Theoretical Approaches to Coping

Abstract

Dealing with stress requires conscious effort, it cannot be perceived as equal to individual's spontaneous reactions. The intentional management of stress must not be confused with defense mechanisms. An exploration of the definition of the term coping, the function of the coping process as well as its differentiation from other similar meanings through a literature review. Three theoretical approaches of coping are introduced; the psychoanalytic approach; approaching by characteristics; and the Lazarus and Folkman interactive model. The strategic methods of the coping approaches are described and the article ends with a review of the approaches including the functioning of the stress-coping process , the classification-types of coping strategies in stress-inducing situations and with a criticism of coping approaches. The comparison of coping in different situations is difficult, if not impossible. The coping process is a slow process, so an individual may select one method of coping under one set of circumstances and a different strategy at some other time.

Headnote

Abstract

Introduction: Dealing with stress requires conscious effort, it cannot be perceived as equal to individual's spontaneous reactions. The intentional management of stress must not be confused with defense mechanisms. Coping differs from adjustment in that the latter is more general, has a broader meaning and includes diverse ways of facing a difficulty.

Aim: An exploration of the definition of the term "coping", the function of the coping process as well as its differentiation from other similar meanings through a literature review.

Methodology: Three theoretical approaches of coping are introduced; the psychoanalytic approach; approaching by characteristics; and the Lazarus and Folkman interactive model.

Results: The strategic methods of the coping approaches are described and the article ends with a review of the approaches including the functioning of the stress-coping process, the classificationtypes of coping strategies in stress-inducing situations and with a criticism of coping approaches.

Conclusions: The comparison of coping in different situations is difficult, if not impossible. The coping process is a slow process, so an individual may select one method of coping under one set of circumstances and a different strategy at some other time. Such selection of strategies takes place as the situation changes.

Key-words: coping, stress, strategies, approaches, health, illness.

Definition of the term "coping"

Although other disciplines (i.e. sociology, biology) also use the term coping (to describe ways in which society or an organism deals with a crisis), the term is primarily part of psychology (Lazarus and Folkman, 1984). The main axis of all the definitions which have been suggested at times is the "struggle" against external and internal adversities, conflicts and intense emotions. According to Lazarus and Folkman (1984), who are considered the founders of the related research, coping is defined as "ongoing cognitive and behavioral efforts to manage specific (external and/or internal) demands that are appraised as taxing or exceeding the resources of the individual. According to the same researchers, this definition (which is widely accepted) has many advantages. Firstly, it describes the term as a process rather than a stable characteristic or behavioral style; the process is described in a more functional manner, but can also become an object of intervention (as opposed to a characteristic or style). Secondly, it refers to an individual's attempts to assessment/evaluation (and not to control, which in itself is often impossible) negative stimuli. This "appraisal" may include redefinition, tolerance, even acceptance of a negative incident, if it is to lead to an effective adaptation. Thirdly, the definition of the cognitive assessment/evaluation makes the term extremely psychological. Fourthly, the definition regards coping as the organism's mobilization or intentional effort of the individual to react to external or internal adversity.

The last mentioned brings to the fore the issue of this term's differentiation from other terms. Specifically because dealing with stress requires conscious effort, it cannot be synonymous with an individual's reflexive or spontaneous reactions, since these are beyond an individual's conscious control (Compas, 1987). It is characteristic that coping attitudes, especially with regards children, are placed in the middle of a continuum, with a newborn's reflexive movements at one end and spontaneous reactions which, due to acquired experience, no longer require conscious control at the other end (Murphy, 1974). For similar reasons, the intentional management of stress must not be confused with defense mechanisms), which are present in the sub-consciousness, that an individual uses in order to reach the same result (stress relief). Coping differs from adjustment in that the latter is more general, has a broader meaning and includes diverse-not only intentional-ways of facing a difficulty (Lazarus and Folkman, 1984; Chang, et al., 2005; Gil-Monte, 2005; Aldwin, 2007; Papazisis et all., 2008; Papazisis et all., 2008a; Zyga, 2010; Karasavvidis et al., 2011; Zyga, 2013).

