coping and resilience leslie h. wind, ph.d mary marshall, lcsw

Coping and Resilience

Leslie H. Wind, Ph.D

Mary Marshall, LCSW

Federal SponsorsNIMH

National Institute of Mental Health

NINR

National Institute of Nursing Research

SAMHSA

Substance Abuse

And

Mental Health Services Administration

Principal Investigators

Betty Pfefferbaum, MD, JD

University of Oklahoma Health Sciences Center

Alan M. Steinberg, PhD

University of California, Los Angeles

Robert S. Pynoos, MD, MPH

University of California, Los Angeles

John Fairbank, PhD

Duke University

Learning Objectives

After completing this module you will be able to:

• Identify and define key concepts and models related to stress, coping, and resilience

• Understand the transactional nature of coping and resilience processes

• Differentiate key culturally-based aspects of coping and resilience

• Discuss coping and resilience issues specific to youth exposed to mass level traumatic events

• Identify gaps in knowledge and research needs

What is Stress?

Northwest Center forPublic Health Practice

Stress Terminology

• Stress: The effect of anything in life to which people must adjust. Stress requires us to adjust our attention and behavior and makes demands on our energy.

• Stressor: Anything that has the effect of causing stress. • Stress Capacity: The amount of stress a person can carry, since

each person has some stress in their lives.

• Stress Load: This refers to the amount, or quantity, of stress a person has in their lives.

Red Cross, 2002


Types of Stress Reactions

• Physiological

• Emotional

• Cognitive

• Behavioral


Stress within a Disaster Context• Disasters are overwhelming, traumatic

events

• Children’s reactions vary by age, developmental maturity, and experience

• Children’s reactions likely vary by stage of recovery

• Children’s needs may not be met


Reactions: Children 1-5

• Helplessness and passivity

• Generalized fear• Heightened arousal• Cognitive confusion• Difficulty talking about

event• Sleep disturbance• Separation

fears/clinging

• Regressive symptoms• Anxiety about death• Grief• Somatic symptoms• Startle response to loud

or unusual noises• Irritability


Reactions: 6-11 Years

• Feelings of responsibility/guilt

• Traumatic play and retelling

• Sleep disturbance• Anger/aggression• Change in behavior,

mood, personality• Somatic symptoms• Fear and anxiety

• Regression• Separation anxiety• Withdrawal• Loss of interest in

activities• Magical thinking• Loss of ability to

concentrate• School avoidance and

decline in school performance


Reactions: 12-18 Years

• Self-consciousness• Life-threatening

reenactment• Abrupt shift in

relationships• Depression• Social withdrawal

• Sleep/eating disturbances

• Decline in school performance

• Rebellion• Accident proneness• Wish for revenge and

action-oriented responses


Children in Disaster

“My daughter was small then, but she has a certain hostility toward everyone. She seems to want to hurt everyone…She liked to play with dolls before the flood, but now she punches out their eyes and pulls their arms off. She calls her daddy on her play phone now when it rains and tells him to come get her because the dam is breaking.” Everything in Its Path by Kai T. Erikson


What is Coping?


Defining Coping

Constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of a person (Folkman & Lazarus, 1984, p. 141)

…anything people do to adjust to the challenges and demands of stress… any adjustments made to reduce the negative impact of stress (Red Cross: Community-based Psychological Support, p. 87)


Think About Kids and Coping

What are some of the ways you see

children and adolescents attempt to cope

with extremely stressful situations?


Conceptualizing Coping Strategies

• Biological/physiological – fight or flight

• Cognitive – how we think about the situation

• Behavioral – behavior related to mental process

• Learned – strategies learned from modeling/observation

• Intentioned – voluntary/involuntary


Lazarus’ Model of Stress and Coping

Antecedents

Individual goals, goal hierarchies, beliefs about self and world, Personal resources

Environment

Harms/losses, threats/challenges, benefits

Person-environment relationship

Appraisal Relational meaning

Coping

Revised relational meaning

Emotions, Functioning,Morale, Health

Processes Outcomes


Transactional Model of Coping

Core Assumptions:• Stressful experiences are construed as

person-environment transactions• Transactions depend on the impact of the

external stressor• Impact is mediated individual/environmental

antecedents, by the person’s repeated appraisal of the stressor, and coping responses

