We developed a multidimensional coping inventory to assess the different ways in which people respond to stress. Five scales (of four items each) measure conceptually distinct aspects of problem-focused coping (active coping, planning, suppression of competing activities, restraint coping, seeking of instrumental social support); five scales measure aspects of what might be viewed as emotional-focused coping (seeking of emotional social support, positive reinterpretation, acceptance, denial, turning to religion); and three scales measure coping responses that arguably are less useful (focus on and venting of emotions, behavioral disengagement, mental disengagement). Study 1 reports the development of scale items. Study 2 reports correlations between the various coping scales and several theoretically relevant personality measures in an effort to provide preliminary information about the inventory's convergent and discriminant validity. Study 3 uses the inventory to assess coping responses among a group of undergraduates who were attempting to cope with a specific stressful episode. This study also allowed an initial examination of associations between dispositional and situational coping tendencies.

Assessing Coping Strategies: A Theoretically Based Approach

The learned helplessness hypothesis is criticized and reformulated. The old hypothesis, when applied to learned helplessness in humans, has two major problems: (a) It does not distinguish between cases in which outcomes are uncontrollable for all people and cases in which they are uncontrollable only for some people (univervsal vs. personal helplessness), and (b) it does not explain when helplessness is general and when specific, or when chronic and when acute. A reformulation based on a revision of attribution theory is proposed to resolve these inadequacies. According to the reformulation, once people perceive noncontingency, they attribute their helplessness to a cause. This cause can be stable or unstable, global or specific, and internal or external. The attribution chosen influences whether expectation of future helplessness will be chronic or acute, broad or narrow, and whether helplessness will lower self-esteem or not. The implications of this reformulation of human helplessness for the learned helplessness model of depression are outlined.

Learned Helplessness in Humans: Critique and Reformulation

Defining hope as a cognitive set that is composed of a reciprocally derived sense of successful (a) agency (goal-directed determination) and (b) pathways (planning of ways to meet goals), an individual-differences measure is developed. Studies demonstrate acceptable internal consistency and test-retest reliability, and the factor structure identifies the agency and pathways components of the Hope Scale. Convergent and discriminant validity are documented, along with evidence suggesting that Hope Scale scores augmented the prediction of goal-related activities and coping strategies beyond other self-report measures. Construct validational support is provided in regard to predicted goal-setting behaviors; moreover, the hypothesized goal appraisal processes that accompany the various levels of hope are corroborated.

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The will and the ways: development and validation of an individual-differences measure of hope.

Achievement goal researchers and theorists have relied primarily on the distinction between performance goals and mastery goals in differentiating competence-based strivings. In this article, an argument is made for incorporating the distinction between approach and avoidance motivation into the performance-mastery dichotomy. Historical, theoretical, and empirical reasons for attending to the approach-avoidance distinction are offered, and a revised, trichotomous framework of achievement goals comprising mastery, performance-approach, and performance-avoidance goals is described and reviewed. This trichotomous framework is discussed in the broader context of a hierarchical model of achievement motivation that attends to the motivational foundation underlying achievement goals per se. Avenues for further theoretical development are also overviewed, including consideration of a mastery-avoidance goal construct.

Approach and avoidance motivation and achievement goals

Cognitive and behavioral pain coping strategies were assessed by means of questionnaire in a sample of 61 chronic low back pain patients. Data analysis indicated that the questionnaire was internally reliable. While patients reported using a variety of coping strategies, certain strategies were used frequently whereas others were rarely used. Three factors: (a) Cognitive Coping and Suppression, (b) Helplessness, and (c) Diverting Attention or Praying, accounted for a large proportion of variance in questionnaire responses. These 3 factors were found to be predictive of measures of behavioral and emotional adjustment to chronic pain above and beyond what may be predicted on the basis of patient history variables (length of continuous pain, disability status, and number of pain surgeries) and the tendency of patients to somaticize. Each of the 3 coping factors was related to specific measures of adjustment to chronic pain.

The use of coping strategies in chronic low back pain patients: Relationship to patient characteristics and current adjustment

