Avoidant Coping Behavior Research Articles

A pilot test of a mindfulness-based communication training to enhance resilience in palliative care professionals

Although many providers enter palliative medicine with the intention of helping others, working in this practice also entails that providers will be repeatedly exposed to the pain, trauma, and the death of their patients. These experiences may threaten the values of providers and evoke a range of avoidant coping behaviors that potentiate distress and erode the quality of care provided. This manuscript reports pilot findings from Aware Compassionate Communication: An Experiential Provider Training Series (ACCEPTS) for Palliative Care Providers that is informed by Mindfulness-Based Interventions and principles of Psychological Flexibility Theory. Providers participated in a group-based 8-week, 10-session training series that emphasized mindfulness and acceptance-based interventions as applied to the needs of those working with the chronically ill and dying. The program included formal meditation practice, communication role plays, and value clarification exercises. Participants completed measures of distress (i.e. Depression, PTSD, and Burnout), and potential mechanisms of change (i.e. cognitive fusion and experiential avoidance) at pre-training, mid-training and post-training. Significant reductions were observed in cognitive fusion (posttreatment d=−.54, p<.05), depressive symptoms (posttreatment d=−.64, p<.01), depersonalization (posttreatment d=−.83, p<.01), PTSD Re-experiencing (posttreatment d=−.34, p<.01). Results indicated that ACCEPTS is an acceptable and feasible intervention for providers that may enhance well-being. More research is needed to assess cognitive fusion as a potential mechanism of change in the program

Coping Behavior and Risk of Post-Traumatic Stress Disorder Among Federal Disaster Responders.

Our knowledge about the impact of coping behavior styles in people exposed to stressful disaster events is limited. Effective coping behavior has been shown to be a psychosocial stress modifier in both occupational and nonoccupational settings. Data were collected by using a web-based survey that administered the Post-Traumatic Stress Disorder (PTSD) Checklist-Civilian, General Coping Questionnaire-30, and a supplementary questionnaire assessing various risk factors. Logistic regression models were used to test for the association of the 3 coping styles with probable PTSD following disaster exposure among federal disaster responders. In this sample of 549 study subjects, avoidant coping behavior was most associated with probable PTSD. In tested regression models, the odds ratios ranged from 1.19 to 1.26 and 95% confidence intervals ranged from 1.08 to 1.35. With control for various predictors, emotion-based coping behavior was also found to be associated with probable PTSD (odds ratio=1.11; 95% confidence interval: 1.01-1.22). This study found that in disaster responders exposed to traumatic disaster events, the likelihood of probable PTSD can be influenced by individual coping behavior style and other covariates. The continued probability of disasters underscores the critical importance of these findings both in terms of guiding mental health practitioners in treating exposed disaster responders and in stimulating future research.

LATENTNA STRUKTURA SRPSKE ADAPTACIJE INDIKATORA STRATEGIJA PREVLADAVANJA

Indikator strategija prevladavanja (Coping Strategy Indicator – CSI: Amirkhan, 1990) je empirijski deriviran instrument namenjen proceni stilova prevladavanja stresa, odnosno nivoa zastupljenosti tri velika stila prevladavanja – rešavanja problema, traženja socijalne podrške i izbegavanja u ponašanju osobe suočene sa stresorom. Uprkos popularnosti i širokoj primeni u različitim kulturnim kontekstima, nalazi o njegovoj strukturnoj invarijantnosti na različitim uzorcima nisu toliko brojni i ne poseduju potpunu saglasnost. Ova studija imala je za cilj proveru psihometrijskih karakteristika, prevashodno konstrukt validnosti Indikatora strategija prevladavanja na uzorku nekliničke populacije mladih u Srbiji. Istraživanje je organizovano sprovođenjem dve studije. U Studiji 1 na uzorku od 327 ispitanika proveravana je konstrukt validnost skale eksplorativnom faktorskom analizom. U Studiji 2, sprovedenoj na uzorku od 1249 studenata Univerziteta u Novom Sadu, dodatno je proveravana konstrukt validnost instrumenta konfirmativnom faktorskom analizom. Ni eksplorativna ni konfirmativna analiza nisu uspele u replikaciji originalne strukture skale. Rezultati eksplorativne faktorske analize sugerisali su visoku heterogenost subskale Izbegavanje. Konfirmativna faktorska analiza sugerisala je skraćenje subskala Rešavanje problema i Traženje socijalne podrške sa početnih jedanaest na šest stavki. Za subskalu Izbegavanje najadekvatnijim se pokazao bifaktorski model sa osam stavki okupljenih oko generalnog faktora izbegavajućih strategija prevladavanja, uz izdvajanje specifičnih faktora Distrakcije, Iluzioniranja i Izolacije. Možemo zaključiti da ovakva adaptacija Indikatora strategija prevladavanja predstavlja pouzdan i validan instrument za procenu strategija prevladavanja. Ipak, u budućim istraživanjima treba dodatno proveriti validnost ovog instrumenta i detaljnije analizirati specifičnosti ponašanja u okviru izbegavajućeg prevladavanja na različitim uzorcima i podnebljima.

