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Abstract

In the past 25 years, more than 30,000 research papers have been published on coping. This is not only a testament to the popularity of this construct but also reflects the enormous interest in the psychological and physical effects of stress. Theoretically, at least part of the reason for differential vulnerability and resilience to stress lies in how individuals cope with stress. Testing this hypothesis has led to the growing understanding of the complexity of the adaptation process. There is simply no ‘‘silver bullet’’ that will magically solve all problems but, rather, the effects of coping vary by how coping strategies are assessed, the type of problem, and a variety of situational factors, as well as the skill and resources of the individual facing the problem.

Outline

Types of Coping
Coping and Health Outcomes

1. Types Of Coping

There are three major approaches to the study of coping: psychoanalytic approaches, coping styles, and coping processes. These approaches to coping differ as to whether they focus on unconscious mechanisms, personality or information processing styles, or environmental influences.

1.1. Psychoanalytic Approaches

Psychoanalytic approaches focus on the use of defense mechanisms, which are unconscious ways of fending off anxiety. Defense mechanisms differ from coping strategies in that they are unconscious, dispositional (e.g., defensive styles), and are associated with pathology, whereas coping strategies are consciously chosen, intentional, and can flexibly respond to environmental demands. However, defense mechanisms vary in the degree to which they distort reality and may be hierarchically arranged from psychotic to adaptive or ‘‘mature.’’ Psychotic defense mechanisms may involve outright denial of reality, whereas ‘‘immature’’ or neurotic mechanisms may consist of denial of the significance of an event, such as intellectualization. The most adaptive or mature defense mechanisms include humor and altruism. Because they are believed to act on an unconscious level, defense mechanisms are difficult to study and they are usually assessed using in-depth interviews and case studies. Thus, there have been few large-scale studies of their effectiveness. However, they did provide the initial impetus for the study of how individuals cope with stress.

1.2. Coping Styles

Coping styles differ from defense mechanisms in that they focus on how people deal with information as well as emotions, and are thought to be consistent across time and situation. As such, they typically take the form of dichotomies such as repression–sensitization, blunting– monitoring, and approach–avoidance. Research studies have typically found that approach styles are associated with better outcomes than avoidance styles. However, this does not hold true across all circumstances, such as with uncontrollable stressors. Furthermore, studies that empirically test consistency in coping across time or situations are rare, and the ones that do include such tests generally find that individuals are not very consistent in how they cope with different types of problems.

1.3. Coping Processes

In contrast to the two previous views, the coping process approach argues that coping is responsive to both environmental demands and personal factors such as values and beliefs. As such, coping strategies are flexible and unfold over time, either in response to changing appraisals or as a function of developmental processes. Coping strategies are proactive and are not simply responses to environmental contingencies. One can appraise a situation as benign, in which case no coping is needed, or as involving threat, harm, or loss or as a challenge, all of which may evoke various coping strategies. Because this approach emphasizes the flexible nature of coping, the focus is on how individuals cope with particular situations and, as mentioned earlier, several studies have shown that coping strategies do vary across situations.

There are many different conceptualizations of coping strategies, but the five general types of coping strategies are problem-focused coping, emotion-focused coping, social support, religious coping, and meaning making. Problem-focused coping, also called instrumental action, encompasses behaviors and cognitions aimed at solving the problem, such as seeking information, taking direct action, or breaking the problem down into more manageable pieces, a strategy referred to as ‘‘chunking.’’ Sometimes, delaying or suppressing action can be a useful problem-focused strategy. For example, purposefully delaying a direct confrontation with someone may lead to a more rapid solution to a problem than acting in anger.

Emotion-focused coping includes a wide range of strategies that are directed toward managing one’s emotional response to the problem. Some examples are avoidance, withdrawal, expressing emotion, and the use of substances such as alcohol or food. As might be expected, avoidance strategies are often associated with poor outcomes, but other emotion-focused strategies, such as expressing emotion through journals or writing, may be associated with positive outcomes.

