More adaptive versus less maladaptive coping: What is more predictive of symptom severity? Development of a new scale to investigate coping profiles across different psychopathological syndromes

Psychological distress and self-reported mental disorders: the partially mediating role of coping strategies

BACKGROUND AND OBJECTIVES

Accumulating evidence suggests a substantial prevalence of mental health disorders worldwide and the association between psychological distress and mental disorders. However, the mechanisms underlying this association are underexplored. Using longitudinal data, this study examined coping strategies as a potential mechanism.

METHODS

Participants (N = 2,333) from the Midlife in the United States (MIDUS) completed psychosocial and mental health surveys over 19 years. A parallel mediation model was used to test the direct association between psychological distress (baseline) and self-reported mental disorders (17-19 years follow-up) and the indirect associations via coping strategies (8-11 years follow-up), controlling for demographics and baseline self-reported mental disorders.

RESULTS

Psychological distress predicted an increased likelihood of mental disorders later in life. Emotion-focused coping was a significant mediator of this association, but problem-focused coping was not. Psychological distress was positively associated with emotion-focused coping, and emotion-focused coping was positively associated with mental disorders. Psychological distress was negatively associated with problem-focused coping; however, no association was found between problem-focused coping and mental disorders.

CONCLUSIONS

Findings provide further support for the longitudinal association between psychological distress and mental health disorders and extend prior research by showing the partial mediating role of emotion-focused coping in this association.

A mouse model of the 3-hit effects of stress: Genotype controls the effects of life adversities in females

Helplessness is a dysfunctional coping response to stressors associated with different psychiatric conditions. The present study tested the hypothesis that early and adult adversities cumulate to produce helplessness depending on the genotype (3-hit hypothesis of psychopathology). To this aim, we evaluated whether Chronic Unpredictable Stress (CUS) differently affected coping and mesoaccumbens dopamine (DA) responses to stress challenge by adult mice of the C57BL/6J (B6) and DBA/2J (D2) inbred strains depending on early life experience (Repeated Cross Fostering, RCF). Three weeks of CUS increased the helplessness expressed in the Forced Swimming Test (FST) and the Tail Suspension Test by RCF-exposed female mice of the D2 strain. Moreover, female D2 mice with both RCF and CUS experiences showed inhibition of the stress-induced extracellular DA outflow in the Nucleus Accumbens, as measured by in vivo microdialysis, during and after FST. RCF-exposed B6 mice, instead, showed reduced helplessness and increased mesoaccumbens DA release. The present results support genotype-dependent additive effects of early experiences and adult adversities on behavioral and neural responses to stress by female mice. To our knowledge, this is the first report of a 3-hit effect in an animal model. Finally, the comparative analyses of behavioral and neural phenotypes expressed by B6 and D2 mice suggest some translationally relevant hypotheses of genetic risk factors for psychiatric disorders.

The development of compulsive coping behavior depends on dorsolateral striatum dopamine-dependent mechanisms

Humans greatly differ in how they cope with stress, a natural behavior learnt through negative reinforcement. Some individuals engage in displacement activities, others in exercise or comfort eating, and others still in alcohol use. Across species, adjunctive behaviors, such as polydipsic drinking, are used as a form of displacement activity that reduces stress. Some individuals, in particular those that use alcohol to self-medicate, tend to lose control over such coping behaviors, which become excessive and compulsive. However, the psychological and neural mechanisms underlying this individual vulnerability have not been elucidated. Here we tested the hypothesis that the development of compulsive adjunctive behaviors stems from the functional engagement of the dorsolateral striatum (DLS) dopamine-dependent habit system after a prolonged history of adjunctive responding. We measured in longitudinal studies in male Sprague Dawley rats the sensitivity of early established vs compulsive polydipsic water or alcohol drinking to a bilateral infusion into the anterior DLS (aDLS) of the dopamine receptor antagonist α-flupentixol. While most rats acquired a polydipsic drinking response with water, others only did so with alcohol. Whether drinking water or alcohol, the acquisition of this coping response was insensitive to aDLS dopamine receptor blockade. In contrast, after prolonged experience, adjunctive drinking became dependent on aDLS dopamine at a time when it was compulsive in vulnerable individuals. These data suggest that habits may develop out of negative reinforcement and that the engagement of their underlying striatal system is necessary for the manifestation of compulsive adjunctive behaviors.

Predictors and Functional Outcomes Associated With Longitudinal Trajectories of Anxiety and Depression from 2 to ≥36 Months After Moderate to Severe Traumatic Brain Injury

This study investigated longitudinal trajectories of anxiety and depressive symptoms following moderate-severe traumatic brain injury (TBI), predictors of the trajectories, and associations with 1-year return to productivity. One hundred forty-eight patients with moderate-severe TBI were assessed at 2, 5, 12, and ≥36 months post-injury on the Beck Anxiety Inventory and the Beck Depression Inventory. Clinical interviews obtained information about demographics, injury characteristics, and 1-year return to productivity. Latent growth mixture modeling identified trajectories of anxiety and depression across time. The three-step method identified predictors of trajectories, and χ2 analyses determined associations between trajectories and 1-year return to productivity. Analyses revealed that four-class models of anxiety and depression best fit the data. Most individuals had stable minimal (67%) or low (18%) levels of anxiety over time. Two other subsets of individuals were classified by anxiety that worsened rapidly (7%) or improved in the 1st year but worsened by 3 years post-injury (9%). Similarly for the depression trajectories, most individuals had stable minimal (70%) or low (10%) levels of depression over time. Others had depression that worsened rapidly (12%) or was delayed, with onset 1-year post-injury (8%). Predictors of worsening anxiety and depression included younger age, less education, and male gender. Those with worsening anxiety or depression were less likely to return to productivity by 1-year post-injury. There is a significant burden of anxiety (15%) and depression (20%) in the 3 years after moderate-severe TBI. Future research targeting at-risk patients may help to improve quality of life and functional recovery.