Approaches concerning coping

A great proportion of the research on coping is to be found in the 1966 edition of Richard Lazarus's book Psychological Stress and the Coping Process. Earlier, an extensive study concerning coping took place in the framework of the Psychology of the Ego focusing on the role of defenses, as seen through the research of Haan (1969), Menninger (1963) and Vaillant (1977). The aforementioned were interested in the pathology and dealt with the role of defenses in psychopathology (Folkman and Moskowitz, 2004). The view that every form of psychopathology is related to a certain defense was quite a strong psychoanalytic one which had a strong influence on Clinical Psychology. For instance, hysterical neurosis was related to Repulsion, obsessivecompulsive disorder to intellectualisation and paranoia to Projection.

This view was expressed through the convergence of the three developmental variables which are in common with Freud's theory: (a) the stage of psychosexual development of a child who experiences the trauma, (b) the primary impulses and conflicts of the stage and (c) the traits of a child's cognitive development, all of which go to make up the defenses.

In spite of the neatness and the probable link between the three variables, observation fails to confirm the close relationship between the developmental stage, the content of the impulses and the cognitive development firmly enough. Moreover, the link between the forms of psychopathology and certain defenses is too simplistic to be acceptable (Lazarus, 1993).According to the trait approach, personality traits influence the methods of address. Approach researchers who have dealt with the development of tools to measure coping's traits are Byrne (1964), Goldstein (1959), Gleser and Ihilevich (1969) and Moos (1974).

Research based on the traits approach tends to point to a relationship between personality traits and physiological and/or psychological reactions of the body to stress, but does not provide precise information on the actual handling processes the individual participates uses. These processes are deduced from the quality of the traits and their relationship to possible variables.

Research conducted by Kobasa (1979) explains the specific approach. Two groups of managers were formed. The first consisted of men who showed a high degree of toughness, high levels of stress and a low level of sickness. The second group consisted of men who also showed some degree of toughness, a high level of stress and a high level of sickness (i.e. control and cognitive control), Kobasa drew conclusions on how they would manage changes in their work. But Kobasa did not provide data describing precise dealing processes for both groups and did not other sources in order to back her conclusions (Folkman, 1982).

One of the first models created with the intention of describing and explaining the process an individual goes through in his attempt to deal with stressful situations, is Lazarus and Folkman's transactional model (1984).

The model purports that there is interaction between the individual and the stressful situation, which is particularly obvious in the individual's assessment of the problem being faced. Lazarus and Folkman (1984) define stress as a specific relationship between the individual and his environment, which is expressed through his evaluation that the situation he is faced with significantly burdens or even exceeds his mental resources thus endangering his mental balance.

According to the interactive model, the individual goes through two different processes which are of crucial importance to the outcome of the problem. The first is cognitive assessment which refers to the extent and the way the situation relates to the individual.

The second refers to how the problem is dealt with. Dealing with a problem is defined as the attempt to find a solution, tolerate and/or reduce the external and internal pressures caused by the situation. The interactive model is not linear.

On the contrary, Lazarus and Folkman (1984) claim that dealing with stress is a dynamic process during which revision of the assessment leads to changes in the way it is dealt with and vice versa.

In more detail, two stages are identified in the cognitive assessment process. The first stage is the primary assessment, in other words it is when the individual assesses the significance of the event and attributes a meaning to it (i.e. insignificant, positive, emotionally depressing, and so on). The second stage is the secondary assessment, when the individual assesses his/her available resources for dealing with the event (i.e. perception of control of stressful conditions, in other words, to what extent the problem is controllable).

The theoretical model of Lazarus and Folkman was suggested for the description and interpretation of relevant behaviour in adults. It is, however, evident that it may also be valid, and it is valid, in the case of children and adolescents, needless to say with the differentiations dictated by the developmental nature of child/adolescent behaviour. The relevance of this theoretical model is demonstrated by the fact that no different approaches to issues of stress and coping have been suggested. It is worth taking a brief look at two reviews of this issue, which extend the Lazarus and Folkman model and add a clear, new dimension.

a. The first review (Boakaerts, 1996) introduces the whole "stress-coping" procedure as a series of successive elements which interact with one another from the moment a stressful stimulus arises until it is dealt with. Such elements are: (1) the negative situation in itself, (2) the coping skills, (3) the aims of coping, (4) the evaluation of the situation, (5) the intent to cope, and (6) the particular strategies adopted. Two more component parts of the whole process are added to this group of elements, and are characteristic of the model: the modification of coping skills and the evaluation of the aims of coping. These two parts are a continuation and consequence of the application of the specific strategies (element 6) in dealing with a stress-inducing stimulus. Finally, it should be noted that the writer considers the role of work memory, which is linked to (and is influenced by) the first four elements, namely the stimulus, the skills and the reason for coping, as well as the evaluation of the situation, to be significant.

