Coping Mechanisms

Emad Algorani; Vikas Gupta

Coping Mechanisms

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Definition/Introduction

Coping is defined as the thoughts and behaviors mobilized to manage internal and external stressful situations.[1] It is a term used distinctively for conscious and voluntary mobilization of acts, different from 'defense mechanisms' that are subconscious or unconscious adaptive responses, both of which aim to reduce or tolerate stress.[2]

When individuals are subjected to a stressor, the varying ways of dealing with it are termed 'coping styles,' which are a set of relatively stable traits that determine the individual's behavior in response to stress. These are consistent over time and across situations.[3] Generally, coping is divided into reactive coping (a reaction following the stressor) and proactive coping (aiming to neutralize future stressors). Proactive individuals excel in stable environments because they are more routinized, rigid, and are less reactive to stressors, while reactive individuals perform better in a more variable environment.[4]

Coping scales measure the type of coping mechanism a person exhibits. The most commonly used scales are COPE (Coping Orientation to Problems Experienced), Ways of Coping Questionnaire, Coping Strategies Questionnaire, Coping Inventory for Stressful Situations, Religious-COPE, and Coping Response Inventory.[5]

Coping is generally categorized into four major categories which are[1]:

Problem-focused, which addresses the problem causing the distress: Examples of this style include active coping, planning, restraint coping, and suppression of competing activities.
Emotion-focused, which aims to reduce the negative emotions associated with the problem: Examples of this style include positive reframing, acceptance, turning to religion, and humor.
Meaning-focused, in which an individual uses cognitive strategies to derive and manage the meaning of the situation
Social coping (support-seeking) in which an individual reduces stress by seeking emotional or instrumental support from their community.

Many of the coping mechanisms prove useful in certain situations. Some studies suggest that a problem-focused approach can be the most beneficial; other studies have consistent data that some coping mechanisms are associated with worse outcomes.[6][1] Maladaptive coping refers to coping mechanisms that are associated with poor mental health outcomes and higher levels of psychopathology symptoms. These include disengagement, avoidance, and emotional suppression.[7]

The physiology behind different coping styles is related to the serotonergic and dopaminergic input of the medial prefrontal cortex and the nucleus accumbens.[4] The neuropeptides vasopressin and oxytocin also have an important implication relative to coping styles. On the other hand, neuroendocrinology involving the level of activity of the hypothalamic-pituitary-adrenocortical axis, corticosteroids, and plasma catecholamines were unlikely to have a direct causal relationship with an individual's coping style.[8]

Issues of Concern

Patients using maladaptive coping mechanisms are more likely to engage in health-risk behaviors than those with appropriate mechanisms. They are also more non-adherent and more likely to use cigarettes or alcohol.[9]

Coping influences patients' compliance to therapy and the course of the disease by lifestyle changes. In disorders where non-medicinal treatment plays a role in the progression, coping mechanisms are important in determining the severity of such conditions. Coping styles may be helpful in patients' educational programs or psychotherapy, and paying attention to them could contribute to the prevention of sequelae.[10][11]

The importance of coping styles does not only affect the patients alone but also their physicians and nurses. Healthcare workers are more likely to choose a problem-oriented coping mechanism while the tendency to choose avoidance decreases with age and employment duration. The incidence of burnout syndrome decreases with the use of problem-oriented coping mechanisms, social integration, and the use of religion.[12][13]

Clinical Significance

Understanding coping mechanisms is a cornerstone in choosing the best approach to the patient to build an effective doctor-patient relationship. The need to monitor the patient's level of distress and coping mechanisms arise because patients who adopt maladaptive mechanisms are more likely to perceive their doctors as being disengaged and less supportive. This perception is clinically significant because about one out of four cancer patients use a maladaptive coping mechanism.[14]

The relation between maladaptive coping mechanisms and numerous disorders has been established. Psychiatric disorders such as PTSD, anxiety, and major depression, and somatic symptoms were all correlated with coping styles related to avoidance.[15] This scenario holds for other disorders such as hypertension and heart diseases, where maladaptive coping strategies were used by patients who had more severe symptoms.[16]

Nursing, Allied Health, and Interprofessional Team Interventions

Teaching patients and their caregivers appropriate coping skills can have a significant impact on the way they perceive their condition, the severity of the symptoms, and the psychological distress associated with it. In patients diagnosed with lung cancer, assertive communication was associated with less pain interference and psychological distress; coping skills effects extend to family caregivers who reported less psychological distress when practicing guided imagery. Other coping mechanisms as mindfulness might not be as beneficial in certain situations.[17] [Level 2]

