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Individuals with bipolar disorder respond to affective symptoms with a range of coping behaviours, which may further maintain the symptoms.
To examine moment-to-moment dynamics between affective states and coping behaviours, and to evaluate the role of cognitive appraisals of internal states as moderators.
Forty-six individuals with bipolar disorder completed a clinical interview and an experience sampling assessment over 6 days. Time-lagged analyses were conducted by multilevel regression modelling.
A total of 1807 momentary entries were analysed. Negative affect predicted an increase in rumination at the subsequent time point (β = 0.21, s.e. = 0.08, P = 0.009, 95% CI 0.05–0.36), and vice versa (β = 0.03, s.e. = 0.01, P = 0.009, 95% CI 0.01–0.05). Positive affect predicted an increase in adaptive coping (β = 0.26, s.e. = 0.11, P = 0.018, 95% CI 0.04–0.47), and vice versa (β = 0.02, s.e. = 0.01, P = 0.019, 95% CI 0.00–0.03). Positive affect also predicted a decrease in rumination (β = −0.15, s.e. = 0.06, P = 0.014, 95% CI −0.26 to −0.03), and vice versa (β = −0.03, s.e. = 0.01, P = 0.016, 95% CI −0.06 to −0.01). Extreme cognitive appraisals predicted stronger associations between affective states and coping behaviours.
Feedback loops between affective states and coping behaviours were revealed in the daily life of individuals with bipolar disorder, which were moderated by extreme cognitive appraisals.
Certain ways of responding to psychotic experiences (PEs) appear more commonly associated with clinical distress (e.g. avoidance) and other ways with benign or positive outcomes (e.g. reappraisal and acceptance). Past research has largely been limited to retrospective self-report. We aimed to compare clinical and non-clinical individuals on experimental analogues of anomalous experiences.
Response styles of two groups with persistent PEs (clinical n = 84; non-clinical n = 92) and a control group without PEs (n = 83) were compared following experimental analogues of thought interference (Cards Task, Telepath) and hearing voices (Virtual Acoustic Space Paradigm).
The non-clinical group with PEs were less likely to endorse unhelpful response styles, such as passive responding or attempts to avoid, suppress, worry about or control mental experiences, compared with the clinical group on all three tasks. The clinical group were more likely to endorse unhelpful response styles compared with controls on two out of three tasks (Cards Task and Telepath). The non-clinical group performed similarly to controls on unhelpful responding across all tasks. There were no group differences for helpful response styles, such as cognitive reappraisal or mindful acceptance of experiences.
In line with cognitive models of psychosis, the findings suggest that the way in which individuals respond to unusual experiences may be an important factor in understanding clinical distress, supporting the therapeutic rationale of targeting potentially unhelpful patterns of response.
The conceptualisation of Alzheimer's disease as an illness with ‘no future’ exposes people with the condition to significant fear and stress. Therefore, exploring how people look ahead to the future in the face of Alzheimer's disease is of foremost importance. Semi-structured interviews (N = 14) explored the future outlook of people with early (N = 5) and late-onset (N = 7) Alzheimer's disease and those who support them (N = 14). Thematic analysis identified how participants managed their changing futures through focusing on positive information, and taking ‘one day at a time’. Younger and older people shared similar future outlook and subsequent coping strategies, as predicted by Carstensen's Socioemotional Selectivity Theory. Both people with Alzheimer's disease and those who support them avoided looking far ahead as a way of managing the uncertain future, and had little awareness of future planning in the context of current policies. Such avoidance suggests that policy which encourages future planning should consider its utility and explore ways of helping people to plan, whilst focusing on daily living.
Unwanted pursuit behaviours (UPBs) comprise repeated and unwanted efforts to establish intimate contact in the form of harassing, tracking, and monitoring. These are common among young adults following the breakup of a romantic relationship, typically by the rejected partner. The relational goal pursuit theory (RGPT) proposes that UPB users overestimate the importance of a relationship to higher-order goals. This study assessed how well a new coping-based approach and the RGPT model predicted UPB frequency and scope. Two hundred participants (50% female; aged 19–24) completed an anonymous online survey. Ruminating was linked to both greater frequency and scope of UPB use. Higher levels of emotion-focused coping and perceived self-efficacy to re-establish intimacy were linked to the use of a wider scope of unwanted pursuit behaviours. Insights gained from UPB users are necessary for understanding mechanisms associated with the turbulent and distressing aftermath of a romantic breakup.