b. The second alternative review of the "stress-coping" process is extended by the Lazarus and Folkman theoretical model to include the individual's social circle (Berg et al., 1998). According to these reviewers, coping with a stressful stimulus is not down to the individual, but depends on the social group to which the individual belongs. The "others" do not merely support the individual's decisions/actions, but are involved in a group effort to cope with the stress. Not even the stress-inducing stimulus is considered to be a feature of the individual, but is acknowledged as a feature of the group. This model evolves in response to constant changes in the relationship between an individual and the group during successive stages of its development (Vasilaki et al., 2001).

The functioning of the stress-coping process

Cohen and Lazarus (1979), following a review of the relevant bibliography, quote the following functions which are part of coping with stressful situations: (a) "it reduces the harmful environmental conditions and improves the individual's perspectives for "recovery: (b) it steels the individual and enables him/her to endure or adapt to negative circumstances and situations (c) it helps maintain a positive self-image (d) and emotional stability and (e) makes the individual able to maintain satisfactory relationships with other individuals".

However, coping with stress is not a uniform behavioural pattern adopted by all individuals during a negative environmental situation. On the contrary, it consists of individual, specific behavioural patterns, whose use and appearance depends on various factors. These groups of cognitive processes, behaviours and skills, which motivate the individual when he/she expects (or is already experiencing) a stressful experience, are called stressful situation coping strategies (Latack and Havlovic, 1992). It goes without saying that not all strategies have the same functionality. Thus, there are coping strategies which are aimed at the source of the stress, which they attempt to reduce or alter (problem focused strategies). On the other hand, there are strategies which are aimed at the emotion, attempting to regulate it. This can be achieved, for example, by avoiding the source of the stress, with cognitive restructuring or deliberately choosing to turn towards the positive aspects sides of one's self or the situation (Compas, 1987).

In all the aforementioned cases, the main function of the coping strategies is to facilitate the individual's adaptation. The extent to which all the strategies are effective has been the subject of many studies because of its importance to human mental health. In brief, the most significant conclusion which arises is that the strategies which focus on the problem have a positive effect on the individual's ability to adapt, while those which focus on the emotion are considered to impede this ability. It is a theoretically sound conclusion which also appears to be borne out in practice. This is less so in the case of problem focused strategies than in the case in emotion focused strategies (Masel, et al., 1996).

However, these indications have been questioned. Researchers have shown that in the study of the effectiveness of coping strategies, another significant factor should be taken into account: the controllability of the situation causing the stress/anxiety. There are quite a few indicators that, when the situation is considered controllability, it is more likely that problem focused strategies will be used. When, on the other hand, the situation cannot be objectively modified, it is more likely than an emotion focused strategy will be used (Terry, 1991).

The theory of goodness of fit, as suggested by Folkman and her partners in the field of coping, is relevant to this (Folkmanet al.,1979; Roussi et al., 2000). According to this theory, the functionality/effectiveness of a strategy depends on how well matched the coping strategy is with the characteristics of the stress-inducing stimulus (especially regarding its controllability). So, a problem focused strategy is functionally-adaptive when adopted in order to deal with a stressful stimulus which is perceived to be controllable. In such a case, an emotion focused strategy would impede adaptability. On the other hand, an emotion focused strategy is functional/adaptive when the event/stimulus is considered impossible to control/modify. In such a case every problem focused coping effort should be considered adaptability impeding. This theory received is only partially borne out in practice, perhaps because of conceptual problems and methodological inadequacies (Masel et al., 1996).

Classification-types of coping strategies in stress-inducing situations'

Many dimensions have been suggested for the classification of coping strategies in stress-inducing situations. Lazarus and Folkman (1984), using an individual's direction of actions as classification criteria, have suggested the known discrimination between problem focused strategies and emotion focused strategies. A similar classification discriminates between approach strategies and avoidance strategies (Herman and McHale, 1993). Both types of strategy have been called both engagement strategies and disengagement strategies, respectively (Tobin et al., 1989). In a similar vein, Bilings and Moos (1981) speak of active strategies and avoidance strategies.