Factors Influencing Farmers' Use of Adaptive and Maladaptive Coping Strategies

OBJECTIVES

Chronic stress is associated with a variety of negative outcomes for farmers in the United States (U.S) and worldwide, who face near-constant exposure to internal (e.g. family conflict) and external (e.g. weather) stressors. Research indicates that farmers' stress may be reduced by engaging in adaptive coping strategies and avoiding maladaptive coping strategies. However, little is known about what predicts their coping strategy use. Informed by the transactional theory of stress and coping, the present manuscript seeks to identify factors associated with U.S. farmers' use of adaptive and maladaptive coping strategies.

METHODS

U.S. farmers (N = 135) completed survey assessments of factors theorized to be associated with coping strategy choice (maladaptive beliefs about farm stress management, farm stress management self-efficacy, age, and sex) as well as measures of adaptive and maladaptive coping.

RESULTS

Farm stress management self-efficacy was a significant, positive predictor of adaptive coping, and maladaptive beliefs about farm stress management were a significant, positive predictor of maladaptive coping. Maladaptive beliefs about farm stress management and farm stress management self-efficacy interacted to predict maladaptive coping, such that the positive relationship between maladaptive beliefs about farm stress management and maladaptive coping was significant at higher levels of self-efficacy. Sex was unrelated to coping strategies, and age was negatively associated with maladaptive coping strategies but unassociated with adaptive coping strategies.

CONCLUSION

The findings point to the utility of increasing farm stress self-management self-efficacy to increase farmers' adaptive coping and reducing maladaptive beliefs about farm stress management to reduce maladaptive coping. Efforts to promote adaptive coping by increasing self-efficacy should also target maladaptive beliefs farmers hold toward stress management, because increasing self-efficacy may also increase the likelihood of maladaptive coping when maladaptive beliefs are present.

The Prospective Effects of Coping Strategies on Mental Health and Resilience at Five Months after HSCT

OBJECTIVES

Hematopoietic stem cell transplantation (HSCT) is a stressful event that engenders psychological distress. This study examines the prospective effects of coping strategies during hospitalization on resilience and on various mental-health dimensions at five months after transplantation.

METHODS

One hundred and seventy patients (M_age = 52.24, SD = 13.25) completed a questionnaire assessing adjustment strategies during hospitalization, and 91 filled out a questionnaire five months after HSCT (M_age = 51.61, SD = 12.93).

RESULTS

Multiple regression analyses showed that a fighting spirit strategy positively predicted resilience (p < 0.05), whereas anxious preoccupations predicted anxiety (p < 0.05), poorer mental QoL (p < 0.01), and were associated with an increased risk of developing PTSD (OR = 3.27, p < 0.01; 95% CI: 1.36, 7.84) at five months after transplantation. Hopelessness, avoidance, and denial coping strategies were not predictive of any of the mental health outcomes. Finally, the number of transplantations was negatively related to a fighting spirit (p < 0.01) and positively related to hopelessness-helplessness (p < 0.001): Conclusions: These results highlight the importance of developing psychological interventions focused on coping to alleviate the negative psychological consequences of HSCT.

The mediating effects of coping styles on the relationship between trait mindfulness and romantic relationship satisfaction

The purpose of the current study was to explore the influence of coping styles and trait mindfulness on the satisfaction of romantic relationships (RRS) among college students. Of the 305 participants, 258 (males: 115, 44.6%) had previously been in, or were presently in a romantic relationship. All participants completed the MAAS, CSQ, and questions about RRS. There was a significant meditating role of mature coping styles in the relationship between trait mindfulness and RRS (indirect effect [95% CI] = 0.021 [0.001, 0.052]). However, the mediating effect of immature coping styles was not significant (indirect effect [95% CI] = 0.038 [-0.020, 0.097]). Mature coping style plays an important mediating role in the relationship between mindfulness and relationship satisfaction.

Problem Solving and Emotion Coping Styles for Social Anxiety: A Meta-analysis of Chinese Mainland Students

Studies of how positive and negative coping styles affect social anxiety show mixed results. Hence, our two meta-analyses determined the overall effect sizes of problem solving-focused coping (PSC) styles and emotion-focused coping (EFC) styles on social anxiety in mainland China (PSC: k = 49 studies, N = 34,669; EFC: k = 52, N = 36,531). PSC was negatively linked to social anxiety (- .198), and EFC was positively linked to social anxiety (.223). In years with more national income, PSC's and EFC's effect sizes were larger. PSC's effect sizes were smaller among rural students (vs. urban students), larger among older students (university, high school, middle school), and larger in cross-sectional (vs. longitudinal) studies. When using SAD (vs. others) social anxiety measures, PSC effect sizes were larger, but EFC effect sizes were smaller. EFC effect sizes were larger in studies with convenience (vs. representative) samples. Gender, single child status, and coping style measurement showed no moderation effects. These findings suggest that using problem solving-focused coping styles rather than emotion-focused may reduce social anxiety, so future experimental studies can test this idea more rigorously.

