Prospective Study of the Effectiveness of Coping in Pediatric Patients

Findings about the influence of coping on psychological adjustment in children with different medical conditions are inconsistent and often based on cross-sectional data. This prospective study evaluated the effect of various coping strategies on children’s post-traumatic stress symptoms and behavioral problems 1 month and 1 year after an accidental injury or the diagnosis of a chronic disease in 161 pediatric patients 6–15 years of age. Only minor positive effects of coping on psychosocial adjustment were found: Religious coping reduced post-traumatic stress symptoms. Active coping strategies had negative effects on internalizing and externalizing behavioral problems. Support seeking strategies, distraction, and avoidance had no impact on long-term psychosocial adjustment     

Cognitive coping strategies and symptoms of depression and anxiety: a comparison between adolescents and adults

The present study focused on comparability of adolescents and adults in the reporting of cognitive coping strategies and their relationship to symptoms of depression and anxiety. Two samples were included: 487 adolescents attending a secondary school and 630 adults from a general practitioners practice. Data were obtained on symptoms of depression and anxiety and the use of nine cognitive coping strategies: acceptance, catastrophizing, other-blame, positive reappraisal, putting into perspective, refocus on planning, positive refocusing, rumination and self-blame.The results showed that all cognitive coping strategies were reported by adolescents to a significantly lesser extent than by adults. Further, it was shown that both in adolescents and adults a considerable percentage of the variance in symptomatology was explained by the use of cognitive coping strategies. Although adolescents and adults differed in relative strength of the relationships, generally speaking, conclusions were the same: in both groups, the cognitive coping strategies self-blame, rumination, catastrophizing and positive reappraisal were shown to play the most important role in the reporting of symptoms of psychopathology, showing the importance of introducing prevention and intervention programmes at an early stage.     

Coping strategies in twins with chronic fatigue and chronic fatigue syndrome

Objectives: Individuals with chronic fatigue and chronic fatigue syndrome (CFS) face debilitating symptoms as well as stressful life situations that may result from their condition. The goal of this study was to examine the coping strategies used by fatigue-discordant twin pairs. Methods: We utilized a co-twin design to assess how twin pairs discordant for chronic fatigue and CFS cope with stress. All twin pairs were administered the Revised Ways of Coping Checklist. Results: Overall, the pattern of coping strategies was similar for fatigued and non-fatigued twins. However, twins with chronic fatigue or CFS utilized more avoidance strategies than their non-fatigued counterparts; those with chronic fatigue also used more avoidance relative to problem-focused coping than their co-twins. Conclusions: These results suggest that while fatigue-discordant twins generally exhibit similar behavior patterns in order to cope with stress, there may be an association between fatigue and avoidance coping. Future research should focus on the role of avoidance and its relationship to fatiguing illnesses.     

Adolescent Humor and its Relationship to Coping,Defense Strategies,Psychological Distress,and Well-Being

Objective This study investigated the psychometric properties of the Humor Styles Questionnaire (HSQ) in measuring adolescent humor, including the relationship between humor and coping style, defense style, depressive symptoms, and adjustment in a non-clinical sample of adolescents. Method Humor, coping, defense strategies, depressive symptoms, and adjustment were investigated in 94 adolescents aged 12–15. Results The HSQ demonstrated adequate internal consistency. Inter-scale correlational patterns and scale means were similar for adolescents and adults. Convergent validity for the HSQ was supported by its relationship to: an adolescent-standardized humor defense scale; coping and defense strategies; and depressive symptoms and adjustment. Clinical utility of the HSQ was demonstrated by its unique contribution in predicting both depressive symptoms and adjustment above and beyond contributions from coping and defense composites. Discussion The HSQ appears to be a psychometrically sound and clinically useful measure to assess humor dimensions in adolescents.     

