Coping and Resilience Leslie H. Wind, Ph.D Mary Marshall, LCSW

Coping and Resilience
Leslie H. Wind, Ph.D
Mary Marshall, LCSW
Federal Sponsors
NIMH
National Institute of Mental Health
NINR
National Institute of Nursing Research
SAMHSA
Substance Abuse
And
Mental Health Services Administration
Principal Investigators
Betty Pfefferbaum, MD, JD
University of Oklahoma Health Sciences Center
Alan M. Steinberg, PhD
University of California, Los Angeles
Robert S. Pynoos, MD, MPH
University of California, Los Angeles
John Fairbank, PhD
Duke University
Learning Objectives
After completing this module you will be able to:
• Identify and define key concepts and models related
to stress, coping, and resilience
• Understand the transactional nature of coping and
resilience processes
• Differentiate key culturally-based aspects of coping
and resilience
• Discuss coping and resilience issues specific to
youth exposed to mass level traumatic events
• Identify gaps in knowledge and research needs
What is Stress?
Stress Terminology
• Stress: The effect of anything in life to which people must
adjust. Stress requires us to adjust our attention and behavior
and makes demands on our energy.
• Stressor: Anything that has the effect of causing stress.
• Stress Capacity: The amount of stress a person can carry, since
each person has some stress in their lives.
• Stress Load: This refers to the amount, or quantity, of stress a
person has in their lives.
Red Cross, 2002
Northwest Center for
Public Health Practice
Types of Stress Reactions
• Physiological
• Emotional
• Cognitive
• Behavioral
Northwest Center for
Public Health Practice
Stress within a Disaster Context
• Disasters are overwhelming, traumatic
events
• Children’s reactions vary by age,
developmental maturity, and experience
• Children’s reactions likely vary by stage of
recovery
• Children’s needs may not be met
Northwest Center for
Public Health Practice
Reactions: Children 1-5
• Helplessness and
passivity
• Generalized fear
• Heightened arousal
• Cognitive confusion
• Difficulty talking about
event
• Sleep disturbance
• Separation
fears/clinging
•
•
•
•
•
Regressive symptoms
Anxiety about death
Grief
Somatic symptoms
Startle response to loud
or unusual noises
• Irritability
Northwest Center for
Public Health Practice
Reactions: 6-11 Years
• Feelings of
responsibility/guilt
• Traumatic play and
retelling
• Sleep disturbance
• Anger/aggression
• Change in behavior,
mood, personality
• Somatic symptoms
• Fear and anxiety
•
•
•
•
Regression
Separation anxiety
Withdrawal
Loss of interest in
activities
• Magical thinking
• Loss of ability to
concentrate
• School avoidance and
decline in school
performance
Northwest Center for
Public Health Practice
Reactions: 12-18 Years
• Self-consciousness
• Life-threatening
reenactment
• Abrupt shift in
relationships
• Depression
• Social withdrawal
• Sleep/eating
disturbances
• Decline in school
performance
• Rebellion
• Accident proneness
• Wish for revenge and
action-oriented
responses
Northwest Center for
Public Health Practice
Children in Disaster
“My daughter was small then, but she has
a certain hostility toward everyone. She
seems to want to hurt everyone…She liked
to play with dolls before the flood, but now
she punches out their eyes and pulls their
arms off. She calls her daddy on her play
phone now when it rains and tells him to
come get her because the dam is
breaking.”
Everything in Its Path by Kai T. Erikson
Northwest Center for
Public Health Practice
What is Coping?
Northwest Center for
Public Health Practice
Defining Coping
Constantly changing cognitive and behavioral efforts
to manage specific external and/or internal demands
that are appraised as taxing or exceeding the
resources of a person (Folkman & Lazarus, 1984, p.
141)
…anything people do to adjust to the challenges and
demands of stress… any adjustments made to
reduce the negative impact of stress (Red Cross:
Community-based Psychological Support, p. 87)
Northwest Center for
Public Health Practice
Think About Kids and Coping
What are some of the ways you see
children and adolescents attempt to cope
with extremely stressful situations?
