Adaptive Coping Skills Research Articles

Purpose in life among haemodialysis caregivers: Links with adaptive coping, caregiver burden, and psychological distress.

Research has evidenced that purpose in life helps to minimise the strains of providing informal care to a significant other, but little is known about whether this psychological resource influences the paths from stressors to the health outcomes of family caregiving and through which mechanisms it can exert this protective effect. This study aimed to explore the moderating role of purpose in life on the (mediated through adaptive coping) relationship between caregiver burden and psychological distress in haemodialysis caregivers. A cross-sectional study was conducted with a convenience sample of family caregivers (n=173; M=55.9, SD=15.6years old) of adults undergoing haemodialysis. A moderated-mediation model was computed to explore the interaction effects of purpose in life on the path between burden and distress, having adaptive coping behaviours as parallel mediators. Results showed that purpose in life had a buffering effect on the mediated (through acceptance coping) relationship between burden and distress (index of partial moderated-mediation: bsimple=-0.029, 95% bootstrap confidence interval (CI) [-0.070, -0.002]), and that this conditional effect was lowest at high levels of the moderator (at +1SD: bsimple=0.038, SE=0.026, 95% bootstrap CI [0.001, 0.098]). Use of emotional support (F(1,159)=4.395, p=0.038) and positive reframing (F(1,159)=5.648, p=0.019) also mediated this path. This study expands knowledge about the modifiable internal resources through which purpose in life can help promote psychosocial adjustment to the haemodialysis caregiving process. Mental health promotion initiatives aimed at this population need to consider combining different intervention approaches to foster purpose in life and train adaptive (and flexible) coping skills.

Momentary autonomic engagement during parent-adolescent conflict: Coping as a moderator of associations with emotions.

Regulatory efforts are hypothesized to affect associations between emotions and physiology (i.e., concordance) to facilitate adaptive functioning. Assessing the role of coping on physiological-emotional concordance during ecologically relevant scenarios can elucidate whether concordance can serve as a biomarker of risk or resilience. The present study assessed self-reported coping as a moderator of minute-to-minute associations between autonomic nervous system activity and emotions (i.e., physiological-emotional concordance) in caregivers (N = 97) and adolescents (N = 97; ages 10-15) during a dyadic conflict task. Models included physiological variables (sympathetic, skin conductance level [SCL]; and parasympathetic, respiratory sinus arrhythmia [RSA]) and their interaction (SCL × RSA) as predictors of emotions, with coping variables as moderators. Caregivers' use of primary control coping (e.g., problem solving and emotional expression) and secondary control coping (e.g., cognitive reappraisal and acceptance) use in response to family stress predicted more positive emotional experiences during the laboratory conflict task. Adolescents' use of secondary control coping moderated the SCL-emotion association, such that increases in momentary SCL were associated with more positive emotion ratings for youth reporting higher secondary control coping. For youth who report more adaptive trait-level coping skills, momentary changes in SCL may reflect active engagement and attentiveness to facilitate more positive emotional experiences. Findings advance our understanding of the interrelationships between physiological responses and psychological experiences during relevant, interactive scenarios. Autonomic responses are differentially related to affective states depending on the coping strategies that adolescents employ, suggesting that concordance may be associated with intervention targets (i.e., coping skills).

Effectiveness of a Mindfulness-Based Intervention Program to Improve Communication and Stress Coping Skills in University Students.

Investigating the contribution of mindfulness training to psychological well-being and quality of life in the university setting is of interest. The objective of the study is to present a comparative analysis of the scores in the variables of self-efficacy, resilience, coping strategies, and communication skills before and after the application of an intervention program based on mindfulness. An ex post facto cross-sectional design and a convenience sample of participants were adopted. The participants were students belonging to Education Sciences who benefited from the activities of the program. Instruments were administered to assess mindfulness, self-efficacy, resilience, coping strategies, and communication skills. The correlations of the mindfulness variable with the other psychoeducational variables evaluated were also analyzed. The results indicate an increase in the scores in the selected variables of mindfulness, resilience, communication skills, and some of the coping strategies considered productive or functional such as problem solving, self-criticism, emotional expression, desiderative thinking, social support, and cognitive restructuring. Statistically significant correlations were also observed between the variable mindfulness and those of perceived self-efficacy, resilience, coping strategies, and communication skills. The development of mindfulness training programs in the university setting is necessary to contribute to the improvement of more adaptive coping skills and the promotion of resilience.

