Cognitive Coping Style Research Articles

EFFECTS OF RUMINATION AND INITIAL SEVERITY ON REMISSION TO COGNITIVE THERAPY FOR DEPRESSION.

Trait rumination, a tendency to focus on depressive symptoms and negative information, is associated with longer and more severe episodes of depression. This study examined whether trait rumination was also associated with initial remission from unipolar depression in Cognitive Therapy, which we hypothesized would target this coping style. Eighty one patients completed measures of depressive severity and rumination before and after 16-20 sessions of procedurally determined Cognitive Therapy. Pre-treatment rumination and severity were generally associated with later initial remission and lower odds of achieving remission. Limited evidence also suggested that for the most severe patients, rumination was associated with earlier initial remission and greater odds of achieving initial remission. Cognitive Therapy was associated with significant reductions in both rumination and severity. Results suggest that 1) pre-treatment assessment of rumination and severity could help to plan treatment course and 2) Cognitive Therapy is associated with changes in cognitive coping styles.

Coping style mediates impact of stress on alcohol use: a prospective population‐based study

This study examines the relationship between stressful life-events and alcohol use in a longitudinal cohort study, and investigates whether gender, coping style and social support modify this relationship. Data analysed in this paper come from a sample of 1608 men and 1645 women drawn randomly from the cohort known as the Dutch Lifestyle and Health Study, consisting of 16,210 men and women aged 45-70 years, who were followed-up for 4 years (1996-2000). Alcohol use (recent and in the more distant past), occurrence of threatening life-events, coping style (action, cognitive and emotion coping), social support (perceived, actual support and social contacts) and other potential confounding factors were assessed with five annual self-administered questionnaires. The data were analysed with a mixed-effects modelling technique, controlling for interactions with time and gender. An interaction effect was found between experiencing a negative life-event and emotion coping on alcohol use. A positive relationship was found between the occurrence of negative life-events and alcohol use in subjects scoring high on emotion coping, and a negative one among subjects scoring low on emotion coping. Cognitive coping, action coping, actual support, social contacts and gender did not modify the relationship between life-events and alcohol use. However, having a more cognitive coping style or more social contacts was associated with a lower level of alcohol use, whereas having an action coping style and receiving more actual social support was associated with a higher drinking level. It seems plausible that people scoring high on emotion coping, characterized by a passive, resigned, indulgent and self-accusatory coping style, increase their alcohol use after experiencing a negative life-event.

Cognitive Coping Style Modulates Neural Responses to Emotional Faces in Healthy Humans: A 3-T fMRI Study

Repression designates coping strategies that aim to shield the organism from distressing stimuli by disregarding their aversive characteristics. In contrast, sensitization comprises coping strategies that are employed to reduce situational uncertainty such as analyzing the environment. Functional magnetic resonance imaging was used to study neural correlates of coping styles during the perception of threatening and nonthreatening socially relevant information. Pictures of human faces bearing fearful (ambiguously threatening), angry (unambiguously threatening), happy (nonthreatening), and neutral expressions were presented masked and unmasked. Two groups of subjects were examined who were defined as consistent repressors versus consistent sensitizers with the Mainz Coping Inventory. Sensitizers tended to exhibit stronger neural responses in the amygdala to unmasked fearful faces compared with repressors. Overall, repressors were cortically more responsive to fearful (ambiguously threatening) and happy (nonthreatening) facial expressions than sensitizers, whereas sensitizers presented an enhanced responsivity to angry faces in several prefrontal areas, that is, unambiguously threatening expressions. Results from time series analyses suggest that sensitizers could exhibit less top-down cortical regulation of the amygdala than repressors in the processing of fearful faces. An increased responsivity of the amygdala to ambiguously threatening stimuli may represent a biological determinant of sensitizers' feelings of uncertainty.

