MacArthur SES & Health Network
MacArthur SES & Health Network


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Coping Strategies

Summary prepared by Shelley Taylor in collaboration with the Psychosocial Working Group. Last revised July, 1998.

Chapter Contents

  1. Definition and Background
  2. Measurement
  3. Relation to SES
  4. Relation to Health
  5. Limitations
  6. Network Usage
  7. Conclusions
  8. Selected Bibliography

Definition and Background

Coping strategies refer to the specific efforts, both behavioral and psychological, that people employ to master, tolerate, reduce, or minimize stressful events. Two general coping strategies have been distinguished: problem-solving strategies are efforts to do something active to alleviate stressful circumstances, whereas emotion-focused coping strategies involve efforts to regulate the emotional consequences of stressful or potentially stressful events. Research indicates that people use both types of strategies to combat most stressful events (Folkman & Lazarus, 1980). The predominance of one type of strategy over another is determined, in part, by personal style (e.g., some people cope more actively than others) and also by the type of stressful event; for example, people typically employ problem-focused coping to deal with potential controllable problems such as work-related problems and family-related problems, whereas stressors perceived as less controllable, such as certain kinds of physical health problems, prompt more emotion-focused coping.

An additional distinction that is often made in the coping literature is between active and avoidant coping strategies. Active coping strategies are either behavioral or psychological responses designed to change the nature of the stressor itself or how one thinks about it, whereas avoidant coping strategies lead people into activities (such as alcohol use) or mental states (such as withdrawal) that keep them from directly addressing stressful events. Generally speaking, active coping strategies, whether behavioral or emotional, are thought to be better ways to deal with stressful events, and avoidant coping strategies appear to be a psychological risk factor or marker for adverse responses to stressful life events (Holahan & Moos, 1987).

Broad distinctions, such as problem-solving versus emotion-focused, or active versus avoidant, have only limited utility for understanding coping, and so research on coping and its measurement has evolved to address a variety of more specific coping strategies, noted below in the measurement section.

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Measurement

A variety of idiosyncratic coping measures exist, but in recent years, researchers have typically used one of two instruments: the Ways of Coping measure (Folkman & Lazarus, 1980) or the COPE (Carver, Scheier, & Weintraub, 1989). The Ways of Coping was developed by Folkman, Lazarus, and their associates (Folkman, Lazarus, Dunkel-Schetter, DeLongis, & Gruen, 1986). It is an empirically-derived inventory of specific ways in which people might cope with a stressful event. Individuals are asked to designate or respond to a specific stressor (such as neighborhood crime) and indicate the degree to which they have utilized each particular coping method to deal with it. Responses to the statements are then factor-analyzed to identify more general patterns of coping. In a representative community study that employed this measure, eight distinct coping strategies emerged: Confrontative Coping, Seeking Social Support, Planful Problem-Solving, Self-Control, Distancing, Positive Appraisal, Accepting Responsibility, and Escape/Avoidance. Researchers often add items that address the particular coping needs of the stressful events they are studying. The result, however, is that the Ways of Coping instrument is employed idiosyncratically across different studies, limiting the comparability of results from the instrument across different samples and situations. Moreover, because the specific coping strategies are determined by factor analysis, the factor structure, as well, varies across studies.

By contrast, the development of the COPE was theoretically guided, and items were created to tap a predetermined set of coping strategies. The COPE has a constant set of scales and items and, for this reason, it currently enjoys wide use among coping researchers. The "trait" form of the COPE asks respondents to designate how they typically react to stressful events. The state measure of the COPE is completed by respondents with respect to a specific stressor, designated either by the respondent or by the researcher. An additional advantage of the COPE is the fact that a reliable and validated brief form exists (Carver, 1997).

