Measuring coping

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STRESS AND ILLNESS
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Controllability: People tend to use problem focused coping if they believe that the
problem itself can be changed. In contrast they use more emotion focused coping if
the problem is perceived as being out of their control (Lazarus and Folkman 1987).
Available resources:
Coping is influenced by external resources such as time, money,
education, children, family and education (Terry 1994). Poor resources may make
people feel that the stressor is less controllable by them resulting in a tendency not to use
problem focused coping.
Measuring coping
The different styles of coping have been operationalized in several measures which
have described a range of specific coping strategies. The most commonly used
measures are the Ways of Coping checklist (Folkman and Lazarus 1988) and Cope
(Carver et al. 1989). The coping strategies described by these measures include the
following:
I Active coping (e.g. ‘I’ve been taking action to try to make the situation better’)
I Planning (e.g. ‘I’ve been trying to come up with a strategy about what to do’)
I Positive reframing (e.g. ‘I’ve been looking for something good in what is happening’)
I Self-distraction (e.g. ‘I’ve been turning to work or other activities to take my mind off
things’)
I Using emotional support (e.g. ‘I’ve been getting emotional support from others’)
I Substance use (e.g. ‘I’ve been using alcohol or other drugs to help me get through it’)
I Behavioural disengagement (e.g. ‘I’ve been giving up trying to deal with it’)
I Denial (e.g. ‘I’ve been saying to myself “this isn’t real” ’)
I Self-control (e.g. ‘I tried to keep my feelings to myself’)
I Distancing (e.g. ‘I didn’t let it get to me. I refused to think about it too much’)
I Escape/avoidance (e.g. ‘I wished that the situation would go away’).
Some of these strategies are clearly problem focused coping such as active coping and
planning. Others are more emotion focused such as self control and distancing. Some
strategies, however, are a mix of both problem and emotion focused. For example, positive
reframing involves thinking about the problem in a different way as a means to alter the
emotional response to it. Some strategies can also be considered approach coping such as
using emotional support and planning whereas others reflect a more avoidance coping
style such as denial and substance use.
According to models of stress and illness, coping should have two effects. First, it
should reduce the intensity and duration of the stressor itself. Second, it should reduce
the likelihood that stress will lead to illness. Therefore effective coping can be classified as
that which reduces the stressor and minimizes the negative outcomes. Some research has
addressed these associations. In addition, recent research has shifted the emphasis away
from just the absence of illness towards positive outcomes.
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272 HEALTH PSYCHOLOGY
Coping and the stressor: According to Lazarus and colleagues one of the goals of
coping is to minimize the stressor. Much research has addressed the impact of coping on
the physiological and self-report dimensions of the stress response. For example, Harnish
et al. (2000) argued that effective coping terminates, minimizes or shortens the stressor.
Coping and the stress illness link:
Some research indicates that coping styles may
moderate the association between stress and illness. For some studies the outcome variable has been more psychological in its emphasis and has taken the form of well-being,
psychological distress or adjustment. For example, Kneebone and Martin (2003) critically reviewed the research exploring coping in carers of persons with dementia. They
examined both cross-sectional and longitudinal studies and concluded that problemsolving and acceptance styles of coping seemed to be more effective at reducing stress
and distress. In a similar vein, research exploring coping with rheumatoid arthritis suggests that active and problem-solving coping are associated with better outcomes
whereas passive avoidant coping is associated with poorer outcomes (Manne and Zautra
1992; Young 1992; Newman et al. 1996). For patients with chronic obstructive pulmonary disease (COPD) wishful thinking and emotion focused coping were least effective
(Buchi et al. 1997). Similarly, research exploring stress and psoriasis shows that avoidant
coping is least useful (e.g. Leary et al. 1998). Other studies have focused on more illness
associated variables. For example, Holahan and Moos (1986) examined the relationship
between the use of avoidance coping, stress and symptoms such as stomach-ache and
headaches. The results after one year showed that of those who had experienced stress,
those who used avoidance coping had more symptoms than those who use more
approach coping strategies.
Coping and positive outcomes: Over recent years there has been an increasing
recognition that stressful events such as life events and illness may not only result in
negative outcomes but may also lead to some positive changes in people lives. This
phenomenon has been given a range of names including stress related growth (Park et
al. 1996), benefit finding (Tennen and Affleck 1999), meaning making (Park and Folkman 1997) and growth orientated functioning and crisis growth (Holahan et al. 1996).
This finds reflection in Taylor’s cognitive adaptation theory (Taylor 1983) and is in line
with a new movement called ‘positive psychology’ (Seligman and Csikszentmihalyi
2000). Although a new field of study, research indicates that coping processes which
involve finding meaning in the stressful event, positive reappraisal and problem focused
coping are more associated with positive outcomes (Folkman and Moskowitz 2000). See
Chapter 3 for further discussion.
Coping is considered to moderate the stress/illness link and to impact upon the extent
of the stressor. Much research has involved the description of the kinds of coping styles
and strategies used by people and some studies suggest that some styles might be more
effective than others.
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