Teachers are burdened by high work pressure, suggesting the need for an effective stress coping system to support them. The present study evaluated the effectiveness of coping strategies currently utilized by teachers and explored the potential contribution of group sandplay to coping. The study was led by a group of experienced therapists and sandplay practitioners. Two hundred teachers served as participants, equally divided into two groups: An experimental sandplay group (EG) and control group. Both groups received a 3-hour tutorial on the psychological pressure at work, reactions to it, and physical/mental symptoms resulting from overwhelming pressure, and were introduced to the working principles and process of sandplay. EG participants then engaged in group sandplay for three consecutive days. The Simplified Coping Style Questionnaire was used as an objective measure of participants’ coping styles. Therapists’ and practitioners’ observations were used as subjective information, including the scenes and themes created by participants, individual performance during sandplay activities, and feedback regarding changes to stress coping strategies. We compared participants’ pre-and post-test stress coping strategies. The results revealed a significant improvement in the EG sample at the shift from passive coping (pre-test M = 1.94, 95% CI [1.83–2.05]; post-test M = 0.96, 95% CI [0.92–1.00]) to active coping (pre-test M = 1.76, 95% CI [1.69–1.83]; post-test M = 2.41, 95% CI [2.29–2.53]). Overall, our findings support the conclusion that group sandplay effectively improved Chinese teachers’ overall stress coping abilities.
Informal caregivers often experience high stress levels with little support, especially in rural settings. With a mixed-methods approach, this research explored experiences of rural informal caregivers, including how social identification as a caregiver, social interactions, and formal and informal coping support related to perceived stress. Major focus group themes (n = 8) included lacking available services, balancing challenges, unmet practical needs, and strong community identity. Survey data (n = 22) revealed that perceived coping support (e.g., having someone to turn to), social interactions, and caregiver identity (e.g., perceiving the role as important to one’s self-concept) were associated with lower life upset stress, but only caregiver identity was associated with managing the personal distress and negative feelings associated with caregiving stress. Results suggest that, although available rural services may fall short, other options might alleviate caregiver stress, including facilitating access to coping support, encouraging social interactions, and enhancing caregiver social identity.
This study aimed to investigate associations among spirituality, coping strategies, quality of life (QOL), and the effects of depression and anxiety thereon in cancer patients.
In total, 237 cancer patients referred to a psycho-oncology clinic at a university hospital in Korea were enrolled. After identifying predictors of patient QOL in a stepwise regression model, we developed a hypothetical path model wherein interpersonal coping was considered as a mediating variable between spirituality (meaning/peace) and QOL and wherein depression and anxiety affected each of these three variables.
The direct effect of spirituality (meaning/peace) on QOL was 36.7%. In an indirect model, interpersonal coping significantly mediated the relationship between spirituality (meaning/peace) and QOL. Depression exerted the largest negative effect on spirituality (meaning/peace), interpersonal coping, and QOL. Anxiety had negative effects on spirituality (meaning/peace) and QOL, but a positive effect on interpersonal coping.
Significance of results
Interpersonal coping strategies work as a partial mediator of the relationship between meaning/peace subscales of spirituality and QOL. Effective management of depression may help in achieving better outcomes associated therewith. Greater attention and efforts to improve social connectedness and meaning of life in spiritual well-being may improve the QOL of cancer patients.
