The Role of Coping in the SES-Health Relationship

Amy Teper

February 27, 2008

Coping Definitions“… behaviour that protects people from being

psychologically harmed by problematic social experience” (Perlin & Schooler, 1978)

“… the person's constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the person's resources” (Folkman et al, 1986)

Similar terminology: mastery, adaptation, defense

What should be encompassed in the definition of coping? What should be excluded?

Historical Perspectives

• Research on ‘defense’ in 19th century• Freud initially used concepts of defense and repression interchangeably as

his foundation for psychoanalysis; later recognized repression as a type of defense

• Anna Freud – introduced a categorization of defenses (e.g., regression); the idea that each individual may have a limited ‘repertoire’ of defenses; the idea that different psychopathologies might be related to specific defense styles (did not stand up to future testing); the potential for some defenses to be more pathological than others (‘adaptive’ and ‘non-adaptive’ defenses and hierarchical views on defenses – more ‘mature’ defenses = better mental health)

• ‘Coping’ term first introduced into the literature in late 1960s (Zeidner and Endler, 2008)

What is the benefit of ‘coping’ vs. ‘defense’ terminology?

Coping Theories: Dispositional Approaches

• Derived from Freudian theories (also known as the ego-psychoanalytic model)

• Ego – consists of unconscious cognitive mechanisms• Stipulates that people generally have fixed approaches to coping over time, space and situation

Contextual Approaches:Stress and Coping Theory (Folkman et al, 1986)

Stress↓

Cognitive Appraisal – evaluates whether particular event is relevantto a person’s well-being

Primary appraisal – evaluation of potential harm to self or familySecondary appraisal – evaluation if any way to avoid harm or increase

benefit (coping mechanisms evaluated)Primary and secondary appraisals converge to determine if the event is

deemed attention-worthy↓

Coping – thoughts and actions taken throughout the development of the stressful situation based on the above contextual evaluation

↓Long-term outcome

NOTE: potential for non-linearity of the model

Integrated Approaches

• Contemporary theorists suggest the importance of both dispositional and contextual models

• They suggest that broadly applicable, preferred coping mechanisms may transcend particularsituational influences (coping ‘styles’)

(Zeidner and Endler)

Are these models useful?

Coping Strategy Classifications“… the specific efforts, both behavioral and psychological, that people

employ to master, tolerate, reduce, or minimize stressful events.” (MacArthur, 1998)

Lazarus & Folkman,1980

• Problem-solving strategies – that target the stressor itselfExamples: planning; suppression of competing activities

• Emotion-focused strategies – deal with the emotional distress resulting from the stressorExamples: denial; acceptance; seeking emotional social support

Problem-solving strategies tend to prevail when people feel that something productive can be done

Most strategies combine problem-solving and emotion-focused to a certain extent

Bigger problems more likely to evoke greater number of responses

Active – change the nature of the stressor

Examples: positive reinterpretation of event, religion

Avoidant – activities or mental states that keep one from addressing the stressor

Examples: mental and behavioural disengagement

Stress

↓

Appraisal

↓

Coping

Changing the nature of the

stressor (rare)

Changing your

perception of the stress (common)

Employing stress

management strategies

Resources“Coping resources are social and personal characteristics

upon which people may draw when dealing with stressors” (Pearlin and Schooler, 1978)

Social resources – i.e. social support (ready availability; SES dependent)

Psychological resources - personal characteristics, i.e. self-esteem, self-denigration, mastery, perceived sense of control (unevenly distributed by SES)

Coping resources – knowledge and ability to use different coping strategies (aka. coping ‘repertoire’)

Resources are thought to influence the choice and efficiency of coping strategies (i.e. perhaps people in lower SES less likely to choose active, problem-based approaches because of decreased social support and self-esteem)

How do ‘resources’ fit in aforementioned models?

Measuring Coping

Ways of Coping Checklist (WCC) (Lazarus & Folkman)• Empirically based• 68 Yes/No items • How participants respond to a particular stressful event• 7 scales relating to problem (1) and emotion-focused (6) problem -coping

strategies: problem-focused, seeking social support, blamed-self, avoidance, wishful thinking

• Scoring developed through factor analysis with 100 men

Ways of Coping Questionnaire (WCQ) (Lazarus & Folkman)• Modified from WCC• 66 items (4 point Likert scales)• 8 scales: problem-focused, wishful thinking, distancing, emphasizing the positive,

self-blame, seeking social support, tension-reduction, self-isolation

COPE (Carver, 1989)

• A theoretically based model derived from the Lazarus model of stress and a model of behavioural self-regulation

• 13 scales were developed relating to either problem-focused or emotion-focused strategies (active coping, planning, suppression of competing activities, restraint coping, seeking social support for instrumental reasons, seeking social support for emotional reasons, venting of emotions, behavioural disengagement, helplessness, positive reinterpretation and growth, denial, acceptance, turning to religion)

• Likert scales (frequencies of use)• Items were written and piloted that were either shown in

previous studies or theoretically believed to be functional or non-functional elements of coping

• Test-retest reliability established• Correlation between scales examined

Do these instruments seem comprehensive? Any potential problems?