Physicians, psychiatrists, physical therapists, nurses, and health educators share the role of educating patients to become more responsible for their health. Interprofessional involvement can help patients cope better with the symptoms of their illnesses. Coping skills training programs didn't prove to be effective in reducing pain severity among knee osteoarthritis patients. They did not confer pain or functional benefit beyond that with surgical and postoperative care, but combining both physical exercises and coping skills training with treatment had a more significant improvement.[18][19][20] [Level 1, Level 2]

Nursing, Allied Health, and Interprofessional Team Monitoring

Understanding the coping styles is central to support the patient's coping efforts. Talking with the medical staff to seek information and social support was the most popular coping strategy in anxious surgical patients. Monitoring patients' coping strategies using various coping scales (e.g., COPE, Ways of Coping Questionnaire, Coping Strategies Questionnaire) can help in evaluating the patient's psychological status and continued improvement.[21]

Details

References

[1]

Folkman S, Moskowitz JT. Coping: pitfalls and promise. Annual review of psychology. 2004:55():745-74 [PubMed PMID: 14744233]

[2]

Venner M. [Adjustment, coping and defense mechanisms--deciding factors in the therapeutic process]. Zeitschrift fur die gesamte innere Medizin und ihre Grenzgebiete. 1988 Jan 15:43(2):40-3 [PubMed PMID: 3358307]

[3]

de Boer SF, Buwalda B, Koolhaas JM. Untangling the neurobiology of coping styles in rodents: Towards neural mechanisms underlying individual differences in disease susceptibility. Neuroscience and biobehavioral reviews. 2017 Mar:74(Pt B):401-422. doi: 10.1016/j.neubiorev.2016.07.008. Epub 2016 Jul 9 [PubMed PMID: 27402554]

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Coppens CM, de Boer SF, Koolhaas JM. Coping styles and behavioural flexibility: towards underlying mechanisms. Philosophical transactions of the Royal Society of London. Series B, Biological sciences. 2010 Dec 27:365(1560):4021-8. doi: 10.1098/rstb.2010.0217. Epub [PubMed PMID: 21078654]

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Kato T. Frequently Used Coping Scales: A Meta-Analysis. Stress and health : journal of the International Society for the Investigation of Stress. 2015 Oct:31(4):315-23. doi: 10.1002/smi.2557. Epub 2013 Dec 12 [PubMed PMID: 24338955]

Level 1 (high-level) evidence

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Stoeber J, Janssen DP. Perfectionism and coping with daily failures: positive reframing helps achieve satisfaction at the end of the day. Anxiety, stress, and coping. 2011 Oct:24(5):477-97. doi: 10.1080/10615806.2011.562977. Epub 2011 Jun 12 [PubMed PMID: 21424944]

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Compas BE, Jaser SS, Bettis AH, Watson KH, Gruhn MA, Dunbar JP, Williams E, Thigpen JC. Coping, emotion regulation, and psychopathology in childhood and adolescence: A meta-analysis and narrative review. Psychological bulletin. 2017 Sep:143(9):939-991. doi: 10.1037/bul0000110. Epub 2017 Jun 15 [PubMed PMID: 28616996]

Level 3 (low-level) evidence

[8]

Koolhaas JM, de Boer SF, Coppens CM, Buwalda B. Neuroendocrinology of coping styles: towards understanding the biology of individual variation. Frontiers in neuroendocrinology. 2010 Jul:31(3):307-21. doi: 10.1016/j.yfrne.2010.04.001. Epub 2010 Apr 9 [PubMed PMID: 20382177]

Level 3 (low-level) evidence

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Sánchez M, Rice E, Stein J, Milburn NG, Rotheram-Borus MJ. Acculturation, coping styles, and health risk behaviors among HIV positive Latinas. AIDS and behavior. 2010 Apr:14(2):401-9. doi: 10.1007/s10461-009-9618-y. Epub [PubMed PMID: 19847637]

[10]

Cattelaens K, Schewe S, Schuch F. [Treat to target-participation of the patient]. Zeitschrift fur Rheumatologie. 2019 Jun:78(5):416-421. doi: 10.1007/s00393-019-0629-4. Epub [PubMed PMID: 30937529]

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Rydlewska A, Krzysztofik J, Libergal J, Rybak A, Rydlewski J, Banasiak W, Ponikowski P, Jankowska EA. [Coping styles in patients with systolic heart failure]. Przeglad lekarski. 2013:70(1):15-8 [PubMed PMID: 23789299]

