Coping and Resilience

1. Coping and Resilience Leslie H. Wind, Ph.D Mary Marshall, LCSW

2. Federal Sponsors NIMH National Institute of Mental Health NINR National Institute of Nursing Research SAMHSA Substance Abuse And Mental Health Services Administration

3. Principal Investigators Betty Pfefferbaum, MD, JD University of Oklahoma Health Sciences Center Alan M. Steinberg, PhD University of California, Los Angeles Robert S. Pynoos, MD, MPH University of California, Los Angeles John Fairbank, PhD Duke University

4. Learning Objectives After completing this module you will be able to: Identify and define key concepts and models related to stress, coping, and resilience Understand the transactional nature of coping and resilience processes Differentiate key culturally-based aspects of coping and resilience Discuss coping and resilience issues specific to youth exposed to mass level traumatic events Identify gaps in knowledge and research needs

5. What is Stress?

6. Stress Terminology • Stress: The effect of anything in life to which people must adjust. Stress requires us to adjust our attention and behavior and makes demands on our energy. • Stressor: Anything that has the effect of causing stress. • Stress Capacity: The amount of stress a person can carry, since each person has some stress in their lives. • Stress Load: This refers to the amount, or quantity, of stress a person has in their lives. Red Cross, 2002

7. Types of Stress Reactions • Physiological • Emotional • Cognitive • Behavioral

8. Stress within a Disaster Context • Disasters are overwhelming, traumatic events • Children’s reactions vary by age, developmental maturity, and experience • Children’s reactions likely vary by stage of recovery • Children’s needs may not be met

9. Helplessness and passivity Generalized fear Heightened arousal Cognitive confusion Difficulty talking about event Sleep disturbance Separation fears/clinging Regressive symptoms Anxiety about death Grief Somatic symptoms Startle response to loud or unusual noises Irritability Reactions: Children 1-5

10. Feelings of responsibility/guilt Traumatic play and retelling Sleep disturbance Anger/aggression Change in behavior, mood, personality Somatic symptoms Fear and anxiety Regression Separation anxiety Withdrawal Loss of interest in activities Magical thinking Loss of ability to concentrate School avoidance and decline in school performance Reactions: 6-11 Years

11. Self-consciousness Life-threatening reenactment Abrupt shift in relationships Depression Social withdrawal Sleep/eating disturbances Decline in school performance Rebellion Accident proneness Wish for revenge and action-oriented responses Reactions: 12-18 Years

12. Children in Disaster “My daughter was small then, but she has a certain hostility toward everyone. She seems to want to hurt everyone…She liked to play with dolls before the flood, but now she punches out their eyes and pulls their arms off. She calls her daddy on her play phone now when it rains and tells him to come get her because the dam is breaking.” Everything in Its Path by Kai T. Erikson

13. What is Coping?

14. Defining Coping Constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of a person (Folkman & Lazarus, 1984, p. 141) …anything people do to adjust to the challenges and demands of stress… any adjustments made to reduce the negative impact of stress (Red Cross: Community-based Psychological Support, p. 87)

15. Think About Kids and Coping What are some of the ways you see children and adolescents attempt to cope with extremely stressful situations?

16. Conceptualizing Coping Strategies • Biological/physiological – fight or flight • Cognitive – how we think about the situation • Behavioral – behavior related to mental process • Learned – strategies learned from modeling/observation • Intentioned – voluntary/involuntary

17. Lazarus’ Model of Stress and Coping Antecedents Individual goals, goal hierarchies, beliefs about self and world, Personal resources Processes Outcomes Person-environment relationship Relational meaning Appraisal Environment Harms/losses, threats/challenges, benefits Coping Emotions, Functioning,Morale, Health Revised relational meaning

18. Transactional Model of Coping Core Assumptions: • Stressful experiences are construed as person-environment transactions • Transactions depend on the impact of the external stressor • Impact is mediated individual/environmental antecedents, by the person’s repeated appraisal of the stressor, and coping responses • The system changes moment to moment Lazarus, 1999

19. Primary appraisal Secondary appraisal Coping efforts Problem management Emotional Regulation Meaning-based coping Outcomes of coping Dispositional coping styles Optimism Information seeking Glanz, Rimer, & Lewis, 2002 Transactional Model Concepts

20. Emotion Focused Coping Coping efforts that are directed toward regulating emotional states: -- Denial/avoidance -- Distraction or minimization -- Wishful thinking -- Self-control of feelings -- Seeking meaning -- Self-blame -- Expressing/sharing feelings Folkman & Lazarus, 1984 Compas & Epping, 1993

21. Problem-Focused Coping Efforts to act on the source of stress to change the person, the environment, or the relationship between the two: 1. Planned problem solving 2. Confrontation Compas & Epping, 1993

22. Responses to Stress Model Voluntary Strategies 1. Primary Control Coping - Attempts to modify stressful problem or emotion (problem solving) 2. Secondary Control Coping – Attempts to adapt via cognition (cognitive restructuring) 3. Disengagement Coping - Attempts to redirect attention away from the stressor or emotional reaction (denial, wishful thinking) Wadsworth et al, 2004

23. Responses to Stress Model Involuntary Strategies 4. Involuntary Engagement – Directed toward the stressor or their emotional reactions (arousal, rumination, impulsive action) 5. Involuntary Disengagement – Directed away from the stressor or their emotional reactions (emotional numbing, escape) Wadsworth et al, 2004