Northwest Center for
Public Health Practice
Conceptualizing Coping
Strategies
• Biological/physiological – fight or flight
• Cognitive – how we think about the situation
• Behavioral – behavior related to mental process
• Learned – strategies learned from
modeling/observation
• Intentioned – voluntary/involuntary
Northwest Center for
Public Health Practice
Lazarus’ Model of
Stress and Coping
Antecedents
Individual goals,
goal hierarchies,
beliefs about self
and world, Personal
resources
Processes
Personenvironment
relationship
Outcomes
Appraisal
Relational
meaning
Environment
Harms/losses,
threats/challenges,
benefits
Coping
Revised
relational
meaning
Northwest Center for
Public Health Practice
Emotions,
Functioning,
Morale,
Health
Transactional Model
of Coping
Core Assumptions:
• Stressful experiences are construed as
person-environment transactions
• Transactions depend on the impact of the
external stressor
• Impact is mediated individual/environmental
antecedents, by the person’s repeated
appraisal of the stressor, and coping
responses
• The system changes moment to moment
Lazarus, 1999
Northwest Center for
Public Health Practice
Transactional Model
Concepts
•
•
•
•
Primary appraisal
Secondary appraisal
Coping efforts
Problem
management
• Emotional
Regulation
• Meaning-based
coping
• Outcomes of coping
• Dispositional coping
styles
• Optimism
• Information seeking
Glanz, Rimer, & Lewis, 2002
Northwest Center for
Public Health Practice
Emotion Focused Coping
Coping efforts that are directed toward
regulating emotional states:
-- Denial/avoidance
-- Distraction or minimization
-- Wishful thinking
-- Self-control of feelings
-- Seeking meaning
-- Self-blame
-- Expressing/sharing feelings
Folkman & Lazarus, 1984
Compas & Epping, 1993
Northwest Center for
Public Health Practice
Problem-Focused Coping
Efforts to act on the source of stress to change
the person, the environment, or the relationship
between the two:
1. Planned problem solving
2. Confrontation
Compas & Epping, 1993
Northwest Center for
Public Health Practice
Responses to Stress Model
Voluntary Strategies
1. Primary Control Coping - Attempts to modify
stressful problem or emotion (problem solving)
2. Secondary Control Coping – Attempts to adapt
via cognition (cognitive restructuring)
3. Disengagement Coping - Attempts to redirect
attention away from the stressor or emotional
reaction (denial, wishful thinking)
Wadsworth et al, 2004
Northwest Center for
Public Health Practice
Responses to Stress Model
Involuntary Strategies
4. Involuntary Engagement – Directed toward
the stressor or their emotional reactions (arousal,
rumination, impulsive action)
5. Involuntary Disengagement – Directed away from
the stressor or their emotional reactions
(emotional numbing, escape)
Wadsworth et al, 2004
Northwest Center for
Public Health Practice
Responses to Stress Model
• Emphasizes developmental changes in nature of
stress, internal/external constraints limiting coping
processes, and a complex interplay between
voluntary and involuntary responses to stress.
• Involuntary responses reflect individual differences
in temperament, over-learned and automatic
responses
• Assumes an increase in secondary control coping
and emotion-focused coping and decreases in
disengagement with maturity
Northwest Center for
Public Health Practice
Motivational Model of Coping
Innate Psychological
Needs
Universal Stressors
• Relatedness
• Competence
• Autonomy
• Neglect
• Chaos
• Coercion
Skinner & Wellborn, 1997
Northwest Center for
Public Health Practice
Motivational Model: SelfSystem Processes
• Children’s self-efficacy may be challenged by
chaotic social contexts.