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Kwarta P, Pietrzak J, Miśkowiec D, Stelmach I, Górski P, Kuna P, Antczak A, Pietras T. Personality traits and styles of coping with stress in physicians. Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 2016 May:40(239):301-7 [PubMed PMID: 27234861]

[13]

Ilić IM, Arandjelović MŽ, Jovanović JM, Nešić MM. Relationships of work-related psychosocial risks, stress, individual factors and burnout - Questionnaire survey among emergency physicians and nurses. Medycyna pracy. 2017 Mar 24:68(2):167-178. doi: 10.13075/mp.5893.00516. Epub 2017 Mar 13 [PubMed PMID: 28345677]

Level 3 (low-level) evidence

[14]

Meggiolaro E, Berardi MA, Andritsch E, Nanni MG, Sirgo A, Samorì E, Farkas C, Ruffilli F, Caruso R, Bellé M, Juan Linares E, de Padova S, Grassi L. Cancer patients' emotional distress, coping styles and perception of doctor-patient interaction in European cancer settings. Palliative & supportive care. 2016 Jun:14(3):204-11. doi: 10.1017/S1478951515000760. Epub 2015 Jul 9 [PubMed PMID: 26155817]

[15]

Santarnecchi E, Sprugnoli G, Tatti E, Mencarelli L, Neri F, Momi D, Di Lorenzo G, Pascual-Leone A, Rossi S, Rossi A. Brain functional connectivity correlates of coping styles. Cognitive, affective & behavioral neuroscience. 2018 Jun:18(3):495-508. doi: 10.3758/s13415-018-0583-7. Epub [PubMed PMID: 29572771]

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Casagrande M, Boncompagni I, Mingarelli A, Favieri F, Forte G, Germanò R, Germanò G, Guarino A. Coping styles in individuals with hypertension of varying severity. Stress and health : journal of the International Society for the Investigation of Stress. 2019 Oct:35(4):560-568. doi: 10.1002/smi.2889. Epub 2019 Aug 20 [PubMed PMID: 31397061]

[17]

Winger JG, Rand KL, Hanna N, Jalal SI, Einhorn LH, Birdas TJ, Ceppa DP, Kesler KA, Champion VL, Mosher CE. Coping Skills Practice and Symptom Change: A Secondary Analysis of a Pilot Telephone Symptom Management Intervention for Lung Cancer Patients and Their Family Caregivers. Journal of pain and symptom management. 2018 May:55(5):1341-1349.e4. doi: 10.1016/j.jpainsymman.2018.01.005. Epub 2018 Jan 31 [PubMed PMID: 29366911]

Level 3 (low-level) evidence

[18]

Allen KD, Somers TJ, Campbell LC, Arbeeva L, Coffman CJ, Cené CW, Oddone EZ, Keefe FJ. Pain coping skills training for African Americans with osteoarthritis: results of a randomized controlled trial. Pain. 2019 Jun:160(6):1297-1307. doi: 10.1097/j.pain.0000000000001525. Epub [PubMed PMID: 30913165]

Level 1 (high-level) evidence

[19]

Riddle DL, Keefe FJ, Ang DC, Slover J, Jensen MP, Bair MJ, Kroenke K, Perera RA, Reed SD, McKee D, Dumenci L. Pain Coping Skills Training for Patients Who Catastrophize About Pain Prior to Knee Arthroplasty: A Multisite Randomized Clinical Trial. The Journal of bone and joint surgery. American volume. 2019 Feb 6:101(3):218-227. doi: 10.2106/JBJS.18.00621. Epub [PubMed PMID: 30730481]

Level 1 (high-level) evidence

[20]

Bennell KL, Ahamed Y, Jull G, Bryant C, Hunt MA, Forbes AB, Kasza J, Akram M, Metcalf B, Harris A, Egerton T, Kenardy JA, Nicholas MK, Keefe FJ. Physical Therapist-Delivered Pain Coping Skills Training and Exercise for Knee Osteoarthritis: Randomized Controlled Trial. Arthritis care & research. 2016 May:68(5):590-602. doi: 10.1002/acr.22744. Epub [PubMed PMID: 26417720]

Level 1 (high-level) evidence

[21]

Aust H, Rüsch D, Schuster M, Sturm T, Brehm F, Nestoriuc Y. Coping strategies in anxious surgical patients. BMC health services research. 2016 Jul 12:16():250. doi: 10.1186/s12913-016-1492-5. Epub 2016 Jul 12 [PubMed PMID: 27406264]