Coping Process

Chapter 4February 11, 2014

Clarification

• What is the difference between COPING and ADJUSTMENT?

Clarification

• COPING=>efforts to master, reduce, or tolerate demands created by “stress”

• ADJUSTMENT=>psychological processes through which people manage or cope with the demands and challenges of everyday life.

• The stress response (physiological) requires some behavior

Seesaw Metaphor

• Differently weighted bodies desire the pleasure of seesawing

0000 00 __________________________ ^Adjusting=decision on where to sitCoping=action of assuming position & riding

Overview of Coping

• When various needs are strong and persistent, we experience heightened arousal (stress)

• Meeting important needs tends to reduce stress levels, momentarily, back to optimal

• Coping is about restoration of homeostasis

Recall Maslow’s Hierarchy of Needs

• Physiological Needs=>Air, Water, Food, Temperature Regulation, Homeostasis (e.g., between rest and activity), (sex)

• Social Needs=>Affiliation, Intimacy, Family, (sex)

• Having met needs, through coping behaviors, we experience: Satisfaction, Fulfillment, Safety, Homeostasis

Figure 2.15 Maslow’s hierarchy of needs. According to Maslow, human needs are arranged in a hierarchy, and individuals must satisfy their basic needs first, before they progress to higher needs. In the diagram, higher levels in the pyramid represent progressively less basic needs. People progress upward in the hierarchy when lower needs are satisfied reasonably well, but they may regress back to lower levels if basic needs cease to be satisfied.

Needs=>Coping Behaviors=>Satisfaction

• Needs can be personality based

• Needs can vary in importance from time to time

• Needs can be related to need satisfaction in the past or imagined future

• Needs tend to be cyclical

• Needs are ever present through life

Coping Strategies of Limited Value

• Giving Up=>”learned helplessness”• Acting Aggressively=>cyber-bullying• Indulging Yourself=>booze, carbs, drugs, movies, internet addiction• Blaming Yourself=>negative self talk• Defensive Coping

Defensive Coping, fig. 4.3

• Defense Mechanisms for Coping: Denial of reality Fantasy Intellectualization Undoing Overcompensation

Constructive Coping, fig. 4.4

• Appraisal Focused -detecting & disputing negative self talk*Problem Focused -seek social support & impulse control time management, better assertiveness*Emotion Focused -releasing pent up emotions, exercise meditate

Rational-Emotive Behavior Therapy

Albert Ellis (1913-2007)=>

-altering one’s patterns of irrational thinking to reduce maladaptive emotions and behavior

-Catastrophic thinking=>unrealistic appraisals of stress that exaggerate the magnitude of one’s problems

Altering Client’s Patterns of Irrational Thinking

Ellis

A=>Activating event produces stressB=>Belief system=> negative thinking, catastrophic thinking, “musterbating”C=>Consequences of negative thinking results in emotional distress (anger, outrage, anxiety, depression)=> sympathetic ns overdrive=>coping strategies of limited value

Ellis: The roots of catastrophic thinking

• MUSTERBATING

-I must have acceptance and love from certain people -I must perform well in all endeavors -others must behave the way I believe -Events must go the way I like

Other roots of negative thinking

• Upbringing

• Life experiences

• Personality

• Inheritance

Problem-Focused Constructive Coping

• Clarify the problem=>break it down into simple components (ex., how many stressors do I have), prioritize, plan*Generate alternative course of action=> “plan A,” “plan B,” “plan C”*Evaluate alternatives and select a course of

action*Take action while maintaining flexibility

Emotion-Focused Constructive Coping

Emotional Intelligence=>the ability to perceive, regulate, use and express emotion (love, sadness, fear, anger, joy)

Forgiveness

Exercise

Meditation/Relaxation

Spirituality

Self-Actualized People Cope in Healthy Ways (fig 2.18)

• Clear perception of reality• Spontaneity, simplicity and naturalness• Problem centered (“PASSION”)• Detachment and need for privacy• Autonomy (avoid “herd” thinking only)• Continued freshness of appreciation• Mystical peak experiences• Feeling of kinship (one with human race)• Strong friendships (but limited in number)• Democratic character structure (egalitarian)• Ethical distinction between means and ends• Philosophical, non-hostile sense of humor• Balance between polarities in personality

Mindfulness and Coping, 3 minute meditation

http://www.youtube.com/watch?v=cDflnqo0TQs

• Meditation (10-20 min, 1x daily) 1. Breath Watching 2. Exhale Pause Watching: Inhale (“I”), Exhale (“AM”), Pause (Very..Relaxed..And..At..Peace.. Right..Now) 3. Mantra 4. Mind Watching (use monitoring words @ every 5 seconds like “image,” “words,” “quiet.”

