Carolyn M. Aldwin and Loriena A. Yancura Dept. of Human and Community Development University of California, Davis
Chapter prepared for P. P. Schnurr & B. L. Green (Eds.), Physical Health Consequences of Exposure to Extreme Stress. Washington, DC: American Psychological Association.
COPING AND HEALTH Even a cursory review of PsychLit reveals that well over 20,000 articles on stress and coping processes have been published in the past two decades (Aldwin, 1999). A smaller proportion of these has specifically examined how individuals cope with trauma. Due to differences between researchers in how trauma is defined, a definitive number is difficult to
determine. However, a search for the key words trauma and coping yielded 1,000 articles. Given the magnitude of this literature, we will not attempt to provide a full review. However, we will briefly outline the different theoretical and methodological approaches to coping (for more complete reviews see Aldwin, 1999; Lazarus, 2000; Parker & Endler, 1996; Schwarzer & Schwarzer, 1996). Then we will examine the similarities and differences between coping with general problems and coping with trauma. Finally, we will provide whether a brief review of the relationship between coping and health outcomes, and focus on whether coping strategies can affect both the psychological and physical outcomes of trauma.
THEORETICAL AND METHODOLOGICAL APPROACHES TO COPING There are four basic theoretical and methodological approaches to coping. Psychoanalytic approaches focus on the use of defense mechanisms, while personality approaches focus on coping styles. Both of these assume that adaptation is primarily a function of personal characteristics. In contrast, the coping process approach draws upon cognitive behavioral models, and is more likely to emphasize environmental demands and influences on coping. Coping process approaches tie the coping strategies to a particular stressful episode. Finally,
COPING AND HEALTH daily coping processes use experience sampling techniques to examine how individuals cope throughout the course of the day with a wide variety of problems.
Psychoanalytic Approaches Research on how individuals adapt grew out of early psychoanalytic studies of defense mechanisms, which are considered to be unconscious ways of warding off anxiety. DSM-IV (American Psychiatric Association, 1994) currently identifies seven major types of defense mechanisms, and orders them hierarchically from more to less severe. The most severe is defensive dysregulation, which refers to frankly psychotic processes involving projection, denial, and delusion. Action refers to acting out, passive aggression, or apathetic withdrawal, and major image-distorting mechanisms include autistic fantasy, projective identification, and splitting. The less severe or "immature" mechanisms include disavowal (denial, projection, and rationalization), minor image-distorting (devaluation, idealization, and omnipotence), and mental inhibitions (displacement, dissociation, intellectualization, repression, and the like). High adaptive or "mature@ defense mechanisms include altruism, humor, and sublimation, as well as suppression. Cramer (2000) compared the similarities and differences between defense mechanisms and coping processes. Defense mechanisms are unconscious, nonintentional, dispositional, hierarchical, and associated with pathology, while coping processes are conscious, used intentionally, situationally determined, nonhierarchical, and associated with normality. In other words, defense mechanisms are designated a priori as being more or less adaptive, and are not
COPING AND HEALTH
consciously chosen. Individuals nonetheless can be characterized by primary defensive styles or defense mechanisms that they are most likely to exhibit under a wide variety of circumstances. In contrast, coping processes are...