Friday, August 12, 2011

Psychology Test Review #4 - Middle Adult/Late Adulthood/Death & Dying

Psychology - Test Review #4 - Middle Adulthood/Late Adulthood/Death and Dying

Middle Adulthood

Ø mid-life crisis

Ø sandwich generation

Ø “decline of the slope”


  1. Physical: 40-60 years old
  2. Health and Wellness
  3. Cognitive Functioning
  4. Theories of Social and Personality Development
  5. Changes in Relationships
  6. Mid-life career issues
  7. Individual Differences

1. Physical Development

Brain and Nervous System

Ø Synaptogenesis vs. synaptic pruning

Ø General rule:

o areas of the brain that develop last, decline first, (frontal – motor/spatial/impulse control and parietal – touch/sensation lobes)

Ø CFS increases to fill in lost space r/t reduction in volume of WMV/GMV

Ø Declines in cognitive functions?

o Not significant decline

Ø Younger vs. middle-aged drivers?

o middle age have better driving records

Ø Who has more accidents????

o young adulthood much more prone to accidents than middle-aged drivers

Reproductive System

Ø Focus of study at this point; happening for both men/women

Ø Climacteric:

o period when reproductive capacity declines or is lost; more common in women

Males - Andropause:

Ø Can happen rapidly but usually a gradual process

Ø Opposite of menopause

Ø slowing down of androgens/testosterone

Ø Still able to procreate through out their life span

Ø Viable sperm produced slightly decreased

Ø Testes shrink gradually

Ø Volume of seminal fluid declines

Ø Impotence: higher level at this age r/t stress; psychological factors; medications

Ø Low Testosterone - many associated problems including:

o fatigue

o reduced sexual interest

o muscle atrophy

o breast enlargement

Females - Menopause

Ø Stopping of menses in 1 year; must be one full year to be technically done

Ø Average is 50; but can span from 30s or beyond mid-50s

Ø Decreased estrogen (E) and progesterone (P)

Ø Weight gain/distribution of fat

Ø Sagging breasts

Menopausal Phases:

Ø 3 phases (over several yrs):

Ø Pre-menopause

Ø Peri-menopause

Ø Post-menopause

Before Menopause

Ø ↓ hormone to brain

Ø FSH stimulate ovaries.

Ø Adrenal glands produce E, P

Ø FSH causes ovaries to ↑ E (egg)

Ø E & P thicken uterine lining. If no pregnancy, hormone levels fall

Ø menstruation

Ø ↓ E & P levels

Ø Cycle begins again


Ø brain senses ↓ E/P

Ø continues to produce FSH

Ø Adrenal glands ↑ E

Ø Ovary does not respond to FSH. E remains ↓ no eggs

Ø no menstruation

1. Premenopausal Phase - late 30s – early 40s

Ø from 1st menstruation (fertile life)

Ø E levels decrease (toward end)

Ø Menstruation may become less regular

Ø Anovulatory cycles (anovulation – going through a cycle with out ovulation)

2. Perimenopausal Phase - 40-60 years

Ø Can span 2-6 years

Ø E & P levels start to become erratic (spike and drop in levels) causing hot/cold flashes

Ø More extreme variations in timing of cycles

Ø Hot flashes/Night Sweats

Ø Just prior to menopause

3. Postmenopausal Phase

Ø No menstration for 1 yr (menopause)

o natural vs. artificial (medications/hysterectomy)

Ø No longer fertile

Ø Pregnancy would be induced by scientific field

Ø E &P decreased

Ø Effects on the body:

o Loss of skin elasticity

o Weight distribution to other areas

o Mood swings

o Drop in libido/vaginal secretions

o Loss of bone mass leading to fragility

Psychological Effects of Menopause

Ø Mood

Ø Body image/self esteem may decrease

Ø Might think they are pregnant; causing it to be a dramatic event

Myth: that all women are crazy at this time

What affects her mood and social functioning?

