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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.

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slide1

Coping and Resilience

Leslie H. Wind, Ph.D

Mary Marshall, LCSW

federal sponsors
Federal Sponsors

NIMH

National Institute of Mental Health

NINR

National Institute of Nursing Research

SAMHSA

Substance Abuse

And

Mental Health Services Administration

principal investigators
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
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

stress terminology
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

types of stress reactions
Types of Stress Reactions
  • Physiological
  • Emotional
  • Cognitive
  • Behavioral
stress within a disaster context
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
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

Reactions: Children 1-5
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

Reactions: 6-11 Years
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

Reactions: 12-18 Years
children in disaster

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

defining coping
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)

think about kids and coping
Think About Kids and Coping

What are some of the ways you see

children and adolescents attempt to cope

with extremely stressful situations?

conceptualizing coping strategies
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
lazarus model of stress and coping
Lazarus’ Model of Stress and Coping

Antecedents

Individual goals, goal hierarchies, beliefs about self and world, Personal resources

Processes

Outcomes

Person-environment relationship

Relational meaning

Appraisal

Environment

Harms/losses, threats/challenges, benefits

Coping

Emotions, Functioning,Morale, Health

Revised relational meaning

transactional model of coping
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

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

Transactional Model Concepts
emotion focused coping
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

problem focused coping
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

responses to stress model
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

responses to stress model23
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

responses to stress model24
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
motivational model of coping
Innate Psychological Needs

Relatedness

Competence

Autonomy

Universal Stressors

Neglect

Chaos

Coercion

Skinner & Wellborn, 1997

Motivational Model of Coping
motivational model self system processes
Motivational Model: Self-System 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
the community stress prevention model
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

summarizing models of coping
Summarizing Models of Coping

Transactional

Motivational

Applied Psychology

common aspects of coping
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
coping in young children
Coping in Young Children
  • Maturation results in developmental stages marked by capacity for self-control
  • Process using internal/external resources to manage demands of environment

Zeitlin & Williamson, 1994

coping in young children31
Coping in Young Children
  • Step 1: Determine meaning of event
  • Step 2: Develop an action plan
  • Step 3: Implement coping effort
  • Step 4: Evaluation effectiveness of

outcome

Zeitlin & Williamson, 1994

evaluating young children s coping
Evaluating Young Children’s Coping
  • Behavior is appropriate for situation
  • Behavior is appropriate developmentally
  • Behavior enables child to achieve objectives
what we know about development and coping
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
more on development
More on Development
  • Attention – increases with age
  • Sense of competence – younger over-estimate; older perceive competence as enduring
  • Locus of control – increases with age
what we know about gender and coping
What We Know About Gender and Coping
  • Mixed findings overall
  • Findings vary by context
coping and culture
Coping and Culture
  • Connection between culture and coping
  • Individualism vs. collectivism
coping and cultural beliefs
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
model of collectivistic coping
Model of Collectivistic Coping
  • Family support
  • Respect for authority figures
  • Intracultural coping
  • Relational universality
  • Forbearance
  • Social activity
  • Fatalism

Chen in Wong & Wong, 2006

more on culture
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

child coping within a cultural context
Child Coping within a Cultural Context
  • Coping strategies vary across groups
  • Ethnicity x Context = Coping
  • Avoidant coping = adaptive and maladaptive
defining resilience
Defining Resilience

A pattern of positive adaptation in the

context of past or present adversity

Wright & Masten, 2005

judging adaptation
Judging Adaptation

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
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
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 concepts46
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 concepts47
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 concepts48
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
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 negativeWright & Masten, 2005

risks pile up
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)
correlates of resilience child characteristics
Correlates of Resilience: Child Characteristics

Social/adaptable temperament

Strong cognitive abilities

Effective emotional and behavioral regulation strategies

Positive view of self

Positive outlook

Faith/sense of meaning in life

Characteristics valued by society and self (talents, humor, appearance)

Masten, 2001

family resilience
Family Resilience

“…coping and adaptational processes

in the family as a functional unit”

Walsh, 2006, p. 15

principles of family resilience
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 resilience54
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
Three Keys to Family Resilience

Family belief systems

Organizational patterns

Communication processes

Walsh,2006

family belief systems
Family Belief Systems

Making meaning of adversity – sense of coherence

Positive outlook

Transcendence and spirituality

organizational patterns
Organizational Patterns

Flexibility – Capacity for change

Connectedness/Cohesion – emotional/structural bonding

Social and economic resources – Extended networks

communication processes
Communication Processes

Clarity – clear communication

Open emotional expression – trust, emotional interaction

Collaborative problem solving – conflict management

correlates of resilience family characteristics
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 Processes in Coping

Family members:

  • can be resources
  • can present impediments
  • are models

Compas & Epping, 1993

correlates of resilience community characteristics
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 pro-social peer associations

Masten, 2001

adaptive systems facilitating development
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
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
Culture and Resilience

Within the cultural context:

Extended family networks

Religious organizations

Other social systems

culturally relevant risk and protective factors
Culturally Relevant Risk and Protective Factors

Socioeconomic status

Social support

Prejudice and discrimination

Acculturation stress

resilience and disaster
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

disaster related outcomes
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 post-disaster problems

PTS: 28-50% after terrorism, hurricanes

factors associated with stress related outcomes
Factors Associated with Stress-Related Outcomes
  • Exposure
  • Demographics
  • Preexisting psychosocial factors
  • Post-disaster recovery environment

La Greca & Prinstein, 2002

predicting children s reaction to disaster
Predicting Children’s Reaction to Disaster

Preexisting Child

Characteristics

Functioning

Traumatic Exposure

Coping Efforts

Post Disaster Recovery Environment

Major Life

Events

Social

Support

what we know about disasters coping strategies
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
more on coping strategies
More on Coping Strategies
  • Findings vary re most common
  • Some strategies associated with symptoms; some not
  • Some strategies are context specific
what we know related to disasters gender
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
what we know related to disasters age
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
what we know related to disasters previous trauma
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
what we know related to disasters culture
What We Know Related to Disasters: Culture
  • Strategy usage
  • Acculturation and PTSD for African Americans
what we know related to disasters self efficacy
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
what we know related to disasters resources
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
future research
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?
factors influencing psychosocial outcomes
Factors Influencing Psychosocial Outcomes
  • Need to continue development of explanatory models
  • Differentiate predictors by type of disaster, development, culture, and time
challenges to understanding coping within a disaster context
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
challenges to understanding resilience
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
we need to
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 self-efficacy within the disaster context
  • Develop and test explanatory models of coping that are sensitive to culture
we need to85
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
then we can
Then We Can…..

Develop, implement, and evaluate interventions supporting individual, family, and community resilience