Using an individual's aims as criteria, Weisz, McCabe and Dennig (1994) classify strategies as primary or secondary control strategies. Another criterion which has been used in classification is the method of coping. So, the methods have been classified as cognitive and behavioral strategies (Ebata and Moos, 1991). As far as functionality/effectiveness are concerned, the coping strategies have been classified as neurodegenerative and mature (McCrae and Costa, 1986).

Finally, Westman and Shirom (1995) suggest an interesting classification for coping strategies. Based on existing bibliography, the writers distinguish two dimensions in stress coping: (a) the content of the strategy, and (b) its surroundings. Based on the content, Westman and Shirom (1995) distinguish immediate and energetic strategies (as opposed to indirect and passive ones) and strategies which are adequate (with regard to environmental requirements). Based on surroundings and environmental requirements, these same authors consider diversity of the stock of available strategies to be important (necessary for diverse environmental requirements) and flexibility (that is an individual's ability to modify his/her strategies depending on the stressinducing stimulus).

Bringing discussion of this topic to a close, let it be noted that all dimensions and types of strategies used to cope with stressinducing situations are valid, to a greater or lesser degree, in children and adolescents, according to the relevant bibliography (Vasilaki et al., 2001).

Criticism of coping approaches

As has already been mentioned, the psychoanalytical approach explains coping in terms of defense which play an important role in regulating emotions. A basic limitation of this approach is that it does not examine those coping methods directed at the problem causing the stress. Another limitation of this approach is that the process is confused with the result of the adaptation. An example which makes the confusion between the process and the result obvious is the study by Wolff, Friedman, Hofer and Mason (1964), on the parents of children who were in the final stage and had fairly good defenses. The extent of the parents' defenses was the criterion used to predict their stress hormone levels. The evaluation of the extent of defense was based partially on the absence of discomfort. Therefore, it comes as no surprise that the secretion of corticosteroids was deemed to be related to the existence of several defenses. This example illustrates the pitfalls of using a measurement system which depends on information which proves the existence of adaptation. A process may be used to explain a result when that process is independent of the result.

The second approach is the one that looks into personality characteristics. The evaluation of coping based on personality characteristics is based on the assumption that all people behave in a fixed manner in all circumstances, although stability in the manner of coping has rarely been proved through research into personality. Some argue that most people are consistent in their behavior under specific circumstances, but not even the study of interaction between individuals and the environment is capable of making any significant contribution to our knowledge regarding the extent to which personality characteristics can contribute to predictions of behavior (Bowers, 1973; Ekehammar, 1974; Magnusson and Endler, 1977; Pervin and Lewis, 1978).

Furthermore, any evaluation based on personality characteristics is one-dimensional and consequently inadequate to perceive the multi-dimensional process of coping, a limitation shared with the psychoanalytical approach. The notes (Mechanic, 1962; Murphy, 1974; Visotsky et al., 1961), conclude that coping with a stress-inducing situation is a composite amalgam of thoughts and attitudes (Lazarus, 1981). For example, the problems faced by people dealing with illness are coping with pain, the hospital environment and nursing practices (Moos and Tsu, 1977), for which a variety of coping strategies is required and not just a onedimensional approach.

In addition, the coping process is a slow process (Lazarus, 1981), so an individual may select one method of coping (i.e. avoidance) under one set of circumstances and a different strategy (i.e. emotion focused strategies) at some other time. Such selection of strategies takes place as the situation changes. It is hard to predict the methods of coping with a stress-inducing stimulus based on static personality characteristics or personality predispositions.

The third approach is that of Folkman and Lazarus who developed the interactive model for environment and individual. This approach has an advantage over the other two in that it allows for the description of complex coping processes, including strategies that focus on the problem and controlling the emotion. This is well explained in research carried out by Mechanic (1962) which describes the method used by students in coping with the source of their stress - forward planning of time, developing skills to meet the needs of tests and controlling their emotions with such strategies as humour, participation in support groups and social comparison. The basic disadvantage of the interactive model is that the coping strategies are described in words, which means they only refer to certain aspects of a certain framework. For example, the coping strategies described by Mechanic refer to matters relevant to examinations and are unsuitable in other context i.e. health, whereas the coping strategies which describe ways of dealing with pain and hospital procedures, are useful in research on illnesses but not on studying. Consequently, the comparison of coping in different situations is difficult, if not impossible (Folkman, 1982; Latack and Havlovic, 2006).