Ø Cultural factors (rite of passage – may equate as a “status symbol” of wisdom)

Skeletal System

Risk: Osteoporosis

Ø Loss of calcium from the bones

Ø Result: decreased bone mass/more brittle bones (more likely to fracture or break)

Ø Risk Factors

o race - Caucasians at increased risk

o gender - women are at increased risk

o underweight

o timing of climacteric - earlier = increase risk r/t lower estrogen production (estrogen good for bones)

o family hx

o diet - low Ca during adolescence/early adulthood; high caffeine intake; alcohol

o sedentary lifestyle (weight bearing on bones helps promote osteocyte activity leading to better bone mass)

Vision and Hearing


Ø Increased number of people requiring glasses for reading

Ø Presbyopia

o Cannot focus on objects that are nearby/close

o Considered primary aging

o Rapid deterioration primarily in 40s-50s


Ø Presbycusis: cannot hear high frequencies

Ø Primary aging…but:

o Environment contributes to increased accelerations (secondary aging)

o Infection

Ø After age 50 = accelerations

Ø Usually more significant in men than women r/t working in noisier environment/listen to music louder

2. Health and Wellness

Health Trends at Mid-Life

Ø health affects quality of life

Ø poor health habits, risky behaviours catch up

Ø in disease r/t deaths during middle age

Ø aches & pains

Ø negative body perception

Ø chronic diseases & disabilities

Cardiovascular Disease

Ø #1 cause of death among adults 55+

o arteries are clogged

o key arteries become blocked=heart attack

o atherosclerosis and arteriosclerosis

o primary aging

o Type A at increased risk of cardiovascular disease over Type B


Ø #2 leading cause of death

o Men (28.2%); Women (23.9%) lifetime prevalence

o Why does risk of cancer ↑ as you get older?

o Lung Cancer (men vs. women)?

o Prostate and Breast Cancer

Risk factors for Cardiovascular Disease and Cancer

Ø smoking

Ø ↑ BP

Ø ↑ Weight

Ø ↑ Cholesterol

Ø ↓ Activity

Ø Poor Diet

Ø Alcohol Consumption

Ø Heredity

Gender and Health

Ø women live longer, but they have more diseases & disabilities

Ø Difference is present in early adulthood, ↑ with age

Ø Why do these differences occur?

3. Cognitive Functioning

Health & Cognitive Functioning

Ø link between level of physical activity person engages in & death rates

Ø lack of mental exercise correlates with decreased ability for memory and cognitive skill

Changes in Memory & Cognition

Ø New Learning: young vs. middle-aged

o semantic memory vs. episodic memory

o learning & remembering new info (e.g. college students)

At this point any decline in cognitive skills within the middle age group are not yet apparent therefore the younger age group does not show an advantage in learning skills. Studies have shown that test results for middle-agers may be higher due to a greater ability to focus, better time management, more efficient study strategies?? This includes both semantic and episodic memory.

4. Theories of Social and Personality Development


Ø Generativity vs. Stagnation

o find meaning in contributing to development of younger adults

Ø Generativity

o sense that one is making contribution to society (i.e. raising children or mentoring)

o find meaning in contributing to development of younger individuals/future generations

Ø Mid life crisis: fact or fiction: Personal outlook changes from “Time since birth” to “time left before death”? At around age 40 people come to the realization that death is inevitable. Not all individuals experience mid life crisis or mid-life transition as it has been renamed. Those who focus on growth rather than the stresses of life will pass through this time easily.

Ø Role transition – we occupy many roles at the same time

o Role Conflict occurs when we are trying to fill two roles at the same time that are in conflict with each other.

o Role Strain occurs when we are trying to fill a role that we have difficulty with. I.e. caring for an aging parent, taking on responsibilities after the death of a spouse.

o Duvall’s Stages of the Family Cycle:

1. Spousal role (married, no children)

2. Parent role (birth of first child)

3. Parent role changes (birth of more children)

4. Parent role changes (child is school aged)

5. Parent role changes (child is adolescence)

6. Parent role changes (children leave home)

7. Postparental stage

8. Work role ends (retirement)

5. Changes in Relationships


Ø Marital stability and satisfaction

o ↑ during middle age

o less stress is associated with this age group

Ø Why?

o ↑ level of control

o Skilled diplomacy - problem solving skills have been developed

o Men report feeling a greater security and satisfaction with their careers

o Women are generally still “climbing the ladder” (time off for raising a family?)

o Financial stress not as evident as not as many large purchases (first home)

o Greater problem solving skills, skilled diplomacy. Individuals report an increased level of control.