Life Satisfaction and Coping in Hindu Adolescents in India

This exploratory study examined the relations between approach and avoidance coping behaviors and general life satisfaction in a sample of 248 Hindu adolescents from an urban area in India. The major findings were threefold. First, gender differences were observed, with females reporting more frequent use of the strategies of seeking social support, direct problem solving, and internalizing behaviors. Second, using multiple regression analyses, the coping behaviors of problem solving and externalizing behaviors accounted for significant, unique variance in life satisfaction scores. Third, gender did not moderate the relations between any of the coping behaviors and life satisfaction. Possible implications for health promotion are discussed.

Larger and More Prominent Graphic Health Warnings on Plain-Packaged Tobacco Products and Avoidant Responses in Current Smokers: a Qualitative Study.

The introduction of tobacco plain packaging legislation in Australia meant that all tobacco products were to be sold in plain dark-brown packaging with 75% front-of-pack graphic health warnings and standardised font type and size for brand name and product variant. The change in the size and prominence of the warnings has been proposed as a reason for behaviour change in smokers in terms of increased intentions to quit and quit attempts. The current research examined attitudes and beliefs of cigarette smokers toward the increased size and prominence of the warnings and effects on their behaviour. Participants (N = 160) completed open-ended responses to questions on beliefs, attitudes and responses to plain packaging. Responses were subjected to inductive thematic content analysis for key themes. Four themes emerged from the analysis: emotional response to packaging, scepticism of health warnings, warnings and cessation behaviour, and avoidant coping behaviours. Participants reported increased negative emotional responses to the packaging and made specific reference to the graphic health warnings. Some participants attempted to discredit the messages. Others reported increased intentions to quit or quitting attempts. There were pervasive reports of avoidant responses including covering or hiding the warnings. Consistent with theories of illness perceptions and coping, current findings indicate that the larger, prominent graphic health warnings on plain-packaged tobacco products had pervasive effects on threat perceptions and subsequent behavioural responses. While some of the reported responses were adaptive (e.g. attempts to quit), others were maladaptive (e.g. avoiding the warnings).

Relations among Personality Characteristics, Environmental Events, Coping Behavior and Adolescents’ Life Satisfaction

This study extended current positive psychological research by examining the mediating role of coping behavior in the relations between environmental and intrapersonal variables as predictors of adolescent global life satisfaction, based on Evans’ (Soc Indic Res 33:47–88, 1994) proposed model. Specifically, we assessed the relations between personality traits (extraversion, neuroticism) and environmental experiences (stressful life events) predicting early adolescents’ global life satisfaction as mediated by approach and avoidance coping behaviors using a sample of 529 students from one middle school in the southeastern United States. The results supported portions of Evans’ model. Statistically significant relations were found for a number of individual pathways between personality and environmental variables (i.e., predictors) and coping variables (i.e., mediators) as well as between approach coping (i.e., one mediator) and life satisfaction (i.e., outcome). Additionally, a small but statistically significant pathway was found between extraversion and life satisfaction when mediated by approach coping. Results suggest that personality, environmental stressors and coping behaviors may play a role in the development of life satisfaction among early adolescents.