Social support involves seeking both emotional and concrete aid from others or advice. The outcome of these types of coping strategies often depends on the social context. For example, confiding in others after a trauma is generally associated with better outcomes, but if the confidant responds negatively, emotional distress may be increased.

The study of religious coping is relatively new. It can contain elements of social support or problem-focused and emotion-focused coping, and it seeks to conserve or transform meaning in the face of adversity. In general, religious coping is associated with positive outcomes, but it does have negative guises. Belief in a punitive God, or feeling that one has been treated unfairly or been deserted, may be associated with much poorer outcomes.

The final category, meaning making, is the least well understood. It is sometimes referred to as ‘‘cognitive reappraisal’’ and involves trying to see the positive or meaningful aspects of the situation, especially with severe or chronic stressors. As with religious coping, how one goes about making meaning may affect its association with outcomes. Simply asking ‘‘Why me?’’ may be associated with poorer outcomes, but coming to realize how a problem fits into the larger pattern of one’s life may be a painful process but in the end may be one way in which individuals grow from stressful or traumatic experiences.

1.4. Measurement Issues

Coping style measures ask individuals how they typically cope with problems. The dichotomized nature of coping styles lends itself well to psychometric assessment. The factor structures of coping style inventories are generally stable, and the factors correlate well with psychological outcomes. Given that coping may not be very stable, however, their ecological validity is somewhat questionable.

Process measures ask individuals to select a recent problem and indicate how they coped with that type of problem. Unfortunately, process measures typically have somewhat ‘‘messy’’ psychometrics, and their factor structures may be unstable. This makes comparison across situations or over time problematic.

Sometimes a more accurate picture can be obtained using multiple assessments, either through daily diaries or through event sampling throughout the day. Although some scholars have criticized the psychometric properties of these measures (often consisting of only one item per strategy), these types of procedures may be especially useful in the context of coping with chronic stressors because they permit within-subject analyses that may yield strong relationships between coping and outcomes.

2. Coping And Health Outcomes

2.1. Mental Health Outcomes

In many ways, being able to successfully cope with problems can be considered a hallmark of psychological health. Difficulties in coping may be associated with emotional distress, including depression and anxiety. However, the relationship is neither simple nor straightforward. Because there may be differences between how people cope with trauma and with more everyday stressors, these two different types of problems are addressed separately.

2.1.1. Coping with Stressors

The relationship between coping and psychological symptoms is characterized by complexity along a number of different dimensions. First, coping strategies have situation-specific effects. Many studies have demonstrated that the effectiveness of coping strategies rests on the controllability of the stressor. Controllable stressors, such as problems at work, are more effectively managed with problem-focused coping, whereas uncontrollable stressors, such as the death of a loved one, are more effectively managed with emotion-focused coping. Second, there may also be a confound between stress, distress, and coping. Higher levels of stress may evoke more coping strategies and also create more distress; thus, all coping strategies will correlate with higher levels of distress in particularly difficult circumstances. Only by controlling for the stressfulness of the problem can the true relationship between coping and mental health be revealed.

Third, there is a difference between short and long-term outcomes. Avoidance coping strategies, for example, may decrease psychological distress in the short term but cause great distress in the long term if the underlying problem remains unresolved. Brief periods of respite, however, can allow individuals to ‘‘recharge their batteries’’ and promote better problem-focused coping in the long term.

Fourth, the causal directionality of coping may not be clear. Rather than coping resulting in depressive symptoms, individuals who are depressed may cope in different ways than nondepressed people.

Fifth, people may employ the same coping strategies with different levels of skill. Thus, it makes sense to determine the efficacy of the strategy—that is, whether it ‘‘worked’’ for that person in that particular situation. Finally, most research has focused only on coping as a means of reducing symptoms. However, effective coping may lead to more positive outcomes, such as increases in mastery, self-knowledge, and better social relationships. Thus, it is not surprising that the literature on coping and mental health is rich but somewhat contradictory.