RSA Breathing

Respiratory Sinus Arrhythmia

Inhale 3 seconds, exhale 7 (more PS)

Inhale 7 seconds, exhale 3 seconds (more S)

Inhale 5 seconds, exhale 5 seconds (maintenance)

Part 2

• Self-indugence as a way of coping

• Methods of reducing addictive behavior

Self-Indulgence is a common “coping” response to stress (Tice et al, 2001)

• Eating sweets and starches – rarely broccoli• Restricting food intake• Drinking alcohol• Getting high • Using other kinds of drug: opiates• Nicotine – smoking cigarettes, chewing• shopping• Gambling• Internet immersion

Forms of Internet addiction

• shopping• online sex• pornography• online gaming• online gambling• social networks

• Global pattern of Internet use (Davis, 2001) –global problem with addiction

Internet addiction

• Kimberly Young (1996, 1998):

• Internet addiction: spending an inordinate amount of time on the Internet and inability to control online use

• Used as a coping strategy – immerse oneself in online world

Signs of addiction: Young’s shortened Internet addiction test

• Do you feel preoccupied with the Internet (think about previous online activity or anticipate next online session)?

• Do you feel the need to use the Internet with increasing amounts of time in order to achieve satisfaction?

• Have you repeatedly made unsuccessful efforts to control, cut back, or stop Internet use?

• Do you feel restless, moody, depressed, or irritable when attempting to cut down or stop Internet use?

• Do you stay on-line longer than originally intended?

• Have you jeopardized or risked the loss of significant relationship, job, educational or career opportunity because of the Internet?

• Have you lied to family members, therapist, or others to conceal the extent of involvement with the Internet?

• Do you use the Internet as a way of escaping from problems or of relieving a dysphoric mood?

Addictive behaviors: how are they alike?• Do you feel preoccupied with __________________)?• Do you feel the need to use ________with increasing amounts of

time in order to achieve satisfaction?• Have you repeatedly made unsuccessful efforts to control, cut back,

or stop _____________use?• Do you feel restless, moody, depressed, or irritable when

attempting to cut down or stop __________ use?• Do you participate in ________ longer than originally intended?• Have you jeopardized or risked the loss of significant relationship,

job, educational or career opportunity because of_____________________?

• Have you lied to family members, therapist, or others to conceal the extent of involvement with_______________?

• Do you use _____________ as a way of escaping from problems or of relieving a dysphoric mood?

The Problematic and Risky Internet UseScreening Scale (PRIUSS)

for Adolescents and Young Adults

• May affect between 4 15% of adolescents and‐ young adults

• Average score of average users: 14 +/- 9.6 (1 S.D.)

• Average score of at-risk users: 21 +/- 12.1 (1 S.D.)

• If use <= 6 hours per day =average• If use > 6 hours per day = high risk

In the news: almost recognized as a real addiction

Video clip:

http://www.youtube.com/watch?v=wtA-AmrbX4Q

-DSM 5: Both sex and Internet addictions are included in appendix

-Internet has no boundaries-like gambling you are looking for the

“hit” – the video or message that will be exciting/interesting -will power gets exhausted-suggests limiting time on Internet

Signs of Internet addiction

• sense of being out of control with time expended

• anxious, depressed or empty when not online use is so excessive it interferes with work, school, home life – disruption of time

• dysfunctional use leads to secrecy and hiding dependence

Lauren Jelenchick, MPH CandidateAdolescent Health Research Team, Department of

Pediatrics, Univ. of Wisconsin, Madison

Factor 1 – Social Consequences• Problems with communicating face to face • Experience increased social anxiety • Fail to create real-life relationships • Offline relationships suffer • Choose to socialize online instead of in-person • Skip out on social events

Lauren Jelenchick (2012, 2013)

Factor 2 – Emotional Consequences• Feel anxious when away from internet • Feel irritated when not using the internet • Experience feelings of withdrawal when not

using the internet• Feel angry when away from the internet • Feel vulnerable when the internet isn't

available

Lauren Jelenchick (2012, 2013)

Factor 3 – Risky and Impulsive Internet Use

• Allow time on the internet to negatively affect your school performance

• Lose motivation to do other things that need to get done • Neglect responsibilities • Avoid other activities in order to stay online • Put internet use in front of important, everyday activities • Lose sleep due to nighttime internet use • Use the internet excessively