Occupational stressors, stress perception levels, and coping styles of medical surgical RNs: a generational perspective.

The purpose of this study was to compare the occupational stressors, the perceived stress levels, and coping styles of 3 generations of medical-surgical (MS) nurses. The literature supports that the nurse's role is stressful based on a variety of factors including physical labor, human suffering, work hours, staffing, and interpersonal relationships. Data indicate that there are generational differences in the response to stress. The 3 predominant nursing generations coexisting in the nursing workforce add to the complexity of the recognition and coping skills to address stress. A correlational design was used. A convenience sample of MS nurses participated in this study by completing 4 questionnaires. Occupational stressors were found to be significant predictors for perceived stress among all generations of nurses in this sample. Also, the higher the level of stress perception among nurses, the higher the use of coping behaviors. Generation Y reported a higher level of perceived stress and higher use of escape avoidance coping behaviors, while baby boomers reported higher use of self-controlling coping behaviors. By identifying the needs of each of the generational cohorts, nurse leaders, nurse educators, and policy makers can better assist the nursing workforce to remain at the bedside, improve patient outcomes, and maintain a positive work environment.

Stress-related Risk Factors for the Maintenance of Major Depression in Adolescent Girls

Background: Major depressive disorder is a highly prevalent disorder in adolescence that entails significant lifetime risk for repeated episodes of depression and other disorders Furthermore, it can have a negative impact on academic and psycho-social functioning with long-lasting effects. Thus, identification of the most relevant risk factors for the continuation of major depressive disorder is important. Method: Seventy one female adolescents between 10 and 18 years who were identified from a community sample as having major depressive disorder were assessed regarding stress vulnerability, stress symptoms, coping behavior and physical complaints. These variables were tested as risk factors for the persistence of major depression six months later. Results: Factors having the highest predictive power for the continuation of major depression were avoidant coping, stress vulnerability and stress related psychic symptoms. Conclusions: Stress symptoms, stress vulnerability, and a strategy of avoidant coping behavior are risk factors for the prolonged existence of major depression and should particularly be considered in prevention of major depression and intervention for depressive symptoms. Keywords: Adolescents, coping, major depression, risk factors, stress.

Longing for existential recognition: A qualitative study of everyday concerns for people with somatoform disorders

ObjectivePatients with somatoform disorders could be vulnerable to stressors and have difficulties coping with stress. The aim was to explore what the patients experience as stressful and how they resolve stress in everyday life. MethodsA cross-sectional retrospective design using 24 semi-structured individual life history interviews. Data-analysis was based on grounded theory. ResultsA major concern in patients was a longing for existential recognition. This influenced the patients' self-confidence, stress appraisals, symptom perceptions, and coping attitudes. Generally, patients had difficulties with self-confidence and self-recognition of bodily sensations, feelings, vulnerability, and needs, which negatively framed their attempts to obtain recognition in social interactions. Experiences of recognition appeared in three different modalities: 1) “existential misrecognition” covered the experience of being met with distrust and disrespect, 2) “uncertain existential recognition” covered experiences of unclear communication and a perception of not being totally recognized, and 3) “successful existential recognition” covered experiences of total respect and understanding. “Misrecognition” and “uncertain recognition” related to decreased self-confidence, avoidant coping behaviours, increased stress, and symptom appraisal; whereas “successful recognition” related to higher self-confidence, active coping behaviours, decreased stress, and symptom appraisal. ConclusionDifferent modalities of existential recognition influenced self-identity and social identity affecting patients' daily stress and symptom appraisals, self-confidence, self-recognition, and coping attitudes. Clinically it seems crucial to improve the patients' ability to communicate concerns, feelings, and needs in social interactions. Better communicative skills and more active coping could reduce the harm the patients experienced by not being recognized and increase the healing potential of successful recognition.