• Self-efficacy beliefs lead to interpretations re
competence
• Autonomy vs. coercion = need to experience self as
free to choose vs. pressure to behavior a certain way
• Neglect = social interactions that undermine the
need for relatedness
• Self-system processes become either source of
distress or resource in event of trauma
Northwest Center for
Public Health Practice
The Community Stress
Prevention Model
Six dimensions central to coping with adversity:
• Beliefs/Values – relies on values to cope
• Affect – emotion expression as coping
mechanism
• Social – seeking support/relationships
• Imagination – creative expression to cope
• Cognitive – need honest dialogue & guidance
• Physiological – physical activity as coping
Lahad, Shacham, & Niv, 2000
Northwest Center for
Public Health Practice
Summarizing Models of Coping
• Transactional
• Motivational
• Applied Psychology
Common Aspects of Coping
• Strategies/Patterns: 4 common types
• Flexibility: # strategies
• Effectiveness: How well child thinks it worked
• Self-efficacy: Sense of competence
• Coping Assistance: External resources (formal and
informal)
• Coping Resources: Individual characteristics
Northwest Center for
Public Health Practice
Coping in Young Children
• Maturation results in developmental
stages marked by capacity for selfcontrol
• Process using internal/external
resources to manage demands of
environment
Zeitlin & Williamson, 1994
Northwest Center for
Public Health Practice
Coping in Young Children
•
•
•
•
Step 1:
Step 2:
Step 3:
Step 4:
Determine meaning of event
Develop an action plan
Implement coping effort
Evaluation effectiveness of
outcome
Zeitlin & Williamson, 1994
Northwest Center for
Public Health Practice
Evaluating Young
Children’s Coping
• Behavior is appropriate for situation
• Behavior is appropriate developmentally
• Behavior enables child to achieve objectives
Northwest Center for
Public Health Practice
What We Know About
Development and Coping
• Emotion-focused – increases with age
• Problem-solving skills – mixed findings
• Negative appraisal varies in dimensionality
• Avoidant physical/cognitive responses
increase w/age
Northwest Center for
Public Health Practice
More on Development
• Attention – increases with age
• Sense of competence – younger overestimate; older perceive competence as
enduring
• Locus of control – increases with age
Northwest Center for
Public Health Practice
What We Know
About Gender and Coping
• Mixed findings overall
• Findings vary by context
Northwest Center for
Public Health Practice
Coping and Culture
• Connection between
culture and coping
• Individualism vs.
collectivism
Northwest Center for
Public Health Practice
Coping and Cultural Beliefs
World view is culturally based:
• Utility of effort
• Religious beliefs
• Belief in an entity view of the world
• Belief in a benevolent purpose for events
• Values
• Belief in the ubiquity of change
• Belief in the utility of personal preparation
Northwest Center for
Public Health Practice
Model of Collectivistic Coping
•
•
•
•
•
•
•
Family support
Respect for authority figures
Intracultural coping
Relational universality
Forbearance
Social activity
Fatalism
Chen in Wong & Wong, 2006
Northwest Center for
Public Health Practice
More on Culture…..
• Discrimination and stigma erode
resilience
• Gender constraints are problematic
• Guilt and shame
• Meaning
• Mastery and control
• Help-seeking, stigma, and mistrust
Boss, 2006; Norris & Alegria, 2006
Northwest Center for
Public Health Practice
Child Coping
within a Cultural Context
• Coping strategies vary across groups
• Ethnicity x Context = Coping
• Avoidant coping = adaptive and maladaptive
Northwest Center for
Public Health Practice
What is Resilience?
Northwest Center for
Public Health Practice
Defining Resilience
A pattern of positive adaptation in the
context of past or present adversity
Wright & Masten, 2005
Judging Adaptation
1. There has been a significant threat or risk
to the development or adaptation of the
individual; and
2. The individual’s functioning is satisfactory
according to selected criteria.