• The system changes moment to moment Lazarus, 1999


Transactional Model Concepts

• Primary appraisal• Secondary appraisal• Coping efforts• Problem

management• Emotional

Regulation

• Meaning-based coping

• Outcomes of coping• Dispositional coping

styles• Optimism• Information seeking Glanz, Rimer, & Lewis, 2002


Emotion Focused CopingCoping efforts that are directed toward

regulating emotional states: -- Denial/avoidance -- Distraction or minimization -- Wishful thinking -- Self-control of feelings -- Seeking meaning -- Self-blame -- Expressing/sharing feelings

Folkman & Lazarus, 1984 Compas & Epping, 1993


Problem-Focused Coping

Efforts to act on the source of stress to changethe person, the environment, or the relationshipbetween the two:

1. Planned problem solving 2. Confrontation

Compas & Epping, 1993


Responses to Stress Model Voluntary Strategies

1. Primary Control Coping - Attempts to modify stressful problem or emotion (problem solving)

2. Secondary Control Coping – Attempts to adapt via cognition (cognitive restructuring)

3. Disengagement Coping - Attempts to redirect attention away from the stressor or emotional reaction (denial, wishful thinking)

Wadsworth et al, 2004


Responses to Stress Model

Involuntary Strategies

4. Involuntary Engagement – Directed toward the stressor or their emotional reactions (arousal,

rumination, impulsive action)

5. Involuntary Disengagement – Directed away from the stressor or their emotional reactions (emotional numbing, escape)

Wadsworth et al, 2004


Responses to Stress Model

• Emphasizes developmental changes in nature of stress, internal/external constraints limiting coping processes, and a complex interplay between voluntary and involuntary responses to stress.

• Involuntary responses reflect individual differences in temperament, over-learned and automatic responses

• Assumes an increase in secondary control coping and emotion-focused coping and decreases in disengagement with maturity


Motivational Model of Coping

Innate Psychological Needs

• Relatedness• Competence• Autonomy

Universal Stressors

• Neglect• Chaos• Coercion

Skinner & Wellborn, 1997


Motivational Model: Self-System Processes

• Children’s self-efficacy may be challenged by chaotic social contexts.

• Self-efficacy beliefs lead to interpretations re competence

• Autonomy vs. coercion = need to experience self as free to choose vs. pressure to behavior a certain way

• Neglect = social interactions that undermine the need for relatedness

• Self-system processes become either source of distress or resource in event of trauma


The Community Stress Prevention Model

Six dimensions central to coping with adversity:

• Beliefs/Values – relies on values to cope• Affect – emotion expression as coping mechanism• Social – seeking support/relationships• Imagination – creative expression to cope• Cognitive – need honest dialogue & guidance• Physiological – physical activity as coping Lahad, Shacham, & Niv, 2000

Summarizing Models of Coping

• Transactional

• Motivational

• Applied Psychology


Common Aspects of Coping• Strategies/Patterns: 4 common types

• Flexibility: # strategies

• Effectiveness: How well child thinks it worked

• Self-efficacy: Sense of competence

• Coping Assistance: External resources (formal and informal)

• Coping Resources: Individual characteristics


Coping in Young Children

• Maturation results in developmental stages marked by capacity for self-control

• Process using internal/external resources to manage demands of environment

Zeitlin & Williamson, 1994


Coping in Young Children

• Step 1: Determine meaning of event

• Step 2: Develop an action plan

• Step 3: Implement coping effort

• Step 4: Evaluation effectiveness of

outcome

Zeitlin & Williamson, 1994


Evaluating Young Children’s Coping

• Behavior is appropriate for situation

• Behavior is appropriate developmentally

• Behavior enables child to achieve objectives


What We Know About Development and Coping

• Emotion-focused – increases with age

• Problem-solving skills – mixed findings

• Negative appraisal varies in dimensionality

• Avoidant physical/cognitive responses increase w/age


More on Development

• Attention – increases with age

• Sense of competence – younger over-estimate; older perceive competence as enduring

• Locus of control – increases with age


What We Know About Gender and Coping

• Mixed findings overall

• Findings vary by context


Coping and Culture

• Connection between culture and coping

• Individualism vs. collectivism


Coping and Cultural Beliefs

World view is culturally based:• Utility of effort• Religious beliefs• Belief in an entity view of the world• Belief in a benevolent purpose for events• Values• Belief in the ubiquity of change• Belief in the utility of personal preparation


Model of Collectivistic Coping

• Family support

• Respect for authority figures

• Intracultural coping

• Relational universality

• Forbearance

• Social activity

• FatalismChen in Wong & Wong, 2006


More on Culture…..