Comparison of changes in stress coping strategies between cognitive behavioral therapy and pharmacotherapy.

Coping refers to conscious responses to negative circumstances, with the intention of ameliorating these situations. Few studies have compared the differences between psychotherapy and medication treatment for coping strategies for depression. In this study, we investigated the differences in coping strategies between cognitive behavioral therapy (CBT) combined with medication (CBT group) and medication alone (pharmacotherapy group) among outpatients with depression. A prospective observational study was conducted among 50 patients with major depression (24 and 26 in the CBT and pharmacotherapy groups, respectively). Stress coping strategies (Coping Inventory for Stressful Situations [CISS]) and depression severity (Beck Depression Inventory-Second Edition [BDI-II]) were assessed at baseline and 16 weeks later. Changes in the CISS and BDI-II scores in both groups were tested using repeated analysis of variance. Inverse probability weighting with propensity score analysis was applied to address potential selection bias. At 16 weeks, the CBT group exhibited increased CISS task-oriented coping, distraction, and social diversion scores, which differed from those of the pharmacotherapy group. The CBT group exhibited a significantly greater reduction in depressive symptoms than the pharmacotherapy group. This study was not a randomized controlled trial and thus may have selection bias. Gaining adaptive coping skills, including task-oriented coping, distraction, and social diversion skills, by combining CBT with medication may lead to greater improvement in depression symptoms. These findings suggest that clinicians should evaluate coping strategies and facilitate the acquisition of adaptive coping strategies in patients with depression to reduce their symptoms.

Effects of online coping skills training on stress, anxiety and social problem solving in young people: A randomised controlled study.

Although most young people successfully manage the transition from childhood to adulthood, the speed and magnitude of these changes can cause stress that can exceed the coping abilities of many young people. Previous studies have suggested that adolescence is a vulnerable period for the development of psychiatric disorders; therefore, an adequate coping repertoire must be developed. Our aims were to develop and implement a coping skills training for young people and to evaluate the results of the training. Therefore, the components of the coping skills training programs in the existing literature were used. Young people from Turkey participated in this cluster randomised controlled trial (n = 89; mean age, 20.06 ± 1.44 years). Ten sessions of the coping skills training were applied in the study group (SG; n = 33), and one session was applied in the control group (CG; n = 56). To assess the effects of the coping skills training, all participants completed several psychological questionnaires (for stress, anxiety, coping and social problem-solving evaluations) at the beginning and end of the training. We performed an analysis of covariance (ANCOVA). In cases where ANCOVA assumptions could not be met, the efficacy of the intervention was determined using the mixed design/split-plot analysis of variance. Compared with the CG, the SG had significantly reduced stress and anxiety levels and increased adaptive coping skills. Social problem-solving skills remained relatively similar between the groups. Complete and correct implementation of coping skills training among the youth may contribute positively to the development of adaptive coping skills by reducing their stress and anxiety levels. This online coping skills training program allowed young people to directly experience their response to stress and offered opportunities to try and develop different coping strategies. Coping skills should be considered for successful stress and anxiety management in everyday life.

Preventive Effect of a 7-Week App-Based Passive Psychoeducational Stress Management Program on Students.

Passive psychoeducation is an easily accessible and cost-effective self-guided intervention that does not use elements of active psychotherapies or require homework. The present study aimed to investigate the acceptability and efficacy of a 7-week app-based passive psychoeducation stress management program to promote adaptive emotion regulation and coping skills in university students (i.e., 80% psychology students). Participants were tested via Lime-Survey® at pre- and post-test with the Depression Anxiety Stress Scale-21 (DASS-21), the Response Styles Questionnaire (RSQ), and the Emotion Regulation Questionnaire (ERQ). A stratified permutation block randomization by age, gender, and the DASS-21 stress subscale was performed. Each week, the psychoeducation group (n = 123) received different psychoeducation modules. At the end of each module, participants answered questions about their satisfaction with each module and adherence to psychoeducation. The control group (n = 130) received no intervention. The psychoeducation program led to a significant improvement in the adaptive emotion regulation strategy: "reappraisal" (p = 0.004) and a significant reduction in the dysfunctional coping style: "symptom-related rumination" (p = 0.01) but not to a significant reduction in depression, anxiety, and stress scores compared to the control group. Thus, the present study might demonstrate a preventive effect of an app-based passive psychoeducation program in students with low clinically relevant psychopathological symptoms.