The full COPE is a 60-item measure that yields 15 factors that reflect active versus avoidant coping strategies. In the "traitlike" version, respondents are asked to rate the degree to which they typically use each coping strategy when under stress. In the "statelike" version, respondents rate the degree to which they use each coping strategy to deal with a particular stressful event. Ratings are made on a 4-point Likert-type scale that ranges from "I (usually) don't do this at all" (1) to "I (usually) do this a lot" (4). The measure has good psychometric properties with alphas ranging from .45 to .92, test-retest reliabilities ranging from .46 to .86, and strong evidence of discriminant and convergent validity, with constructs such as hardiness, optimism, control, and self-esteem. The COPE scales are: Active Coping (taking action or exerting efforts to remove or circumvent the stressor), Planning (thinking about how to confront the stressor, planning one's active coping efforts), Seeking Instrumental Social Support (seeking assistance, information, or advice about what to do), Seeking Emotional Social Support (getting sympathy or emotional support from someone), Suppression of Competing Activities (suppressing one's attention to other activities in which one might engage in order to concentrate more completely on dealing with the stressor), Religion (increased engagement in religious activities), Positive Reinterpretation and Growth (making the best of the situation by growing from it or viewing it in a more favorable light), Restraint Coping (coping passively by holding back one's coping attempts until they can be of use), Resignation/Acceptance (accepting the fact that the stressful event has occurred and is real), Focus on and Venting of Emotions (an increased awareness of one's emotional distress, and a concomitant tendency to ventilate or discharge those feelings), Denial (an attempt to reject the reality of the stressful event), Mental Disengagement (psychological disengagement from the goal with which the stressor is interfering, through daydreaming, sleep, or self-distraction), Behavioral Disengagement (giving up, or withdrawing effort from, the attempt to attain the goal with which the stressor is interfering), Alcohol/Drug Use (turning to the use of alcohol and other drugs as a way of disengaging from the stressor), and Humor (making jokes about the stressor).

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Relation to SES

In relating coping strategies to SES, the question is not, are they related, but which coping strategies might be related to SES and how? One might predict that avoidant coping strategies and, possibly, emotional regulation strategies, would be more characteristic as one moves down the SES ladder, because threats from the environment may overwhelm the personal resources of the individual, or the problems created by the environment may be largely uncontrollable; by contrast, the higher one's position on the SES ladder, the more likely one may be able to exert control over stressful events, thus leading to the deployment of active coping strategies. Undoubtedly, datasets exist that would enable us to assess the validity of these hypotheses, but so far, I have uncovered only one. Chuck Carver reanalyzed Gail Ironson's Hurricane Andrew recovery dataset and his results lend modest support to the above predictions. In his study of 168 survivors of Hurricane Andrew, he found that self-distraction was modestly negatively correlated with education (-.25) and with income (-.25), as was denial (-.19, -.17), religion (-.29, -.32), stoicisim (-.34, -.21), thought suppression (-.23, -.23), and suppression of feelings (-.16, education only). Note that the labels do not line up perfectly with the scales, inasmuch as additional items to assess coping with this particular stressor were added to the inventory.

The significance of understanding and measuring coping strategies for the SES and health relation is not only that coping strategies may be reliably related to SES; coping strategies are also significant because they moderate the ways in which stressful events are experienced. Consequently, in our research investigations, if the appraisal of a stressor and the ways in which an individual copes with it are likely to moderate responses to it, then measurement of coping strategies is essential.

Relation to Health

Both the COPE and the Ways of Coping subscales have been reliably tied to psychological distress, such that active coping strategies appear reliably to produce better emotional adjustment to chronically stressful events than do avoidant coping strategies. In terms of physical health outcomes, an active versus avoidant coping strategy was associated with better immune status in HIV-seropositive men (Goodkin, Blaney et al., 1992; Goodkin, Fuchs, Feaster, Leeka, & Rishel, 1992), in individuals infected with herpes simplex virus (Kemeny, 1991), and in men with immunologically-mediated infertility (Kedom, Bartoov, Mikulincer, & Shkolnik, 1992). Use of denial following serostatus notification was associated with more rapid disease progression in HIV-seropositive gay men (Ironson et al, 1994). Active coping with disease was associated with fewer recurrences and longer survival from melanoma (Fawzy et al., 1993). Avoidance coping was associated with lower numbers of T cells and reduced NK cytotoxity among law school students (Segerstom, Taylor, Kemeny, & Fahey, in press).