• Discrimination and stigma erode resilience

• Gender constraints are problematic• Guilt and shame• Meaning• Mastery and control• Help-seeking, stigma, and mistrust

Boss, 2006; Norris & Alegria, 2006


Child Coping within a Cultural Context

• Coping strategies vary across groups

• Ethnicity x Context = Coping

• Avoidant coping = adaptive and maladaptive


What is Resilience?

Defining Resilience

A pattern of positive adaptation in thecontext of past or present adversity

Wright & Masten, 2005

Judging Adaptation

1. There has been a significant threat or risk to the development or adaptation of the individual; and

2. The individual’s functioning is satisfactory according to selected criteria.


Key Concepts in Resilience Research

• Adversity: Environmental conditions that interfere with/threaten the accomplishment of age-appropriate developmental tasks

• Risk: An elevated probability of an undesirable outcome

• Risk Factor: A measurable characteristic in a group of individuals or their situation that predicts negative outcome on a specific criteria

More Key Concepts

• Cumulative Risk: Increased risk due to (a) multiple risk factors present; (b) multiple occurrences of same risk factor; (c) accumulating effects of ongoing adversity

• Vulnerability: Individual susceptibility to undesirable outcomes

More Key Concepts

• Proximal Risk: Risk factors experienced directly by the child

• Distal Risk: Risk related to a child’s ecological context, but mediated via proximal processes

More Key Concepts

• Asset/Resource/Compensatory Factor: A measurable characteristic in a group of individuals or their situation that predicts general/specific positive outcomes

• Protective Factor: Quality of a person/context or their interaction that predicts better outcomes

More Key Concepts

• Cumulative Protection: Presence of multiple protective factors

• Psychosocial Competence: The adaptive use of personal and contextual resources to accomplish developmental tasks

• Developmental Tasks: Expectations of a society for child’s accomplishments according to stage of development

Assumptions Related to Resilience Concepts

• Children may demonstrate resilience at one point in life and not at another;

• Children may demonstrate resilience in only some aspects of life;

• There are linkages among the multiple domains of adaptation, positive and negative



Risks Pile Up

• Risk factors often pile up

• Transitions (divorce, school entry, leaving home, war) pile risks on children within a short timeframe

• Emotional, behavioral, educational, and health problems increase as total risk level increases

• Developmental cascades can occur (one problem leads to another)

Correlates of Resilience: Child Characteristics

• Social/adaptable temperament

• Strong cognitive abilities

• Effective emotional and behavioral regulation strategies

• Positive view of self

• Positive outlook• Faith/sense of

meaning in life• Characteristics

valued by society and self (talents, humor, appearance)

Masten, 2001

Family Resilience

“…coping and adaptational processes in the family as a functional unit”

Walsh, 2006, p. 15

Principles of Family Resilience

• Individual resilience is best understood and fostered in the context of the family and larger social world, as a mutual interaction of individual, family, socio-cultural, and institutional influences

• Crisis events and persistent stresses affect the whole family, posing risks not only for individual dysfunction, but for relational conflict and family breakdown;

Walsh, 2006

Principles of Family Resilience

• Family processes mediate the impact of stress for all its members and relationships;

• Protective processes foster resilience by buffering stress and facilitating adaptation;

• Maladaptive responses increase vulnerability and risks for individual and relational distress;

• All individuals and families have the potential for greater resilience

Three Keys to Family Resilience

• Family belief systems

• Organizational patterns

• Communication processes Walsh,2006

Family Belief Systems

• Making meaning of adversity – sense of coherence

• Positive outlook

• Transcendence and spirituality

Organizational Patterns

• Flexibility – Capacity for change

• Connectedness/Cohesion – emotional/structural bonding

• Social and economic resources – Extended networks

Communication Processes

• Clarity – clear communication

• Open emotional expression – trust, emotional interaction

• Collaborative problem solving – conflict management

Correlates of Resilience: Family Characteristics

• Stable/supportive home environment

• Parents involved in child’s education and activities

• Parents have same characteristics as child resilience correlates

• Socioeconomic advantages

• Postsecondary education of parents

• Faith and religious affiliations

Masten, 2001


Family Processes in Coping

Family members:

• can be resources • can present impediments • are models

Compas & Epping, 1993

Correlates of Resilience:Community Characteristics

• Good quality neighborhood

• Effective schools

• Employment opportunities for parents/teens

• Good public health care

• Access to emergency services

• Connections to caring adult mentors and pro-social peer associations

Masten, 2001

Adaptive Systems Facilitating Development

• Attachment relationships

• Moral and ethical development

• Self-regulatory systems

• Mastery and motivational systems

• Neurobehavioral and information-processing systems

Stability and Change in Adaptation

• Complex interactions of youth with parents, peers, and other adults in home, neighborhood, schools, and workplace impact outcomes