Coping and psychological well-being among persons with relapsing-remitting multiple sclerosis: The role of perceived self-efficacy

ObjectiveTo explore self-efficacy as a possible mediator in the relationship between adaptive coping and psychological well-being (PWB) in persons with relapsing-remitting multiple sclerosis (RRMS). Method174 persons with RRMS (91% Female) completed an online survey consisting of psychosocial questionnaires. The COPE Inventory was used to create an adaptive coping composite that accounts for the relative contributions of both active and avoidant coping. Self-efficacy was measured using the General Self-Efficacy Scale. The Ryff Psychological Well-Being Scales captured several domains of PWB: Positive relations with others, autonomy, purpose in life, environmental mastery, self-acceptance, and personal growth. The SPSS PROCESS macro was used to test whether self-efficacy mediated the association between adaptive coping and each PWB subscale, using 5,000 bootstrap samples to estimate confidence intervals. ResultsIn each mediational model, adaptive coping was significantly associated with each PWB subscale and self-efficacy (all p’s ≤ 0.001). Self-efficacy was also significantly associated with each PWB subscale (p ≤ 0.001). After controlling for self-efficacy, the associations between adaptive coping and positive relations with others (indirect effect = 0.021, 95% CI [0.011, 0.033]) and autonomy (indirect effect = 0.019, 95% CI [0.011, 0.028]) became non-significant. The separate associations between adaptive coping and purpose in life (p = .004), self-acceptance (p = .026), and personal growth (p < .001) remained significant, despite controlling for self-efficacy. ConclusionsSelf-efficacy fully mediated the relationships between adaptive coping and positive relations with others and autonomy in our sample of persons with RRMS. Interventions aimed at increasing adaptive coping skills and self-efficacy may improve relations with others and autonomy among persons with MS.

The Relationship of Coping Mechanisms and Mental Health After Breakup

A person's coping mechanism in dealing with problems in life, whether problems with family, friends, or problems with a partner, can affect mental health conditions. Unstable mental health conditions in students can have an impact on their daily lives. This study aims to determine the relationship between coping mechanisms and mental health after a breakup. By using a cross-sectional approach, a sampling technique using purposive sampling and 101 respondents participated. Data collection using a coping mechanism questionnaire and mental health after a breakup questionnaire. The results showed that some respondents had adaptive coping mechanisms (53.5%) and good mental health (55.4%). The results of statistical analysis using the chi-square test showed a significant relationship between coping mechanisms and mental health (p value=0.001) and students with maladaptive coping mechanisms were 10 times more likely to experience poor mental health after they experienced a breakup. Efforts are needed to improve students' adaptive coping skills to prevent poor mental health problems when they experience a breakup.

Adaptive coping strategies among individuals living with long-term chikungunya disease: a qualitative study in Curaçao

ObjectiveLong-term chikungunya disease is characterised by persistent rheumatic symptoms following chikungunya virus infection. As there is no specific treatment available, affected individuals need strategies to adapt. However, research on these...

Online and school bullying roles: are bully-victims more vulnerable in nonsuicidal self-injury and in psychological symptoms than bullies and victims?

BackgroundBullying leads to adverse mental health outcomes and it has also been linked to nonsuicidal self-injury (NSSI) in community adolescents. It is not clear whether different roles of bullying (bully, victim, bully-victim) are associated with NSSI, furthermore the same associations in cyberbullying are even less investigated.MethodsThe aim of the current study was to test whether students involved in school or online bullying differed from their not involved peers and from each other in psychological symptoms (externalizing and internalizing problems) and in NSSI severity (number of episodes, number of methods). Furthermore, mediation models were tested to explore the possible role of externalizing and internalizing problems in the association of school and online bullying roles with NSSI. In our study, 1011 high school students (66.07% girls; n = 668), aged between 14 and 20 years (Mage = 16.81; SD = 1.41) participated.ResultsLifetime prevalence of at least one episode of NSSI was 41.05% (n = 415). Students involved in bullying used more methods of NSSI than not involved adolescents. In general, victim status was associated mostly with internalizing symptoms, while bully role was more strongly associated with externalizing problems. Bully-victims status was associated with both types of psychological problems, but this group did not show a significantly elevated NSSI severity compared to other bullying roles. Externalizing and internalizing problems mediated the relationship between bullying roles and NSSI with different paths at different roles, especially in case of current NSSI that happened in the previous month.ConclusionsResults highlight that students involved in bullying are more vulnerable to NSSI and to psychological symptoms compared to their peers who are not involved in bullying. It is suggested that bullying roles, especially bully-victim status, need to be identified in school and online settings and thus special attention should be addressed to them to reduce psychological symptoms and NSSI, for example by enhancing adaptive coping skills.