The development of compulsive coping behaviour is associated with a downregulation of Arc in a Locus Coeruleus neuronal ensemble

Some compulsive disorders have been considered to stem from the loss of control over coping strategies, such as displacement. However, the cellular mechanisms involved in the acquisition of coping behaviours and their subsequent compulsive manifestation in vulnerable individuals have not been elucidated. Considering the role of the locus coeruleus (LC) noradrenaline-dependent system in stress and related excessive behaviours, we hypothesised that neuroplastic changes in the LC may be associated with the acquisition of an adjunctive polydipsic water drinking, a prototypical displacement behaviour, and the ensuing development of compulsion in vulnerable individuals. Thus, male Sprague Dawley rats were characterised for their tendency, or not, to develop compulsive polydipsic drinking in a schedule-induced polydipsia (SIP) procedure before their fresh brains were harvested. A new quantification tool for RNAscope assays revealed that the development of compulsive adjunctive behaviour was associated with a low mRNA copy number of the plasticity marker Arc in the LC which appeared to be driven by specific adaptations in an ensemble of tyrosine hydroxylase (TH)+, zif268- neurons. This ensemble was specifically engaged by the expression of compulsive adjunctive behaviour, not by stress, because its functional recruitment was not observed in individuals that no longer had access to the water bottle before sacrifice, while it consistently correlated with the levels of polydipsic water drinking only when it had become compulsive. Together these findings suggest that downregulation of Arc mRNA levels in a population of a TH+/zif268- LC neurons represents a signature of the tendency to develop compulsive coping behaviours.

Running to get "lost"? Two types of escapism in recreational running and their relations to exercise dependence and subjective well-being

Escapism is a fundamental motivation in many forms of activity engagements. At its core, escapism is "a habitual diversion of the mind … as an escape from reality or routine". Accordingly, escapism may entail many adaptive and maladaptive psychological antecedents, covariates, and outcomes. However, few studies have been conducted on escapism as a motivational mindset in running. Here, in a sample of recreational runners (N = 227), we applied a two-dimensional model of escapism, comprising self-expansion (adaptive escapism) and self-suppression (maladaptive escapism), and examined how they were related to exercise dependence and subjective well-being. First, confirmatory factor analyses showed that the escapism dimensions were highly diversifiable in the sample. Then, correlational analyses showed that self-expansion was positively correlated to subjective well-being, whereas self-suppression was negatively related to well-being. Self-suppression was more strongly related to exercise dependence compared to self-expansion. Finally, path analyses evidenced an explanatory role of self-expansion and self-suppression in the inverse relationship between exercise dependence and well-being. In conclusion, the present findings support escapism as a relevant framework for understanding the relationship between exercise dependence in running and subjective well-being.

Less Maladaptiveness of the Maladaptive Coping Styles in Japan than in Germany: Cross-cultural Comparison of Adaptive and Maladaptive Coping Styles

The Maladaptive and Adaptive Coping Style Questionnaire (MAX) is a comprehensive tool for measuring coping styles including three subscales: maladaptive coping, adaptive coping, and avoidance. This study developed a Japanese version of MAX and evaluated the relationship between the coping styles and psychopathologies between the Japanese sample and the German sample. For the cross-cultural comparison, we used the Japanese community sample and German data set acquired by Moritz et al. (Journal of Affective Disorders 191:300–307, 2016). Factor analysis was conducted with the Japanese version of the MAX. Referring to the original version, we hypothesized the three-factor structure. However, the results showed that the adaptive coping subscale had less similarity to the original version, whereas the maladaptive coping and avoidance subscales were similar to the original. As the result of cultural comparison, the Japanese participants showed more maladaptive coping and avoidance. Moreover, the maladaptive coping styles had weaker correlations with the psychopathologies in the Japanese sample than with those in the German sample in the present study.

The longitudinal association between Perceived Stress, PTSD Symptoms, and Post-Traumatic Growth during the COVID-19 Pandemic: the role of coping strategies and psychological inflexibility

The present study investigates the mediating roles of psychological inflexibility and differential coping strategies on perceived stress and post-traumatic symptoms and growth in the context of COVID-19. Study one recruited 662 participants (54.8% women; Mage = 40.64 years, SD = 13.04) who completed a cross-sectional questionnaire. It was proposed that orientation to the problem, avoidance strategies, psychological inflexibility, and positive attitude were mediators for the positive association between perceived stress and PTSD symptoms. The fit indices for the path model were excellent: CFI = 0.977, TLI = 0.950, RMSEA = 0.057 [90%CI = 0.043-0.081], and SRMS = 0.042. Gender and stressful events encountered had indirect effects on the endogenous variables. In study two, 128 participants (57.8% women; Mage = 42.30, SD = 12.08) were assessed for post-traumatic growth one year later. Psychological inflexibility and orientation acted as mediators between perceived stress and PTSD symptoms. Furthermore, a novel path model was constructed in which psychological inflexibility and orientation to the problem as mediators for perceived stress and PTSD symptoms. The indices for the path model were excellent: CFI = 0.99, TLI = 0.97, RMSEA = 0.055 [90%CI = 0.001-0.144], and SRMS = 0.49. Furthermore, PTSD symptoms, psychological inflexibility, and orientation to the problem predicted post-traumatic growth. Specifically, both orientation to the problem (β = .06 [90%CI: .01;.13]) and psychological inflexibility (β = .14 [90%CI: .08;.26]) had an indirect effect on post-traumatic growth. Overall, these results significantly contribute to the literature as orientation to the problem positively predicted PTSD symptoms and post-traumatic growth one year later while psychological inflexibility predicted PTSD symptoms and less post-traumatic growth one year later. These results underline the importance of assessing both symptomology and psychological growth to determine adaptive coping strategies in specific contexts.