Appraisals and cognitive coping styles associated with chronic post‐traumatic symptoms in child road traffic accident survivors

Comparatively little is known about the cognitive appraisals and coping styles of child road traffic accident (RTA) survivors that are associated with chronic post-traumatic reactions. Seventy-five children and young people aged 7-18 who were involved in a road traffic accident and attended an accident and emergency department were assessed 8 months after their accident. Post-traumatic symptoms were assessed by diagnostic interview (CAPS-C) and self-report questionnaires (IES). Demographic, accident and injury severity variables were recorded. Informed by the Ehlers and Clark (2000) model, trauma memory, subjective appraisals of the trauma and cognitive coping styles were assessed. Gender was the only non-cognitive variable associated with significant post-traumatic reactions and explained 5-6% of the overall variance. Trauma memory did not significantly contribute to the final regression model. The addition of the remaining cognitive factors assessing subjective appraisals of the trauma and cognitive coping style resulted in the model accounting for 61-65% of the variance of post-traumatic stress disorder (PTSD) symptoms 8 months post trauma. This study adds support to the applicability of the Ehlers and Clark (2000) cognitive model to children. The results indicate that the theoretically determined appraisals and cognitive coping styles are associated with chronic post-traumatic reactions. The findings suggest the need to develop trauma-focused interventions for children that directly address these key cognitions during therapy.

Are Women at Higher Risk Than Men? Gender Differences Among Teenagers and Adults in Their Response to Threat of War and Terror

ABSTRACT The present study examined whether women are at higher risk of developing stress reactions in situations of war and terror. The study looked at gender differences within two samples–teenagers (n = 353) and adults (n = 890)–regarding the impact of stress that developed in response to a situation of threat of war and terror as a result of Israel's withdrawal from Lebanon. The study tested: (1) gender differences regarding cognitive appraisal of the stressor, coping styles, psychological symptoms, and life satisfaction; (2) whether cognitive appraisal and coping styles mediated gender differences in psychological symptoms and life satisfaction; and (3) whether the two age groups differed regarding the contribution of gender to the studied variables. The results revealed that among the teenagers, gender differences were found only in cognitive appraisal and psychological symptoms, while among adults, gender differences were found in all the studied variables. The results support the mediating hypothesis with regard to psychological symptoms, but not with regard to life satisfaction. The results also show a different contribution of gender in each of the age groups regarding psychological symptoms, but not regarding life satisfaction, which leaves some doubt regarding the assumptions that women tend to be more affected by stress than men.

Monitoring: A Dual‐Function Coping Style

Monitoring (Miller, 1991) is defined as a cognitive coping style characterized by the tendency to seek information about threats. This study found that information seeking in stressful situations is perceived by individuals as related to the emotion-focused more than the problem-focused function of coping and that there is considerable variance among individuals in the perceived functions of information seeking and the relationships among information-seeking reactions and their perceived functions. Information-seeking preferences in a natural stressful situation (a final course examination) were predicted by individual differences in perceived functions of information seeking rather than by generalized behavioral coping styles (monitoring). The results were interpreted in relation to the cognitive-affective system theory (Mischel & Shoda, 1995), and implications for the measurement of coping dispositions were discussed.

Cognitive Coping With the Threat of Rape: Vigilance and Cognitive Avoidance

Individual differences in women's avoidant and vigilant style in coping with the threat of rape were explored in four studies. In the first study, 97 women read a rape scenario and completed measures of cognitive vigilance and avoidance. They also provided ratings of fear of rape and anticipated coping problems in case of sexual assault. Vigilance was associated with significantly higher levels of fear of rape and anticipation of more severe coping problems. No effects were found for cognitive avoidance. Study 2 replicated these findings with a sample of 275 women. In addition, it showed that high vigilance was associated with significantly more rape-preventive behaviors. Study 3, including 172 women, was an online study on the effect of cognitive coping style on fear of rape, anticipated coping problems, and two behavioral measures of rape avoidance. High vigilance was related to higher levels of fear of rape, anticipation of more severe coping problems, and more rape-preventive behaviors. Finally, Study 4 (N=210) showed that individual differences in cognitive coping style affected rape-related affect and behavior in the absence of a rape scenario, underlining the chronic salience of the threat of rape for women. Vigilance was positively related to fear of rape, rape-avoidance behavior, and anticipated coping problems. In contrast, a negative relationship was found between cognitive avoidance and fear of rape, rape-avoidance strategies, and anticipated coping problems. Across the four studies, no evidence was found for an interactive effect of cognitive avoidance and vigilance, as suggested by the construct of repression versus sensitization. The findings are discussed in the light of previous research on repression-sensitization in coping with threatening information.