Congenital melanocytic naevus (CMN) through the lens: Using photo-elicitation interviews to explore adjustment in adolescents with a rare birthmark condition

Adolescents with the rare birthmarks congenital melanocytic naevi (CMN) experience physical and psychosocial challenges, many of which stem from looking different from the ‘norm’. However, some adjust and have positive experiences. Understanding the lived experiences of adolescents who have adjusted to CMN can provide a holistic picture of adjustment and inform the development of support and interventions for others with the condition. Open, participant-driven photo-elicitation interviews were conducted with four White females (15–17 years) who self-identified as having adjusted to CMN. Participants chose five photographs which were used to guide the interviews (47–80 min). Interpretative phenomenological analysis (IPA) was used to analyse the transcribed interview data. Three superordinate themes were identified: ‘Accepting My ‘True’ Self’ (1), ‘I am Not Alone in This’ (2), and ‘Developing as a Person’ (3). The themes related to accepting CMN as part of their identity, developing a positive body image (e.g., body appreciation, broad conceptualisations of beauty, body image flexibility), feeling supported and accepted by family, friends, and others with CMN, and developing adaptive coping skills. Findings suggest positive body image may be important for adjustment and can be determined by an individual. The benefits of using photo-elicitation within appearance research are discussed.

A - 79 Coping and Psychological Well-Being among Persons with Relapsing-Remitting Multiple Sclerosis: the Role of Self-Efficacy.

To explore self-efficacy as a possible mediator in the relationship between adaptive coping and psychological well-being (PWB) in persons with relapsing-remitting multiple sclerosis (RRMS). 174 persons with RRMS (95% Female) completed an online survey consisting of psychosocial questionnaires. The COPE Inventory was used to create an adaptive coping composite that accounts for the relative contributions of both active and avoidant coping. Self-efficacy was measured using the General Self-Efficacy Scale. The Ryff Psychological Well-Being Scales captured several domains of PWB: Positive relations with others, autonomy, purpose in life, self-acceptance, and personal growth. The SPSS PROCESS macro was used to test whether self-efficacy mediated the association between adaptive coping and each PWB subscale, using 5000 bootstrap samples to estimate confidence intervals. In each mediational model, adaptive coping significantly predicted each PWB subscale and self-efficacy (all p's ≤ 0.001). Self-efficacy significantly predicted each PWB subscale (p ≤ 0.001). After controlling for self-efficacy, the associations between adaptive coping and positive relations with others (indirect effect = 0.021, 95% CI [0.011, 0.033]) and autonomy (indirect effect = 0.019, 95% CI [0.011, 0.028]) became non-significant. The separate associations between adaptive coping and purpose in life (p = 0.004), self-acceptance (p = 0.026), and personal growth (p < 0.001) remained significant, despite controlling for self-efficacy. Self-efficacy fully mediated the relationships between adaptive coping and positive relations with others and autonomy in our sample of persons with RRMS. Interventions aimed at increasing adaptive coping skills and self-efficacy may improve relations with others and autonomy among persons with MS.

A multisite, quasiexperimental trial of a college course to support student mental health during the COVID-19 pandemic.