Motivation and coping are two of the most relevant factors associated to well-being. One of our objectives was to describe the motivation to pursue the personal goals, the coping strategies used to pursue them, and the levels of well-being experienced, in a group of people serving prison sentences (n = 175: 143 males and 32 females). We mainly wanted to study the joint contribution of motivation and coping on their well-being. The results have shown that motivation and coping contribute to the different dimensions of well-being. Specifically, we have found that autonomous motivation (AM) as well as problem solving (PS) and positive cognitive restructuring (PCR) coping positively predict self-acceptance (β = .12, p = .06; β = .17, p < .05; β = .24, p < .01 respectively), purpose in life (β = .12, p = .06; β = .35, p < .001 and β = .24, p < .001 respectively) and positive affect (β = .13, p = .06; β = .29, p < .001 and β = .28, p < .001 respectively). Personal growth was positively predicted by AM (β = .21, p < .01) and PCR coping (β = .21, p < .01), and negatively by avoidance coping (β = –.16, p < .05). Negative affect was positively predicted by social support (β = .16, p < .05) and avoidance (β = .42, p < .001) coping. None of the variables analyzed predicted life satisfaction. The results suggest that well-being promotion programs in prison settings should encourage the pursuit of goals by AM and the use of PS and PCR coping to achieve these goals.
Neuropsychiatric symptoms (NPI) of dementia are important determinants of caregiver burden, while caregiver coping styles and competences can relieve burden. Caregivers differ in coping with the demands made on them and in experienced burden. What changes in caregivers explain recovery from burden, and which caregiver characteristics predict recovery from burden over time, and does treatment make a difference?
This study into recovery from burden was a secondary analysis of data collected in a formerly conducted randomized controlled trial (RCT) on the integrated reactivation and rehabilitation (IRR) programme in a psychiatric-skilled nursing home, compared to usual care (UC; i.e. day care, assisted living arrangements, and nursing home wards). For this secondary analysis, longitudinal data on persons with dementia and caregivers were used from baseline (T1), end of treatment (T2), and at nine months (T3).
Caregivers with an improved sense of competence (SCS) who care for persons with dementia with a decreased severity of NPI have the highest chance of recovering from burden (CSI). Caregivers with a tendency to feel involved with others and sympathize with others (affiliation, ICL-R) have a slightly lower probability of improvement with respect to their sense of competence in the short term. The number of improved caregivers was higher in IRR than UC.
Recovery depends on both an improved sense of competence and a decreased severity of NPI. Combined interventions that address both NPI and focus on enhancing caregiver's sense of competence have added value when it comes to decreasing caregiver burden.
Background: Guilt is commonly associated with distress and psychopathology. However, there is a lack of validated measures that assess how people cope with this aversive emotional and cognitive experience. Aims: We therefore developed and validated a self-report measure that assesses how people manage their guilt: the Guilt Management Scale (GMS). Method: The GMS was administered to a non-clinical (n = 339) and clinical (n = 67) sample, alongside other validated measures of guilt severity, coping, thought control and psychological distress. Results from a principal component analysis (PCA) and assessments of test–retest reliability and internal consistency are presented. Results: The PCA yielded a six subscale solution (Self-Punishment, Reparation, People-Focused, Spirituality, Avoidance and Metacognition), accounting for 56.14% of variance. Test–retest reliability and internal consistency was found to be good–excellent for the majority of subscales. Across samples, Self-Punishment was related to higher levels of guilt and distress whilst Metacognition and Reparation were related to less guilt and distress in the non-clinical sample only. Conclusions: This paper provides preliminary evidence for the psychometric properties of the GMS in a non-clinical sample. With development and validation in clinical samples, the GMS could be used to inform psychological formulations of guilt and assess therapy outcomes.
Advance care planning (ACP) increases quality of life and satisfaction with care for those with cancer and their families, yet these important conversations often do not occur. Barriers include patients’ and families’ emotional responses to cancer, such as anxiety and sadness, which can lead to avoidance of discussing illness-related topics such as ACP. Interventions that address psychological barriers to ACP are needed. The purpose of this study was to explore the effects of a mindfulness intervention designed to cultivate patient and caregiver emotional and relational capacity to respond to the challenges of cancer with greater ease, potentially decreasing psychological barriers to ACP and enhancing ACP engagement.
