Use Of Avoidant Coping Strategies Research Articles

Coping in Patients with Hematologic Malignancies Undergoing Hematopoietic Cell Transplantation

Background Patients undergoing hematopoietic cell transplantation (HCT) must cope with immense physical and psychological symptoms during HCT hospitalization, which contribute to a dramatic deterioration in quality of life (QOL). Yet, studies examining pre-HCT coping strategies are limited. We aimed to characterize use of pre-HCT coping strategies, to identify sociodemographic and clinical factors associated with coping strategy use, and to investigate the association of coping strategy use with pre-HCT QOL and psychological distress. Methods We conducted a secondary analysis of baseline data from a multi-site randomized controlled trial evaluating a supportive care intervention for patients with hematologic malignancies undergoing allogeneic or autologous HCT (NCT#03641378). From 10/2018 - 07/2022, the trial enrolled consecutive adults (age ≥ 18) with hematologic cancers undergoing HCT at three tertiary care academic centers. Prior to HCT, we assessed QOL (Functional Assessment of Cancer Therapy - Bone Marrow Transplant), psychological symptoms (Hospital Anxiety and Depression Scale and Post Traumatic Stress Disorder (PTSD) - Civilian Version), and coping (Brief COPE). We categorized coping as either “approach-oriented” (active coping, use of emotional support, positive reframing, acceptance) or “avoidant” (behavioral disengagement, denial, and self-blame). We used the median split method to categorize high and low use of approach-oriented and avoidant coping. Univariate logistic regression was used to identify sociodemographic and clinical factors associated with high use of coping strategies. Multivariate linear regression was used to measure associations of coping strategy use with QOL and psychological distress. Results Of pre-HCT patients (n=360), the majority were male (62.8%), identified as White (77.5%), were younger than 65 (73.6%), and had received at least some college education (78.9%). A minority were unemployed due to disability from illness (29.2%). Approximately half received autologous HCT (n=178, 49.4%). Figure 1 displays the proportion of patients scoring as high utilizers of individual coping strategies. While 31.3% were high utilizers of avoidant coping, 43.5% were high utilizers of approach-oriented coping. Notably, 43 (11.9%) patients identified as high utilizers of both approach-oriented and avoidant coping. No sociodemographic or clinical factors were associated with use of approach-oriented coping. Older age (>65 years, OR=0.9, p=0.01) and higher income (>$100K, OR=0.90, p=0.04) were associated with less frequent use of avoidant coping. Female gender (OR=1.11, p=0.03) and disabled employment status (OR=1.11, p=0.05) were associated with increased likelihood of high use of avoidant coping. Table 1 displays adjusted associations between approach-oriented and avoidant coping strategies and patient-reported outcomes. High use of approach-oriented coping was associated with better pre-HCT QOL (B=6.4, p<0.001) and lower depression (B=-1.1, p=0.001) and anxiety (B=-0.9, p=0.02) symptoms. High use of avoidant coping was associated with worse pre-HCT QOL (B=-11.7, p<0.001) and symptoms of depression (B=1.9, p<0.001), anxiety (B=3.1, p<0.001), and PTSD (B=8.1, p<0.001). Conclusions Prior to HCT, patients frequently employ approach-oriented and avoidant coping strategies. Key sociodemographic factors including age, gender, income level, and employment status were associated with avoidant coping. Patients with high use of approach-oriented coping reported higher baseline QOL and lower psychological distress, while those with high use of avoidant coping strategies reported worse QOL and psychological distress. These data suggest that supportive care interventions which enhance approach-oriented coping and mitigate avoidant coping in pre-HCT populations may improve QOL and reduce psychological distress