The purpose of this study was to investigate the acceptability, appropriateness, feasibility, and preliminary effectiveness of a three-credit college Wellness and Resilience Course (WRC) for improving student mental health and well-being outcomes in the context of the coronavirus disease 2019 (COVID-19) pandemic. Undergraduate students aged 18-24 years old on five campuses in Western Pennsylvania or West Virginia who had either enrolled in the WRC (n = 81) or were attending university as usual (i.e., not enrolled in the WRC; n = 171) participated in surveys at baseline (beginning of semester), end of semester, and 3-month follow-up during the Spring and Fall 2020 semesters. Overall, students rated the WRC as acceptable, appropriate, and feasible. From baseline to the end of semester, students who received the WRC reported significant improvements in psychological flexibility (d = 0.30), mindfulness (d = 0.42), distress tolerance (d = 0.36), and use of dysfunctional and adaptive coping skills (d = 0.32), compared with students who did not receive the WRC. At follow-up, all gains remained statistically significant and students who received the WRC additionally reported significant improvements in stress (d = 0.44) and life satisfaction (d = 0.35) compared with students who did not receive the WRC. These findings offer preliminary evidence that college courses focused on mental wellness may be an important component of campus strategies to increase universal access to mental health support and skills. This study was registered on clinicaltrials.gov on April 8, 2020.

Correlates of Psychological Distress Among African American Young Adults During the COVID-19 Pandemic

The COVID-19 pandemic disproportionately affects African Americans in the United States, including disparate rates of mortality and higher mental health consequences compared to Whites. However, African American young adults are underrepresented in the literature examining psychological distress (i.e., anxiety and depression) during the COVID-19 pandemic. Factors associated with psychological distress are important to examine among African American young adults during the pandemic to better inform culturally appropriate mental health interventions during times of increased uncertainty and isolation. The present study, grounded in the transactional theory of stress and coping, was a secondary analysis of 420 African American young adults exploring gender, age, coping, fear of missing out (FOMO), and COVID-19 news exposure as correlates of anxiety and depression. Results showed that gender, age, level of resilient coping, and experiences of FOMO were associated with psychological distress. Therefore, interventions to reduce psychological distress among African American young adults may need to focus on younger individuals and women, identify adaptive coping skills during times of significant change, and target individuals who experience FOMO.

Professional Quality of Life, Empathy, and Coping Strategies of Young Clinical Psychologists in Lahore, Pakistan

Objectives Empathy, coping strategies, and professional quality of life (ProQoL) play a significant role in an individual’s professional life. Several studies have indicated that the unfavorable consequences of compassion and empathy lead to compassion fatigue and burnout. The present study aims to examine the correlation among empathy, coping strategies, and ProQoL, and assess the moderating role of work experience among young clinical psychologists in Lahore, Pakistan. Methods This is a descriptive-correlational survey. A purposive sampling technique was used to select participants aged 23-37 years with 1-10 years of work experience. Data was collected using standard questionnaires including the Toronto Empathy Questionnaire, the Brief COPE Inventory, and the ProQoL Scale. Their internal consistency was examined using Cronbach’s alpha. Data were analyzed using descriptive statistics, correlational test, categorical regression analysis, and moderation analysis. Results There was a strong correlation between empathy, adaptive coping strategies, and compassion satisfaction. Moderation analysis showed that empathy and years of work experience significantly predicted the ProQoL. Conclusion Clinical psychologists in Lahore need to be educated to stimulate and further use problem-focused and adaptive coping skills to cope with their challenging jobs.

Special Report: Autism Spectrum Disorder and Inflexible Thinking—Affecting Patients Across the Lifespan

Special Report: Autism Spectrum Disorder and Inflexible Thinking—Affecting Patients Across the Lifespan

Less is more: Decreasing the frequency of maladaptive coping predicts improvements in DBT more consistently than increasing the frequency of adaptive coping

It is well-established that participation in dialectical behavior therapy (DBT) results in patients using adaptive coping strategies more frequently. Although coping skill instruction may be necessary to promote decreases in symptoms and behavioral targets in DBT, it is unclear if the frequency with which patients use adaptive coping skills leads to these outcomes. Alternatively, it is possible that DBT also leads patients to use maladaptive strategies less frequently and that these reductions more consistently predict improvements in treatment. We recruited 87 participants with elevated emotion dysregulation (Mage = 30.56; 83.9% female; 75.9% White) to participate in a 6-month course of full-model DBT delivered by advanced graduate students. Participants completed measures of adaptive and maladaptive strategy use, emotion dysregulation, interpersonal problems, distress tolerance, and mindfulness at baseline and after three DBT skills training modules. Both within- and between-person maladaptive strategy use significantly predicted module-to-module changes in all outcomes whereas adaptive strategy use significantly predicted changes in emotion dysregulation and distress tolerance, although the size of these effects did not significantly differ between adaptive and maladaptive strategy use. We discuss the limitations and implications of these results for optimizing DBT.

