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

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Presentation on theme: "Coping and Resilience Leslie H. Wind, Ph.D Mary Marshall, LCSW."— Presentation transcript:

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 Northwest Center for Public Health Practice 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 Northwest Center for Public Health Practice Types of Stress Reactions Physiological Emotional Cognitive Behavioral

8 Northwest Center for Public Health Practice 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 Northwest Center for Public Health Practice Reactions: Children 1-5 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

10 Northwest Center for Public Health Practice Reactions: 6-11 Years 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

11 Northwest Center for Public Health Practice Reactions: 12-18 Years 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

12 Northwest Center for Public Health Practice 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 Northwest Center for Public Health Practice What is Coping?

14 Northwest Center for Public Health Practice 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 Northwest Center for Public Health Practice Think About Kids and Coping What are some of the ways you see children and adolescents attempt to cope with extremely stressful situations?

16 Northwest Center for Public Health Practice 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 Northwest Center for Public Health Practice Lazarus’ Model of Stress and Coping Antecedents Individual goals, goal hierarchies, beliefs about self and world, Personal resources Environment Harms/losses, threats/challenges, benefits Person- environment relationship Appraisal Relational meaning Coping Revised relational meaning Emotions, Functioning, Morale, Health ProcessesOutcomes

18 Northwest Center for Public Health Practice 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 Northwest Center for Public Health Practice Transactional Model Concepts 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

20 Northwest Center for Public Health Practice 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 Northwest Center for Public Health Practice 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 Northwest Center for Public Health Practice 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 Northwest Center for Public Health Practice 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 Northwest Center for Public Health Practice 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 Northwest Center for Public Health Practice Motivational Model of Coping Innate Psychological Needs Relatedness Competence Autonomy Universal Stressors Neglect Chaos Coercion Skinner & Wellborn, 1997

26 Northwest Center for Public Health Practice 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 Northwest Center for Public Health Practice 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 Northwest Center for Public Health Practice 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 Northwest Center for Public Health Practice 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 Northwest Center for Public Health Practice 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 Northwest Center for Public Health Practice Evaluating Young Children’s Coping Behavior is appropriate for situation Behavior is appropriate developmentally Behavior enables child to achieve objectives

33 Northwest Center for Public Health Practice 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 Northwest Center for Public Health Practice 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 Northwest Center for Public Health Practice What We Know About Gender and Coping Mixed findings overall Findings vary by context

36 Northwest Center for Public Health Practice Coping and Culture Connection between culture and coping Individualism vs. collectivism

37 Northwest Center for Public Health Practice 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 Northwest Center for Public Health Practice Model of Collectivistic Coping Family support Respect for authority figures Intracultural coping Relational universality Forbearance Social activity Fatalism Chen in Wong & Wong, 2006

39 Northwest Center for Public Health Practice 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 Northwest Center for Public Health Practice Child Coping within a Cultural Context Coping strategies vary across groups Ethnicity x Context = Coping Avoidant coping = adaptive and maladaptive

41 Northwest Center for Public Health Practice 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 1.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 negative Wright & Masten, 2005

50 Northwest Center for Public Health Practice 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)

51 Correlates of Resilience: Child Characteristics Social/adaptable temperament Strong cognitive abilities Effective emotional and behavioral regulation strategies Positive view of self Positive outlook Faith/sense of meaning in life Characteristics valued by society and self (talents, humor, appearance) Masten, 2001

52 Family Resilience “…coping and adaptational processes in the family as a functional unit” Walsh, 2006, p. 15

53 Principles of Family Resilience Individual resilience is best understood and fostered in the context of the family and larger social world, as a mutual interaction of individual, family, socio-cultural, and institutional influences Crisis events and persistent stresses affect the whole family, posing risks not only for individual dysfunction, but for relational conflict and family breakdown; Walsh, 2006

54 Principles of Family Resilience Family processes mediate the impact of stress for all its members and relationships; Protective processes foster resilience by buffering stress and facilitating adaptation; Maladaptive responses increase vulnerability and risks for individual and relational distress; All individuals and families have the potential for greater resilience

55 Three Keys to Family Resilience Family belief systems Organizational patterns Communication processes Walsh,2006

56 Family Belief Systems Making meaning of adversity – sense of coherence Positive outlook Transcendence and spirituality

57 Organizational Patterns Flexibility – Capacity for change Connectedness/Cohesion – emotional/structural bonding Social and economic resources – Extended networks

58 Communication Processes Clarity – clear communication Open emotional expression – trust, emotional interaction Collaborative problem solving – conflict management

59 Correlates of Resilience: Family Characteristics Stable/supportive home environment Parents involved in child’s education and activities Parents have same characteristics as child resilience correlates Socioeconomic advantages Postsecondary education of parents Faith and religious affiliations Masten, 2001

60 Northwest Center for Public Health Practice Family Processes in Coping Family members: can be resources can present impediments are models Compas & Epping, 1993

61 Correlates of Resilience: Community Characteristics Good quality neighborhood Effective schools Employment opportunities for parents/teens Good public health care Access to emergency services Connections to caring adult mentors and pro- social peer associations Masten, 2001

