COPING Pittsburgh Mind-Body Center Pittsburgh Mind-Body Center Summer Institute 2006.

COPINGCOPING

Pittsburgh Mind-Body Center Pittsburgh Mind-Body Center

Summer InstituteSummer Institute

20062006

Overview of TalkOverview of Talk

• Conceptualizing the coping processConceptualizing the coping process

• Measuring copingMeasuring coping

• Place of coping in Center modelPlace of coping in Center model

• Development of copingDevelopment of coping

• Issues in copingIssues in coping- Dispositional styles vs. situational responsesDispositional styles vs. situational responses

- Adaptive vs. maladaptive ways of copingAdaptive vs. maladaptive ways of coping

Conceptualizing CopingConceptualizing CopingLazarus and Folkman ModelLazarus and Folkman Model

Primary AppraisalPrimary Appraisal

• Significance of event for personSignificance of event for person

- ThreatThreat

- ChallengeChallenge

- Harm/LossHarm/Loss

Secondary AppraisalSecondary Appraisal

• What can I do? How can I cope?What can I do? How can I cope?

Dimensions of CopingDimensions of CopingLazarus and Folkman ModelLazarus and Folkman Model

Problem-focused copingProblem-focused coping

– Action taken to counteract the source of the Action taken to counteract the source of the

stressstress

Emotion-focused copingEmotion-focused coping

– Responses designed to alter the emotions Responses designed to alter the emotions

produced by the eventproduced by the event

Dimensions of CopingDimensions of CopingSuls and Fletcher ModelSuls and Fletcher Model

Approach copingApproach coping

– Responses focused on source of stress and Responses focused on source of stress and

reactions to itreactions to it

Avoidant copingAvoidant coping

– Responses designed to place focus away Responses designed to place focus away

from source of stress and reactions to itfrom source of stress and reactions to it

Dimensions of CopingDimensions of CopingMoos ModelMoos Model

Differentiates responses along Differentiates responses along

two independent dimensionstwo independent dimensions

– Active vs. avoidantActive vs. avoidant

– Behavioral vs. cognitiveBehavioral vs. cognitive

Measuring CopingMeasuring Coping

Omnibus measures:Omnibus measures:

– Ways of Coping Checklist Ways of Coping Checklist (Folkman & Lazarus, 1980; (Folkman & Lazarus, 1980;

revised 1985)revised 1985)

– The COPE The COPE (Carver, Scheier, & Weintraub, 1989)(Carver, Scheier, & Weintraub, 1989)

Dimension-specific measures:Dimension-specific measures:

– Impact of Events Scale Impact of Events Scale (Horowitz et al., 1979)(Horowitz et al., 1979)

– Emotional Approach Coping Scale Emotional Approach Coping Scale (Stanton et (Stanton et

al., 2000)al., 2000)

The COPEThe COPE

• 60 item self-report questionnaire60 item self-report questionnaire

- Dispositional and Situational versionsDispositional and Situational versions

• 15 broad coping subscales15 broad coping subscales

• Broad range of strategies:Broad range of strategies:- BehavioralBehavioral- AffectiveAffective- CognitiveCognitive

(Carver et al., 1989)(Carver et al., 1989)

COPE SubscalesCOPE Subscales

Active Coping:Active Coping: Taking action, exerting efforts to remove or Taking action, exerting efforts to remove or circumvent the stressor.circumvent the stressor.

Planning:Planning: Thinking about how to confront the stressor, Thinking about how to confront the stressor, planning one’s active coping efforts.planning one’s active coping efforts.

Seeking Instrumental Social Support:Seeking Instrumental Social Support:Seeking assistance, information, or advise Seeking assistance, information, or advise about what to do.about what to do.


Seeking Emotional Social Support:Seeking Emotional Social Support: Getting sympathy or emotional support from Getting sympathy or emotional support from someone.someone.

Suppression of Competing Activities:Suppression of Competing Activities: Suppressing one’s attention to activities in Suppressing one’s attention to activities in which one might engage, in order to which one might engage, in order to concentrate more completely on dealing with concentrate more completely on dealing with the stressor.the stressor.

Religion:Religion:Increased engagement in religious activities.Increased engagement in religious activities.


Positive Reinterpretation and Growth:Positive Reinterpretation and Growth:

Making the best of the situation by growing Making the best of the situation by growing from it, or viewing it in a more favorable from it, or viewing it in a more favorable light.light.