Limitations

To the extent that stressors differ across SES or to the extent that the same stressor is experienced differently at different levels of SES, coping differences by SES and/or the role of coping strategies in moderating distress or health outcomes due to stress become difficult to interpret.

Network Usage

The COPE is included in the HIV and Women Study (Taylor).

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Conclusions

Coping strategies may be moderators of the SES and health relationship. At present, the COPE instrument is judged to be the most appropriate measure of coping strategies due to its wide use, easy administration, and standardized scoring procedures. At present, only modest information is available regarding the relation of coping strategies to SES. Evidence suggests a relation of coping strategies to health outcomes, such that avoidant coping strategies are associated with poorer health-relevant outcomes. Subsequent work might profitably focus on relating coping strategies to SES, identifying the importance and meaning of avoidant coping strategies for explaining the SES and health relationship (for example, are avoidant coping methods actually methods of coping, or do they represent self-regulatory deficiencies in effective coping?), and identifying whether active coping or emotional regulation coping represent positive (protective) resources with respect to the SES and health relationship.

Selected Bibliography

Carver, C. S. (1997). You want to measure coping but your protocol's too long: Consider the brief COPE. International Journal of Behavioral Medicine, 4, 91-100.

Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 56, 267-283.

Fawzy, F. I., Fawzy, N. W., Hyn, C. S., Elashoff, R., Guthrie, D., Fahey, J. L., & Morton, D. L. (1993). Malignant melanoma: Effects of an early structured psychiatric intervention, coping, and affective state on recurrence and survival six years later. Archives of General Psychiatry, 50, 681-689.

Folkman, S., & Lazarus, R. S. (1980). An analysis of coping in a middle-aged community sample. Journal of Health and Social Behavior, 21, 219-239.

Folkman, S., Lazarus, R. S., Dunkel-Schetter, C., DeLongis, A., & Gruen, R. J. (1986). Dynamics of a stressful encounter: Cognitive appraisal, coping, and encounter outcomes. Journal of Personality and Social Psychology, 50, 992-1003.

Goodkin, K., Blaney, N. T., Feaster, D., Fletcher, M. A., Baum, M. K., Mantero-Atienza, E., Klimas, N. G., Millon, C., Szapocznik, J., & Eisdorfer, C. (1992). Active coping style is associated with natural killer cell cytotoxicity in asymptomatic HIV-1 seropositive homosexual men. Journal of Psychosomatic Research, 36, 635-650.

Goodkin, K., Fuchs, I., Feaster, D., Leeka, M. A., & Rishel, D. D. (1992). Life stressors and coping style are associated with immune measures in HIV-1 infection a preliminary report. International Journal of Psychiatry in Medicine, 22, 155-172.

Holahan, C. J., & Moos, R. H. (1987). Risk, resistance, and psychological distress: A longitudinal analysis with adults and children. Journal of Abnormal Psychology, 96, 3-13.

Ironson, G., Friedman, A., Klimas, N., Antoni, M., Fletcher, M. A., LaPerriere, A., Simoneau, J., & Schneiderman, N. (1994). Distress, denial, and low adherence to behavioral intentions predict faster disease progression in gay men infected with human immunodeficiency virus. International Journal of Behavioral Medicine, 1, 90-105.

Kedem, P., Bartoov, B., Mikulincer, M., & Shkolnik, T. (1992). Psychoneuroimmunology and male infertility: A possible link between stress, coping, and male immunological infertility. Psychology and Health, 6, 159-173.

Kemeny, M. E. (1991). Psychological factors, immune processes, and the course of herpes simplex and human immunodeficiency virus infection. In N. Plotnikoff, A. Murgo, R. Faith, & J. Wybran (Eds.), Stress and immunity (p. 199-210). Boca Raton, FL: CRC Press.

Segerstrom, S. C., Taylor, S. E., Kemeny, M. E., & Fahey, J. L. (in press). Effects of optimism and coping on stressor-related mood and immune changes. Journal of Personality and Social Psychology.

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