Clinical and Developmental Perspectives on Adolescent Coping

Although the development of appropriate coping strategies has been understood as an essential element of healthy adjustment, few studies have demonstrated the link between coping and psychological development. Similarly, research on adolescents with behavioral problems has neglected coping as an important variable in understanding and treating these conditions. This study examines the relationships between psychological development, coping strategies and symptoms in a sample of 302 psychiatrically hospitalized adolescents, ages 12–16. Subjects completed the Adolescent Coping Orientation for Problem Strategies Questionnaire, (A-COPE), the Youth Self Report symptom checklist (YSR), and Loevinger's measure of ego development. Results showed that Avoidance and Ventilation were associated with increased behavior problems and lower levels of ego development. Problem solving and interpersonal strategies were associated with fewer symptoms and higher levels of development. Significant gender differences were found with girls using more interpersonal coping and boys using more physically active strategies. Gender differences were also found in the relationship of coping strategies to both symptomatic behavior and development. The results are discussed in the context of a developmental approach to adolescent psychopathology.     

Cognitive-behavioral treatment of persistent functional somatic complaints and pediatric anxiety: an initial controlled trial

Background: Children and adolescents who seek medical treatment for persistent physical distress often suffer from co‐occurring anxiety disorders. Treatment options for this impaired population are limited. This study tests the feasibility and potential efficacy of a cognitive‐behavioral intervention targeting pain and anxiety for youth with impairing functional physical symptoms and anxiety disorders presenting to pediatricians for medical care. Methods: Children and adolescents (aged 8–16) experiencing somatic complaints, without an explanatory medical disorder (i.e., functional), were recruited from primary care and specialty (gastroenterologists and cardiologists) pediatricians. Forty children, primarily with gastrointestinal symptoms, who met criteria for a co‐occurring anxiety disorder, were randomly assigned to a cognitive‐behavioral treatment addressing pain and anxiety, Treatment of Anxiety and Physical Symptoms (TAPS), or to a waiting list control. Results: TAPS was found to be an acceptable treatment for this population and was superior to the waiting list condition. Eighty percent of children in TAPS were rated as treatment responders by independent evaluators compared with none of the controls. Overall, self‐ and parent ratings indicated reductions in children's somatic discomfort and anxiety following intervention. TAPS participants maintained clinical gains 3 months following treatment. Conclusions: The study supports the feasibility and preliminary efficacy of a cognitive‐behavioral intervention targeting co‐occurring physical distress and anxiety in youth presenting for medical treatment. Such an approach has the potential to exert broad impact on children's dysfunction and to minimize exposure to invasive, ineffective, and costly medical procedures and treatments. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

Bully victimization and emotional problems in adolescents: Moderation by specific cognitive coping strategies?

Objective

Relationships between bully victimization and symptoms of depression/anxiety were examined. In addition, it was studied whether this relationship was moderated by specific cognitive coping strategies.

Methods

Participants were 582 secondary school students who filled out online self-report questionnaires on bully victimization, cognitive coping, and depression/anxiety. (Moderated) Multiple Regression analysis was performed.

Results

Strong relationships were found between bully victimization and symptoms of depression and anxiety. On top of that, two cognitive coping strategies moderated the relationship between bullying and depression, i.e. rumination (strengthening) and positive refocusing (reducing). Cognitive coping strategies that moderated the effect of bullying on anxiety symptoms were rumination, catastrophizing (strengthening) and positive reappraisal (reducing).

Conclusion

The results provide possible targets for intervention: when helping adolescents who have been bullied, maladaptive cognitive coping strategies could be assessed and challenged, while more adaptive strategies could be acquired.     

Results of an Italian school-based expressive writing intervention trial focused on peer problems

This study investigated the effectiveness of an expressive writing intervention in a sample of Italian early adolescents on internalizing and post-traumatic stress symptoms and coping strategies. Participants were 153 Italian adolescents (48% male), attending 7th grade (M = 12.24 yrs, SD = 0.47). Youth were randomly assigned either to write about personal emotional events related to problems they recently experienced with peers, or trivial topics. Data were collected before and 2 months following the intervention. Analyses revealed no overall intervention effects on symptoms. However, level of peer victimization moderated the effects of the intervention on coping strategies, such that victimized youth in the intervention showed increases in cognitive restructuring and avoidance coping, relative to other groups. Thus, expressive writing affected coping strategies but not internalizing problems in our early adolescent sample.     

