COPING

1. COPING Pittsburgh Mind-Body Center Summer Institute 2008

2. 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

3. 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?

4. 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

5. 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

6. Dimensions of CopingMoos Model Differentiates responses along two independent dimensions • Active vs. avoidant • Behavioral vs. cognitive

7. 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)

8. 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)

9. COPE Subscales • Active Coping: • Taking action, exerting efforts to remove or circumvent the stressor. • Planning: • Thinking about how to confront the stressor, planning one’s active coping efforts. • Seeking Instrumental Social Support: • Seeking assistance, information, or advise about what to do.

10. COPE Subscales • Seeking Emotional Social Support: • Getting sympathy or emotional support from someone. • Suppression of Competing Activities: • Suppressing one’s 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.

11. 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 one’s coping attempts until they can be of use. • Acceptance: • Accepting the fact that the stressful event has occurred and is real.

12. COPE Subscales • Focus on and Venting of Emotions: • An increased awareness of one’s 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.

13. 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.

14. 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

15. 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

16. Development of Coping How do coping tendencies develop? • Influence of genes • Temperaments/IQ • Influence of learning • Idiosyncratic experience/trial and error • Parent/peer modeling

17. 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

18. Correlations between student’s coping responses and coping responses of parents and roommates Active Planning Suppression Restraint Positive coping competing coping reinterpret activities and growth Mother - .16 - .06 .00 - .12 .01 Father - .26 - .12 .19 - .15 - .21 Roommate - .23 - .08 .22 -.07 - .15

19. Correlations between student’s 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 < .05

20. Correlations between student’s 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 < .05

21. Issues in Coping • Dispositional vs. situational assessment • Adaptive vs. maladaptive ways of coping • Importance of engagement vs. disengagement

22. 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?

23. 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

24. Correlations between Dispositional and Situational Coping (CAPS) College Undergraduates: Correlation Coefficient (Scheier et al., 2000)

25. Correlations between Dispositional and Situational Coping (CAPS) College Undergraduates: Correlation Coefficient (Scheier et al., 2000)

26. Correlations between Dispositional and Situational Coping (CAPS) College Undergraduates: Correlation Coefficient (Scheier et al., 2000)

27. Dispositional and Situational Coping and Distress (CAPS) Correlation Coefficient

28. Dispositional and Situational Coping and Distress (CAPS) Correlation Coefficient

29. Dispositional and Situational Coping and Distress (CAPS) Correlation Coefficient

30. Mediation Coping Dispositions Distress Situational Responses

31. 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 < .05* * p < .01* * * p < .001

32. 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

33. 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

34. Functionality of Coping: General Characterization Mental Physical Health Health Active Coping+++/- ++ Avoidant Coping---/+ --/+ Moderators: Chronicity/Control Emotion-focused Coping---/++ -/+ Moderators: Pos reint & growth, humor, acceptance (links to active coping)

35. Engagement vs. disengagement The benefits of remaining engaged Focus on Specifics

36. 74 gay/bisexual men Mean age: 38 years 95% white Mean length of diagnosis: 12.2 months Living with AIDS Study (Data from Reed et al., 1994)

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

38. Realistic Acceptance and Survival Percentage surviving (Data from Reed et al., 1994)

39. Further Manifestations of Process • Active coping • Fighting spirit • Vital exhaustion • Stoic acceptance

40. 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?

41. Components of Disengagement • Withdrawal of effort • Relinquishment of commitment

42. Give up effortbut remain committed to goal Distress, despondency, futility Give up goal commitment, disengage from goal Absence of distress 1 Obstacles seem too great to overcome 2

43. Scale back to more limited goal in same domain Potential for positive outcomes Potential for positive outcomes Pick alternate path to high order goal Potential for positive outcomes Form new goal or new path to high order goal Aimlessness, emptiness, loneliness Give up goal commitment, no new goal Give up effort but remain committed to goal 1 Distress, despondency, futility Obstacles seem too great to overcome 2 a Give up goal commitment, disengage from goal b c d

44. Components of Re-engagement • Identify new goals • Commit to those goals • Pursue those new goals

45. Goal Disengagement Items from GAS If I have to stop pursuing an important goal in my life: • It’s easy for me to reduce my effort toward the goal. • I stay committed to the goal for a long time, I can’t let it go.

46. 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.

47. Phenomenon Parents might have to restructure life goals (e.g., career goals, daily activities, being with child) 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)

48. 30 30 20 20 10 10 0 0 -1 SD +1 SD -1 SD +1 SD Disengagement Re-Engagement Effects of Disengagement and Re-Engagement on Depression Cancer Parents Cancer Parents r = -.53* r = -.64** Depression (CES-D) Contol Parents Contol Parents

49. 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?

50. 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