Problematic Internet use and academic engagement during the COVID-19 lockdown: The indirect effects of depression, anxiety, and insomnia in early, middle, and late adolescence

BACKGROUND

During the COVID-19 pandemic, the transition of online learning introduces challenges for adolescents to engage in learning. The increased access and persistent Internet use could heighten the risk of problematic Internet use (PIU) that has been increasingly recognized as a risk factor for academic engagement. This study aims to investigate the direct and indirect relationships between PIU and academic engagement through psychopathological symptoms (i.e., depression, anxiety, insomnia) in early, middle, and late adolescence.

METHODS

In all, 4852 adolescents (51.5% females; M_age = 13.80 ± 2.38) from different regions of Chinese mainland participated in the study and completed questionnaires.

RESULTS

Depression and then insomnia as well as anxiety and then insomnia mediated the relationship between PIU and academic engagement. Anxiety exhibited a double-edged effect, that is, a positive relation with academic engagement directly and a negative relation with academic engagement indirectly through insomnia. Multigroup analyses showed that the indirect effects of PIU on academic engagement through depression and subsequent insomnia in middle and late adolescence were stronger than that in early adolescence, whereas the direct effect in early adolescence was stronger than that in middle adolescence.

LIMITATION

This study was cross-sectional in design and relied upon self-report measures.

CONCLUSION

These findings improve the understandings of how PIU relates to academic engagement through psychopathological symptoms and highlight developmental differences of adolescence.

A Qualitative Study of Self and Caregiver Perspectives on How Autistic Individuals Cope With Trauma

Background

Coping can moderate the relationship between trauma exposure and trauma symptoms. There are many conceptualisations of coping in the general population, but limited research has considered how autistic individuals cope, despite their above-average rates of traumatic exposure.

Objectives

To describe the range of coping strategies autistic individuals use following traumatic events.

Methods

Fourteen autistic adults and 15 caregivers of autistic individuals, recruited via stratified purposive sampling, completed semi-structured interviews. Participants were asked to describe how they/their child attempted to cope with events they perceived as traumatic. Using an existing theoretical framework and reflexive thematic analysis, coping strategies were identified, described, and organized into themes.

Results

Coping strategies used by autistic individuals could be organized into 3 main themes: (1) Engaging with Trauma, (2) Disengaging from Trauma, and (3) Self-Regulatory Coping. After the three main themes were developed, a fourth integrative theme, Diagnostic Overshadowing, was created to capture participants' reports of the overlap or confusion between coping and autism-related behaviors.

Conclusions

Autistic individuals use many strategies to cope with trauma, many of which are traditionally recognized as coping, but some of which may be less easily recognized given their overlap with autism-related behaviors. Findings highlight considerations for conceptualizing coping in autism, including factors influencing how individuals cope with trauma, and how aspects of autism may shape or overlap with coping behavior. Research building on these findings may inform a more nuanced understanding of how autistic people respond to adversity, and how to support coping strategies that promote recovery from trauma.

Neural correlates of emotional reactivity predict response to cognitive-behavioral therapy in obsessive-compulsive disorder

BACKGROUND

Examining predictive biomarkers to identify individuals who will likely benefit from a specific treatment is important for the development of targeted interventions. The late positive potential (LPP) is a neural marker of attention and elaborated stimulus processing, and increased LPP responses to negative stimuli are characteristic of pathological anxiety. The present study investigated whether LPP reactivity would prospectively predict response to cognitive-behavioral therapy (CBT), the first-line treatment for obsessive-compulsive disorder (OCD).

METHODS

To this end, the LPP in response to negative as compared to neutral pictures was examined in 45 patients with OCD, who underwent CBT in a naturalistic outpatient setting. LPP amplitudes were used as predictors of symptom reduction after CBT.

RESULTS

We found that higher LPP amplitudes to negative relative to neutral stimuli were predictive of lower self-reported OCD symptoms after completion of CBT, controlling for pre-treatment symptoms. Further, LPP reactivity was negatively correlated with self-reported habitual use of suppression in everyday life.

LIMITATIONS

Some participants had already begun treatment at the time of study participation. Overall, results need further replication in larger samples and standardized therapy settings.

CONCLUSIONS

The current findings suggest that patients with increased emotional reactivity benefit more from CBT, possibly through less avoidance of anxiety-provoking stimuli during exposure with response prevention, a crucial component in CBT for OCD. Although its clinical utility still needs to be evaluated further, the LPP constitutes a promising candidate as a prognostic marker for CBT response in OCD.