Differential Effects of Cancer Rehabilitation Depending on Diagnosis and Patients’ Cognitive Coping Style

Objective The major aim was to explore the extent to which the Miller Behavioral Style Scale (MBSS) can be used to differentiate cancer patients who are likely to benefit from rehabilitation efforts with a strong information component from those who are not. Methods Newly diagnosed patients with breast, gastrointestinal, or prostate cancer (N = 442) were included in a randomized, prospective study of the effects (on anxiety, depression, intrusion, avoidance) of rehabilitation approximately 4 months after diagnosis as compared with control patients. Patients were classified as “monitors” or “blunters” on the basis of the MBSS (368 patients, 83%, completed the MBSS). Results The expected interaction at postintervention between coping style and experimental condition (ie, rehabilitation or control) was found only for avoidance among breast and prostate cancer patients. Assignment to the rehabilitation or control condition was of no importance for outcome among blunters. Among monitors, the response pattern differed between breast and prostate cancer patients. Prostate cancer monitors seemed to benefit from rehabilitation on all outcome measures, whereas intrusion and avoidance were reduced among breast cancer patients in the control condition. This interaction of diagnosis with condition (rehabilitation or control) among monitors is suggested to be due to demands for diagnosis-specific information during diagnostic work, in the period just after diagnosis, and before treatment decision. Conclusions Only the monitor concept seems useful for predicting response to cancer rehabilitation with a strong information component. However, whether rehabilitation is of benefit depends also on other factors.

An examination of thought control strategies employed by acute and chronic insomniacs

Study objectives: Theoretical accounts of the progression of insomnia from acute to chronic are lacking. A framework is proposed and tested to examine differences in cognitive coping styles between acute and chronic insomniacs and the relation of cognitive processing and sleep hygiene to causal attributions of insomnia. Method: In a cross-sectional design, the relationship among sleep disturbance, causal attributions and various psychological and behavioural variables was examined in a convenience sample of acute and chronic insomniacs from the general population ( N=308). Results: Negative appraisals and the cognitive coping styles ‘Worry’ and ‘Punishment’ were found to be associated with both acute and chronic insomnia, whereas ‘Distraction’ as a cognitive coping strategy significantly reduced reports of chronic insomnia. The results are discussed in relation to multi-level interventions and future directions in theory, research and application.

Resilience in response to life stress: the effects of coping style and cognitive hardiness

Direct effects and buffering models were tested in relation to cognitive hardiness and coping for general health and psychological functioning. Mature age university students ( N=187) completed measures assessing life event stress and traumatic life experiences (independent variables) cognitive hardiness and coping style (moderator variables), and general health, somatization, anxiety and depression (dependent variables). In general results supported a direct effects model of the relationship between life stress and psychological health. Cognitive hardiness, aspects of coping style and negative life events directly impacted on measures of psychological and somatic distress. In several cases there was also support for a buffering model in which cognitive hardiness moderated the effects of emotional coping or adverse life events on psychological distress.

Postoperative cognitive dysfunction versus complaints: a discrepancy in long-term findings.

This review describes the discrepancy in findings between postoperative cognitive performance and postoperative cognitive complaints long time after an operation under general anesthesia. Shortly (from 6 hr to 1 week) after an operation a decline in cognitive performance is reported in most studies. However, long time (from 3 weeks to 1-2 years) after an operation this is rarely found although some patients are still reporting cognitive complaints. In general this kind of research is suffering from severe methodological problems (use of insensitive tests, lack of control groups, lack of parallel tests, different definitions of cognitive decline). However, these problems cannot totally explain the discrepancy in findings in the long term. Thus, there are patients who have persistent cognitive complaints long time after an operation, that cannot be measured with cognitive tests. More psychological factors such as fixation on short-term cognitive dysfunction, mood, coping style, and personality are possible explanations for these cognitive complaints in the long term. As a consequence, these factors should be a topic in future research elucidating the persistence of these cognitive complaints long time after an operation under general anesthesia.

