COPING

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COPING
Pittsburgh Mind-Body Center Summer
Institute 2006
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Overview of Talk

• Conceptualizing the coping process
• Measuring coping
• Place of coping in Center model
• Development of coping
• Issues in coping
• Dispositional styles vs. situational responses
• Adaptive vs. maladaptive ways of coping

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Conceptualizing CopingLazarus and Folkman Model

• Primary Appraisal
• Significance of event for person
• Threat
• Challenge
• Harm/Loss
• Secondary Appraisal
• What can I do? How can I cope?

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Dimensions of CopingLazarus and Folkman Model

• Problem-focused coping
• Action taken to counteract the source of the
  stress
• Emotion-focused coping
• Responses designed to alter the emotions produced
  by the event

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Dimensions of CopingSuls and Fletcher Model

• Approach coping
• Responses focused on source of stress and
  reactions to it
• Avoidant coping
• Responses designed to place focus away from
  source of stress and reactions to it

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Dimensions of CopingMoos Model

• Differentiates responses along two independent
  dimensions
• Active vs. avoidant
• Behavioral vs. cognitive

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Measuring Coping

• Omnibus measures
• Ways of Coping Checklist (Folkman Lazarus,
  1980 revised 1985)
• The COPE (Carver, Scheier, Weintraub, 1989)
• Dimension-specific measures
• Impact of Events Scale (Horowitz et al., 1979)
• Emotional Approach Coping Scale (Stanton et al.,
  2000)

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The COPE

• 60 item self-report questionnaire
• Dispositional and Situational versions
• 15 broad coping subscales
• Broad range of strategies
• Behavioral
• Affective
• Cognitive

(Carver et al., 1989)
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COPE Subscales
Active Coping Taking action, exerting efforts
to remove or circumvent the stressor. Planning
Thinking about how to confront the stressor,
planning ones active coping efforts. Seeking
Instrumental Social Support Seeking assistance,
information, or advise about what to do.
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COPE Subscales
Seeking Emotional Social Support Getting
sympathy or emotional support from
someone. Suppression of Competing Activities
Suppressing ones attention to activities in
which one might engage, in order to concentrate
more completely on dealing with the
stressor. Religion Increased engagement in
religious activities.
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COPE Subscales
Positive Reinterpretation and Growth Making
the best of the situation by growing from it, or
viewing it in a more favorable light. Restraint
Coping Coping passively by holding back ones
coping attempts until they can be of
use. Acceptance Accepting the fact that the
stressful event has occurred and is real.
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COPE Subscales
Focus on and Venting of Emotions An increased
awareness of ones emotional distress, and a
concomitant tendency to ventilate or discharge
those feelings. Denial An attempt to reject
the reality of the stressful event. Use of Drugs
or Alcohol Turning to the use of alcohol or
other drugs as a way of disengaging from the
stressor.
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COPE Subscales
Behavioral Disengagement Giving up or
withdrawing effort from the attempt to attain the
goal with which the stressor is
interfering. Mental Disengagement Psychological
disengagement from the goal with which the
stressor is interfering, through daydreaming,
sleep or self-distraction. Humor Making jokes
about the stressor.
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Four Main Clusters
Active .72 Denial .80 Pos Rein Growth .71 Beh
Disengage .76 Planning .67 Mental Disengage
.58 Supp Comp Activ .63 Restraint
Coping .59 Acceptance .52 Emot Soc
Supp .86 Humor .67 Instru Soc Supp .79 Religion -
.59 Focus on/Vent Emot .76 Use of drugs/alcoh
.47
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Place of Coping in Center Model
Chronic/Stable Burdens and Resources Coping
dispositions
Psychological Pathways Affect, Quality of
life, Perceived stress, Depression,
Purpose Emotion-focused coping
Biological Pathways
Disability Disease
Acute Precipitating Event
Behavioral Pathways Active coping
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Development of Coping
How do coping tendencies develop?

• Influence of genes
• Temperaments/IQ
• Influence of learning
• Idiosyncratic experience/trial and error
• Parent/peer modeling

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CMU Parent Study
Subjects 44 college students, their
parents (42 mothers, 41 fathers), and their
roommates (43). Measures COPE 60 item
inventory assessing 15 conceptually distinct
coping strategies
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Correlations between students coping responses
and coping responses of parents and roommates
Active Planning Suppression Restraint Positive
coping competing coping reinterpret activiti
es and growth Mother - .16 - .06 .00 - .12
.01 Father - .26 - .12 .19 - .15 -
.21 Roommate - .23 - .08 .22 -.07 - .15
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Correlations between students coping responses
and coping responses of parents and roommates
Humor Instrumental Religion Emotional
Acceptance soc support soc
support Mother .20 - .16 .46 - .11
.11 Father .09 .00 .20 .14
.19 Roommate .50 .01 .23 .11 - .18


p lt .05
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Correlations between students coping responses
and coping responses of parents and roommates
Denial Focus on Mental Behavioral Use
of venting disengage- disengage- drugs
or of emotions ment ment alcohol Mother -
.19 .02 - .12 - .07 .29 Father
.02 .14 .04 .01 .40 Roommate - .04
.00 .27 .06 .16

p lt .05
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Issues in Coping

• Dispositional vs. situational assessment
• Adaptive vs. maladaptive ways of coping
• Importance of engagement vs. disengagement

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Dispositional vs. Situational Assessment
Some questions

• Is the notion of coping styles useful?
• How do these relate to coping responses in
  particular situations?
• Which is better to assess?