52 Association Between COVID-19 Coping Strategies and Cognitive Function in Older Adults

Objective:Cognitive function may underlie the use of more adaptive as compared to maladaptive coping strategies to manage pandemic-related stress in older adults. As the composition of coping strategies varies with context, we investigated the factor structure of 14 established coping strategies. We then aimed to determine whether specific coping strategies were associated with cognitive function.Participants and Methods:141 adults aged 50-90 years old completed the study via Zoom. The National Alzheimer’s Coordinating Center TCog battery assessed cognitive function. The Brief Cope, adapted to evaluate COVID-19, measured 14 specific coping strategies.Results:Based on our factor analyses, Avoidant (e.g., denial and substance use) and Approach (e.g., planning, instrumental and emotional support systems) coping composite scores were formed. Regression analyses, adjusted for age and education, indicated that 12.9% of the variance in the use of Avoidance coping strategies was explained by worse performance on measures of episodic memory, executive attention/processing speed, working memory, and verbal fluency. A closer examination indicated that verbal fluency was not a statistically significant contributor to the model. 9.1% of the variance in Approach coping strategies was related to cognitive function with working memory and verbal fluency being statistically significant contributors to the model.Conclusions:Older adults with better performance on higher-order cognitive testing may utilize more effective coping strategies in older adults. These results have implications for attenuating pandemic-related stress and warrant developing brief interventions to help facilitate problem-solving and reduce emotional distress in those with lower cognitive resources.

Determinants of quality of life in frontline healthcare providers caring for COVID-19 patients.

To investigate the factors affecting quality of life in healthcare providers who care for patients with COVID-19. Healthcare providers caring for COVID-19 patients during the pandemic suffered a deterioration in their quality of life. Several studies have explored their psychological impact of working with COVID patients, but none have examined the causes of this deterioration. A cross-sectional study. In the current study, the authors investigated the factors affecting quality of life in 293 healthcare providers recruited from a medical centre in northern Taiwan who had recently cared for patients with suspected or confirmed COVID-19 by analysing their responses to an online self-report questionnaire, using bivariate correlations and structural equation modelling. Reporting of this research adheres to the STROBE guideline. The study identified an important sequence of factors that mediated the effects of perceived success of epidemic prevention policies, family relations problems and education level on quality of life in a sample of healthcare workers caring for COVID-19 patients. The mediators were use of approach-oriented coping strategies and current mental health status. Specifically, use of approach-oriented coping strategies was found to directly cause improved quality of life and indirectly cause improved mental health, whereas use of avoidant coping strategies was found to directly cause worsening of mental health. Poor mental health predicted poor quality of life. Results suggest that implementation of sound epidemic prevention policies that promote adoption of approach-oriented coping behaviour should lead to a better quality of life in the future for healthcare providers working in challenging circumstances. Assessment of these policies as well as the providers' family relations are necessary first steps to improving the success of approach-oriented coping behaviour in this population, which in turn can improve their mental health and quality of life. Neither patients nor members of the public were involved in the design or execution of the study.

Predictors of anxiety and depression in Korean adults during COVID-19 pandemic

Purpose: This study was conducted to identify the mental health status of Korean adults during the COVID-19 pandemic and to verify the predictors and mediating effects of avoidance coping on the relationship between the intolerance of uncertainty and anxiety and the intolerance of uncertainty and depression.Methods: An online survey was completed by 191 Korean adults from 19 to 64 years old. Using the IBM SPSS Win 19.0 program, the data were analyzed through the frequency, mean, t-test or analysis of variance, Pearson’s correlation coefficient, linear regression analysis and Sobel test.Results: Of the survey respondents 21.5%, and 33.5% respectively were classified into anxiety and depression risk groups. The predictors of anxiety were intolerance of uncertainty (<i>β</i>=.52), avoidance coping (<i>β</i>=.21), and response efficacy (<i>β</i>=-.15). Those variables explained 47.7% of the respondents’ anxiety. The predictors of depression were intolerance of uncertainty (<i>β</i>=.40), avoidance coping (<i>β</i>=.20), and response-efficacy (<i>β</i>=-.12). These variables explained 34.9% of the participants’ depression. Among the predictors of anxiety and depression, avoidance coping was the significant mediating variable.Conclusion: The predictors of anxiety and depression during the COVID-19 pandemic were revealed to be intolerance of uncertainty, avoidance coping, and response-efficacy. These results indicate the necessity of providing the cognitive interventions and reducing the use of avoidance coping strategies on a personal level. Community-level efforts, including early detection and health communication strategies, should prioritize risk groups for example young adults. The study suggests it will be necessary to provide sufficient information, psychological support and economic policy alternatives related to the COVID-19 pandemic on the national level.