The Mindfully Optimizing Delivery of End-of-Life (MODEL) Care intervention provided 12 hours of experiential training to two cohorts of six to seven adults with advanced-stage cancer and their family caregivers (n = 13 dyads). Training included mindfulness practices, mindful communication skills development, and information about ACP. Patient and caregiver experiences of the MODEL Care program were assessed using semistructured interviews administered immediately postintervention and open-ended survey questions delivered immediately and at 4 weeks postintervention. Responses were analyzed using qualitative methods.
Four salient themes were identified. Patients and caregivers reported the intervention (1) enhanced adaptive coping practices, (2) lowered emotional reactivity, (3) strengthened relationships, and (4) improved communication, including communication about their disease.
Significance of results
The MODEL Care intervention enhanced patient and caregiver capacity to respond to the emotional challenges that often accompany advanced cancer and decreased patient and caregiver psychological barriers to ACP.
The study aimed to gather data on posttraumatic stress and depression in adolescents following the 2015 Nepal earthquake and explore the adolescents’ coping strategies.
In a questionnaire-based, cross-sectional study about 1 year after the earthquake, adolescents in two districts with different degrees of impact were evaluated for disaster experience, coping strategies, and symptoms of posttraumatic stress and depression measured with the Child Posttraumatic Stress Scale and the Depression Self Rating Scale.
In the studied sample (N=409), the estimated prevalence of posttraumatic stress disorder (PTSD) (43.3%) and depression (38.1%) was considerable. Prevalence of PTSD was significantly higher in the more affected area (49.0% v 37.9%); however, the prevalence figures were comparable in adolescents who reported a stress. The prevalence of depression was comparable. Female gender, joint family, financial problems, displacement, injury or being trapped in the earthquake, damage to livelihood, and fear of death were significantly associated with a probable PTSD diagnosis. Various coping strategies were used: talking to others, praying, helping others, hoping for the best, and some activities were common. Drug abuse was rare. Most of the coping strategies were comparable among the clinical groups.
A considerable proportion of adolescents had posttraumatic stress and depression 1 year after the earthquake. There is a need for clinical interventions and follow-up studies regarding the outcome. Disaster Med Public Health Preparedness. 2019;13:236–242)
Rural households in developing countries depend on crops, forest extraction and other income sources for their livelihoods, but these livelihood contributions are sensitive to climate change. Combining socioeconomic data from about 8,000 smallholder households across the tropics with gridded precipitation and temperature data, we find that households have the highest crop income at 21°C temperature and 2,000 mm precipitation. Forest incomes increase on both sides of this agricultural maximum. We further find indications that crop income declines in response to weather shocks while forest income increases, suggesting that households may cope by reallocating inputs from agriculture to forests. Forest production may thus be less sensitive than crop production to climatic fluctuations, gaining comparative advantage in extreme climates and under weather anomalies. This suggests that well-managed forests might help poor rural households to cope with and adapt to future climate change.
Many bereaved siblings have still not come to terms with their grief many years after the loss, but few studies have focused on what can help. The aims of this study were to identify cancer-bereaved adolescents’ and young adults’ ways of coping with grief after loss of a sibling, and examine whether these ways of coping were related to their experience of having worked through their grief.
This nationwide survey of 174 cancer-bereaved siblings (73% participation rate) is based on one open-ended question about coping with grief (“What has helped you to cope with your grief after your sibling's death?”) and one closed-ended question about siblings’ long-term grief (“Do you think you have worked through your grief over your sibling's death?”). The open-ended question was analyzed with content analysis; descriptive statistics and Fisher's exact test were used to examine the relation between type of coping and siblings’ long-term grief.
The siblings described four ways of coping: (1) thinking of their dead brother/sister and feeling and expressing their grief; (2) distracting or occupying themselves; (3) engaging in spiritual and religious beliefs/activities; and (4) waiting for time to pass. One of these categories of coping with grief, namely, engaging in spiritual and religious beliefs and activities, was associated with siblings’ experience of having worked through their grief two to nine years after the loss (p = 0.016).
Significance of results
Those siblings who had used spirituality, religious beliefs, and activities to cope were more likely to have worked through their grief than those who had not.