An Examination of the Reciprocal Relationship Between Avoidance Coping and Symptoms of Anxiety and Depression

The current study examined whether avoidance coping predicted anxious and depressive symptoms prospectively in a nonclinical sample. One hundred and ninety-nine students were assessed at two time points over an eight-week period on their symptoms of anxiety, depression, and cognitive and behavioral avoidance coping. Structural equation modeling was used to analyze the hypotheses. Results suggested that Time 1 anxious symptoms predicted both cognitive and behavioral avoidance coping at Time 2, and Time 1 cognitive avoidance coping predicted anxiety at Time 2. Time 1 depression predicted Time 2 behavioral avoidance coping, and Time 1 behavioral avoidance coping predicted increased depressive symptoms at Time 2. These findings extend our knowledge of the reciprocal role that avoidance coping plays in symptoms of anxiety and depression.

Responsibility attribution of HIV infection and coping among injection drug users in Malaysia

This study explored responsibility attribution (RA) of HIV/AIDS infection (i.e., how an individual perceives the cause of their HIV/AIDS infection) and its relationship to coping styles among injection drug users (IDUs) with HIV/AIDS. In addition, this study investigated whether self-esteem, social support, and religiosity mediate the relationship between RA and coping styles of IDUs with HIV/AIDS. Participants were 201 adult IDUs with HIV/AIDS participating in the National Drug Rehabilitation Center in Malaysia. Five measures were used to assess the above constructs. Cluster analysis, analysis of variance, and mediation analyses were conducted. Results of this study indicated that IDUs with HIV/AIDS in Malaysia can be classified into four homogenous attribution groups: external, fatalistic, internal, and indeterminate. Mediator analyses revealed that combination of self-esteem, social support, and religiosity mediate the relationship between RA and coping behaviors. Clinicians working with IDUs with HIV/AIDS need to address the role of RA, self-esteem, religiosity, and social support as these psychosocial constructs are linked to coping with HIV/AIDS. Future researchers should investigate whether enhancing self-esteem, social support, and religiosity can promote active problem-solving coping and reduce the use of avoidance coping behaviors.

Measuring acceptance in irritable bowel syndrome: preliminary validation of an adapted scale and construct utility

It has been well established that how irritable bowel syndrome (IBS) patients respond to their illness experiences (physical, psychological) has a great impact on their symptoms, psychosocial functioning and quality of life. Recently it has been shown that using acceptance coping strategies (rather than control coping strategies) is linked to positive outcomes in several chronic illness contexts (e.g. chronic pain, diabetes, epilepsy).This study is intended to evaluate the factor structure and other psychometric properties of an acceptance measure adapted for the IBS population (IBSAAQ) and to investigate its possible utility in the prediction of key IBS outcomes. A sample of 121 IBS patients attending a specialized gastroenterology clinic completed a series of self-report measures assessing acceptance of IBS, general acceptance, symptom severity, IBS impact on quality of life, general quality of life, gastrointestinal-specific anxiety, avoidant coping behaviours, depression, anxiety and stress. Factor analysis supported a 2-factor structure explaining 48.5% of variance. The total scale and its subscales (activity engagement/IBS willingness) were found to have adequate internal consistency (all α's > 0.80) and test-retest stability. Correlation analyses showed good convergent and concurrent validity. Regression analyses showed that the IBSAAQ and its subscales significantly contributed to the prediction of IBS outcomes. The IBSAAQ is a valid and reliable measure of acceptance in IBS. This measure might be of use for the study of the impact of coping strategies on outcomes in IBS and of the effectiveness of acceptance-based approaches (e.g. acceptance and commitment therapy).

The Association between Symptoms, Pain Coping Strategies, and Physical Activity Among People with Symptomatic Knee and Hip Osteoarthritis

Effective use of coping strategies by people with chronic pain conditions is associated with better functioning and adjustment to chronic disease. Although the effects of coping on pain have been well studied, less is known about how specific coping strategies relate to actual physical activity patterns in daily life. The purpose of this study was to evaluate how different coping strategies relate to symptoms and physical activity patterns in a sample of adults with knee and hip osteoarthritis (OA; N = 44). Physical activity was assessed by wrist-worn accelerometry; coping strategy use was assessed by the Chronic Pain Coping Inventory. We hypothesized that the use of coping strategies that reflect approach behaviors (e.g., Task Persistence), would be associated with higher average levels of physical activity, whereas avoidance coping behaviors (e.g., Resting, Asking for Assistance, Guarding) and Pacing would be associated with lower average levels of physical activity. We also evaluated whether coping strategies moderated the association between momentary symptoms (pain and fatigue) and activity. We hypothesized that higher levels of approach coping would be associated with a weaker association between symptoms and activity compared to lower levels of this type of coping. Multilevel modeling was used to analyze the momentary association between coping and physical activity. We found that higher body mass index, fatigue, and the use of Guarding were significantly related to lower activity levels, whereas Asking for Assistance was significantly related to higher activity levels. Only Resting moderated the association between pain and activity. Guarding, Resting, Task Persistence, and Pacing moderated the association between fatigue and activity. This study provides an initial understanding of how people with OA cope with symptoms as they engage in daily life activities using ecological momentary assessment and objective physical activity measurement.