Restraint Coping:Restraint Coping: Coping passively by holding back one’s Coping passively by holding back one’s coping attempts until they can be of use.coping attempts until they can be of use.

Acceptance:Acceptance:Accepting the fact that the stressful event Accepting the fact that the stressful event has occurred and is real.has occurred and is real.


Focus on and Venting of Emotions:Focus on and Venting of Emotions: An increased awareness of one’s emotional An increased awareness of one’s emotional distress, and a concomitant tendency to ventilate distress, and a concomitant tendency to ventilate or discharge those feelings.or discharge those feelings.

Denial:Denial: An attempt to reject the reality of the stressful An attempt to reject the reality of the stressful event.event.

Use of Drugs or Alcohol:Use of Drugs or Alcohol: Turning to the use of alcohol or other drugs as a Turning to the use of alcohol or other drugs as a way of disengaging from the stressor.way of disengaging from the stressor.


Behavioral Disengagement:Behavioral Disengagement: Giving up or withdrawing effort from the Giving up or withdrawing effort from the attempt to attain the goal with which the attempt to attain the goal with which the stressor is interfering.stressor is interfering.

Mental Disengagement:Mental Disengagement:Psychological disengagement from the goal Psychological disengagement from the goal with which the stressor is interfering, through with which the stressor is interfering, through daydreaming, sleep or self-distraction.daydreaming, sleep or self-distraction.

Humor:Humor:Making jokes about the stressor.Making jokes about the stressor.

Four Main ClustersFour Main Clusters

ActiveActive .72.72 DenialDenial .80 .80

Pos Rein & GrowthPos Rein & Growth .71.71 Beh DisengageBeh Disengage .76 .76

PlanningPlanning .67.67 Mental DisengageMental Disengage .58 .58

Supp Comp ActivSupp Comp Activ .63.63

Restraint CopingRestraint Coping .59.59

AcceptanceAcceptance .52.52

Emot Soc SuppEmot Soc Supp .86.86 HumorHumor .67 .67

Instru Soc SuppInstru Soc Supp .79.79 ReligionReligion -.59-.59

Focus on/Vent EmotFocus on/Vent Emot .76.76 Use of drugs/alcoh Use of drugs/alcoh .47 .47

Chronic/Stable Burdens and Resources

Coping dispositions

Acute Precipitating

Event

Psychological Pathways

Affect, Quality of life,

Perceived stress, Depression,

Purpose

Emotion-focused coping

Behavioral Pathways

Active coping

Biological Pathways

DisabilityDisease

Place of Coping in Center ModelPlace of Coping in Center Model

Development of Coping Development of Coping

• Influence of genesInfluence of genes

– Temperaments/IQTemperaments/IQ

• Influence of learningInfluence of learning

– Idiosyncratic experience/trial and errorIdiosyncratic experience/trial and error

– Parent/peer modelingParent/peer modeling

How do coping tendencies How do coping tendencies develop?develop?

CMU Parent StudyCMU Parent Study

Subjects:Subjects:

44 college students,44 college students,their parents (42 mothers, 41 fathers), their parents (42 mothers, 41 fathers), and their roommates (43).and their roommates (43).

Measures:Measures:

COPE: 60 item inventory assessing COPE: 60 item inventory assessing 15 conceptually distinct coping 15 conceptually distinct coping strategiesstrategies

Correlations between student’s Correlations between student’s coping responses and coping coping responses and coping

responses of parents and responses of parents and roommatesroommates

ActiveActive PlanningPlanning SuppressionSuppression RestraintRestraint PositivePositivecopingcoping competingcompeting copingcoping reinterpretreinterpret

activitiesactivities and growthand growth

MotherMother - .16- .16 - .06- .06 .00.00 - .12- .12 .01 .01

FatherFather - .26- .26 - .12- .12 .19.19 - .15- .15 - .21- .21

RoommateRoommate - .23- .23 - .08- .08 .22.22 -.07-.07 - .15- .15



HumorHumor InstrumentalInstrumental Religion Religion Emotional Emotional Acceptance Acceptancesoc support soc support soc supportsoc support