Wright & Masten, 2005
Key Concepts in
Resilience Research
• Adversity: Environmental conditions that interfere
with/threaten the accomplishment of age-appropriate
developmental tasks
• Risk: An elevated probability of an undesirable
outcome
• Risk Factor: A measurable characteristic in a group
of individuals or their situation that predicts negative
outcome on a specific criteria
More Key Concepts
• Cumulative Risk: Increased risk due to (a)
multiple risk factors present; (b) multiple
occurrences of same risk factor; (c)
accumulating effects of ongoing adversity
• Vulnerability: Individual susceptibility to
undesirable outcomes
More Key Concepts
• Proximal Risk: Risk factors experienced
directly by the child
• Distal Risk: Risk related to a child’s
ecological context, but mediated via proximal
processes
More Key Concepts
• Asset/Resource/Compensatory Factor: A
measurable characteristic in a group of
individuals or their situation that predicts
general/specific positive outcomes
• Protective Factor: Quality of a
person/context or their interaction that
predicts better outcomes
More Key Concepts
• Cumulative Protection: Presence of multiple
protective factors
• Psychosocial Competence: The adaptive use
of personal and contextual resources to
accomplish developmental tasks
• Developmental Tasks: Expectations of a
society for child’s accomplishments according
to stage of development
Assumptions Related to
Resilience Concepts
• Children may demonstrate resilience at one
point in life and not at another;
• Children may demonstrate resilience in only
some aspects of life;
• There are linkages among the multiple
domains of adaptation, positive and negative
Wright & Masten, 2005
Risks Pile Up
• Risk factors often pile up
• Transitions (divorce, school entry, leaving home,
war) pile risks on children within a short timeframe
• Emotional, behavioral, educational, and health
problems increase as total risk level increases
• Developmental cascades can occur (one problem
leads to another)
Northwest Center for
Public Health Practice
Correlates of Resilience:
Child Characteristics
• Social/adaptable
• Positive outlook
temperament
• Faith/sense of
• Strong cognitive
meaning in life
abilities
• Characteristics
• Effective emotional
valued by society
and behavioral
and self (talents,
regulation strategies
humor, appearance)
• Positive view of self
Masten, 2001
Family Resilience
“…coping and adaptational processes
in the family as a functional unit”
Walsh, 2006, p. 15
Principles of
Family Resilience
• Individual resilience is best understood and
fostered in the context of the family and
larger social world, as a mutual interaction of
individual, family, socio-cultural, and
institutional influences
• Crisis events and persistent stresses affect
the whole family, posing risks not only for
individual dysfunction, but for relational
conflict and family breakdown;
Walsh, 2006
Principles of
Family Resilience
• Family processes mediate the impact of stress for all
its members and relationships;
• Protective processes foster resilience by buffering
stress and facilitating adaptation;
• Maladaptive responses increase vulnerability and
risks for individual and relational distress;
• All individuals and families have the potential for
greater resilience
Three Keys to
Family Resilience
• Family belief systems
• Organizational patterns
• Communication processes
Walsh,2006
Family Belief Systems
• Making meaning of adversity – sense of
coherence
• Positive outlook
• Transcendence and spirituality
Organizational Patterns
• Flexibility – Capacity for change
• Connectedness/Cohesion –
emotional/structural bonding
• Social and economic resources – Extended
networks
Communication Processes
• Clarity – clear communication
• Open emotional expression – trust,
emotional interaction
• Collaborative problem solving – conflict
management
Correlates of Resilience:
Family Characteristics
• Stable/supportive
home environment
• Parents involved in
child’s education
and activities
• Parents have same
characteristics as
child resilience
correlates
• Socioeconomic
advantages
• Postsecondary
education of parents
• Faith and religious
affiliations
Masten, 2001
Family Processes in Coping
Family members:
• can be resources
• can present impediments
• are models
Compas & Epping, 1993
Northwest Center for
Public Health Practice
Correlates of Resilience:
Community Characteristics
• Good quality
neighborhood
• Effective schools
• Employment
opportunities for
parents/teens
• Good public health care
• Access to emergency
services
• Connections to caring
adult mentors and prosocial peer
associations
Masten, 2001
Adaptive Systems Facilitating
Development
• Attachment relationships
• Moral and ethical development
• Self-regulatory systems
• Mastery and motivational systems
• Neurobehavioral and information-processing
systems
Stability and Change in
Adaptation
• Complex interactions of youth with parents,
peers, and other adults in home,
neighborhood, schools, and workplace
impact outcomes
• Critical turning points correspond to
developmental challenges
Culture and Resilience
Within the cultural context:
• Extended family networks
• Religious organizations
• Other social systems
Culturally Relevant Risk and
Protective Factors
• Socioeconomic status
• Social support
• Prejudice and discrimination
• Acculturation stress
Resilience and Disaster
• The nature of the threat must be considered
• Developmental timing influences reactions
• Child experiences/responses of children are
influenced by family, peer, and school functioning,
particularly by people to whom children are attached
• Family, peers, and larger systems influenced by
perceptions of the safety of other system members
Masten & Obradovic, 2007
What Do We Know Within
the Disaster Context?