Associations between COVID-19 Work-Related Stressors and Posttraumatic Stress Symptoms among Chinese Doctors and Nurses: Application of Stress-Coping Theory

Healthcare workers are vulnerable to posttraumatic stress symptoms (PTSS) due to stressful work during the COVID-19 pandemic. This study aimed to investigate whether the associations between COVID-19 work-related stressors and PTSS would be mediated by maladaptive and adaptive coping strategies and moderated by perceived family support based on stress-coping theory. An anonymous online survey was conducted among 1449 doctors and nurses in five hospitals in China between October and November 2020 during the “post-outbreak” period. The prevalence of PTSS assessed by the Posttraumatic Symptom Scale Self-Report was 42%. Logistic regression analysis revealed that worries about being infected with COVID-19, perceived difficulties in family caregiving, coping strategies of rumination, catastrophizing, acceptance, and perceived family support were independently associated with PTSS. Furthermore, maladaptive and adaptive coping partially mediated the association between COVID-19 work-related stressors and PTSS.The results of multi-group analyses showed that perceived family support tended to intensify the associations between COVID-19 work-related stressors and adaptive coping and between adaptive coping and PTSS, whereas perceived family support attenuated the positive association between COVID-19 work-related stressors and PTSS. The findings suggest tailor-made health interventions with respect to alleviation of work-related stressors and coping skill training to reduce the risk of PTSS among healthcare workers, especially for those with lower perceived family support.

Profiles of Stress and Coping Associated With Mental, Behavioral, and Internet Use Problems Among Adolescents During the COVID-19 Pandemic: A Stratified Random Sampling and Cluster Analysis

Background

Adolescents are vulnerable to behavioral and mental health problems, which might be further exacerbated during the COVID-19 pandemic. This study explored how participants with different profiles of stressful life events, coping resources (i.e., self-esteem and perceived social support) and coping strategies (i.e., maladaptive and adaptive coping) varied in the prevalence of mental, behavioral, and Internet use problems.

Methods

Data were collected from a large and representative sample of Chinese secondary school students in Hong Kong (n = 3,136) from September to November 2020 (48.1% males; mean age = 13.6 years old). Cluster analysis and logistic regression models were used for analysis.

Results

The prevalence of suicidal ideation and sleep disturbance was 29.8 and 55.4%, respectively. Behavioral problems were most frequently reported in excessive social media use (53.5%), followed by excessive Internet gaming (43.6%), obesity (34.1%), damaging properties (14.6%), and alcohol or substance abuse (5.1%). The results of cluster analysis yielded three distinctive stress and coping profiles: severe profile (High Risk/Low Protective; 17.0%), moderate profile (Moderate Risk/Moderate Protective; 35.8%), and mild profile (Low Risk/High Protective; 47.2%). Participants with severe and moderate profiles displayed significantly higher levels of mental (range for AOR: 2.08–15.06; all p < 0.001) and behavioral health problems (range for AOR: 1.22–11.22; all p < 0.05) compared to the mild profile cluster.

Conclusions

Adolescents' mental and behavioral health may be shaped by a combination of stressful life events and variations in coping resources as well as strategies. Transdiagnostic and multimodal interventions on these factors are warranted to reduce mental, behavioral, and Internet use problems among adolescents.

Coping in the Emergency Medical Services: Associations with the personnel’s stress, self-efficacy, job satisfaction, and health

Background

Emergency Medical Services personnel (EMSP) are recurrently exposed to chronic and traumatic stressors in their occupation. Effective coping with occupational stressors plays a key role in enabling their health and overall well-being. In this study, we examined the habitual use of coping strategies in EMSP and analyzed associations of coping with the personnel’s health and well-being.

Method

A total of N = 106 German Red Cross EMSP participated in a cross-sectional survey involving standardized questionnaires to report habitual use of different coping strategies (using the Brief-COPE), their work-related stress, work-related self-efficacy, job satisfaction, as well as mental and physical stress symptoms.

Results

A confirmatory factor analysis corroborated seven coping factors which have been identified in a previous study among Italian emergency workers. Correlation analyses indicated the coping factor “self-criticism” is associated with more work-related stress, lower job satisfaction, and higher depressive, posttraumatic, and physical stress symptoms. Although commonly viewed as adaptive coping, the coping factors “support/venting”, “active coping/planning”, “humor”, “religion”, and “positive reappraisal” were not related to health and well-being in EMSP. Exploratory correlation analyses suggested that only “acceptance” was linked to better well-being and self-efficacy in EMSP.

Conclusion

Our results emphasize the need for in-depth investigation of adaptive coping in EMSP to advance occupation-specific prevention measures.

Impact of coping styles on substance use in persons with psychosis, siblings, and controls

BACKGROUND

Substance use is overrepresented in patients with psychosis. Maladaptive coping has been proposed as one of the mechanisms which might underlie this high prevalence. Patients are known to apply more maladaptive coping compared to the healthy population. However, it is unknown whether coping is associated with the use of different substances across those with different vulnerability for psychosis, and whether coping mediates the possible association between life events and substance use.

METHODS

In this multicenter, cohort study, 429 patients, 504 siblings, and 220 controls were included. We determined whether coping was associated with tobacco smoking, cannabis use, or alcohol consumption. Multivariable logistic regression models were applied whilst correcting for potential confounders. We performed post-hoc analyses to explore the association between negative life events, tobacco smoking, and the role of coping as a mediator in patients with psychosis.