62 Adaptive Systems Facilitating Development Attachment relationships Moral and ethical development Self-regulatory systems Mastery and motivational systems Neurobehavioral and information-processing systems

63 Stability and Change in Adaptation Complex interactions of youth with parents, peers, and other adults in home, neighborhood, schools, and workplace impact outcomes Critical turning points correspond to developmental challenges

64 Culture and Resilience Within the cultural context: Extended family networks Religious organizations Other social systems

65 Culturally Relevant Risk and Protective Factors Socioeconomic status Social support Prejudice and discrimination Acculturation stress

66 Resilience and Disaster The nature of the threat must be considered Developmental timing influences reactions Child experiences/responses of children are influenced by family, peer, and school functioning, particularly by people to whom children are attached Family, peers, and larger systems influenced by perceptions of the safety of other system members Masten & Obradovic, 2007

67 What Do We Know Within the Disaster Context?

68 Disaster Related Outcomes Statistics are unavailable on number of children/adolescents impacted by disaster Symptoms are similar across disasters Anxiety disorders, depression, behavioral disorders are most commonly reported post- disaster problems PTS: 28-50% after terrorism, hurricanes

69 Northwest Center for Public Health Practice Factors Associated with Stress-Related Outcomes Exposure Demographics Preexisting psychosocial factors Post-disaster recovery environment La Greca & Prinstein, 2002

70 Northwest Center for Public Health Practice Predicting Children’s Reaction to Disaster Traumatic Exposure Preexisting Child Characteristics Coping Efforts Post Disaster Recovery Environment Major Life Events Social Support Functioning

71 Northwest Center for Public Health Practice What We Know about Disasters: Coping Strategies Negative strategies = higher PTSD, depression Negative self-attribution and guilt = higher PTSD Higher PTSD, depression = use more strategies

72 Northwest Center for Public Health Practice More on Coping Strategies Findings vary re most common Some strategies associated with symptoms; some not Some strategies are context specific

73 Northwest Center for Public Health Practice What We Know Related to Disasters: Gender Girls use affective coping and social support more than boys Adolescent girls use more problem solving; boys use more emotional numbing Some studies find no gender differences Girls have higher rates of posttraumatic symptoms

74 Northwest Center for Public Health Practice What We Know Related to Disasters: Age Adolescent girls who use primary control coping have less anxiety Involuntary disengagement in adolescents associated with more anxiety Younger children: Wishful thinking, positive coping, social withdrawal, blame-anger Adolescents: Distraction, avoidance, active coping, support coping

75 Northwest Center for Public Health Practice What We Know Related to Disasters: Previous Trauma No difference in strategy effectiveness More previous trauma = greater perception of effectiveness of coping More previous trauma = use more strategies Associated with use of active coping strategies

76 Northwest Center for Public Health Practice What We Know Related to Disasters: Culture Strategy usage Acculturation and PTSD for African Americans

77 Northwest Center for Public Health Practice What We Know Related to Disasters: Self-Efficacy One Month Post-Event Perception of life threat Depression Three Months Post-Event Children’s ability to cope at T1 most predictive of coping at T2** Family communication about event

78 Northwest Center for Public Health Practice What We Know Related to Disasters: Resources Support seeking = fewer symptoms Assistance with distraction and emotional processing = more PTSD Parents provide most help in roles and routines, social support Friends help more with emotional processing Social withdrawal unrelated to coping assistance

79 Northwest Center for Public Health Practice WHAT DO WE NEED TO KNOW?

80 Northwest Center for Public Health Practice Future Research What factors influence coping and resilience in children and families within a disaster context? By what processes do they interact in producing psychosocial outcomes?

81 Northwest Center for Public Health Practice Factors Influencing Psychosocial Outcomes Need to continue development of explanatory models Differentiate predictors by type of disaster, development, culture, and time

82 Northwest Center for Public Health Practice Challenges to Understanding Coping within a Disaster Context Disasters are unpredictable Lack of clarity and agreement about nature of coping in children Lack of consensus on definitions Poor instrumentation Lack longitudinal study

83 Northwest Center for Public Health Practice Challenges to Understanding Resilience Risk and protective factors poorly specified and inconsistently operationalized Utility of risk and protective factors for screening is insufficiently examined Mediating and moderating relationships are insufficiently examined

84 Northwest Center for Public Health Practice We Need To… Increase standardization in measurement of coping in childhood and adolescence based on clear definitions and cultural considerations Examine coping style, flexibility, and self- efficacy within the disaster context Develop and test explanatory models of coping that are sensitive to culture

85 Northwest Center for Public Health Practice We Need To….. Conceptualize risk and protective factors in ways that effectively inform prevention, intervention, and public policy Distinguish direct and indirect relationships among risk and protective factors, mediators and moderators; over time Develop theory-driven explanatory models Utilize advanced modeling techniques

86 Northwest Center for Public Health Practice Then We Can….. Develop, implement, and evaluate interventions supporting individual, family, and community resilience

87 Northwest Center for Public Health Practice


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