The present study explored the component structure of coping in preschoolers as measured by the Children's Coping Scale — Revised (CCS-R) through principal component analysis (PCA). The study also examined the relationship between different coping patterns and mental health (as measured by the Strengths and Difficulties Questionnaire; SDQ) in preschoolers. One hundred and thirty-two parents of preschoolers enrolled at a university-affiliated Early Learning Centre in Melbourne, Australia completed the CCS-R and the SDQ as part of a larger project. The PCAs found that a three-component structure of coping in preschoolers best fit the data for all general and situation-specific forms of the CCS-R. The majority of the forms, for both mothers and fathers, resulted in the components of: (1) Positive Coping, (2) Negative Coping — Emotional Inhibition, and (3) Negative Coping — Emotional Expression. The Situation Specific Coping forms resulted in the most reliable components, and the items that loaded on each component were the most consistent with previous research, underscoring a need to focus on situation-specific, as opposed to general, coping in preschoolers. Results for the relationship between the CCS-R and the SDQ found associations between positive coping and positive mental health, and negative coping was associated with some aspects of poor mental health. The patterns of associations provide evidence of construct validity for the component structure of the CCS-R and also highlight opportunities for intervention for this age group. Understanding the processes involved in managing and adapting to stress provides the opportunity to develop prevention and intervention approaches targeted at healthy adaption. Coping in preschoolers, and the degree to which preschoolers’ coping is associated with mental health, is largely under-studied in comparison to other life stages. The present study contributes to this small body of research in an effort to help inform teaching and therapeutic approaches for preschoolers.
A cognitive behavioral model predicts that coping responses mediate the relationship between falls related psychological concerns and falls incidence, in community-dwelling older people. If empirical support could be found for this pathway then interventions could be developed to reduce falls risk by targeting coping strategies. Therefore, this study aimed to begin the process of testing whether coping responses mediate the association between falls self-efficacy (a principal element of falls related psychological concerns) and falls incidence, in community-dwelling older people.
In a cross-sectional design, 160 community-dwelling older people (31 male, 129 female; mean age 83.47 years) completed the Falls Efficacy Scale–International, the Revised-Ways of Coping Questionnaire, the Turning to Religion subscale of the COPE, and a falls questionnaire. Data were analyzed via mediation analysis using a bootstrapping approach.
Lower falls self-efficacy was associated with higher falls incidence, and more self-controlling coping was found to be a partial mediator of this association, with a confidence interval for the indirect effect of (0.003, 0.021) and an effect size of κ2
= 0.035. The association was not mediated by the other measured coping responses; namely, turning to religion, distancing, seeking social support, accepting responsibility, escape-avoidance, planful problem-solving, and positive reappraisal.
Self-controlling coping may mediate the association between falls self-efficacy and falling. If longitudinal studies confirm this finding then coping could be targeted in interventions to reduce falls.
While improvements in healthcare have resulted in children with complex and life-threatening conditions living longer, a proportion of them still die. The death of a child puts parents at increased risk for anxiety, depression, and complicated grief. Increasing our understanding of the coping strategies that parents use under such extreme circumstances will enable us to best provide support to families, before and after a child's death. Our aim herein was to develop a theoretical framework of parental coping.
Evidence from the literature was employed to develop a theoretical framework to describe parental coping in the context of having a child with a life-limiting illness who is declining and facing eventual death.
The reasoning and argument consists of three guiding elements: (1) the importance of approach as well as avoidance (as coping strategies) in the context of managing the extreme emotions; (2) the importance of the social aspect of coping within a family, whereby parents cope for others as well as for themselves; and (3) the importance of a flexible and balanced coping profile, with parents using different coping strategies simultaneously. Central to the proposed framework is that effective coping, in terms of adjustment, is achieved by balancing coping strategies: accessing different coping strategies simultaneously or in parallel with a specific focus on (1) approach and avoidance and (2) coping aimed at self and others.
Significance of results:
Understanding of parental coping strategies is essential for health professionals in order to support parents effectively.
