Patterns of coping preference among persons with schizophrenia: Associations with self-esteem, hope, symptoms and function.

Abstract

Data from first person accounts (Frese, 1993) structured interviews (Mueser, et al., 1997) and formal assessments (Ritsner et al., 2006) suggest that many with schizophrenia spectrum disorders experience enduring difficulties coping effectually with daily and unexpected stress. They may struggle to solve problems (e.g. Corrigan and Toomey, 1995; Penn, et al, 1993), and tend, as a matter of style, to ignore stressors or abandon attempts to find alternative solutions to problems when their usual patterns of behavior fail (Farhall & Gehrke, 1997; Lysaker, Wilt, Plascek-Hallberg, Brenner, & Clements, 2003; Wilder-Willis, et al., 2002). In addition to having a tendency to employ specific forms of coping which may repeatedly fail, persons with schizophrenia appear to have a limited range of possible ways to respond when under stress. It is not simply, therefore, that persons with schizophrenia choose the wrong behavior when facing a challenge but that they may have a coping style which does not include enough possibilities beyond reacting and avoidance (Roe, Yanos & Lysaker, 2006). Overall, ineffective coping is a matter of broad clinical concern. The inability to manage and respond to stress is believed to be among the primary causes of relapse and reduced quality of life in schizophrenia (Ritsner, et al, 2003; Ventura, et al, 1989). Research has suggested that more impoverished and avoidant styles of coping styles are linked to greater affective distress, greater levels of positive and negative symptoms, lesser hope and more frequent hospitalizations (e.g. Bak et al., 2001; 2003; Lysaker et al., 2005; 2001; Macdonald et al., 1998; Meyer, 2001; Modestin, et al., 2004; Middleboe and Mortensen, 1997; Ritsner & Ratner, 2006; Wiedl, 1992). Simply put, as persons fail to cope they feel increasingly overwhelmed and demoralized, which may lead to exacerbations in symptoms , which may then reinforce maladaptive coping style s in the manner of a vicious cycle. To date, one limitation of the research on coping in schizophrenia is that it has tended to focus on either individual pieces of the coping process or on general patterns of active vs. passive or emotional focused approaches to stressors, rather than profiles of coping preference. In other words, beyond a broad understanding of the differences between functional and dysfunctional coping it remains unclear whether there are particular combinations of coping behaviors which are particularly adaptive as opposed to maladaptive for persons with schizophrenia. For instance, are there coping profiles which involve a preference for taking action in the absence of actively considering alternatives that contribute to psychosocial impairment? Are there certain patterns or combinations of avoidant coping more closely linked to dysfunction than others? Is having no coping preference linked more closely with health or dysfunction? Understanding how coping profiles are related to health could be of clinical importance and point to possible means of both assessment and intervention for persons seeking recovery from schizophrenia. To examine this issue we have previously suggested that an adaptive coping preference may be assessed among persons with schizophrenia. We defined a coping preference for an action orientation, which we labeled acting; and a coping preference for thinking or talking with others, which we labeled considering (Lysaker, et al., 2004). We have further suggested that a preference alone for acting or a preference alone for considering might be linked with dysfunction. Evidence supporting this includes a study with a small sample in which those identified as having preference for both acting and considering, as opposed to a preference for one or neither, was linked to better work performance in rehabilitation over time (Lysaker, et al., 2004). In the current study we have sought to expand this research by determining if groups of persons with schizophrenia could be detected who varied according to their coping profile and whether those groups differed in the expected direction on objective measures of wellness and function. …