24. Responses to Stress Model • Emphasizes developmental changes in nature of stress, internal/external constraints limiting coping processes, and a complex interplay between voluntary and involuntary responses to stress. • Involuntary responses reflect individual differences in temperament, over-learned and automatic responses • Assumes an increase in secondary control coping and emotion-focused coping and decreases in disengagement with maturity

25. Innate Psychological Needs Relatedness Competence Autonomy Universal Stressors Neglect Chaos Coercion Skinner & Wellborn, 1997 Motivational Model of Coping

26. Motivational Model: Self-System Processes • Children’s self-efficacy may be challenged by chaotic social contexts. • Self-efficacy beliefs lead to interpretations re competence • Autonomy vs. coercion = need to experience self as free to choose vs. pressure to behavior a certain way • Neglect = social interactions that undermine the need for relatedness • Self-system processes become either source of distress or resource in event of trauma

27. The Community Stress Prevention Model Six dimensions central to coping with adversity: • Beliefs/Values – relies on values to cope • Affect – emotion expression as coping mechanism • Social – seeking support/relationships • Imagination – creative expression to cope • Cognitive – need honest dialogue & guidance • Physiological – physical activity as coping Lahad, Shacham, & Niv, 2000

28. Summarizing Models of Coping Transactional Motivational Applied Psychology

29. Common Aspects of Coping • Strategies/Patterns: 4 common types • Flexibility: # strategies • Effectiveness: How well child thinks it worked • Self-efficacy: Sense of competence • Coping Assistance: External resources (formal and informal) • Coping Resources: Individual characteristics

30. Coping in Young Children • Maturation results in developmental stages marked by capacity for self-control • Process using internal/external resources to manage demands of environment Zeitlin & Williamson, 1994

31. Coping in Young Children • Step 1: Determine meaning of event • Step 2: Develop an action plan • Step 3: Implement coping effort • Step 4: Evaluation effectiveness of outcome Zeitlin & Williamson, 1994

32. Evaluating Young Children’s Coping • Behavior is appropriate for situation • Behavior is appropriate developmentally • Behavior enables child to achieve objectives

33. What We Know About Development and Coping • Emotion-focused – increases with age • Problem-solving skills – mixed findings • Negative appraisal varies in dimensionality • Avoidant physical/cognitive responses increase w/age

34. More on Development • Attention – increases with age • Sense of competence – younger over-estimate; older perceive competence as enduring • Locus of control – increases with age

35. What We Know About Gender and Coping • Mixed findings overall • Findings vary by context

36. Coping and Culture • Connection between culture and coping • Individualism vs. collectivism

37. Coping and Cultural Beliefs World view is culturally based: • Utility of effort • Religious beliefs • Belief in an entity view of the world • Belief in a benevolent purpose for events • Values • Belief in the ubiquity of change • Belief in the utility of personal preparation

38. Model of Collectivistic Coping • Family support • Respect for authority figures • Intracultural coping • Relational universality • Forbearance • Social activity • Fatalism Chen in Wong & Wong, 2006

39. More on Culture….. • Discrimination and stigma erode resilience • Gender constraints are problematic • Guilt and shame • Meaning • Mastery and control • Help-seeking, stigma, and mistrust Boss, 2006; Norris & Alegria, 2006

40. Child Coping within a Cultural Context • Coping strategies vary across groups • Ethnicity x Context = Coping • Avoidant coping = adaptive and maladaptive

41. What is Resilience?

42. Defining Resilience A pattern of positive adaptation in the context of past or present adversity Wright & Masten, 2005

43. Judging Adaptation There has been a significant threat or risk to the development or adaptation of the individual; and 2. The individual’s functioning is satisfactory according to selected criteria. Wright & Masten, 2005

44. Key Concepts in Resilience Research Adversity: Environmental conditions that interfere with/threaten the accomplishment of age-appropriate developmental tasks Risk: An elevated probability of an undesirable outcome Risk Factor: A measurable characteristic in a group of individuals or their situation that predicts negative outcome on a specific criteria

45. More Key Concepts Cumulative Risk: Increased risk due to (a) multiple risk factors present; (b) multiple occurrences of same risk factor; (c) accumulating effects of ongoing adversity Vulnerability: Individual susceptibility to undesirable outcomes

46. More Key Concepts Proximal Risk: Risk factors experienced directly by the child Distal Risk: Risk related to a child’s ecological context, but mediated via proximal processes

47. More Key Concepts Asset/Resource/Compensatory Factor: A measurable characteristic in a group of individuals or their situation that predicts general/specific positive outcomes Protective Factor: Quality of a person/context or their interaction that predicts better outcomes

48. More Key Concepts Cumulative Protection: Presence of multiple protective factors Psychosocial Competence: The adaptive use of personal and contextual resources to accomplish developmental tasks Developmental Tasks: Expectations of a society for child’s accomplishments according to stage of development

49. Assumptions Related to Resilience Concepts Children may demonstrate resilience at one point in life and not at another; Children may demonstrate resilience in only some aspects of life; There are linkages among the multiple domains of adaptation, positive and negativeWright & Masten, 2005

50. Risks Pile Up • Risk factors often pile up • Transitions (divorce, school entry, leaving home, war) pile risks on children within a short timeframe • Emotional, behavioral, educational, and health problems increase as total risk level increases • Developmental cascades can occur (one problem leads to another)