Are Beslan’s Children Learning to Cope?

This longitudinal study aimed to assess the course of psychological symptoms and coping behaviors in 33 adolescents directly and indirectly exposed to the 2004 terrorist attack in Beslan, Russia. We also investigated the role of coping in the development of posttraumatic stress. At 1.5 and 3 years postattack, youths' psychological distress was measured using the Brief Symptom Inventory 18; emotional and behavioral difficulties were assessed via the Strength and Difficulties Questionnaire; and coping behaviors were measured using the Brief COPE. Three years after the attack, posttraumatic stress symptoms were evaluated via the UCLA Posttraumatic Stress Disorder Reaction Index. Directly exposed youths showed a significant increase in psychological distress (P = .05) and a decrease in active coping (P = .042), whereas indirectly exposed youths reported better mental health and more active coping over time. Compared to girls, boys showed a disproportionate increase in psychological distress, emotional and behavioral problems, and avoidant coping. Direct exposure to the attack and the endorsement of avoidant coping behaviors significantly predicted the severity of posttraumatic symptoms at follow-up (P < .05 for both). Our findings highlight the importance of conducting follow-up studies to monitor long-term psychological functioning and to screen for adolescents who may need additional referral for trauma treatment. The long-term detrimental effects of avoidant coping on youths' psychological well-being underscore the need to implement early psychoeducational interventions to minimize adverse outcomes and prevent the chronicity of posttraumatic reactions.

Non-specific physical symptoms in relation to actual and perceived proximity to mobile phone base stations and powerlines

BackgroundEvidence about a possible causal relationship between non-specific physical symptoms (NSPS) and exposure to electromagnetic fields (EMF) emitted by sources such as mobile phone base stations (BS) and powerlines is insufficient. So far little epidemiological research has been published on the contribution of psychological components to the occurrence of EMF-related NSPS. The prior objective of the current study is to explore the relative importance of actual and perceived proximity to base stations and psychological components as determinants of NSPS, adjusting for demographic, residency and area characteristics.MethodsAnalysis was performed on data obtained in a cross-sectional study on environment and health in 2006 in the Netherlands. In the current study, 3611 adult respondents (response rate: 37%) in twenty-two Dutch residential areas completed a questionnaire. Self-reported instruments included a symptom checklist and assessment of environmental and psychological characteristics. The computation of the distance between household addresses and location of base stations and powerlines was based on geo-coding. Multilevel regression models were used to test the hypotheses regarding the determinants related to the occurrence of NSPS.ResultsAfter adjustment for demographic and residential characteristics, analyses yielded a number of statistically significant associations: Increased report of NSPS was predominantly predicted by higher levels of self-reported environmental sensitivity; perceived proximity to base stations and powerlines, lower perceived control and increased avoidance (coping) behavior were also associated with NSPS. A trend towards a moderator effect of perceived environmental sensitivity on the relation between perceived proximity to BS and NSPS was verified (p = 0.055). There was no significant association between symptom occurrence and actual distance to BS or powerlines.ConclusionsPerceived proximity to BS, psychological components and socio-demographic characteristics are associated with the report of symptomatology. Actual distance to the EMF source did not show up as determinant of NSPS.