STRESS AND PSYCHOLOGICAL WELL-BEING IN FAMILIES TREATING SCHIZOPHRENIA PATIENTS

Introduction: Schizophrenia is a severe mental disorder characterized by decreased cognitive function and skills in social relations, inability to carry out self-care, and fulfilling the need for daily activities. The problems that occur in schizophrenic patients do not only affect the patients themselves, but also the families who care for the patients. Families have a burden in caring for schizophrenic patients. Families who are caregivers are vulnerable to stress which can affect their role as family companions. Various adjustments that must be faced in their role as caregivers are often a separate stressor, especially for families who lack adaptive coping skills. So that adaptive coping is needed to deal with stress and improve the psychological well-being of families in caring for schizophrenic patients. This study aims to determine the description of stress and psychological well-being in families who care for schizophrenic patients. Method: This type of research is quantitative descriptive with a cross-sectional approach, carried out at the Kembaran I Purwokerto Health Center. The number of samples of families caring for schizophrenic patients was 30 using the total sampling technique. The research instrument was the Perceived Stress Scale (PSS) questionnaire consisting of 10 items and the Psychological Well-Being Scale (PWBS) consisting of 42 items. The analysis used is descriptive quantitative. Result: The results of this study showed that most of the families who cared for schizophrenia patients had moderate stress levels are 28 families (93.3%) and moderate levels of psychological well-being in 25 families (83.3%). Conclusion: Stressful conditions can affect the level of psychological well-being in families who care for schizophrenic patients. Psychoeducation is needed to help families choose appropriate coping strategies in dealing with stressors and improve their psychological well-being. Keywords: families treating schizophrenia, psychological well-being, stress

Everybody Copes: An Interprofessional Workshop on Stress, Coping, and Helping Primary Care Patients Manage Medical Stressors.

The value of psychological principles has become apparent in medical settings, especially with the rise of patient-centered care. We aimed to provide a curriculum informing medical providers about the theoretical basis and clinical utility of the social-cognitive model of stress and coping. This workshop was delivered to an interprofessional team of faculty and trainees. Our initial pedagogical approach was to relate the concepts of cognitive appraisals and coping strategies to participants' own stress responses. We then used didactic presentation and small-group activities to explore ways to promote adaptive coping with patients to improve health outcomes. Learners participated in a mindfulness exercise, conceptualized coping strategies given a hypothetical case scenario, and, in small groups, role-played a patient encounter to construct an effective coping repertoire for the patient. Participants completed a prework self-assessment and workshop evaluation form. The 2.5-hour workshop had 48 participants from five professions (medicine, education, physician assistant, pharmacology, psychology). We received 35 evaluations (73% response rate). Learners reported increased real-world skills (M = 8.0 out of 10) and feeling better prepared for working in interprofessional settings (M = 7.6 out of 10). Qualitative feedback suggested that participants recognized the importance of individual differences in coping with stress and felt they could categorize strategies into emotion- or problem-focused coping. This workshop provided participants with basic knowledge about the social-cognitive model of stress and coping and allowed them to practice newly learned skills in a role-play as an interprofessional medical care team.

The Relationship of Spirituality with Coping Mechanism in Patients with Type 2 Diabetes Mellitus in Sukabumi Regency, Indonesia

Aim: Apart from the obvious health consequences, diabetes mellitus leads in unfavorable psychological responses that can lead to emotional problems. Individual coping techniques for lowering stress and making treatment decisions in which spirituality plays a significant role. The study aimed was to determine the relationship between spirituality and the coping mechanisms of type 2 diabetes mellitus patients. Methods: This is correlational study with cross-sectional approach. Total sampling was used to collect data from 54 people diagnosed with type 2 diabetes. The spirituality instrument uses the Daily Spiritual Experience Scale (DSES) and the coping mechanism uses The Brief Cope. Statistical analysis using chi-square. Results: The results showed that most respondents had moderate spirituality (59,3%) and adaptive coping mechanisms (55.6%). The chi-square test results obtained a P-value of 0.008, so there is a relationship between spirituality and coping mechanisms in type 2 DM patients. Conclusion: The results showed that most of the respondents had moderate spirituality and adaptive coping mechanisms. Spirituality and adaptive coping skills are predicted to be enhanced by nurses, particularly in populations at risk for chronic disease.