References

References

Aldwin C.M.(2007). Stress, Coping, and Development: An Integrative Perspective.New York: Guilford Press.

Berg, C. A., Meegan, S. P., & Deviney, F. P. (1998). A social-contextual model of coping with everyday problems across the lifespan. International Journal of Behavioral Development, 22 (2): 239-261.

Billings, A. G., & Moos, R. H. (1981). The role of coping responses and social resources in attenuating the stress of life events. Journal of Behavioral Medicine, 4:139-157.

Boekaerts, M. (1996). Coping with stress in childhood and adolescence. Στο µ. Zeidner & N. S. Endler (Eds.), Handbook of coping: Theory, research, and applications (pp. 452-484). New York: Wiley.

Bowers, K.S. (1973). Situationism in psychology: An analysis and a critique. Psychological Review, 80: 307-336.

Byrne, D. (1964). Repression-sensitization as a dimension of personality. In: Maher, B.A. (Ed.) Progress in Experimental Personality Research (pp. 170-220). Academic Press, New York..

Chang, E.M., Hancock, K.M., Johnson, A., Daly, J. &Jackson, D. (2005) Role stress and nurses: Review of related factors and strategies for moving forward. Nursing and Health Sciences, 7: 57-65.

Cohen, F., & Lazarus, R. S. (1979). Coping with the stresses of illness. Στο G. C. Stone, F. Cohen and N. E. Adler (Eds.), Health Psychology. San Francisco: Jossey-Bass.

Compas, B.E. (1987). Coping with stress during childhood and adolescence. Psychological Bulletin, 101 (3): 393-403.

Ebata, A. T., & Moos, R. H. (1991). Coping and adjustment in distressed and healthy adolescents. Journal of Applied Developmental Psychology, 12: 33-54.

Ekehammar, B. (1974). Interactionism in personality from a historical perspective. Psychological Bulletin, 81: 1026-1048.

Folkman, S. & Moskowitz, J. T. (2004). Coping: Pitfalls and Promise. Annu Rev Psychol, 55: 745-74.

Folkman, S. (1982). An approach to the measurement of coping. Journal of Occupational Behavior, 3: 95-107.

Folkman, S., Schaefer, C., & Lazarus, R.S. (1979). Cognitive processes and mediators of stress and coping. Στο V. Hamilton and D. Warburton (Eds.), Human stress and cognition (pp. 265-298). Chichester, UK: Wiley.

Gil-Monte, P. (2005) Factorial validity of the Maslach Burnout Inventory among Spanish professionals. Revista de Saude Publica, 39(1): 1-8.

Gleser, G. C., & Ihilevich, D. (1969). An objective instrument for measuring defense mechanisms. Journal of Consulting and Clinical Psychology, 33: 51-60.

Goldstein, M. J. (1959). The relationship between coping and avoiding behavior and response to feararousing propaganda, Journal of Abnormal and Social Psychology, 58: 247-252.

Haan, N. (1969). A tripartite model of ego functioning: values and clinical research application. J. Nerv. Ment. Dis, 148: 14-30

Herman, M. A., & McHale, S. M. (1993). Coping with parental negativity: Links with parental warmth and child adjustment. Journal of Applied Developmental Psychology, 14: 1-14.

Latack, J.C. & Havlovic S.J. (2006). Coping with job stress: A conceptual evaluation framework for coping measures, 13(5):479-508.

Karasavvidis, S., Avgerinou, C., Lianou, E., Priftis, D., Lianou, A., & Siamaga, E. (2011). Mental retardation and parenting stress. International Journal of Caring Sciences, 4 (1): 21-31.

Kobasa, S.C. (1979). Stressful life events, personality, and health: An inquiry into hardiness. Journal of Personality and Social Psychology, 37: 1-11.

Latack, J.C. & Havlovic, S. J. (1992). Coping with job stress: A conceptual evaluation framework for coping measures. Journal of Organizational Behavior, 13: 479-508.