Behavioral Escape Avoidance Coping in African-American Men Who Have Sex with Men

The purpose of this exploratory study was to investigate differences between African-American men who have sex with men (MSM) who use behavioral escape avoidance coping responses and those who do not. In particular, we investigated differences in the African-American MSM in our study on psychosocial factors such as internalized homonegativity, exploration phase sexual identity, and the importance of race/ethnicity identity to self-concept; and we investigated the association of these factors on the likelihood of the use of behavioral escape avoidance coping responses. Eighty-three African-American MSM completed our online assessment tool. Chi-square tests and modified Poisson regression were used to test our hypotheses. Our results revealed significant differences in the internalized homonegativity, exploration phase sexual identity, and in the importance of race/ethnicity identity to self-concept for the men in this study who endorsed behavioral escape avoidance coping responses compared to those who did not endorse behavioral escape avoidance coping responses.

Intimate Partner Violence and Maternal Depression During the Perinatal Period: A Longitudinal Investigation of Latinas

This study assessed the course of perinatal depression among 210 Latinas who were and were not affected by intimate partner violence (IPV) and identified associated psychosocial factors. Peak depression prevalence occurred prenatally among 45.7% of IPV-exposed and 24.6% of non-IPV-exposed Latinas. At each assessment, depression was significantly higher for IPV-exposed compared to non-IPV-exposed mothers. Mastery and social support were associated with lower depression, whereas history of IPV, perceived stress, and avoidant coping behaviors were associated with higher depression. Findings support recommendations for routine depression and IPV screening of Latinas in perinatal clinical settings.

Relationships Among Locus of Control, Coping Behaviors, and Levels of Worry Following Exposure to Hurricanes

To explore the relationships among locus of control, coping behaviors, and levels of worry following exposure to hurricanes, the current study examines the responses of college students who were exposed to one or more hurricanes affecting central Florida in 2004. The results show that an external locus of control is related significantly and positively to avoidant coping behaviors. External locus of control and different types of coping behaviors (i.e., problem-focused, emotion-focused, and avoidant coping) also are related significantly and positively to levels of worry. Finally, in regression analyses, avoidant coping behaviors are a partial mediator in the relationship between locus of control and worry, and worry is a partial mediator in the relationship between locus of control and avoidant coping behaviors. Our findings suggest the importance of examining individuals' explanations for the major events that occur in their lives, so that these explanations can be examined in psychological interventions.

The facilitative nature of avoidance coping within sports injury rehabilitation

Avoidance coping has commonly been reported within literature to be a debilitative process. However, in situations where goal attainment is reduced or eradicated avoidance coping strategies appear to have some benefit. The aim of this study was to identify the role of avoidance coping within the sports injury rehabilitation setting. A mixed methodological approach was utilized with four professional male rugby union players, concurrent with their rehabilitation from anterior cruciate ligament (ACL) surgery. Twice monthly interviews were conducted with each player, along with a self-report diary and the Coping with Health, Injuries and Problems (CHIP; Endler & Parker, 2000) inventory. Content analysis showed six higher-order themes split into two general dimensions: (a) behavioral avoidance coping (physical distraction, social interaction, maladaptive behaviors), and (b) cognitive avoidance coping (denial, thought stopping, cognitive distraction). Results suggest avoidance coping strategies facilitate control of short-term emotional states, as well has appearing to have long-term benefits for injured players. Particular benefits were associated with undertaking alternate work within the sports organization.

Social Support, Discrimination, and Coping as Predictors of Posttraumatic Stress Reactions in Youth Survivors of Hurricane Katrina

This study examined the influence of aspects of the post–Hurricane Katrina recovery environment (i.e., discrimination, social support) and coping behaviors on children's posttraumatic stress reactions (symptoms of posttraumatic stress disorder [PTSD], anxiety, and depression). Data corresponding to 46 youth (M = 11.43 years; 39% girls; 33% African American, 67% European American) revealed that greater helpfulness from extrafamilial sources of social support predicted lower levels of child-rated symptoms of PTSD, anxiety, and depression. A positive predictive relation was found between helpfulness from professional support sources and PTSD, perhaps suggesting that parents whose children were experiencing higher PTSD symptom levels sought professional support and reported it to be helpful. Youths' avoidant coping behaviors predicted both PTSD and anxiety symptoms. Discrimination, active coping, and familial support did not predict any of the posttraumatic stress reactions assessed in this study.