MotherMother .20.20 - .16 - .16 .46 .46 - .11 - .11 .11 .11

FatherFather .09.09 .00 .00 .20 .20 .14 .14 .19 .19

RoommateRoommate .50.50 .01 .01 .23 .23 .11 .11 - .18- .18

** p < .05 p < .05

**

**



Denial Denial Focus on Focus on MentalMental Behavioral Behavioral Use ofUse of & venting& venting disengage-disengage- disengage-disengage- drugs ordrugs or

of emotionsof emotions mentment ment ment alcoholalcohol

MotherMother - .19 - .19 .02.02 - .12 - .12 - .07 - .07 .29.29

FatherFather .02 .02 .14.14 .04.04 .01.01 .40 .40

RoommateRoommate - .04 - .04 .00.00 .27.27 .06.06 .16.16

** p < .05 p < .05

**

Issues in CopingIssues in Coping

• Dispositional vs. situational assessmentDispositional vs. situational assessment

• Adaptive vs. maladaptive ways of copingAdaptive vs. maladaptive ways of coping

– Importance of engagement vs. Importance of engagement vs.

disengagementdisengagement

Dispositional vs. Dispositional vs. Situational AssessmentSituational Assessment

• Is the notion of coping styles Is the notion of coping styles

useful?useful?

• How do these relate to coping How do these relate to coping

responses in particular situations?responses in particular situations?

• Which is better to assess?Which is better to assess?

Some Some questions:questions:

College Adaptation Study College Adaptation Study (CAPS)(CAPS)

Sample:Sample:

– 89 first-semester undergraduates89 first-semester undergraduates

COPE:COPE:

– Dispositional — Start of the semesterDispositional — Start of the semester

– Situational — 12 to 16 weeks laterSituational — 12 to 16 weeks later

Outcomes:Outcomes:

– DepressionDepression

– Perceived stressPerceived stress

– Subjective healthSubjective health

00.10.20.30.40.50.60.70.80.9

1

Active coping

Planning Suppressionof competing

activities

Restraintcoping

Instrumentalsocial

support

College Undergraduates:

(Scheier et al., 2000)

Correlations between Correlations between Dispositional and Situational Dispositional and Situational

Coping (CAPS)Coping (CAPS)

Corr

ela

tion C

oeffi

cient

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

Denial BehavioralDisengagement

MentalDisengagement

Use of drugs oralcohol

Acceptance





Corr

ela

tion C

oeffi

cient

00.10.20.30.40.50.60.70.80.9

1

Focus on andventing ofemotions

Emotional SocialSupport

Religion PositiveReinterpretation

and growth

Humor





Corr

ela

tion C

oeffi

cient

-0.8-0.6-0.4

-0.20

0.20.4

0.60.8

Acceptance Active Coping BehavioralDisengagement

Denial Use of drugs oralcohol

Dispositional Coping Situational Coping

Dispositional and Situational Dispositional and Situational Coping and Distress (CAPS)Coping and Distress (CAPS)

Corr

ela

tion C

oeffi

cient

-0.8-0.6-0.4-0.2

00.20.40.60.8

Turning toReligion

Restraint Coping Suppression ofcompetingactivities

Emotional socsupport

Instrumental social support



Corr

ela

tion C

oeffi

cient

-0.8-0.6-0.4-0.2

00.20.40.60.8

Focus on andventing ofemotions

Humor Mentaldisengagement

Planning PositiveReinterpretation

and growth



Corr

ela

tion C

oeffi

cient

Mediation Mediation

CopingCopingDispositionsDispositions DistressDistress

SituationalSituationalResponsesResponses

Mediation Analyses (CAPS)Mediation Analyses (CAPS)

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

**

DispositionalDispositional SituationalSituationalCopingCoping CopingCoping

Active copingActive coping - 0.13 - 0.13 - 0.36 - 0.36

Behavioral DisengagementBehavioral Disengagement 0.140.14 0.540.54

DenialDenial 0.200.20 0.370.37

Use of drugs or alcoholUse of drugs or alcohol 0.100.10 0.290.29

Focus on/venting emotionsFocus on/venting emotions 0.130.13 0.150.15

Pos Reinterpretation & GrowthPos Reinterpretation & Growth - 0.25 - 0.25 - 0.34 - 0.34

PlanningPlanning - 0.04 - 0.04 - 0.25- 0.25

**********

******

****

**

**

**

Conclusions Conclusions

• Coping styles predict situational responsesCoping styles predict situational responses

• Both predict adjustment (situational stronger)Both predict adjustment (situational stronger)

• Situational responses largely (but not entirely) Situational responses largely (but not entirely)

mediate effects of dispositional coping stylesmediate effects of dispositional coping styles

• Which to use?Which to use?