Effectiveness of Coping Strategies

• How coping purges problem and hardships from our lives

• Also how well it prevents hardships from resulting in emotional stress

In general…

• The larger a person’s coping repertoire, the better he or she will cope

• Problem-focused coping strategies are seen as more beneficial for well-being

• Emotion-focused coping strategies sometimes shown beneficial in the short-run

Coping and Health Models

1. Coping has a direct impact on health (through blood pressure, rate of recovery etc.)

2. Coping has an indirect impact on health (through changing health behaviours i.e. visiting a physician)

3. Coping acts as a stress buffer

Link to health

• Use of denial and withdrawal linked to psychological stress and depression (MacArthur, 1998)

• Worse outcomes for emotionally distressed cancer and cardiac patients (MacArthur, 1998)

Gender, Stress and Coping

• Women appear to have similar numbers of life events to men but perceive them as more negative and less controllable (Matud, 2004), Women tend to have more life events

• Women tend to use avoidance and emotional coping styles more frequently than men (Matud, 2004) (Pearlin & Schooler, 1978)

• Men tend to use problem-based coping styles more frequently (Matud, 2004)

• Women report more somatic symptoms than men (Matud, 2004)

Note: These findings have not been replicated across the board

Stress

Life Events

Chronic Stress

Daily Hassles

Coping

Women

Emotion-focused, avoidance

Problem-focused

Mental Illness

Distress

Physical Health Outcomes

Appraisal, Resources, Personality/Disposition (Coping styles)

No differential in self-rated health

Stress

Life Events

Chronic Stress

Daily Hassles

Coping

Men

Emotion-focused, avoidance

Problem-focused

Mental Illness

Addictive behaviour (eg. heavy drinking)

Physical Health Outcomes

Appraisal, Resources, Personality/Disposition (Coping styles)

No differential in self-rated health

SES and Coping

• Education is more strongly correlated to coping than income

• People with lower education levels tend to have more limited coping repertoires (i.e. do not have access to coping techniques such as positive comparisons, devaluation)

• People with less education have fewer resources (reliable social support, self-esteem, mastery)

• People with less education tend use more emotion-focused strategies, compared to those with higher education who utilize problem-focused strategies (Pearlin & Schooler)

Summary: What is known• Stressors unevenly distributed -> Of

the three types of stresses (life events, chronic stress and daily hassles) -> people in LES not shown to experience more undesirable life events but more daily hassles (depends on what events measured in investigation) (Thoits, 1995)

• Susceptible groups more emotionally reactive to stressors (Thoits, 1995)

• Uneven distribution of ‘positive’ coping strategies among gender and socioeconomic status

What is left to be uncovered

• Should money and flexibility should be considered coping strategies?

• Specific mechanisms of action in the stress-coping relationship

• How does coping mediate (or moderate) the stress – mental health relationship?

• The physical illness link (the mental-physical health link and how coping mediates the stress-physical health relationship)

• Physiological level explanations

ReferencesCarver CS and Scheier MF. Assessing Coping Strategies: A Theoretically Based Approach

Journal of Personality and Social Psychology 1989, Vol. 56, No. 2, 267-283Endler, Norman, Parker, James D Multidimensional assessment of coping: A critical

evaluation. Journal of Personality and Social Psychology. 1990 May Vol 58(5) 844-854 Folkman S et al. Dynamics of a Stressful Encounter: Cognitive Appraisal, Coping, and

Encounter Outcomes Journal of Personality and Social Psychology 1986, Vol. 50, No. 5, 992-1003

MacArthur JD and MacArthur CT. Research Network on Socioeconomic Status and Health: Coping Strategies. Last revised 1998. Available: http://www.macses.ucsf.edu/Research/Psychosocial/notebook/coping.html Retrieved: February 25, 2008

Matud PI. Gender Differences in Stress and Coping Styles. Journal of Personality and Social Psychology. 2004; 37:7

Pearlin LI and Schooler C. The Structure of Coping. Journal of Health and Social Behavior. 19: 2-21

Thoits PA. Stress, Coping and Social Support Processes: Where are we? What next? Journal of Health and Social Behavior. 1995 (Extra Issue ) 53-79

Zeidner M and Endler NS. Handbook of Coping: Theory, Research, Applications. Available: http://books.google.ca/books?id=IZWHsi0DwZIC&dq=handbook+of+coping&pg=PP1&ots=ZJ2WbJ10_q&sig=IfMpdv7f80QgYkaZa5xLGHiLZJA&hl=en&prev=http://www.google.ca/search?hl=en&q=handbook+of+coping&sa=X&oi=print&ct=title&cad=one-book-with-thumbnail#PPA68,M1 Retrieved February 26, 2008