The role of coping strategies in predicting change in parenting efficacy and depressive symptoms among mothers of adolescents with developmental disabilities

Background Parents of children with developmental disabilities (DD) face greater caregiving demands than parents of children without DD. There is considerable variability in parents' adjustment to raising a child with DD, however. In line with a strengths‐based approach, this study explores coping strategies as potential mechanisms of resilience among mothers of adolescents with DD. This study examines the frequency with which mothers use various coping strategies and the extent to which those strategies moderate the relationship between adolescent behaviour problems and aspects of maternal well‐being. Both positive and negative dimensions of well‐being are explored, with maternal depressive symptoms and perceived parenting efficacy examined as outcomes cross‐sectionally and longitudinally. Methods The present study focuses on 92 mothers and their adolescents with DD. The adolescents had a wide range of diagnoses, all with continuing special needs. Data were collected from mothers through interviews and self‐administered questionnaires when their adolescents were aged 15 and aged 18. A structured assessment of the adolescent was completed during home visits at age 15. Results Mothers reported frequently using strategies of denial and planning but rarely using strategies of mental and behavioural disengagement to cope with recent stressful situations. Adolescent behaviour problems were found to contribute to greater symptoms of depression and lower feelings of parenting efficacy as well as increases in depressive symptoms over time. Mothers of sons, but not daughters, reported increases in parenting efficacy across their child's adolescent period. Above and beyond adolescent factors, several coping strategies emerged as significant predictors of mothers' symptoms of depression and perceived parenting efficacy. Moreover, use of Active Coping/Planning, Positive Reinterpretation/Growth, and Behavioural/Mental Disengagement as coping strategies moderated the impact of adolescent behaviour problems on maternal depressive symptoms. Conclusions This study extends previous findings by focusing on both positive and negative dimensions of parent well‐being during their child's adolescent period. Adolescence can be a stressful time for parents, with typical developmental tasks entailing additional strains for parents of adolescents with DD. The present findings point to several coping strategies that may reduce the impact of challenging behaviours during this period on mothers' symptoms of depression and feelings of parenting efficacy. Certain coping strategies were found to exert a greater impact on maternal well‐being for parents of adolescents with higher levels of behaviour problems, suggesting that interventions may benefit from an increased focus on this group of mothers with heightened caregiving demands.     

Coping strategies and behavioral/emotional problems among Chinese adolescents

This study was carried out to describe strategies used to cope with stress and to explore the association between coping strategies and behavioral/emotional problems in a community sample of adolescents from Mainland China. Participants completed a self-administered questionnaire incorporating the Chinese Trait Coping Style Questionnaire, the Chinese version of the Youth Self-Report of Child Behavior Checklist, and a number of demographic questions. Results indicated that Chinese adolescents often used multiple coping strategies when faced with stress. Principal factor analysis followed by oblique rotation revealed two dimensions of coping strategies in Chinese adolescents: active coping and avoidant coping. A series of logistic regression analyses showed that avoidant coping was significantly associated with increased risk for internalizing and externalizing problems, but active coping was associated with reduced risk, after adjustment for child's age and sex and father's occupation. These findings provide evidence of the association between coping and mental health problems in Chinese adolescents.     

Gender and developmental effects on perceived stress, coping, somatic symptoms and psychological disorders among children and adolescents

The aim of this one-year longitudinal study was to investigate gender and developmental effects on perceived stress related to interpersonal stressors, coping strategies, somatic symptoms and psychological disorders. Additionally, associations of perceived stress and coping styles at the first assessment with psychological problems at the second measurement were examined. In total, N = 169 Austrian children and adolescents (ages 10 to 13 years) participated in this self-report study. Compared to male children and adolescents, female counterparts scored higher on perceived stress related to interpersonal stressors and on social support but evaluated a lower amount of distraction. Moreover, girls reported higher levels of somatic symptoms and anxiety/depression. Boys showed a developmental increase in anger control problems and both genders showed developmental increases in antisocial behavior. Low levels of the emotion-focused coping strategies distraction and minimization were related longitudinally to emotional and behavioral disorders. The results support gender-adjusted stress management programs applied in the primary and secondary prevention.     

