Monitoring processing style: to see or not to see

In this issue you will find a paper by Sherman et al., entitled "The effect of ‘monitoring processing style’ on post-surgical neuropathic pain in women with breast cancer.” This commentary focuses on the evidence base relevant to the ‘monitoring processing style’ (monitoring), based on the accumulating body of work on this construct. Monitoring is a temporally stable dispositional tendency to attend to, scan for, and amplify threatening health-related cues or information. Most of the research on monitoring has been assessed using the Monitor-Blunter Style Scale (MBSS), a brief self-report instrument with well-established reliability, validity, and utility (Miller, 1987). The MBSS has successfully been used to categorize individuals as either high monitors or low monitors (blunters).

The monitoring construct is theoretically derived from the Cognitive–Social Health Information-Processing (C-SHIP) model (Roussi and Miller, 2014), which delineates five key cognitive-affective variables that mediate the response to health threats: a) health-relevant knowledge and perceptions regarding one’s personal health risks and vulnerabilities; b) health-relevant beliefs and expectancies about being able to obtain effective care, as well as self-efficacy expectancies (e.g., degree of confidence in one’s ability to cope with a health problem or adhere to recommendations); c) health-relevant values and goals (e.g., pros and cons of available medical regimens); d) health-relevant affects and emotions activated in health information processing (e.g., level of anxiety and concerns about a medical result or procedure); and e) health-relevant self-regulatory competences and skills for coping by generating and maintaining goal-oriented health-protective behaviors (e.g., for decision making, adherence, managing health-related distress, and for achieving effective communication and support). These variables are common denominators in virtually all current cognitive-social models of health behavior.

Based on an extensive network of findings, high monitors generally display a signature cognitive-affective profile when facing health threats. Related to encodings, they know more about their health problem and are more likely to overestimate their personal health risks. They also have more negative beliefs and expectations regarding the health threat, and are more likely to exaggerate its severity and seriousness. In addition, high monitors place greater value on the pros of adhering to their medical care and on acquiring information about their health to help them problem-solve and reduce uncertainty, but are less satisfied with the information they receive from healthcare providers. At the affective level, high monitors experience more negative emotional responses to health threats, particularly greater worry, concerns, and distress, particularly when the threat is high, and are more in need of emotional support. At the self-regulatory level, when the health threat is more controllable and less severe, e.g., as when undertaking preventive measures for disease via routine screening, high monitors tend to demonstrate high adherence and effective coping. However, when facing more difficult-to-control and severe health threats, e.g., feedback of abnormal results or a diagnosis of cancer, high monitors tend to experience affects such as “intrusive ideation,” i.e., intrusive and repetitive thinking about the threat, and “avoidant ideation,” i.e., effortfully avoiding thinking about the threat, and consequent denial and disengagement (Miller, 1995). Thus, the high monitoring repertoire entails both effective and ineffective coping, the former when the health threat is more controllable and routine, and the latter when it is more uncontrollable, severe, and uncertain.

The Sherman et al. article adds to this literature, by showing that monitoring is associated not only with cognitive-affective and behavioral factors, but also with post-surgical pain levels among women who have undergone breast cancer surgery. These results are significant since they suggest that sustained attention to health threats involves not only increased subjective stress among high monitors, but also higher somatic symptom monitoring and actual somatic symptoms over time. These findings parallel previous results showing that high monitors show greater physiological arousal in the face of health threats, as well as greater symptomatology (e.g., nausea and vomiting) in response to cancer treatments. Taken together, this body of research indicates that it is important to consider signature personality profiles such as monitoring when designing interventions at the biobehavioral level, including psychoeducational, counseling, psychotherapeutic, symptom management, and support interventions in the health context.

In response to routine or short-term diagnostic and surgical procedures, interventions that provide detailed procedural and sensory preparatory information appear to be efficacious for high monitors, since information decreases uncertainty, risk perceptions, and worry. However, when facing more long-term, severe, and recurrent health threats, such as in the context of diagnosis, treatment or post-treatment phase, support and coping skills to enhance psychological and medical outcomes may be beneficial, in conjunction with information and reassurance about the consequences of the procedure. The agenda for future research is to improve patient-centered outcomes and quality of care by assessing and addressing monitoring processing styles in a preventive fashion so that psychosocial outcomes, pain management, and related symptom monitoring are enhanced, whether through use of traditional, digital, or web-based communication technologies.