Socioeconomic disparities in distress and coping in gynecologic oncology patients (568)

Socioeconomic disparities in distress and coping in gynecologic oncology patients (568)

Cybervictimization and Depression among Adolescents: Coping Strategies as Mediators.

Studies have shown the relationships among cybervictimization, coping strategies, and depression, but no study has examined the mechanism that links the three variables. Accordingly, this study used the transactional model of stress and coping theory as a conceptual framework and proposed that coping strategies are mediators for the effects of cybervictimization on depression. A total of 387 adolescents were recruited by using the purposive sampling method. The results showed that cybervictimization is not directly associated with depression. All the coping strategies are found to be associated with cybervictimization, but only the avoidant coping strategy is the statistical mediator for the effects of cybervictimization on depression. This study’s findings suggest that the transactional model of stress and coping theory may provide a framework in the area of cyberbullying and recommend more actions to be taken in order to reduce the use of avoidance coping strategies among victims of cyberbullying.

One Cannot Pour From an Empty Cup: Compassion Fatigue, Burnout, Compassion Satisfaction, and Coping Among Child Life Specialists

Child life specialists provide support across various medical units and are frequently exposed to high-intensity, stressful, or traumatic situations. As such, they are at risk of developing burnout and compassion fatigue; however, limited research has examined the relationship between professional well-being of child life specialists and use of coping strategies. The present study examined professional quality of life, including compassion satisfaction, compassion fatigue, and burnout, using survey responses from 196 child life specialists across the United States and Canada to examine whether professional quality of life varied based on reported coping strategies, frequency of supervision and consultation, or hospital units on which participants worked. Results revealed use of avoidant coping strategies was associated with lower likelihood of compassion satisfaction and higher risk of compassion fatigue and burnout. On the other hand, more frequent consultation with colleagues was associated with higher likelihood of compassion satisfaction. Child life specialists who worked in hematology/oncology units reported higher risk of compassion fatigue than those on other medical units. This study provided several implications for practice to enhance child life specialists’ professional quality of life. Researchers should consider qualitative studies to better understand the professional quality of life of child life specialists in order to improve the delivery of quality, family-centered care.

Prospective examination of the therapeutic role of psychological flexibility and cognitive reappraisal in the ceremonial use of ayahuasca.

Evidence suggests that psychedelic-assisted therapy carries transdiagnostic efficacy in the treatment of mental health conditions characterized by low mood and the use of avoidance coping strategies. While preliminary evidence suggests that psychological flexibility and emotion regulation processes play an important role within psychedelic therapy, this prospective study addressed methodological gaps in the literature and examined the ability of ayahuasca to stimulate acute states of cognitive reappraisal and long-term changes in psychological flexibility and mood. The study also explored whether moderating factors predisposed participants to experience therapeutic changes. Participants (N = 261) were recruited from three Shipibo ayahuasca retreat centers in Central and South America and completed assessments on mood, psychological flexibility, and acute ceremonial factors. Expectancy, demand characteristics, and invalid responding were controlled for with several validity scales. Participants reported significant reductions in negative mood after three months, as well as increases in positive mood and psychological flexibility. Acute experiences of reappraisal during the ayahuasca ceremony exerted the strongest moderating effects on increases in positive mood and psychological flexibility. Increases in psychological flexibility statistically mediated the effects of acute psychological factors, including reappraisal, on changes in positive mood. These results highlight the role of acute psychological processes, such as reappraisal, and post-acute increases in psychological flexibility as putative mechanisms underlying positive outcomes associated with psychedelics. These results also provide support for the integration of third-wave and mindfulness-based therapy approaches with psychedelic-assisted interventions.