In the news: almost recognized as a real addiction

Video clip: In 2008, China began to list Internet addiction as a clinical diagnosis category

http://www.youtube.com/watch?v=jqctG3NnDa0

China’s Web Junkies 1:30-7:00 minutesInternet Addiction Treatment Center near Beijing

-DSM 5: Both sex and Internet addictions are included in appendix-Internet has no boundaries-like gambling you are looking for the

“hit” – the video or message that will be exciting/interesting -will power gets exhausted-suggests limiting time on Internet

China’s Web Junkies (New York Times 1/14)

youtube commentary:”this is completely retarded treating people like this, just limit their usage, learn how to set the router for limited use. The only thing you accomplish by doing this to your children is turning them into mental cases”

Problem-focused constructive coping: reducing addictive behaviors

The process of change: problem =>motivation to change =>method of change

Problems are there to be solved.

4 steps in systematic problem solving• “Systematic Problem Solving” is a step-by-

step technique for tackling problems (pp. 113 in text)1. clarify the problem – often people do not

know what, exactly, is causing stress.2. generate alternative courses of action –

use “brainstorming” to generate ideas.3. evaluate your alternatives and select a

course of action.4. take action while maintaining flexibility

Chapt. 4: Coping and hoping to change

• Most people with stress and coping problems know they need to change but…………..

• most people don’t change, e.g., Internet addiction,

eating disorders, alcohol anddrug dependency, procrastination, poor time management, etc.

• Why not?

• inspirations and barriers to change

Why not change if person admits there is a problem?

When addicted/dependent - motivation to change varies

Person:• may be perceive self to be weak and incapable• usually ambivalent – pros and cons• sees recovery or change as a distant dream or

fantasy• motivation fluctuates

3 methods of reducing addictive behavior

• Contingency management: one of largest effect sizes with addictions=>based on behavior therapies

• Motivational interviewing

• CBT =>cognitive behavior therapy

Motivational interviewing

What can we do to increase motivation to change and improve coping?

2 ways to increase motivation:1. Increase internal motivation2. Focus on the positives for staying

the same

five types of motivation: Self-Determination Theory (Vansteenkiste et al, 2005)

Type of moti-vation

amotivation external motivation

introjected motivation

identifiedmotivation

intrinsic motivation

Motiva- tionalForce

discourage-ment and helpless-ness

expectations/rewards/punishmentsfrom others & environment

guilt, shame, guilt-inducing internal pressures

personal values/Commit-ment

enjoyment, pleasure, interest, satisfying, fun

Locus of causality

impersonal external external internal internal

Motivation to give up internet addiction or alcohol?

Intrinsic motivation?

Identified motivation (personal values)?

Introjected (from someone else) motivation?

External motivation? (Expect reward or punishment from outside self)

Decisional balance sheet applied to addiction (Miller and Rollnick, 2002)

Positives for staying the same

Negatives of change

Negatives for staying the same

Positives of change

It is the positives for staying the same that keep

people stuck

Young’s solution: Cognitive Behavior Therapy (CBT)

CBT is effective treatment for compulsive disorders

Thoughts• monitor thoughts • identify trigger thoughts: “Life is unfair to me.”• learn to respond with new coping skills: Behavior establish baseline of compulsive behaviors moderate/eliminate dysfunctional behaviors enhance non-online computer life (social,

occupational)

Optional slides about applying decisional balance sheet to eating disorders

Motivating people: pros and consexample - pros and cons of eating disorders

(Gale et al, 2006)

Goal: acknowledge, with patient, ways in which eating disorders are either adaptive (friend) or problematic (enemy)

How are ED’s adaptive?

• In the Gale study (roughly 200 Ss) , the more the pros endorsed and the fewer the cons or negatives endorsed the more positively people feel about remaining with ED

Decisional balance sheet (Miller and Rollnick, 2002)

Positives for staying the same: weight management skill to

feel good about

Negatives of change: possible weight gain

Negatives for staying the same: continued bone loss

Positives of change: more time spent on other activities

It is the positives for staying the same that keep

people stuck

pros for anorexia (Gale et al, 2006)

safe and structured:-makes me feel safe -gives structure to my life-helps keep control-organizes world-gives purpose

-feel protected-secure-get me through life-dependable/consistent

skill/special:-something I am good at-ED a skill- in ED, I am an expert-I can do at least one thing

better than others-lifts me up above others