RESULTS

A positive association was found in patients between passive coping and tobacco smoking (fully adjusted OR 1.65, 95% CI 1.18-2.31). Tobacco smoking patients experienced more negative life events compared to non-smoking patients and passive coping mediated this association. In siblings and controls, none of the coping strategies were associated with substance use.

CONCLUSIONS

The coping style of patients with psychosis is associated with tobacco smoking and mediates the association between negative events and tobacco smoking. No significant associations were found in siblings, controls or concerning other substance use. Future research is required to examine whether enhancing healthy coping strategies decreases tobacco use in patients with psychosis.

Longitudinal assessment of the common sense model before and during the COVID-19 pandemic: A large coeliac disease cohort study

OBJECTIVE

Psychosocial factors likely play a substantial role in the well-being of those living with coeliac disease, especially during the COVID-19 pandemic, however, little research has examined well-being in this cohort using an integrated socio-cognitive model. This study had two aims: (1) Examine changes in gastrointestinal symptoms, psychosocial factors, and well-being outcomes (i.e., psychological distress, quality of life [QoL]) associated with the pandemic, (2) Examine the interrelationship of these variables across timepoints using the Common Sense Model (CSM).

METHODS

1697 adults with coeliac disease (Time 1, pre-pandemic; 83.1% female, mean age = 55.8, SD = 15.0 years) and 674 follow-up participants (Time 2, pandemic; 82.8% female, mean age = 57.0, SD = 14.4 years) completed an online questionnaire. Hypotheses were tested using repeated measures MANOVA and cross-lagged panel model analyses.

RESULTS

Participants reported improved QoL, and reduced gastrointestinal symptoms, negative illness perceptions and maladaptive coping from pre-pandemic to during the pandemic. There was no significant change in pain catastrophising or psychological distress. Cross-lagged effects showed gastrointestinal symptoms to predict negative illness perceptions, which in turn were predictive of poorer outcomes across all variables except pain catastrophising. Consistent with the CSM, there was a reciprocal relationship between illness perceptions and QoL over time. Maladaptive coping and pain catastrophising demonstrated limited predictive utility.

CONCLUSION

The COVID-19 pandemic appears to have had a small beneficial effect across several indices of well-being among adults with coeliac disease. Cross-lagged relationships highlight illness perceptions as a predictor of well-being outcomes and a potential target for psychosocial interventions.

Interactions Between Experience, Genotype and Sex in the Development of Individual Coping Strategies

Coping strategies, the first line of defense against adversities, develop through experience. There is consistent evidence that both genotype and sex contribute to the development of dysfunctional coping, leading to maladaptive outcomes of adverse experiences or to adaptive coping that fosters rapid recovery even from severe stress. However, how these factors interact to influence the development of individual coping strategies is just starting to be investigated. In the following review, we will consider evidence that experience, sex, and genotype influence the brain circuits and neurobiological processes involved in coping with adversities and discuss recent results pointing to the specific effects of the interaction between early experiences, genotype, and stress in the development of functional and dysfunctional coping styles.

Coping styles moderate the relationship between perceived discrimination and eating behaviors during the transition to college

The transition to college is a critical developmental window during which eating behaviors are susceptible to dysregulation. Changes in exposure to discrimination contribute to alterations in eating behaviors, which may be exacerbated or attenuated by coping styles. The present longitudinal study examines whether increases in perceived discrimination predict increases in overeating and decreases in eating well during the transition to college. We expect that adaptive coping styles will buffer against, while maladaptive coping styles will exacerbate, the effects of increases in perceived discrimination on increases in overeating and decreases in eating well. First year students (n = 804) were assessed at two time points: the spring before freshman year (Time 1) and one year later during the spring semester of freshman year (Time 2). Two distinct coping styles emerged from a factor analysis: adaptive (active coping, planning, emotional support, positive reframing, acceptance, instrumental support) and maladaptive coping (denial, venting, self-blame, self-distraction). Increases in perceived discrimination, lower adaptive coping, and higher maladaptive coping had main effects for predicting more overeating at Time 2. Among students who reported increases in perceived discrimination, higher use of adaptive coping was associated with less overeating at Time 2 while higher use of maladaptive coping was associated with more overeating. While adaptive and maladaptive coping styles had main effects on eating well, change in perceived discrimination did not. Neither adaptive nor maladaptive coping styles interacted with change in perceived discrimination to predict eating well. Findings inform a gap in the literature about the relationship between discrimination and eating behaviors from a developmental perspective by demonstrating that adaptive and maladaptive coping styles influence the effects of changes in perceived discrimination on overeating during the college transition.

Coping Strategies, Neural Structure, and Depression and Anxiety During the COVID-19 Pandemic: A Longitudinal Study in a Naturalistic Sample Spanning Clinical Diagnoses and Subclinical Symptoms

BACKGROUND

Although the COVID-19 pandemic has been shown to worsen anxiety and depression symptoms, we do not understand which behavioral and neural factors may mitigate this impact. To address this gap, we assessed whether adaptive and maladaptive coping strategies affect symptom trajectory during the pandemic. We also examined whether pre-pandemic integrity of brain regions implicated in depression and anxiety affect pandemic symptoms.