Infertility-related stress, social support, and coping of women experiencing infertility in Vietnam

BackgroundWomen with an infertility problem living in traditional and developing countries face extensive social pressure, infer-tility-related stress, and distress, which possibly affect their choices of coping strategies. The present study aims to investigate the impact of infertility-related stress and social support on coping of Vietnamese women who live with an infertility diagnosis.Participants and procedureA cross-sectional study was conducted with 192 women diagnosed with infertility at two hospitals in the north and central regions of Vietnam. Participants completed a questionnaire consisting of the Multidimensional Scale of Per-ceived Social Support, the Copenhagen Multi-centre Psychosocial Infertility coping scales and the Fertility Problem Inventory, and questions about their sociodemographic characteristics, infertility-related history, and key social rela-tionships. Four linear regression analyses were performed on four coping strategies: active-avoidance coping (AAC), active-confronting coping (ACC), passive-avoidance coping (PAC), and meaning-based coping (MBC).ResultsThe findings show that high infertility-related stress significantly predicted the use of avoidance coping strategies (AAC and PAC) among these women, while those with a high level of perceived social support tended to use ACC and MBC. None of the four linear regression models support the moderating role of social support in the relationship between infertility-related stress and coping styles.ConclusionsThe study findings show that levels of infertility-related stress and perceived social support have a direct effect on the choice of coping strategies among Vietnamese women diagnosed with infertility. The study results have practical implications in the Vietnamese context, including: (i) the development and adaptation of evidence-based and cultur-ally appropriate interventions and counselling strategies; and (ii) social policy advocacy to better support women diagnosed with infertility, their husbands, and both as couples.

Early Palliative Care in Acute Myeloid Leukemia.

Simple SummarySeveral new targeted drugs for the treatment of acute myeloid leukemia (AML) have been developed in recent years. However, their potential efficacy should be balanced with the possibility of a poor outcome. For patients with solid tumors, the integration of palliative care (PC) with standard oncologic care, eight weeks after the diagnosis of advanced cancer, has demonstrated many benefits. In patients with hematologic malignancies, this model is underutilized. Here, we review the PC needs and the evidence in the literature supporting the early integration of PC in the disease trajectory of patients with AML. Early PC should be the standard of care for patients with AML. Efforts should also be made to extend the integrated PC model to patients with other hematologic malignancies.Background: Several novel targeted therapies seem to improve the outcome of acute myeloid leukemia (AML) patients. Nonetheless, the 5-year survival rate remains below 40%, and the trajectory of the disease remains physically and emotionally challenging, with little time to make relevant decisions. For patients with advanced solid tumors, the integration of early palliative care (EPC) with standard oncologic care a few weeks after diagnosis has demonstrated several benefits. However, this model is underutilized in patients with hematologic malignancies. Methods: In this article, we analyze the palliative care (PC) needs of AML patients, examine the operational aspects of an integrated model, and review the evidence in favor of EPC integration in the AML course. Results: AML patients have a high burden of physical and psychological symptoms and high use of avoidant coping strategies. Emerging studies, including a phase III randomized controlled trial, have reported that EPC is feasible for inpatients and outpatients, improves quality of life (QoL), promotes adaptive coping, reduces psychological symptoms, and enhances the quality of end-of-life care. Conclusions: EPC should become the new standard of care for AML patients. However, this raises issues about the urgent development of adequate programs of education to increase timely access to PC.

Emotional responses and coping strategies of medical students during the COVID-19 pandemic.

Objectives:To assess the emotional responses and coping strategies of medical students during the lockdown and social distancing measures implemented during the coronavirus disease -19 (COVID-19) pandemic.Methods:This cross‑sectional study is based on data collected from undergraduate medical students at the College of Medicine, Alfaisal University Riyadh, Saudi Arabia, during the fall semester of academic year 2020-2021. All the participants completed a self-administered online questionnaire consisting of 3 parts: demographic information, emotional response scale, and 14-item, adapted brief coping orientation to problems experienced inventory to determine the use of avoidant or approach coping strategies. Coping and emotional response scores were compared using t-test. Linear regression analysis was also performed.Results:A total of 261 students from all years were included. Overall scores were higher for avoidant coping strategies. The use of avoidant coping strategies was significantly higher in females (p=0.03) and in preclinical students (p<0.001). Preclinical students had a higher mean score for anger (p=0.002). Conversely, students in the clinical phase had higher scores for anxiety (p=0.005) and sadness (p=0.027). The regression analysis of emotional responses and coping strategies suggests that avoidant coping is a predictor of anger (p=0.003) and sadness (p=0.005).Conclusion:Interventions to train medical students in the use of more productive and effective coping strategies may reduce negative emotional responses linked to the present COVID-19 pandemic and in the future.