Cognitive coping and depressive symptoms in the elderly: a longitudinal study

The objective of the present longitudinal study was to examine the relationship between cognitive coping strategies and depressive symptoms at old age. At the two and a half year follow-up study, a community sample of 99 people aged 67 years and older filled out a self-report questionnaire comprising the Geriatric Depression Scale, the Cognitive Emotion Regulation Questionnaire and a negative life events checklist. Cognitive coping strategies seemed to play an important role in relation to depressive symptoms in late life. Elderly persons with more depressive symptoms reported to use acceptance, rumination and catastrophizing to a significantly higher extent and positive reappraisal to a significantly lower extent than those with lower depression scores. After controlling for negative life events and prior depressive symptoms, acceptance and positive reappraisal retained their significant relationship with current depressive symptoms. It is suggested that intervention programs should pay attention to these aspects by challenging the 'maladaptive' strategies, and by supplying the more 'adaptive' strategies. This could be linked to the well-established cognitive therapies.     

Cognitive coping in anxiety-disordered adolescents

The present study investigated differences in cognitive coping strategies between anxiety-disordered and non-anxious adolescents. In addition, the interaction effect with gender as well as differences between specific anxiety diagnoses was examined. A clinical sample of 159 anxiety-disordered adolescents and a general community sample of 370 non-anxious adolescents were recruited. Nine cognitive coping strategies were assessed in all adolescents (aged 12-16 years). Results showed that anxiety-disordered adolescents had significantly higher scores on most of the cognitive coping strategies than non-anxious adolescents. The cognitive coping strategies rumination, self-blame and catastrophizing accounted for most of the variance. Gender did not modify the results. Further analyses within the anxiety-disordered sample indicated that adolescents with a generalized anxiety disorder scored significantly higher on rumination, but not on other cognitive coping strategies, than social phobic adolescents. The results suggest that cognitive coping is a valuable target for psychological assessment and treatment in adolescents.     

Coping strategies used by adolescents in dealing with family relocation overseas.

This study investigated: (a) the types of coping strategies adolescents commonly employ in response to family relocation overseas; and (b) whether sex, age, self-concept, behavioral adjustment, and previous history of moves affect the types of strategies used by these sojourners. For this purpose, we selected a widely used model of coping which distinguishes between approach and avoidance strategies and a sample of teenagers whose families had recently relocated in Belgium. Four assessment instruments were utilized: the Background Information Data Sheet, the Stress Response Scale, the Piers-Harris Children's Self-Concept Scale, and the Coping Responses Inventory--Youth Form. Results indicated that adolescent sojourners selected both approach and avoidance strategies to cope with family relocation overseas. Correlational analyses further showed that females and older teenagers tended to rely significantly more on approach strategies than on avoidance strategies. Self-concept and behavioral adjustment were also found to be related to the type coping strategies employed, while the history of previous relocation was not.     

Coping styles as moderating the relationships between terrorist attacks and well-being outcomes

This study aims to explore use of coping strategies among adolescents and their relationships with well being in the context of ongoing terrorism. Furthermore, we aim to explore to what extent coping styles in addition to exposure variables explain well being of adolescents facing ongoing terror. During September 2003, after three years of ongoing terror attacks, 913 Israeli adolescents aged 12-18 years, completed the following questionnaires during regular class sessions: Demographics, Achenbach's Youth Self Report; Exposure to Terror and Post Traumatic Stress (PTS) questionnaire; Adolescent Coping Scale (ACS) and Brief Symptoms Inventory. Adolescents employed mainly problem solving strategies which mean they have the capacity to cope well in spite of stressful events. Emotional focused coping was associated with PTS and mental health problems. Regression analysis of different exposure and coping variables revealed that exposure, appraisal (subjective exposure) and coping styles explained 26-37% of the variance of different psychological problems. The findings highlight the importance of appraisal (subjective exposure) and coping strategies, for understanding adolescents' mental health outcomes. Moreover, these findings are relevant to the development of prevention/intervention programs that facilitate youth's cognitive and emotional adjustments to ongoing trauma risks and terror threats.     

