller Behavioral Style Scale (MBSS; Miller, 1987). For this purpose, variants of both coping styles were studied in a naturalistic setting: 37 women who underwent prenatal diagnosis were interviewed at home about their ways of coping with different stages of the procedure, a few days before they expected the diagnostic results. Interview fragments pertaining to cognitive confrontation and avoidance were selected and analysed by two investigators in order to generate categories of avoidance and confrontation coping strategies. For some of the fragments, inter judge reliability was assessed using new judges. A comparison between the categories found and the kinds of items used in the MBSS shows that in real life more coping variants occur than those represented in the MBSS, in particular variants that involve a combination of cognitive confrontation and avoidance. Implications for the dimensionality of both concepts and for their measurement are discussed.

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