Self-efficacy, coping strategies and quality of life in women and men requiring assisted reproductive technology treatments for anatomical or non-anatomical infertility

ObjectiveTo examine the magnitude and the predictors of emotional reactions to an infertility diagnosis, comparing women and men who were clinically diagnosed with an anatomical cause of infertility or non-anatomical cause of infertility. Study designCross-sectional study involving a total of 133 adults waiting for infertility treatment at the IVF and Infertility Unit of the S. Orsola University Hospital in Bologna (Italy). Of these, 107 patients (55 with anatomical causes of infertility and 52 with non-anatomical causes of infertility; response rate: 80%) took part to the study. After providing informed written consent, each participant was asked to complete the Infertility Self-efficacy Scale, the Fertility Quality of Life, and the Brief Coping Orientation to Problem Experienced, which they returned at their second access to the Unit. Differences between the groups were analyzed through a series of univariate ANOVA, whereas a multiple regression analysis was used to jointly examine the predictors of fertility quality of life. ResultsResults showed both gender related and diagnosis related differences. Women had statistically significant lower scores than men on the Infertility Self-Efficacy Scale and on the global, emotional, and mind–body subscales of the Fertility Quality of Life, while they scored significantly higher on the emotion focused and socially supported subscales of the Coping Orientation to Problem Experienced. Independently of gender, patients with non-anatomical causes of infertility scored poorly than patients with anatomical causes of infertility on the relational subscale of the Fertility Quality of Life and on the Avoidant scale of the Brief Coping Orientation to Problem Experienced. Hierarchical multiple regression analyses revealed that higher levels of self-efficacy and a lower use of avoidant coping strategies predicted a more positive quality of life over and above gender and cause of infertility. ConclusionThis study partly confirms data on gender differences in experiencing the psychological burden of infertility and adds some new information, particularly with respect to the prediction of quality of life indicators over and above infertility cause.

Victim and Perpetrator Acknowledgement of Intimate Partner Violence and Victim Psychopathology.

The present study assesses differences between acknowledged and unacknowledged victims in post-victimization psychopathology, abuse disability and coping. Few studies have examined abuse acknowledgment among intimate partner violence (IPV) victims. To our knowledge, this study is the first to use an experimental manipulation to assess changes in acknowledgment among IPV victims. Female undergraduate students currently in dating relationships completed demographic, coping and psychopathology questionnaires, and the Conflict Tactics Scale (CTS). They then watched a video of an IPV perpetrator who either acknowledged abuse or did not acknowledge abuse. Following the video, participants completed a psychopathology questionnaire and a post-video acknowledgment assessment. Approximately 38% of the sample reported IPV victimization. Only 7.89% acknowledged victimization. Acknowledged IPV victims had the highest mean victimization score but reported psychopathology similar to nonvictims on all subscales except phobic anxiety. Unacknowledged victims reported greater psychopathology, depression, anxiety, and hostility than nonvictims and were more symptomatic overall. Unacknowledged victims reported more frequent use of avoidant coping strategies than nonvictims. These strategies included substance use, self-blame, and behavioral disengagement. Acknowledged and unacknowledged victims reported greater abuse disability than nonvictims, and acknowledged victims reported greater life restriction than unacknowledged victims. Following the video, the number of acknowledged victims nearly doubled, and acknowledged victims reported increased depression. On the basis of these findings, clinicians and researchers should carefully consider acknowledgment as a potential factor in post-victimization mental health and explore ways to increases victim acknowledgment.