• Critical turning points correspond to developmental challenges

Culture and Resilience

Within the cultural context:

• Extended family networks• Religious organizations• Other social systems

Culturally Relevant Risk and Protective Factors

• Socioeconomic status

• Social support

• Prejudice and discrimination

• Acculturation stress

Resilience and Disaster• The nature of the threat must be considered

• Developmental timing influences reactions

• Child experiences/responses of children are influenced by family, peer, and school functioning, particularly by people to whom children are attached

• Family, peers, and larger systems influenced by perceptions of the safety of other system members

Masten & Obradovic, 2007

What Do We Know Within the Disaster Context?

Disaster Related Outcomes

• Statistics are unavailable on number of children/adolescents impacted by disaster

• Symptoms are similar across disasters

• Anxiety disorders, depression, behavioral disorders are most commonly reported post-disaster problems

• PTS: 28-50% after terrorism, hurricanes


Factors Associated with Stress-Related Outcomes

• Exposure

• Demographics

• Preexisting psychosocial factors

• Post-disaster recovery environment

La Greca & Prinstein, 2002


Predicting Children’s Reaction to Disaster

Traumatic Exposure

Preexisting ChildCharacteristics

Coping Efforts

Post Disaster Recovery Environment

Major LifeEvents

SocialSupport

Functioning


What We Know about Disasters: Coping Strategies

• Negative strategies = higher PTSD, depression

• Negative self-attribution and guilt = higher PTSD

• Higher PTSD, depression = use more strategies


More on Coping Strategies

• Findings vary re most common

• Some strategies associated with symptoms; some not

• Some strategies are context specific


What We Know Related to Disasters: Gender

• Girls use affective coping and social support more than boys

• Adolescent girls use more problem solving; boys use more emotional numbing

• Some studies find no gender differences

• Girls have higher rates of posttraumatic symptoms


What We Know Related to Disasters: Age

• Adolescent girls who use primary control coping have less anxiety

• Involuntary disengagement in adolescents associated with more anxiety

• Younger children: Wishful thinking, positive coping, social withdrawal, blame-anger

• Adolescents: Distraction, avoidance, active coping, support coping


What We Know Related to Disasters: Previous Trauma

• No difference in strategy effectiveness

• More previous trauma = greater perception of effectiveness of coping

• More previous trauma = use more strategies

• Associated with use of active coping strategies


What We Know Related to Disasters: Culture

• Strategy usage

• Acculturation and PTSD for African Americans


What We Know Related to Disasters: Self-Efficacy

One Month Post-Event• Perception of life threat • Depression

Three Months Post-Event• Children’s ability to cope at T1 most predictive

of coping at T2**• Family communication about event


What We Know Related to Disasters: Resources

• Support seeking = fewer symptoms

• Assistance with distraction and emotional processing = more PTSD

• Parents provide most help in roles and routines, social support

• Friends help more with emotional processing

• Social withdrawal unrelated to coping assistance


WHAT DO WE NEED TO KNOW?


Future Research

• What factors influence coping and resilience in children and families within a disaster context?

• By what processes do they interact in producing psychosocial outcomes?


Factors Influencing Psychosocial Outcomes

• Need to continue development of explanatory models

• Differentiate predictors by type of disaster, development, culture, and time


Challenges to Understanding Coping within a Disaster Context

• Disasters are unpredictable

• Lack of clarity and agreement about nature of coping in children

• Lack of consensus on definitions

• Poor instrumentation

• Lack longitudinal study


Challenges to Understanding Resilience

• Risk and protective factors poorly specified and inconsistently operationalized

• Utility of risk and protective factors for screening is insufficiently examined

• Mediating and moderating relationships are insufficiently examined


We Need To…

• Increase standardization in measurement of coping in childhood and adolescence based on clear definitions and cultural considerations

• Examine coping style, flexibility, and self-efficacy within the disaster context

• Develop and test explanatory models of coping that are sensitive to culture


We Need To…..• Conceptualize risk and protective factors in

ways that effectively inform prevention, intervention, and public policy

• Distinguish direct and indirect relationships among risk and protective factors, mediators and moderators; over time

• Develop theory-driven explanatory models

• Utilize advanced modeling techniques


Then We Can…..

Develop, implement, and evaluate interventions supporting individual,

family, and community resilience

coping and resilience leslie h. wind, ph.d mary marshall, lcsw

Documents

northwest center

stress capacity

stress load

lcsw slide

school performance slide

research needs slide

phd duke university

experience childrens