A controlled trial of the SibworkS group program for siblings of children with special needs

Siblings of children with a disability are an at risk group for emotional and behavioral problems. This study evaluated an intervention to promote the emotional and behavioral functioning of siblings of children with disabilities and chronic health conditions. SibworkS is a six-week manual-based, cognitive–behavioral group support program focussed on strengthening siblings’ perceived social support, self-esteem, problem-solving skills, adaptive coping behaviors and positive sibling relationships. Fifty-six children aged 7–12 were allocated to either the SibworkS program (n = 30) or waitlist control (n = 26) in alternating sequence. The primary outcome was siblings’ emotional and behavioral functioning. Additional outcomes were self-esteem, perceived social support, the sibling relationship and coping behaviors. Siblings were followed-up immediately after the intervention and at 3-months. Siblings participating in the SibworkS intervention were reported to have fewer emotional and behavioral difficulties than siblings in the control group immediately following the intervention and at the 3-month follow-up. Participation in SibworkS was associated with fewer emotional and behavioral difficulties for siblings. Implications for practice and future research include recommendations for improving program participation.     

Assessing the Implementation and Effects of a Trauma-Focused Intervention for Youths in Residential Treatment

This paper describes methods being used to implement and assess the effects of a trauma-focused intervention in residential treatment programs for youths with emotional and behavioral problems, and histories of maltreatment and exposure to family or community violence. Preliminary baseline profiles of the therapeutic environments and youths are also presented. The intervention, referred to as the Sanctuary Model® (Bloom, 1997), is based in social psychiatry, trauma theories, therapeutic community philosophy, and cognitive-behavioral approaches. Within the context of safe, supportive, stable, and socially responsible therapeutic communities, a trauma recovery treatment framework is used to teach youths effective adaptation and coping skills to replace nonadaptive cognitive, social, and behavioral strategies that may have emerged earlier as means of coping with traumatic life experiences.     

The effect of coping on the caregiver of elderly patients with dementia

Abstract Ninety-eight caregivers of elderly patients with cognitive impairment were surveyed by questionnaires in order to examine the relationship between their coping strategies and subjective burden. Confrontative coping and avoidance coping were significantly associated with their burden. The severity of cognitive impairment and the behavioral problems of the patients were also significantly associated with the caregivers' burden. However, a multiple regression analysis suggested that the caregivers' coping strategies may be more important than the patients' condition in terms of the effects on the burden.     

The behavioral and emotional correlates of epilepsy in adolescence: a 7-year follow-up study

This 7-year follow-up study examined the behavioral and emotional adjustment of 29 adolescents who experienced regular moderate seizures during middle childhood. Compared with national nonreferred norms on Achenbach checklists, both mothers and adolescents reported clinically significant difficulties in multiple areas regardless of current seizure status. Adolescents who currently experience regular seizures (N=10) reported no differences on psychological outcomes compared with nonseizing counterparts; in contrast, current seizure status was a strong predictor of mother-reported externalizing problems. Hierarchical regression analyses indicated that feelings about having or having had a seizure disorder and mother-adolescent relationship factors were significant predictors of current adjustment over and above current seizure status. Early mother-child relationship process variables and early medical risk were not associated with current adolescent outcomes. The findings are discussed in terms of the multidetermined nature of psychological adjustment to chronic medical illness and factors that may produce versus maintain behavioral and emotional problems in children and adolescents with seizure disorders.     

Biopsychosocial issues and risk factors in the family when the child has a chronic illness

Between 10 and 20 million American children and adolescents have some type of chronic health condition or impairment. There has been a recent interest in the psychological aspects--emotional and behavioral--of chronic illness in children and adolescents. Major new areas of science, such as behavioral medicine, have emerged to address the research and clinical demands of this field. Several studies already have demonstrated the increased risk for psychiatric problems in children with chronic health conditions to be three to four times greater than their healthy peers. The proposed perspective shifts from a traditional sole reliance on medical diagnosis to a focus more on the dimensions of adjustment, socioeconomic status, visibility of condition, social support, and family functioning.