Assessment of cognitive coping styles: A closer look at situation-response inventories

Cognitive coping style approaches establish two concepts central to the understanding of people's responses to a stressful situation: “attention” and “avoidance”. Theoretical frameworks corresponding to these conceptions are Sensitization-Repression (Byrne, 1961), Monitoring-Blunting (Miller, 1980), and Vigilance-Cognitive Avoidance (Krohne, 1986). Such types of cognitive coping styles are usually measured by means of situation-response inventories. In the present article, we take a closer look at this kind of coping assessment by considering the scenarios, the coping options and response formats, the dimensionality of the constructs, and published data on the reliability and the validity of seven situation-response inventories. Three important points deserve to be highlighted: (a) it probably makes little sense to assess coping style using scenarios that diverge maximally with respect to controllability and predictability since coping is not assumed to show such complete cross-situational stability; (b) similarly named inventories rely on largely different operationalizations and can hardly be considered as measuring similar constructs; and (c) monitoring/vigilance and blunting/avoidance generally emerge as independent constructs, which argues against use of summary scores.

Work-related stress and occupational burnout in AIDS caregivers: Test of a coping model with nurses providing AIDS care

Occupational stress and burnout are potential threats to quality of care for people living with HIV/AIDS. A total of 445 nurses who provide care to people living with HIV/AIDS responded to an anonymous postal survey that consisted of: demographic and work history questions, the Maslach Burnout Inventory, Rotter's Internal-External Locus of Control scale, and internal and external coping styles as measured by the Ways of Coping scale. Path analyses showed that both external (13.6% of the variance) and internal (3.1% of the variance) coping styles significantly predicted levels of burnout among AIDS caregivers, over and above participants' age, perceived workload and locus of control. Mediation analyses further showed that external coping mediates the effect of locus of control on burnout, but internal coping styles do not exhibit mediation. Results therefore replicate and extend previous research demonstrating the important roles of cognitive and behavioural coping styles in understanding burnout among providers of AIDS care.

Coping with metastatic melanoma: the last year of life.

Few longitudinal studies have concurrently investigated cognitive appraisal, coping and psychological adjustment in patients with terminal cancer. This study aimed to (i) consider patterns of change in these variables during the last year of life and (ii) consider covariates associated with patients' psychological adjustment. Questionnaires were sent to a cohort of stage IV melanoma patients seen at the Sydney Melanoma Unit between 1991 and 1996, approximately every 3 months, for up to 2 years. A sub-sample of 110 patients completed at least one questionnaire in the last year of life. Repeated measures linear regression was used to model cognitive appraisal, coping and psychological adjustment. In the last year of life, patients' cognitive appraisal of their disease remained relatively stable, whereas their use of active coping strategies increased (p=0. 04). There was some deterioration in psychological adjustment, particularly in patients' ability to minimize the impact of cancer on daily life (p=0.03), but this effect did not remain significant when patients' level of tiredness was included in the model. Cognitive appraisal, coping style and quality of life indicators were all associated with psychological adjustment. These findings suggest that while patients work hard to actively cope with their disease, they experience increasing levels of tiredness, and deterioration in their mood and ability to function in their daily lives.

WOMEN'S EXPERIENCE OF TRAUMATIC STRESS IN CANCER TREATMENT

In this study we investigated gender differences in the prevalence and predictors of posttraumatic stress disorder (PTSD) in a sample of cancer patients. Eighty-seven patients (59 women and 28 men) recruited from a local cancer clinic completed measures of individual coping style, social support resources, symptoms of PTSD, and the nature of the trauma associated with these symptoms. PTSD symptoms were more frequently reported by women (27% versus 10%). Predictors of PTSD for women were (1) perceived intensity of cancer treatment; (2) problems with health care professionals; (3) and cognitive avoidant coping style. For men, the sole predictor of elevated PTSD scores was behavioral avoidance. Women reported significantly higher levels of treatment intensity (TI), greater numbers and types of treatment, and more problems with health care professionals. Interpersonal and relational aspects of their illness were reported as most stressful, compared with men who were more concerned with work and finances. These differences may, in part, reflect an androcentric model of cancer treatment, which women experience as particularly stressful.

Neuroticism and extraversion as predictors of coping styles during early adolescence

This study examined how neuroticism, extraversion and neuroticism×extraversion predict cognitive approach, behavioral approach and avoidance coping styles. A group of 268 (138 males and 130 females) 12- and 13-year old adolescents completed questionnaires covering these measures. The results indicated that in males, extraversion predicted all three coping styles positively. In this group, neuroticism also predicted avoidance coping positively, and it exacerbated the effect of extraversion on all three coping styles. In females, extraversion predicted both the approach coping styles positively, while neuroticism predicted avoidance coping positively. For females, there was no neuroticism×extraversion interaction. These findings are discussed in terms of the effects of gender, neuroticism and extraversion on adolescent coping styles during early adolescence.