METHODS

In a naturalistic sample of 169 adults (66.9% female; age 19-74 years) spanning psychiatric diagnoses and subclinical symptoms, we assessed anhedonia, tension, and anxious arousal symptoms using validated components (21-item Depression, Anxiety, and Stress Scale), coping strategies (Brief-Coping Orientation to Problems Experienced), and gray matter volume (amygdala) and cortical thickness (hippocampus, insula, anterior cingulate cortex) from magnetic resonance imaging T1-weighted scans. We conducted general linear mixed-effects models to test preregistered hypotheses that 1) maladaptive coping pre-pandemic and 2) lower structural integrity pre-pandemic would predict more severe pandemic symptoms; and 3) coping would interact with neural structure to predict pandemic symptoms.

RESULTS

Greater use of maladaptive coping strategies was associated with more severe anxious arousal symptoms during the pandemic (p = .011, false discovery rate-corrected p [p FDR] = .035), specifically less self-distraction (p = .014, p FDR = .042) and greater self-blame (p = .002, p FDR = .012). Reduced insula thickness pre-pandemic predicted more severe anxious arousal symptoms (p = .001, p FDR = .027). Self-distraction interacted with amygdala volume to predict anhedonia symptoms (p = .005, p FDR = .020).

CONCLUSIONS

Maladaptive coping strategies and structural variation in brain regions may influence clinical symptoms during a prolonged stressful event (e.g., COVID-19 pandemic). Future studies that identify behavioral and neural factors implicated in responses to global health crises are warranted for fostering resilience.

Do coping strategies really affect cardiovascular events? The Isfahan cohort study of adults in Eastern Mediterranean Regional Office

AIMS

Psychological factors are among the most suspected indicators which may cause atherosclerosis. Coping strategies modifying psychological stress may be significantly associated with health outcomes. However, little is known about the influence of adaptive and maladaptive coping strategies on major adverse cardiovascular disease (CVD) events. The purpose of this study is to examine this idea among a sample of adults. Design: cohort study.

METHODS AND RESULTS

The Isfahan cohort study (ICS) is a longitudinal population-based, prospective study. Participants (N=6323 individuals aged 35 years or greater at baseline) were selected by multistage random sampling with 6-year intervals (i.e. 2001: 6323 individuals, 2007: 3296 individuals, and 2013: 1706 individuals). Adaptive and maladaptive coping strategies were evaluated by a multicomponent self-administered stress management paper-based questionnaire. All CVD events were confirmed by a blinded panel of experts and a marginal cox regression model was used to model the survival data. Adaptive coping strategies could be protective against CVD events with hazard ratios (95% confidence interval) [0.97 (0.95-0.99)] and maladaptive coping strategies seem to be a risk factor, 1.02 (1.01-1.04) in the whole population. Individuals younger than 60 showed similar results, with 0.96 (0.93-0.98) and 1.04 (1.01-1.07) for adaptive and maladaptive coping strategies, respectively. However, these findings were not replicated among seniors older than age 60.

CONCLUSION

Based on our results, coping strategies have an important role in cardiovascular events, particularly among young adults. According to the results, informing patients about adaptive stress management may promote primary prevention of CVD events.

Coping with the crisis: the effects of psychological capital and coping behaviors on perceived stress

Purpose

The COVID-19 pandemic has dramatically altered the daily lives of millions of people around the world, substantially increasing anxiety and stress levels for many. Psychological capital (PsyCap), a multidimensional construct that includes hope, optimism, resilience and self-efficacy, may serve as a resource for helping people more effectively cope with uncertainty resulting in lower levels of perceived stress. The authors hypothesize a negative relationship between PsyCap and perceived stress that is partially and differentially mediated by adaptive and maladaptive coping styles. The authors further hypothesize that work context (home vs workplace) will moderate the relationships between coping styles and perceived stress.

Design/methodology/approach

After receiving Institutional Review Board approval, data were collected during the first week of May 2020 using an online survey. The hypothesized model was tested using structural equation modeling (SEM) techniques, specifically Mplus 8. The authors validated their initial findings using PROCESS Model 14 with 5,000 boot-strapped samples and a 95% confidence interval.

Findings

The authors’ results show that adaptive and maladaptive coping styles differentially mediate the effects of PsyCap on perceived stress with the indirect effects of PsyCap on perceived stress through maladaptive coping being stronger than the indirect effects through adaptive coping. The authors found support for the relationships in our hypothesized model.

Practical implications

The authors’ findings suggest that health interventions aimed at increasing PsyCap may be an effective means of reducing maladaptive coping and perceived stress. Future research should continue to explore PsyCap as a potential means of shaping positive health behaviors.

Originality/value

This study makes a unique contribution to the literature by explaining how PsyCap operates through coping to affect perceptions of stress in the context of the COVID-19 pandemic.

Effectiveness of Body Psychotherapy. A Systematic Review and Meta-Analysis

Despite the growing relevance and applicability of elements based on and derived from the embodied mind paradigm, body psychotherapy (BPT) appears not to be a well-established treatment option. This might be due to a lack of proof for its efficacy. We searched electronic databases (Pubmed MEDLINE, PsycInfo, and PSYNDEX) for randomized controlled trials (RCTs) examining predefined BPT interventions. A total of 2,180 references were screened, of which 113 studies were scrutinized in detail and 18 RCTs finally included. The observed effect size (ES) demonstrated medium effects of BPT on primary outcomes psychopathology and psychological distress. In case of significant statistical heterogeneity, exploratory subgroup analyses revealed diagnosis and the degree of control group activity as noteworthy moderators. For secondary outcomes, evidence was scarce, and an improvement could be demonstrated only for coping abilities. The identified evidence indicates that BPT is beneficial for a wide spectrum of psychic suffering. There is a strong need for high-quality studies with bigger samples and for well-defined diagnostic entities to underpin its effectiveness.