Group psychological education film pathway for alcoholics and their families: a study on changes

This research evaluates the individual traits and family system dysfunctional habits modification of participants in the multi-family psychological education group 'Primo Percorso' (GPP) of the alcohology service NOA Perini - ASST Fatebenefratelli - Sacco, Milano. This is constituted by a multi-discipline team (physicians, systemic psychologists psychotherapists, social worker and professional educator). The GPP was created to allow participants to work on themselves, on their own personal story and on their dysfunctional family relationships with tools that stem from reflecting on 12 topics, which are explained and developed by a therapist also through film watching. The sample we analysed is assembled by 46 patients. The following variables were measured: alexithymia, avoidance coping strategies, self-esteem, quality of life and psychological distress. From the results it emerges that by the end of the treatment program alcoholic patients and their relatives show improved self-esteem and an increase in general and relational functioning. There is a decrease in perceived stress, in the use of avoidance coping strategies, and in symptoms of anxiety and depression, as well as physical ones. There is no evidence of significant changes in the alexithymia variable. The effect of the group factor (alcoholic patient with/without relative) was significant only for the avoidance variable. Both patients and relatives show an improvement in all the evaluated variables except for alexithymia by the end of the treatment. Relatives have a positive effect in the patient's change in relation to the coping strategies, that are poorer in the subjects with their own relatives in the group compared with those who are alone.

Coronavirus Disease Stress Among Italian Healthcare Workers: The Role of Coping Humor.

The study aimed to understand how coping strategies in general and humor-based coping strategies in particular modulate the perception of pandemic-related stress in a sample of Italian healthcare workers during the coronavirus disease (COVID-19) outbreak in Italy. A total of 625 healthcare workers anonymously and voluntarily completed a 10-min questionnaire, which included psychometrically valid measurements preceded by a set of questions aimed at determining workers’ exposure to COVID-19. The Perceived Stress Scale was used to measure healthcare workers’ stress levels, and the Brief COPE Scale and Coping Humor Scale were used to assess participants’ avoidant or approach coping style and verify the degree to which they relied on humor to cope with stress. The results show that (1) levels of perceived stress were higher in healthcare workers who were more exposed to COVID-19 (i.e., who came into contact with COVID-19 patients or worked in wards dedicated to COVID-19) in comparison to less-exposed workers; (2) participants who reported a higher use of avoidant coping strategies perceived the situation as more stressful than those who used them less; and (3) healthcare workers who reported higher use of humor-based coping strategies perceived the situation as less stressful in comparison with those who reported less use of coping humor. Such findings expanded other research studies by including coping humor as a potential factor to mitigate the perceived stress related to COVID-19. The paper concludes with a discussion of implications for future research and limitations of the study.

Symptom patterns of sexually abused teenage girls seeking services.

Child sexual abuse (CSA) is associated with a host of negative repercussions. Yet, scholarly reports highlight the diversity of symptom presentation in survivors of CSA. Relying on the complex posttraumatic stress disorder (C-PTSD) framework, this study aimed to identify symptom profiles in teenage girls seeking services following disclosure of CSA. Participants included 207 teenage girls aged 12-18. They completed questionnaires on PTSD symptoms (i.e., reexperiencing, avoidance, and hyperarousal) and domains of impairments of the C-PTSD (i.e., interpersonal difficulties, biology, affect and behavioral regulation, dissociation, cognition, and self-concept). A latent profile analysis identified three profiles: PTSD, Complex PTSD, and Resilient. Results support the validity of the C-PTSD model with a subgroup reporting classic PTSD symptoms as well as alterations in several domains of functioning. Our second aim was to explore potential correlates of the resulting symptom profiles. Both personal and family factors were found to distinguish profiles, with teens in the Resilient group reporting fewer associations with delinquent peers, less use of avoidance coping strategies, and more maternal support than the two other profiles. Furthermore, CSA severity did not differ between the Complex PTSD and the Resilient profiles. The current findings argue in favor of a more individualized approach to treatment taking into consideration differences in presentation of symptoms among profile teenage survivors of CSA. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Associations Between Approach and Avoidance Coping, Psychological Distress, and Disordered Eating Among Candidates for Bariatric Surgery