Emptying the nest

Ø In Canada

o majority do NOT experience stress when children leave the home

o majority of children remain within the same geographic region

Ø Those who do

o have self identified as being a parent before any other role

o those in labour force do not experience stress as much as self-identified parents

o they now need to determine who they are without that function

Ø The revolving door phenomenon

o ↑ in adult children living at home

o Why:

§ It has become socially acceptable for adult children to move back into the family home.

§ This may be due to divorce, change in career (returning to school)

Grand parenting - Styles (3) Types

1. Remote – do not see grandchildren often; may be due to geographic location or other block to visitation

2. Companionate – frequent contact with warm interactions with grandchildren

3. Involved – directly involved in everyday care of grandchildren or close emotional ties

Care for aging parents

Ø Impact of care giving role:

o Care Giver Burden” is a factor that is taken seriously. This may include financial pressures, time constraints, stress of watching an aging parent (or watching a parent age). Programs exist to help alleviate some of the stress that this role encompasses.

Ø Why Women?

o Women are more likely to assume the role of caregiver (possibly due to natural caring instincts or to stereotype of who should assume role)

Help of mother vs. father

Ø Daughters are 4x more likely (than sons) to help mothers

Ø Daughters are 40% more likely than sons to help fathers (fathers less likely to accept help? Wives live longer, so fathers may not require outside help?)

Ø Sons are more likely to supply financial help while daughters supply physical/emotional support

6. Mid-life career issues

Work Satisfaction

Ø Job satisfaction

Ø Middle age men - satisfaction - more established

Ø Middle age women - satisfaction

Work dissatisfaction in middle age

Ø time pressure

Ø difficulty co-workers

Ø boring tasks (i.e. a pilot who is no longer able to fly and now must assume a desk job)

Ø fear of losing job

Career transitions can be more difficult in middle age vs. earlier r/t real or perceived “Ageism” (discrimination due to age)

Unemployment and Career Transitions

Two types of career changes

1. Involuntary Career Change – leave job for external reasons (lay off, fired, company closure)


· risk of anxiety, depression, mental disorders

· physical illness

· BP

· mortality

· Negative impact on relationships due to interpretation of loss

2. Voluntary Career Change – leave job for internal reasons for change but still stressful

· ↓ risk for mental illness due to change

· May still have a ↓ impact on relationship if not handled properly

7. Individual Differences

Continuity & Change in Personality

Ø Continuity

o ?

Ø Changes in the ‘Big Five

Ø Conscientiousness ↑ up to 30, continue ↑ slower rate

Ø Agreeableness ↑ between age 30 – 60

Ø Neuroticism ↓ across adulthood, (women)

Ø Openness (men /women) ↓ after 30

Ø Extroversion Women ↓ after 30 men ↑

Late Adulthood

Ø Dementia, Stroke, Chronicity

Ø nursing care facilities


1. Variability in Late Adulthood

2. Physical Changes

3. Mental Health

4. Cognitive Changes

5. Theories of Social and Personality Development

6. Individual Differences

7. Social Relations

8. Career Issues

1. Variability in Late Adulthood


Ø scientific study of aging

Ø in late adulthood this is a period of individual variability rather than decline

Characteristics of the elderly population



- average 65 yr old lives to 82

- average 65 yr old lives to 87

- average 80 yr old likely to live to 90

- average 80 yr old can expect to live to over 92

Ø Men - If they are healthy when they reach 65 then if they live to 80 they are more likely to live to 90.

Ø Women - “The longer you live the more likely you are to live longer”

Characteristics of the Elderly Population

Ø elderly women than men

Ø ***but gender gap is narrowing

Ø In 1981

o women lived 7.1 yrs longer

Ø In 2001

o women lived 5.1 years longer

o females born in 2001 or > = estimated life expectancy of 82.1 yrs

o males born in 2001 or > estimated life expectancy of 77 yrs

Ø notice the narrowing of the age gap, there is a greater equality between the sexes

Ø this may be due to females taking on more roles outside of the house, being exposed to more of the industrial pollutants or men taking a greater interest in healthy behaviors


Ø Young – old (60-75) least amount of issues

Ø Old – old (75-85)

Ø Oldest – old (85+)

o fastest growing, 13% of total population in 2000

o estimated to 5x by 2051

§ This group is more likely to suffer from disease, mental health issues

§ “Frail Elderly” cannot care for themselves


Ø majority of older adults: “health is good or excellent”

Ø largest determining factor of adult’s physical and mental status over 65 years:

o If you think you are healthy you will be; if you think you are unhealthy you will be

Limitation on activities:

Ø Functional Status:

o measure of ability to perform certain roles/tasks (ADL’s and IADL’s)


o self-help tasks (i.e. bathing, dressing, and using the toilet)

Ø 2. Instrumental ADLS

o more complex daily living tasks (i.e. doing housework, cooking)

Ø 44% (85+) experience diffilculty with ADL’s and IADL’s

o More than 56% do not!