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College Adaptation Study (CAPS)

• Sample
• 89 first-semester undergraduates
• COPE
• Dispositional Start of the semester
• Situational 12 to 16 weeks later
• Outcomes
• Depression
• Perceived stress
• Subjective health

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Correlations between Dispositional and
Situational Coping (CAPS)
College Undergraduates
Correlation Coefficient
(Scheier et al., 2000)
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Correlations between Dispositional and
Situational Coping (CAPS)
College Undergraduates
Correlation Coefficient
(Scheier et al., 2000)
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Correlations between Dispositional and
Situational Coping (CAPS)
College Undergraduates
Correlation Coefficient
(Scheier et al., 2000)
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Dispositional and Situational Coping and Distress
(CAPS)
Correlation Coefficient
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Dispositional and Situational Coping and Distress
(CAPS)
Correlation Coefficient
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Dispositional and Situational Coping and Distress
(CAPS)
Correlation Coefficient
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Mediation
Coping Dispositions
Distress
Situational Responses
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Mediation Analyses (CAPS)
Dispositional Situational Coping Coping Active
coping - 0.13 - 0.36 Behavioral
Disengagement 0.14 0.54 Denial 0.20 0.37 Use of
drugs or alcohol 0.10 0.29 Focus on/venting
emotions 0.13 0.15 Pos Reinterpretation
Growth - 0.25 - 0.34 Planning - 0.04 - 0.25










p lt .05 p lt .01 p lt .001
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Conclusions

• Coping styles predict situational responses
• Both predict adjustment (situational stronger)
• Situational responses largely (but not entirely)
  mediate effects of dispositional coping styles
• Which to use?
• Base decision on conceptual issues and/or study
  needs

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Functionality of Coping
Characterization of field

• Lots of work on psychological well-being
• Adjustment to chronic/acute disease
• Adjustment to medical problems
• Less work on physical health/relationship to
  disease processes

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Functionality of Coping General Characterization
Mental Physical Health Health Active
Coping /- Avoidant Coping ---/ --/ Moder
ators Chronicity/Control Emotion-focused
Coping ---/ -/ Moderators Pos reint
growth, humor, acceptance (links to active
coping)
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Focus on Specifics

• Engagement vs. disengagement
• The benefits of remaining engaged

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Living with AIDS Study

• 74 gay/bisexual men
• Mean age 38 years
• 95 white
• Mean length of diagnosis 12.2 months

(Data from Reed et al., 1994)
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Realistic Acceptance

• Try to accept what might happen.
• Prepare myself for the worst.
• Refuse to believe that this problem has happened.

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Realistic Acceptance and Survival
Percentage surviving
(Data from Reed et al., 1994)
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Further Manifestations of Process

• Active coping
• Fighting spirit
• Vital exhaustion
• Stoic acceptance

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Disengagement and Successful Living

• Much research suggests giving-up is bad
• Questions
• Is disengagement always bad?
• Is persistence always good?
• Might disengagement produce positive effects if
  goals are unattainable?

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Components of Disengagement

• Withdrawal of effort
• Relinquishment of commitment

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1
Obstacles seem too great to overcome
2
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Give up effort but remain committed to goal
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Distress, despondency, futility
Obstacles seem too great to overcome
2
a
Give up goal commitment, disengage from goal
b
c
d
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Components of Re-engagement

• Identify new goals
• Commit to those goals
• Pursue those new goals

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Goal Disengagement Items from GAS

• If I have to stop pursuing an important goal in
  my life
• Its easy for me to reduce my effort toward
• the goal.
• I stay committed to the goal for a long time,
• I cant let it go.

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Goal Re-engagement Items from GAS

• If I have to stop pursuing an important goal in
  my life
• I seek other meaningful goals.
• I convince myself that I have other meaningful
• goals to pursue.
• I start working on other new goals.

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Children with Cancer Study
(Wrosch et. al. , 2003)

• Sample (cross-sectional)
• 20 parents whose children were diagnosed with
  cancer
• 25 parents with healthy children (matched
  control group)

• Main Measures
• Disengagement (a .79), Re-Engagement (a .86)
• Depression (CES-D, a .94)

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Effects of Disengagement and Re-Engagement on
Depression
Cancer Parents
Cancer Parents
r -.53
r -.64
Depression (CES-D)
Contol Parents
Contol Parents
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Goal Adjustment and Cortisol Levels

• Examined goal adjustment and objective
• measure of health -- cortisol secretion
• Normally, cortisol peaks in the early morning
  hours declines steadily throughout the day
• Those experiencing stress have a flattened
  cortisol rhythm, with low morning output or no
  drop in secretion during the day
• Wrosch, C., Miller, G.E., Scheier, M.F., de
  Pontet, S.B. (under review), Giving up on
  unattainable goals Benefits for health?

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Goal Adjustment and Cortisol Levels

• Sample
• 54 participants
• Recruited via newspaper ad
• 38 female 24 Caucasian 85 of non-Caucasians
  were African-American
• Average age 30.3

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Goal Adjustment and Cortisol Levels

• Measures include
• Goal disengagement
• Goal reengagement
• Diurnal cortisol rhythm - collected on 4 separate
  days

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Salivary Cortisol Levels
Goal Disengagement and Cortisol Levels
Wrosch, C., et al., Study 3.
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Life Truth
You have to know when to hold em, know when to
fold em. Don Schlitz, The Gambler