The study of stress and coping points to two concepts central to an understanding of the response to trauma: approach and avoidance. This pair of concepts refers to two basic modes of coping with stress. Approach and avoidance are simply metaphors for cognitive and emotional activity that is oriented either toward or away from threat. An approach-avoidance model of coping is presented in the context of contemporary theoretical ap- proaches to coping. The research literature on coping ef- fectiveness, including evidence from our laboratory, is dis- cussed, and speculations are made about the implications for future research. The study of stress and coping has become quite popular in recent years, particularly in regard to traumatic life events. Although the area is broad and the coping process is complex, there is a striking coherence in much of the literature. This coherence is based on two concepts central to an understanding of coping with trauma: approach and avoidance. In its simplest form, this pair of concepts refers to two basic orientations toward stressful infor- mation, or two basic modes of coping with stress. Ap- proach and avoidance are shorthand terms for the cog- nitive and emotional activity that is oriented either toward or away from threat. In this article we will present the case for utilizing the concepts of approach and avoidance to provide a co- herent theoretical structure to our understanding of cop- ing with stress. Several different formulations of the ap- proach-avoidance dimension will be reviewed, followed by a brief review of the coping effectiveness literature. Several studies from our laboratory will be used to illus- trate the relationship between coping and outcome. Fi- nally, a general approach-avoidance model of coping will be presented, with suggestions for further research to cor- roborate or extend the theory. The study of coping with stress has been split into two areas: anticipation of future stressful events and re- covery from trauma. These areas have been kept re- markably distinct in both theory and research on coping. Although there are clearly important differences between the two cases, we have chosen not to emphasize this dis- tinction. For any given stress, anticipation and recovery are not always clearly separable; dealing with a trauma involves coming to terms with the event itself and with the threat of recurrence in the future. More important, Correspondence concerning this article should be sent to Susan

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Approach, avoidance, and coping with stress.

Children and adults exposed to chronic interpersonal trauma consistently demonstrate psychological disturbances that are not captured in the posttraumatic stress disorder (PTSD) diagnosis. The DSM-IV (American Psychiatric Association, 1994) Field Trial studied 400 treatment-seeking traumatized individuals and 128 community residents and found that victims of prolonged interpersonal trauma, particularly trauma early in the life cycle, had a high incidence of problems with (a) regulation of affect and impulses, (b) memory and attention, (c) self-perception, (d) interpersonal relations, (e) somatization, and (f) systems of meaning. This raises important issues about the categorical versus the dimensional nature of posttraumatic stress, as well as the issue of comorbidity in PTSD. These data invite further exploration of what constitutes effective treatment of the full spectrum of posttraumatic psychopathology.

https://www.hartfocus.nl/UserFiles/Disorder%20of%20Extreme%20Stress%202005-1.pdf

Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma.

Background. In post-traumatic stress disorder (PTSD) there is a need for self-rating scales that are sensitive to treatment effects and have been tested in a broad range of trauma survivors. Separate measures of frequency and severity may also provide an advantage.Methods. Three hundred and fifty-three men and women completed the Davidson Trauma Scale (DTS), a 17-item scale measuring each DSM-IV symptom of PTSD on 5-point frequency and severity scales. These subjects comprised war veterans, survivors of rape or hurricane and a mixed trauma group participating in a clinical trial. Other scales were included as validity checks as follows: Global ratings, SCL-90-R, Eysenck Scale, Impact of Event Scale and Structured Clinical Interview for DSM-III-R.Results. The scale demonstrated good test–retest reliability (r = 0·86), internal consistency (r = 0·99). One main factor emerged for severity and a smaller one for intrusion. In PTSD diagnosed subjects, and the factor structure more closely resembled the traditional grouping of symptoms. Concurrent validity was obtained against the SCID, with a diagnostic accuracy of 83% at a DTS score of 40. Good convergent and divergent validity was obtained. The DTS showed predictive validity against response to treatment, as well as being sensitive to treatment effects.Conclusions. The DTS showed good reliability and validity, and offers promised as a scale which is particularly suited to assessing symptom severity, treatment outcome and in screening for the likely diagnosis of PTSD.

Assessment of a new self-rating scale for post-traumatic stress disorder

ObjectiveA century of clinical research has noted a range of trauma-related psychological problems that are not captured in the DSM-IV framework of posttraumatic stress disorder (PTSD). This study investigated the relationships between exposure to extreme stress, the emergence of PTSD, and symptoms

Dissociation, somatization, and affect dysregulation: the complexity of adaptation of trauma.

Two hundred thirty four participants in the DSM-IV Posttraumatic Stress Disorder (PTSD) Field Trial who reported sexual and/or physical abuse were evaluated. Participants were categorized according to type of abuse (physical, sexual, both), duration of abuse (acute versus chronic), and onset of abuse (early versus late). Separate logistic regression analyses examined the relationship between age of onset, duration, abuse type, and the complex PTSD (CP) lifetime diagnosis for women and men. Sexually abused women, especially those who also experienced physical abuse, had a higher risk of developing CP, although CP symptoms occurred at a high base rate among physically abused women. The theoretical implications and incremental clinical usefulness of targeting CP symptoms with abused populations are discussed.

Susan Roth

Papers

Approach, avoidance, and coping with stress.

Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma.

Assessment of a new self-rating scale for post-traumatic stress disorder

Dissociation, somatization, and affect dysregulation: the complexity of adaptation of trauma.

Complex PTSD in Victims Exposed to Sexual and Physical Abuse: Results from the DSM-IV Field Trial for Posttraumatic Stress Disorder