This study was twofold: 1) to assess parental reactions to childhood cancer throughout the oncological experience and 2) to explore associations between parents’ reactions during treatment and cancer-related distress at survival. A cross-sectional descriptive study collecting data (at survival) from retrospective (perceived social support, optimism, distress, coping in the worst situation) and current variables (general stress, distress regarding cancer, benefit finding) was carried out. Forty-one parents of childhood cancer survivors were assessed. High levels of distress (M = 9.5, SD = 1.32, range 4-10) and self-reported efforts to overcome difficulties occurring during the hospitalization (M = 7.48, SD = 3.01, range 0-10) were found. However, parents received high social support from very different sources. This could explain the satisfactory levels of optimism found (43.9% of the sample, M ≥ 16, range 9 – 24). Most parents reported to use engagement (M = 2.57, SD = 0.41, range 1-4) and help-seeking (M = 2.52, SD = 0.53, range 1-4) coping strategies to overcome difficulties. Some parents recognized to use psychological defenses when coping with the distress of cancer. However, this disengagement style was less preferred (M = 1.62, SD = 0.37, range 1-4). Finally, 22% of parents reported positive consequences and 60% reported positive and negative consequences too. When exploring how treatment experiences can influence cancer-related distress in survivorship, we observed that those who received less social support used more disengagement coping and referred higher efforts to overcome difficulties during treatment, displayed persistent distress at survival. These same parents showed higher scores on general stress. Besides, these results were not influenced by child’s sequelae at survival. These findings support the hypothesis that “the end of treatment is not the end”. Consequently, special attention should be placed in screening parents experiences throughout different milestones of cancer to design tailored interventions aimed at reducing persistent distress at survival.
Background: Hearing voices can be a common and distressing experience. Psychological treatment in the form of cognitive behavioural therapy for psychosis (CBTp) is effective, but is rarely available to patients. The barriers to increasing access include a lack of time for clinicians to deliver therapy. Emerging evidence suggests that CBTp delivered in brief forms can be effective and offer one solution to increasing access. Aims: We adapted an existing form of CBTp, coping strategy enhancement (CSE), to focus specifically on distressing voices in a brief format. This intervention was evaluated within an uncontrolled study conducted in routine clinical practice. Method: This was a service evaluation comparing pre–post outcomes in patients who had completed CSE over four sessions within a specialist out-patient service within NHS Mental Health Services. The primary outcome was the distress scale of the Psychotic Symptoms Rating Scale – Auditory Hallucinations (PSYRATS-AH). Results: Data were available from 101 patients who had completed therapy. A reduction approaching clinical importance was found on the PSYRATS distress scale post-therapy when compared with the baseline. Conclusions: The findings from this study suggest that CSE, as a focused and brief form of CBTp, can be effective in the treatment of distressing voices within routine clinical practice. Within the context of the limitations of this study, brief CSE may best be viewed as the beginning of a therapeutic conversation and a low-intensity intervention in a stepped approach to the treatment of distressing voices.
The literature about the care givers of patients with Disorders of Consciousness (DOCs) has highlighted the impact on both mental and physical dimensions of quality of life. This study aimed to: (1) describe emotional burden, quality of life, and coping styles in care givers of hospitalized patients with DOCs, compared to Italian normative data; (2) explore the relationships between these variables and their associations with socio-demographic features; and (3) describe their changes over time.
Fifteen care givers of patients with DOCs, mostly middle-aged women, were assessed using the Family Strain Questionnaire, the SF-36 Health Survey, and the Coping Orientation to Problems Experienced – Nuova Versione Italiana. Eleven subjects were also assessed after 6 and 12 months. Data were analysed through descriptive statistics, correlations, and nonparametric tests of group differences.
Compared to the Italian normative data, our sample showed a worse outcome in mental health, social functioning, global mental component, and emotional role functioning. Furthermore, subjects with high emotional burden had more thoughts of death compared to subjects with low emotional burden. Follow-up analyses revealed no variables changed over time.
These results highlight the need for psychological interventions and support, since care givers represent an important part of an all-embracing support and care network for patients with DOCs.