Ø For those who experience difficulties

o r/t disease such as arthritis and HTN

o Women have higher instances of arthritis than men = greater difficulty


Ø Osteoarthritis

o cartilage wears down bone

o bone rubs together

Ø Rheumatoid arthritis

o autoimmune disease

o joints attacked

o inflammation/thickening of joint lining


Ø interactions among heredity, environmental & behavior

Maximum lifespan

Ø Humans = 110-120 years

Ø Centenarians (100 +)

Ø Octogenarians (80+)

Ø Amount of 100+ expected to 4X from 2001-2010 (majority are female)


o Heredity- runs in families

o most age 100+ have large # of siblings (think time of birth, large families were common)

Hayflick limit

Ø Theory: species are subject to genetically programmed time limit

Ø cells no longer replicate accurately after this time (hamsters 2 years, dogs 14 years, etc)


Ø located at tip of chromosome

Ø repetitive string of DNA

Ø function: timekeeping device

Ø Hypothesized that this has a timekeeping function. The # and size of telomere decreases after each replication of the cell. Can determine life span by measuring.

Physical exercise/health habits linked to:

Ø longevity

Ø ↓ rate of disease

Ø better cognitive functioning

Ø most crucial factor = physical exercise - link to longevity

2. Physical Changes

The Brain & Nervous System

4 main changes in the adult brain

1. ↓ brain weight

2. ↓ gray matter

3. ↓ synaptic speed

4. ↓ dendrite density ***most central

o experience and aging involved - well educated vs. poorly educated – significantly less atrophy of cerebral cortex in educated individuals (relates to use of brain, if you don’t use it - you lose it)

o Loss of some dendrites = ↓ # of connections.

o Loss of gray matter = loss of dendrite branches

o Loss of dendrite density (DD) results in slowing of synaptic speed, slowing of reaction time

Senses & Other Body Systems

Taste, Smell & Touch

Ø Ability to taste:

Ø does not ↓ but

Ø ↓ # of taste buds

Ø ↓ smell

Ø ↓ sensitivity to touch (proximal-distal pattern reversal)


Ø enlarged blind spot

Ø ↓ pupil function

Ø cataract – clouding of eyes formation

Ø glaucoma – pressure in eye


Ø Tinnitus - risk for men (may be due to environmental factors)

Theories of Biological Aging

Free Radicals

Ø molecules that have an unpaired electron, causes un-repairable cell damage

Ø due to:

o normal by product of body metabolism

o exposure to certain foods, sun, pollution causes irreparable cell damage

§ will cause rate of free radicals

§ antioxidants such as Vitamins A, C, E help to reduce # of free radicals

Terminal Drop

Ø physical/mental declines in old age are part of the dying process

Ø all adults retain excellent physical/mental function until a few years before death, then there is a significant decline in all functions

Behavioural Effects of Physical Changes

General Slowing

Ø dendritic loss

Ø arthritic changes

Ø ↓ elasticity in both muscle and skin

Ø ↓ speed of nerve impulses

3. Mental Health

Ø Frontal lobes (Broca’s area) Left hemisphere:

o production of speech

o damage to this area produces Broca’s Aphasia (expressive)

o understand speech but cannot produce speech

Ø Temporal lobes – includes the primary auditory cortex, auditory information (Wernicke’s area):

o damage to this area produces Wernicke’s aphasia (receptive)

Ø Multi-infarct dementia

o often due to multiple small strokes, irreversible damage but functioning can improve

o many other causes for symptoms:

§ head trauma

§ depression

§ alcohol abuse


Ø Neurological disorder, problems with memory/thinking affect emotional, social, and physical functioning

Ø Number one cause of institutionalization (especially women in Canada)

Alzheimer’s disease

Ø Irreversible degeneration condition, most common cause of dementia

Ø Early Stages:

o STM difficulties

o Disorientation

Ø Later Stages:

o May fail to recognize people

o Aphasia

o Physical symptoms

o General lifespan = 5 years


Ø Difficulties making a diagnosis

o Ageism

Ø Mistaken for dementia

o Prevalence:

Ø Clinical depression less common – younger adults


Ø Dysthymia (slow depression) increases somewhat with age

o Suicide – higher for men than women

o Risk Factors:

§ Inadequate social support – needs higher levels of support at this age

§ Chronic or nagging health problems

§ Poverty – fixed rate to one number monthly not being able to pursue more

§ Health status – determines how health will be later on

§ Education – less bran atrophy

§ Emotional loss – house, license

§ Gender – late adulthood

4. Cognitive Changes

Cognitive Functioning

Ø Young old (65-75): cognitive changes small if any at all

Ø Old-old & oldest –old – average decreases


Ø forgetfulness with age

Ø STM Function:

o declines around 50-60; continues to decline

Ø Everyday Memory:

o declines around 50-60; continues to decline

5. Theories of Social and Personality Development


Ø Ego integrity vs. despair stage:

o achieve sense of satisfaction with their lives

Ø Ego Integrity:

o feeling that your life was worthwhile

Ø Reminiscence:

o reflecting on past experiences, positive emotional experience, necessary party of this stage

Activity Theory & Disengagement Theory

Ø Activity Theory

o it is normal and healthy for older adults to remain as active as possible for as long as possible

Ø Disengagement theory:

o it is normal and healthy to scale down social lives and separate from others to a certain degree

o 3 aspects:

§ Shrinkage of life space

§ Increased individuality

§ Acceptance of these changes

6. Individual Differences

The Successful Aging Paradigm

Ø Successful aging:

o Maintaining physical health, mental abilities, social competence, and overall satisfaction with life

Ø 3 Components:

o physical

o mental

o social

o Additional aspect - individual’s sense of life satisfaction

§ Behavioral choices

§ Recovery

§ Education and learning

Ø Perceived control = ↑ factor in stress

Ø Langer & Rodin (1976) study

o Nursing home residents study of control over care vs no control:

If not given control: 30% of residents died within first 18 months


15% dying if given control over aspects of care

Ø Social Support

o Increased mental well-being

o direct correlation of physical recovery with ↑ support (women)

Ø Key to successful aging:

o Social structure that offers opportunities to occupy:

§ Meaningful roles

§ Remain socially connected

§ Life satisfaction, or sense of personal well-being

§ Perceived adequacy of social support and income

§ Self-ratings of health may be most significant predictors of life satisfaction and morale

*** Self-ratings of health may be most significant predictors of life satisfaction & morale ***

Criticism of Successful aging

Ø Misleading

Ø May promote ageism

o disables older adults

Ø For many – no amount of social support, optimism, mental activities, willingness to participate in rehab will change disability

Ø No control of the effects of aging

7. Social Relations

Elder Abuse

Ø World elder abuse awareness day (June 15)

Ø Not common

o 7% emotional abuse

o 1% physical abuse

o 1% financial abuse

o most likely directed to demented elders (especially if demented elder is violent)

Ø Risk factors:

o Mental illness or alcoholism in abuse

o Social isolation

o $ Dependency of abuser on victim

o External stresses


Ø Marital Satisfaction

o after last child leaves home and satisfaction drastically at retirement (higher than when couple first married)

o Increased based more on loyalty, familiarity, and mutual investment

o Increased pleasure, decreased conflict

o Married = increased life satisfaction, health, and decreased rates of institutionalization

Family Relationships

Ø Effects of Relationship with Adult Children

o with time

Ø Grandchildren and siblings

o positive from beginning

8. Career Issues in Late Adulthood

Timing of retirement

Ø Retirement Age:

o 65 years

Reasons for retirement

Ø Health (poor)

Ø Family - why?

Ø Financial support - from children?