Individuals seeking bariatric surgery evidence risk for binge and disordered eating behaviors, which can lead to poorer post-surgical weight loss outcomes. Use of avoidant coping strategies to manage stress, along with symptoms of depression, are associated with disordered eating in the general population. However, the role of coping has not been examined among candidates for bariatric surgery, and coping and depression have rarely been considered in combination. Given the emerging standard that psychologists are involved in evaluations and treatment before and after surgery, consideration of these variables is clinically relevant. Participants were 399 patients undergoing pre-surgical bariatric psychological assessment. Hierarchical linear regression analyses tested whether gender, age, and BMI; approach and avoidance coping; and depression and anxiety were associated with disordered eating (binge eating, restraint, eating concerns, shape concerns, weight concerns) in a cross-sectional study design. In initial steps of the model controlling demographic variables, approach coping predicted less and avoidance coping predicted more disordered eating across most outcomes examined. In models including depression and anxiety, avoidance (but not approach) coping remained a relevant predictor. The effects of depression were also quite robust, such that participants who were more depressed reported more disordered eating. More anxious participants reported more restrained eating. Avoidance coping and depressive symptoms emerged as key variables in understanding recent disordered eating among patients considering bariatric surgery. Pre-surgical psychological evaluations and treatment approaches could be enhanced with consideration of patient coping strategies, particularly avoidant coping responses to stress, independent of psychological distress.

A randomized-controlled trial of treatment for self-stigma among persons diagnosed with schizophrenia-spectrum disorders.

A substantial body of research indicates that self-stigma is associated with poorer outcomes related to recovery among people with severe mental illnesses. Narrative Enhancement and Cognitive Therapy (NECT) is a structured, group-based approach which targets the effects of self-stigma. A randomized-controlled trial was conducted to examine the efficacy of NECT. One hundred and seventy persons, recruited from both outpatient and comprehensive treatment settings, meeting criteria for schizophrenia-spectrum disorders and moderate-to-elevated self-stigma, were randomly assigned to NECT or supportive group therapy and assessed at four time points over the course of nearly a year. Participants completed measures of self-stigma, hope, self-esteem, functioning, psychiatric symptoms, coping with symptoms, and narrative insight. Analyses indicated that NECT participants in outpatient sites improved significantly more over time in self-stigma compared to supportive group therapy participants in outpatient sites, while NECT participants in comprehensive (including day treatment and psychiatric rehabilitation program) sites improved significantly more in hopelessness and narrative insight than other participants. NECT participants as a group showed decreases in the social withdrawal component of self-stigma, decreased in their use of avoidant coping strategies, and were more engaged in treatment than supportive group therapy participants. There was no evidence for effects of NECT on social functioning or psychiatric symptoms. Findings suggest that NECT primarily impacts self-stigma and related outcomes, and that the degree of its effects is partially dependent on the treatment context in which it is offered.

College Students' Coping and Psychological Help-Seeking Attitudes and Intentions

The relationship between college students' coping and psychological help-seeking attitudes and intentions was examined. Seven hundred and nineteen students participated (180 men, 537 women, and two individuals who did not indicate their gender). Questionnaires were completed online and included the Brief COPE and Beliefs About Psychological Services scales. It was found that for students with previous counseling experience, coping by means of greater use of support seeking and less use of avoidant coping strategies was associated with greater intent to seek psychological help, greater stigma tolerance, and greater belief in psychologists' expertness. Problem-focused coping was unrelated to psychological help-seeking attitudes and intentions among these students. For students without previous counseling experience, coping by means of greater use of support seeking (emotional support, instrumental support, and venting), greater use of problem-focused coping (active coping, positive reframing, religion, and planning), and less use of avoidant coping strategies (denial, substance use, behavioral disengagement, and self-blame) was associated with greater stigma tolerance and greater belief in psychologists' expertness. For these students, coping behaviors were not related to intentions to seek counseling.

An Exploratory Study of How Older Cubans Cope with Difficult Living Conditions

Population aging is a concern to policy makers in Cuba where by 2025 there will be more pensioners than workers. We describe a unique, exploratory study of older Cubans 60+ years of age and how they cope with stress associated with economic vulnerability and adverse living conditions. Many older persons have incomes too low to provide a minimum standard of living. We address the following questions. (1) What chronic environmental stressors do older persons face? (2) What strategies do they employ to cope with these stressors? (3) What implications for policy follow from these questions? We discuss qualitative data from interviews with 50 older persons conducted in Havana in a mixed methods investigation. Most participants appraised difficult living conditions as hard to change, which explains a high prevalence of the use of avoidance coping strategies, including resignation. Policy makers need to understand how older persons cope with adversity to determine relevant service needs for this population.