Disaster Related Outcomes
• Statistics are unavailable on number of
children/adolescents impacted by disaster
• Symptoms are similar across disasters
• Anxiety disorders, depression, behavioral
disorders are most commonly reported postdisaster problems
• PTS: 28-50% after terrorism, hurricanes
Factors Associated with
Stress-Related Outcomes
• Exposure
• Demographics
• Preexisting psychosocial factors
• Post-disaster recovery environment
La Greca & Prinstein, 2002
Northwest Center for
Public Health Practice
Predicting Children’s
Reaction to Disaster
Preexisting Child
Characteristics
Traumatic Exposure
Coping Efforts
Functioning
Post Disaster Recovery Environment
Major Life
Events
Social
Support
Northwest Center for
Public Health Practice
What We Know about
Disasters: Coping Strategies
• Negative strategies = higher PTSD,
depression
• Negative self-attribution and guilt = higher
PTSD
• Higher PTSD, depression = use more
strategies
Northwest Center for
Public Health Practice
More on Coping Strategies
• Findings vary re most common
• Some strategies associated with
symptoms; some not
• Some strategies are context specific
Northwest Center for
Public Health Practice
What We Know Related to
Disasters: Gender
• Girls use affective coping and social support more
than boys
• Adolescent girls use more problem solving; boys
use more emotional numbing
• Some studies find no gender differences
• Girls have higher rates of posttraumatic symptoms
Northwest Center for
Public Health Practice
What We Know Related to
Disasters: Age
• Adolescent girls who use primary control coping
have less anxiety
• Involuntary disengagement in adolescents
associated with more anxiety
• Younger children: Wishful thinking, positive coping,
social withdrawal, blame-anger
• Adolescents: Distraction, avoidance, active coping,
support coping
Northwest Center for
Public Health Practice
What We Know Related to
Disasters: Previous Trauma
• No difference in strategy effectiveness
• More previous trauma = greater perception of
effectiveness of coping
• More previous trauma = use more strategies
• Associated with use of active coping
strategies
Northwest Center for
Public Health Practice
What We Know Related to
Disasters: Culture
• Strategy usage
• Acculturation and PTSD for African
Americans
Northwest Center for
Public Health Practice
What We Know Related to
Disasters: Self-Efficacy
One Month Post-Event
• Perception of life threat
• Depression
Three Months Post-Event
• Children’s ability to cope at T1 most predictive
of coping at T2**
• Family communication about event
Northwest Center for
Public Health Practice
What We Know Related to
Disasters: Resources
• Support seeking = fewer symptoms
• Assistance with distraction and emotional
processing = more PTSD
• Parents provide most help in roles and routines,
social support
• Friends help more with emotional processing
• Social withdrawal unrelated to coping assistance
Northwest Center for
Public Health Practice
WHAT DO WE
NEED TO KNOW?
Northwest Center for
Public Health Practice
Future Research
• What factors influence coping and resilience
in children and families within a disaster
context?
• By what processes do they interact in
producing psychosocial outcomes?
Northwest Center for
Public Health Practice
Factors Influencing
Psychosocial Outcomes
• Need to continue development of
explanatory models
• Differentiate predictors by type of disaster,
development, culture, and time
Northwest Center for
Public Health Practice
Challenges to Understanding
Coping within a Disaster Context
• Disasters are unpredictable
• Lack of clarity and agreement about nature of coping
in children
• Lack of consensus on definitions
• Poor instrumentation
• Lack longitudinal study
Northwest Center for
Public Health Practice
Challenges to
Understanding Resilience
• Risk and protective factors poorly specified
and inconsistently operationalized
• Utility of risk and protective factors for
screening is insufficiently examined
• Mediating and moderating relationships are
insufficiently examined
Northwest Center for
Public Health Practice
We Need To…
• Increase standardization in measurement of
coping in childhood and adolescence based
on clear definitions and cultural
considerations
• Examine coping style, flexibility, and selfefficacy within the disaster context
• Develop and test explanatory models of
coping that are sensitive to culture
Northwest Center for
Public Health Practice
We Need To…..
• Conceptualize risk and protective factors in
ways that effectively inform prevention,
intervention, and public policy
• Distinguish direct and indirect relationships
among risk and protective factors, mediators
and moderators; over time
• Develop theory-driven explanatory models
• Utilize advanced modeling techniques
Northwest Center for
Public Health Practice
Then We Can…..
Develop, implement, and evaluate
interventions supporting individual,
family, and community resilience
Northwest Center for
Public Health Practice
Northwest Center for
Public Health Practice