Ø Sex differences - who retires sooner:

o Women or Men? Look up

Effects of Retirement

Ø Financial

o ↓; living on a fixed income

Death and Dying and Bereavement

Ø different perspectives (Freud, Erikson)

Ø developments stages and how they proceed death and dying (how does a child/adolescent/adult perceive death)

Ø cultural practices/rituals


  1. The Experience of Death (p 578)
  2. The Meaning of Death Across the Lifespan (p 582)
  3. The Process of Dying (p 589)

1. The Experience of Death

Death Itself:

Ø Clinical Death

o vital signs absent (heart stops)

o resuscitation possible

Ø Brain Death

o no vital signs (brain activity

o resuscitation not possible

Ø Social Death

o treat deceased person as corpse (close eyes, death certification)

Where Death Occurs

Ø Hospitals

o ¾ deaths in hospital or long-term care facility

o Old-old vs. young adults – young adults die in hospitals more than old

Ø Hospice

o Emphasis on individual, family control over dying

o Type of care is palliative care

o Kübler-Ross – “Death was dignity”

Euthanasia - what do you think?

Ø Case #3: Karen Ann Quinlan

o Age 21

o Collapsed after a party

o Permanent vegetative state

o Parents requested to stop life saving efforts

o Hospital refused

o Removed 1976

o Died 1985

Ø Case #2: Sue Rodreguez

o Diagnose with Lou Gehrigs Disease

o Fought for “right to die” lost in supreme court 2x

o 1994 died assisted suicide

Ø Case #1: Terri Schiavo

o Brain damage @ age 26

o Hospitalized from 1990-2005

o Husband = legal guardian

o Controversy = remove of feeding tube

Do people have the right to die?

Ø 2 forms of euthanasia (aka: “mercy killing”)

o Passive:

§ withholding life saving interventions

o Active:

§ assisted suicide - actively causing death

o Living Wills

§ most agree individuals should be able to determine how much life-support will be used

2. The Meaning of Death across the Lifespan

Children's and Adolescents' Understanding of Death

Ø Preschool Children:

o reverse death through (prayers and wishes), dead person’s can feel, breathe, lack understand of life

Ø School age children (Concrete Operational Stage):

o death is permanent and universal, understanding of conservation (can exist somewhere else but never back here), experience with death (how much have they been exposed to the concept)

Ø Adolescents (Formal Operational Stage):

o Personal fable (story)

o Contributes to frequency of risk behaviours and unrealistic beliefs about personal death (may contribute to adolescent suicide)

The Meaning of Death for Adults

Ø Early Adulthood

o Unique invulnerability - believe that bad things only happen to others

o Experience with death...nursing students vs. business

Ø Middle and Late Adulthood

o Death changes roles and relationships

o Middle age...”time since birth to time until death”

o Meaning of death for most adults = loss

o Younger adults - loss for opportunity to experience things

o Older adults = loss of time to complete inner work

Fear of Death

Ø Wong:

o Existentialist researcher -

o “Death is the only certainty in life. All living organisms die; there is no exception. However, human beings alone are burdened with the cognitive capacity to be aware of their own inevitable mortality and to fear what may come afterwards. Furthermore, their capacity to reflect on the meaning of life and death creates additional existential anxiety (Wong, 2003).”

o Wong suggests our fear of death is due to 6 existential uncertainties:

§ The finality of death

§ The uncertainty of what follows

§ Annihilation anxiety or feat of non-existence

§ The ultimate loss

§ Fear of pain/loneliness

§ Fear of failing to complete life work

Fear of Death (Across adulthood)

Ø Middle-Aged Adults

o Realization that one is not immortal

o Increase anxiety

Ø Late Adulthood

o Acceptance

o Anxieties = how death will occur

Fear of Death (Religion)

Ø Religious vs. atheist

o lower fear of death amongst people who have a religion

Ø Transition vs. end

o Spiritual search for meaning in our lives is intensified by reality of death

3. The Process of Dying

Kübler-Ross's Stages of Dying

Ø Denial

Ø Anger

Ø Bargaining

Ø Depression

Ø Acceptance

Criticisms & Alternative Views

Ø Methodological problems:

o Initial setting of Kübler-Ross’s Study:

§ was small

§ mostly women

§ all Caucasian

§ one cultural group

§ poses the question:

· How can she then say her study was universal???

Ø Cultural specificity:

o not universal when study was conducted on “whites” only

o poses the question:

§ What constitutes a “good death” among different cultures???

Responses to Impeding Death

Ø Greer’s Classification of women's attitudes 3 months after diagnosed with breast cancer:

o Denial (+ avoidance)

o Fighting Spirit

o Stoic Acceptance (Fatalism - not sad; not happy)

o Helpless/hopeless group

o Anxious preoccupation

§ If initial reaction was denial or fighting spirit:

· Less likely to die of Breast Cancer

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