The role of religious and spiritual beliefs in coping with malignant melanoma.

This study investigated the role of spiritual and religious beliefs in ambulatory patients coping with malignant melanoma. One-hundred and seventeen patients with melanoma being seen in an outpatient clinic completed a battery of measurements including the newly validated Systems of Belief Inventory (SBI-54). No correlation was found between SBI-54 scores and levels of distress. However, there was a correlation between greater reliance on spiritual and religious beliefs and use of an active-cognitive coping style (r = 0.46, p < 0.0001). Data suggest that use of religious and spiritual beliefs is associated with an active rather than passive form of coping. We suggest that such beliefs provide a helpful active-cognitive framework for many individuals from which to face the existential crises of life-threatening illness.

The role of religious and spiritual beliefs in coping with malignant melanoma

This study investigated the role of spiritual and religious beliefs in ambulatory patients coping with malignant melanoma. One-hundred and seventeen patients with melanoma being seen in an outpatient clinic completed a battery of measurements including the newly validated Systems of Belief Inventory (SBI-54). No correlation was found between SBI-54 scores and levels of distress. However, there was a correlation between greater reliance on spiritual and religious beliefs and use of an active–cognitive coping style (r=0.46, p<0.0001). Data suggest that use of religious and spiritual beliefs is associated with an active rather than passive form of coping. We suggest that such beliefs provide a helpful active–cognitive framework for many individuals from which to face the existential crises of life-threatening illness. Copyright © 1999 John Wiley & Sons, Ltd.

Repression and coping with the threat of rape

A study is reported which examined the impact of repressive coping style on processing and recalling information about rape. It was predicted that repressors selectively avoid threatening information about a rape incident and that selective avoidance is reflected in poorer recall for details of the rape account as well as anticipation of fewer coping problems in the event of sexual victimization. A total of N=143 women were presented with an authentic rape scenario taken from police files. The sample was divided into repressors, sensitizers, non-anxious and defensive high-anxious individuals on the basis of an anxiety and a social desirability measure. Differential memory by the four groups for the rape scenario was measured in a free-recall task. In addition, respondents were asked to anticipate potential coping problems they thought they would experience in the event of sexual victimization, and they were asked to indicate their behavioural precautions against a sexual assault. As predicted, repressors showed poorer recall for the described rape than both sensitizers and non-anxious subjects. Results were less conclusive concerning the proposed interaction of anxiety and defensive avoidance on anticipated coping problems. No effect was found of cognitive coping style on behavioural precautions against rape. The findings are discussed with respect to the construct validity of repression as a cognitive strategy for coping with threat in the domain of sexual violence. Copyright © 1999 John Wiley & Sons, Ltd.

Cognitive coping styles of women sexually abused in childhood: a qualitative study

Objective: The aim was to investigate cognitive coping strategies used by a nonclinical sample of women with a history of childhood sexual abuse, to examine whether cognitive appraisals affected their current coping strategies and psychological well-being. Method: Qualitative research methods were used to enable the sample to convey their own ideas about factors and meanings they attributed to their experience of child sexual abuse. The sample of 40 was drawn from one of two stratified sub samples randomly selected from electoral rolls for interview in 1989 and re-interviewed in 1995. One sub sample had reported childhood sexual abuse and the other had reported none. Inductive content analysis and coding of themes were carried out using appropriate software and supplemented by quantitative interview data. Results: Six main coping strategies were identified and then assessed to determine their mediating influence on psychiatric disorder, self-esteem and self reported difficulties experienced as adults. Overall, abuse characteristics did not predict outcome but women who “deliberately suppressed” the abuse incidents were more likely to have low self-esteem and women who “reframed” were significantly less likely to have a psychiatric diagnosis. Conclusions: Some cognitive coping strategies employed after experiencing child sexual abuse impinge on later psychological well-being or subsequent relationships with other people. One of the more challenging findings to come out of the study was that women who “reframed” the sexual abuse event were more likely to have favorable mental health outcomes but were also more likely to report that their own child had been sexually abused.