Lazarus, R.S. & Folkman, S. (1984). Stress, appraisal and coping. New York: Springer.

Lazarus, R.S. (1981). The stress and coping paradigm. In: Eisdorfer, C., Cohen, D., Kleinman, A., & Maxim, P. (Eds) Theoretical Bases for Psychopathology (pp. 173-209). Spectrum, New York,

Lazarus, R.S. (1993). Coping Theory and Research: Past, Present, and Future. Psychosomatic Medicine, 55:234-247.

Magnusson, D., & Endler, N.S. (Eds) (1977). Personality at the Crossroads, Erlbaum, N. J. Hillsdale.

Masel, C. N., Terry, D. J., &Gribble, M. (1996). The effects of coping on adjustment: Re-examining the goodness of fit model of coping effectiveness. Anxiety, Stress and Coping, 9:279-300.

McCrae, R. R., & Costa, P. T., Jr. (1986). Personality, coping, and coping effectiveness in an adult sample. Journal of Personality, 54: 385-405.

Mechanic, D. (1962). Students Under Stress. The Free Press, New York.

Menninger, K. (1963). The Vital Balance: The Life Process in Mental Health and Illness. New York: Viking.

Moos, R. (1974). Psychological techniques in the assessment of adaptive behavior. In: Coelho, G.V., Hamburg, D.A.& Adams, J.E. (Eds). Coping and Adaptation (pp. 334-399). Basic Books, New York.

Moos, R., & Tsu, V. D. (1977). The crisis of physical illness: An overview. In: Moos, R. (Ed.), Coping with Physical Illness (pp.1-22). Plenum, New York.

Murphy, L. B. (1974). Coping, vulnerability, and resilience in childhood. Óôï G.V. Coelbo, D.A. Hamburg & J.A. Adams (Eds.), Coping and adaptation (pp. 101-124). New York: Basic Books.

Papazisis G, Tsiga E, Papanikolaou N, Vlasiadis I, Sapountzi-Krepia D. (2008) Psychological distress, anxiety and depression among nursing students in Greece. International Journal of Caring Sciences. 1 (1): 42-46

Papazisis G, Vlasiadis I, Papanikolaou N, Tsiga E, Sapountzi-Krepia D. (2008a) Depression and anxiety among nursing students in Greece. Annals of General Psychiatry 7 (Supplement 1), S209

Pervin, L. A., & Lewis, M. (Eds). (1978). Perspectives in Interactional Psychology, Plenum, New York.

Roussi, P., Miller, S. M., & Shoda, Y. (2000). Discriminative facility in the face of threat : Relationship to psychological distress. Psychology and Health, 15, 21-33.

Terry, D. J. (1991). Stress, coping and adaptation to new parenthood. Journal of Social and Personal Relationships, 8: 527-547.

Tobin, D. L., Holroyd, K. A. Reynolds, R. V., & Wigal, J. K. (1989). The hierarchical factor structure of the Coping Strategies Inventory. Cognitive Therapy and Research, 13: 343-361.

Vaillant, GE. (1977). Adaptation to Life. Boston, MA: Little, Brown.

Vasilaki E., Triliva S., & Bezevegkis H. (2001). Coping with stress, anxiety. Athens: Greek Letters.

Visotsky, H. M., Hamburg, D. A., Goss, M. E., & Lebovits, B. A. (1961). Coping behaviour under extreme stress. Archives of General Psychiatry, 5: 423-448.

Weisz, J. R., McCabe, M., & Dennig, M.D. (1994). Primary and secondary control among children undergoing medical procedures: Adjustment as a notion of coping style. Journal of Consulting and Clinical Psychology, 62:324-332.

Westman, M., & Shirom, A. (1995). Dimensions of coping behaviour. A proposed conceptual framework. Anxiety, Stress and Coping, 8: 87-100.

Wolff, C.T., Friedman, S.B., Hofer, M.A., & Mason, J.W. (1964). Relationship between psychological defenses and mean urinary 17-hydroxycorticosteroid excretion rates: I.A. predictive study of parents of fatally ill children. Psychosomatic Medicine, 26: 576-591.

Zyga, S. (2010). Introduction to Nursing Science. Athens, Beta Medical Publishers Ltd.

Zyga, S. (2013). Stress in Nursing Students. International Journal of Caring Sciences, 6 (1), 1-2