2.1.2. Coping with Trauma

Traumatic stressors are ones that either threaten or expose individuals to loss of life and major physical damage to themselves, loved ones, or large numbers of individuals. Surprisingly, the trauma literature is much clearer in demonstrating the efficacy of coping strategies. In general, how individuals cope with trauma and its sequelae are better predictors of the development of posttraumatic stress disorder (PTSD) than simply exposure to trauma.

There are four ways in which coping with trauma differs from coping with less severe stressors. First, traumatic circumstances are often uncontrollable and many people fall back on the use of unconscious defense mechanisms, such as denial and repression. For example, depersonalization may be the only possible response to being tortured. Second, disclosure and seeking support from others appear to be especially important in traumatic situations. However, if the disclosure evokes negative responses from others, PTSD symptoms may become worse. Some individuals are relatively successful at ‘‘partitioning off’’ their trauma experience and rebuilding their lives.

Third, the process of coping with traumatic events and their sequelae is much longer and may take years. Finally, the coping strategy of meaning making is particularly important in dealing with trauma. Whether an individual is able to make some sense out of traumatic events can determine whether those events lead to positive or negative mental health outcomes.

2.2. Physical Health Outcomes

The evidence for the effect of coping on physical health outcomes such as pain, blood pressure, catecholamines, lipids, and immune system function is much weaker, in part because studies are relatively rare and may focus on special populations, such as heart disease patients or AIDS victims.

We identified four models by which coping may affect health outcomes. The direct effects model examines a simple correlation between coping and health outcomes, regardless of the situation or type of stressor. For example, instrumental action may be associated with better lipid or immune system profiles whether the stressor is major or minor. Second, coping may moderate or buffer the effects of stress on health outcomes. That is, there are no direct effects, but individuals under high levels of stress who use instrumental action may have lower blood pressure levels. The mediated effects models suggest that the effects of coping depend on a variable or variables intervening between coping and physical health outcomes. For example, many of the physiological effects

of coping on health might be explained through its effect on psychological distress. If an individual’s coping strategies decrease negative affect, then it may be associated with better immune system profiles. The fourth model is the contextual effects model, which states that the effect of coping on health might depend on environmental context. For example, Zautra and colleagues showed that seeking social support may be effective in reducing pain for diseases such as osteoarthritis but less effective for rheumatoid arthritis, in part because the symptoms in the latter illness are less clear and thus may be more difficult for others to understand.

There is evidence for each of these models; however, none of them has received overwhelming empirical support. Clearly, much research is needed to illuminate the pathways by which coping influences physical health outcomes.

References:

Aldwin, C. M. (1999). Stress, coping, and development: An integrative approach. New York: Guilford.
Cramer, P. (2000). Defense mechanisms in psychology today: Further processes for adaptation. American Psychologist, 55, 637–646.
de Ridder, D., & Kerssens, J. (2003). Owing to the force of circumstances? The impact of situational features and personal characteristics on coping patterns across situations. Psychology & Health, 18(2), 217–236.
Folkman, S., & Moskowitz (1994). Coping: Pitfalls and promise. Annual Review of Psychology, 55, 745–774.
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal &coping. New York: Springer-Verlag.
Mikulincer, M., & Florian, V. (1996). Coping and adaptation to trauma and loss. In M. Zeidner, & N. S. Endler (Eds.), Handbook of coping: Theory, research, applications (pp. 554–572). New York: Wiley.
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Skinner, E. A., Altman, J., & Sherwood, H. (2003). Searching for the structure of coping: A review and critique of category systems for classifying ways of coping. Psychological Bulletin, 129, 216–269.
Tennen, H., Affleck, G., Armeli, S., & Carney, M. A. (2000). A daily process approach to coping: Linking theory, research, and practice. American Psychologist, 55, 626–636.
Valliant, G. E. (1993). The wisdom of the ego. Cambridge, MA: Harvard University Press.

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