– Base decision on conceptual issues and/or study Base decision on conceptual issues and/or study

needsneeds

Functionality of CopingFunctionality of Coping

• Lots of work on psychological well-beingLots of work on psychological well-being

– Adjustment to chronic/acute diseaseAdjustment to chronic/acute disease

– Adjustment to medical problemsAdjustment to medical problems

• Less work on physical health/relationship Less work on physical health/relationship

to disease processesto disease processes

Characterization of field:Characterization of field:

Functionality of Coping: General Functionality of Coping: General CharacterizationCharacterization

MentalMental PhysicalPhysicalHealthHealth HealthHealth

Active CopingActive Coping +++/- ++

Avoidant CopingAvoidant Coping ---/+ --/+Moderators:Moderators:Chronicity/ControlChronicity/Control

Emotion-focused CopingEmotion-focused Coping ---/++ -/+Moderators:Moderators:Pos reint & growth, humor,Pos reint & growth, humor,acceptance acceptance (links to active coping)(links to active coping)

• Engagement vs. Engagement vs.

disengagementdisengagement

• The benefits of remaining The benefits of remaining

engagedengaged

Focus on SpecificsFocus on Specifics

• 74 gay/bisexual men74 gay/bisexual men

• Mean age: 38 yearsMean age: 38 years

• 95% white95% white

• Mean length of diagnosis: 12.2 Mean length of diagnosis: 12.2 monthsmonths

(Data from Reed et al., 1994)

Living with AIDS Living with AIDS StudyStudy

• Try to accept what might Try to accept what might happen.happen.

• Prepare myself for the worst.Prepare myself for the worst.

• Refuse to believe that this Refuse to believe that this problem has happened.problem has happened.

Realistic AcceptanceRealistic Acceptance

00.10.20.30.40.50.60.70.80.9

1

0 10 20 30 40

months

High Accept

Low Accept

(Data from Reed et al., 1994)

Realistic Acceptance Realistic Acceptance and Survivaland Survival

Perc

en

tag

e s

urv

ivin

gP

erc

en

tag

e s

urv

ivin

g

•Active copingActive coping

•Fighting spiritFighting spirit

•Vital exhaustionVital exhaustion

•Stoic acceptanceStoic acceptance

Further Manifestations Further Manifestations of Processof Process

Disengagement and Disengagement and Successful LivingSuccessful Living

• Much research suggests giving-up is badMuch research suggests giving-up is bad

• QuestionsQuestions– Is disengagement always bad?Is disengagement always bad?

– Is persistence always good?Is persistence always good?

– Might disengagement produce positive effects if Might disengagement produce positive effects if

goals are unattainable? goals are unattainable?

Components of Components of DisengagementDisengagement

• Withdrawal ofWithdrawal of effort effort

• Relinquishment ofRelinquishment of commitment commitment

ObstaclesObstaclesseem too great toseem too great to

overcomeovercome


overcomeovercome

Give up Give up goalgoalcommitmentcommitment,,

disengagedisengagefrom goalfrom goal

Give up Give up goalgoalcommitmentcommitment,,


Give up Give up efforteffort butbutremainremain

committed tocommitted to goalgoal

Give up Give up efforteffort butbutremainremain

committed tocommitted to goalgoal

1111

2222

DistressDistress,,despondency,despondency,

futilityfutility

DistressDistress,,despondency,despondency,

futilityfutility

AbsenceAbsenceof distressof distressAbsenceAbsence

of distressof distress


overcomeovercome


overcomeovercome

Give up goalGive up goalcommitment,commitment,


Give up goalGive up goalcommitment,commitment,


Scale back to more Scale back to more limited goal in limited goal in same domainsame domain

Scale back to more Scale back to more limited goal in limited goal in same domainsame domain

Pick alternatePick alternatepath to highpath to highorder goalorder goal

Pick alternatePick alternatepath to highpath to highorder goalorder goal

Form new goalForm new goalor new path toor new path tohigh order goalhigh order goal

Form new goalForm new goalor new path toor new path tohigh order goalhigh order goal

