The Role of Coping in the SESHealth Relationship

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The Role of Coping in the SES-Health Relationship

• Amy Teper
• February 27, 2008

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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?

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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?

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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

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Contextual ApproachesStress and Coping Theory
(Folkman et al, 1986)

• Stress
• ?
• Cognitive Appraisal evaluates whether
  particular event is relevantto a persons
  well-being
• Primary appraisal evaluation of potential harm
  to self or family
• Secondary 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

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Integrated Approaches

• Contemporary theorists suggest the importance of
  both dispositional and contextual models
• They suggest that broadly applicable, preferred
  coping mechanisms may transcend particular
• situational influences (coping styles)
• (Zeidner and Endler)
• Are these models useful?

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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 itself
• Examples planning suppression of competing
  activities
• Emotion-focused strategies deal with the
  emotional distress resulting from the stressor
• Examples 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

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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
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Changing the nature of the stressor (rare)

• Stress
• ?
• Appraisal
• ?
• Coping

Changing your perception of the stress (common)
Employing stress management strategies
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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?

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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

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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?

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Effectiveness of Coping Strategies

• How coping purges problem and hardships from our
  lives
• Also how well it prevents hardships from
  resulting in emotional stress

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In general

• The larger a persons 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

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Coping and Health Models

• Coping has a direct impact on health (through
  blood pressure, rate of recovery etc.)
• Coping has an indirect impact on health (through
  changing health behaviours i.e. visiting a
  physician)
• Coping acts as a stress buffer

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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)

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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

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Appraisal, Resources, Personality/Disposition
(Coping styles)
Women
Stress
Coping
Mental Illness
Physical Health Outcomes
Life Events
Emotion-focused, avoidance
No differential in self-rated health
Distress
Chronic Stress
Problem-focused
Daily Hassles
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Appraisal, Resources, Personality/Disposition
(Coping styles)
Men
Stress
Coping
Mental Illness
Physical Health Outcomes
Life Events
Emotion-focused, avoidance
Addictive behaviour (eg. heavy drinking)
No differential in self-rated health
Chronic Stress
Problem-focused
Daily Hassles
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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)

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Summary What is known

• Stressors unevenly distributed -gt Of the three
  types of stresses (life events, chronic stress
  and daily hassles) -gt 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

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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

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References

• Carver CS and Scheier MF. Assessing Coping
  Strategies A Theoretically Based Approach
  Journal of Personality and Social Psychology
  1989, Vol. 56, No. 2, 267-283
• Endler, 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/n
  otebook/coping.html Retrieved February 25, 2008
• Matud PI. Gender Differences in Stress and Coping
  Styles. Journal of Personality and Social
  Psychology. 2004 377
• 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?idIZWHsi0DwZICdqha
  ndbookofcopingpgPP1otsZJ2WbJ10_qsigIfMpdv7
  f80QgYkaZa5xLGHiLZJAhlenprevhttp//www.google.
  ca/search?hlenqhandbookofcopingsaXoiprint
  cttitlecadone-book-with-thumbnailPPA68,M1
  Retrieved February 26, 2008