Give up goalGive up goalcommitment,commitment,no new goalno new goal

Give up goalGive up goalcommitment,commitment,no new goalno new goal

Give up effort Give up effort butbut

remain remain committed to committed to

goalgoal

1111

2222

Distress,Distress,despondency,despondency,

futilityfutility

PotentialPotentialfor for positivepositiveoutcomesoutcomes




AimlessnessAimlessness,,emptiness,emptiness,lonelinessloneliness

AimlessnessAimlessness,,emptiness,emptiness,lonelinessloneliness



aaaa

bbbb

cccc

dddd

Components of Re-Components of Re-engagementengagement

• IdentifyIdentify new goals new goals

• CommitCommit to those goals to those goals

• Pursue Pursue those new goalsthose new goals

Goal Disengagement Items Goal Disengagement Items from GASfrom GAS

If I have to stop pursuing an important goal in If I have to stop pursuing an important goal in

my life:my life:

• It’s easy for me to reduce my effort toward It’s easy for me to reduce my effort toward

the goal.the goal.

• I stay committed to the goal for a long time, I stay committed to the goal for a long time,

I can’t let it go.I can’t let it go.

Goal Re-engagement Items Goal Re-engagement Items from GASfrom GAS

If I have to stop pursuing an important goal in my If I have to stop pursuing an important goal in my

life:life:

• I seek other meaningful goals.I seek other meaningful goals.

• I convince myself that I have other meaningfulI convince myself that I have other meaningful

goals to pursue.goals to pursue.

• I start working on other new goals.I start working on other new goals.

Children with Cancer StudyChildren with Cancer Study (Wrosch et. al. , 2003)(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 ( = .79), Re-Engagement ( = .86)• Depression (CES-D, = .94)

Phenomenon

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

Effects of Disengagement and Effects of Disengagement and Re-Engagement on DepressionRe-Engagement on Depression

Dep

ress

ion

(CE

S-D

)

r = -.53* r = -.64**

0

10

20

30

-1 SD +1 SD

Disengagement

Cancer Parents

Contol Parents0

10

20

30

-1 SD +1 SD

Re-Engagement

Cancer Parents

Contol Parents

Goal Adjustment and Cortisol Goal Adjustment and Cortisol LevelsLevels

• Examined goal adjustment and objectiveExamined goal adjustment and objective measure of health -- cortisol secretionmeasure of health -- cortisol secretion

• Normally, cortisol peaks in the early Normally, cortisol peaks in the early morning hours & declines steadily morning hours & declines steadily throughout the daythroughout the day

• Those experiencing stress have a Those experiencing stress have a flattened cortisol rhythm, with low flattened cortisol rhythm, with low morning output or no drop in morning output or no drop in secretion during the daysecretion during the day

Wrosch, C., Miller, G.E., Scheier, M.F., de Pontet, S.B. (under Wrosch, C., Miller, G.E., Scheier, M.F., de Pontet, S.B. (under review), Giving up on unattainable goals: Benefits for health?review), Giving up on unattainable goals: Benefits for health?


• Sample…Sample…

• 54 participants54 participants

• Recruited via newspaper adRecruited via newspaper ad• 38 female; 24 Caucasian; 85% of non-38 female; 24 Caucasian; 85% of non-

Caucasians were African-AmericanCaucasians were African-American• Average age = 30.3Average age = 30.3


• Measures include…Measures include…

• Goal disengagementGoal disengagement

• Goal reengagementGoal reengagement

• Diurnal cortisol rhythm - collected Diurnal cortisol rhythm - collected on 4 separate dayson 4 separate days

Goal Disengagement and Goal Disengagement and Cortisol Levels Cortisol Levels

Salivary Cortisol LevelsSalivary Cortisol Levels

0

5

10

15

20

25

1 4 9 11

Hours from Awakening

Saliv

ary

Cor

tisol

(nm

ol/L

)

Low GoalDisengagement (BelowMedian)High GoalDisengagement (AboveMedian)

Wrosch, C., et al., Study 3.Wrosch, C., et al., Study 3.

Life TruthLife Truth

You have to know when to hold ‘em,You have to know when to hold ‘em,

know when to fold ‘em.know when to fold ‘em.

Don SchlitzDon Schlitz, The Gambler, The Gambler

COPING Pittsburgh Mind-Body Center Pittsburgh Mind-Body Center Summer Institute 2006.

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