The role of frontal-subcortical connectivity in the relation between coping styles and reactivity and downregulation of negative emotion

Coping styles (CS) reflect individuals' habitual use of strategies for coping with negative events in daily life. Although research into coping has not reached consistent agreement about classifying coping strategies as either inherently adaptive or maladaptive, the influence of maladaptive CS on mental health is noticeable. CS might also be related to emotion regulation and associated brain systems. Participants (N = 165) completed measurements of CS, trait emotions including trait anxiety, depressive symptoms and happiness and then performed an emotion regulation task, in conjunction with functional MRI. Individual differences in maladaptive CS use were associated with higher trait negative emotionality and higher state reactivity of negative emotion. Concurrent bilateral amygdala-right middle frontal gyrus (MFG) connectivity during passive negative stimulus processing mediated the relation between maladaptive CS and negative emotion ratings. Psychophysiological interaction analyses showed that maladaptive and adaptive CS were linked to patterns of frontal-subcortical connectivity during state emotion regulation. These results suggest that maladaptive CS might be related to negative emotion processing and weaker spontaneous regulation and indicate that maladaptive CS is a risk factor in individual mental health.

Coping Patterns and Emotional Distress in Patients With Chronic Obstructive Lung Disease Who Are Undergoing Lung Transplant Evaluation

OBJECTIVES

Living with severe lung disease like chronic obstructive pulmonary disease (COPD) is a very stressful situation. The way patients cope may impact their symptoms of anxiety and depression and physical function as well. We studied how ways of coping are associated with levels of emotional distress and lung function in patients with COPD being evaluated for lung transplantation.

METHODS

Sixty-five (mean age 57 years, 46% females) patients completed the General Health Questionnaire-30 (GHQ-30) assessing emotional distress and the Ways of Coping Questionnaire. Measurements of lung function and 6-minute walk test were included.

RESULTS

Seventeen (26%) patients had elevated emotional distress. Logistic regression of chronic GHQ score with gender, age, body mass index, lung function, and coping scales as covariates showed that escape avoidance and self-controlling coping and forced vital lung capacity were significantly associated with high emotional distress. Odds ratio of emotional distress increased with 5.2 per tertile (P = .011) in escape avoidance coping score. Moreover, we revealed that emotionally distressed patients cope with their current situation by refusing to believe the current situation and taking their distress out on other people.

CONCLUSION

Among patients with COPD, a high level of emotional distress was uniquely associated with escape-avoidance coping and lung function. Future work should ascertain whether coping style predicts distress or whether distress increases the use of escape-avoidance coping. Nevertheless, our findings indicate that if either element is present, health care professionals should be attentive to the need for interventions to improve patients' well-being.

Clinical and theoretical relevance of responses to analogues of psychotic experiences in people with psychotic experiences with and without a need-for-care: an experimental study

BACKGROUND

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.

METHOD

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).

RESULTS

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.

CONCLUSIONS

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.

Childhood trauma and coping in patients with psychotic disorders and obsessive-compulsive symptoms and in un-affected siblings

BACKGROUND

Research on environmental and individual risk-factors in patients with a psychotic disorder and co-occurring obsessive-compulsive symptoms (OCS) is limited.

OBJECTIVE

This study aimed to examine the role of childhood trauma and coping on the occurrence of OCS in patients with a psychotic disorder and on a subclinical level in siblings.

PARTICIPANTS AND SETTING

626 patients and 638 siblings from the Genetic Risk and Outcome of Psychosis (GROUP) study were included in the current study.

METHODS

Differences between patients and siblings with and without OCS were analyzed with between-group comparisons. Mediation analyses investigated the effect of coping on the association between trauma and OCS severity.

RESULTS

Patients and siblings with OCS reported more childhood traumatic events, particularly sexual (OR = 1.62 / 3.26) and emotional (OR = 1.47 / 2.04) abuse compared to those without OCS. Both patients (d = 0.69) and siblings (d = 0.49) with co-occurring OCS showed a higher tendency for dysfunctional passive coping strategies compared to the group without OCS. The tendency for passive coping mediated the association between sexual and emotional abuse and OCS severity in patients.

CONCLUSIONS

Results imply that childhood trauma is associated with the presence of co-occurring OCS. Enhancing active coping strategies might have a beneficial effect in the prevention and treatment of co-occurring OCS in patients with psychotic disorders.

Self-compassion as mediator between coping and social anxiety in late adolescence: A longitudinal analysis

INTRODUCTION

Previous research uncovered that self-compassion is related to coping strategies elicited during stressful situations, and might also contribute to less biased perceptions of social situations. Hence, the current study's objective was to investigate longitudinally the mediator role of self-compassion in the relation between coping and social anxiety in late adolescence, with emphasis on the first months of adjustment to college life.

METHODS

The sample included 63 first-year students (75% women) from Romania with a mean age of 18.76 years. They filled out the Coping Orientation to Problems Experienced Inventory at Time 1 (beginning of the first semester), as well as the Self-Compassion Scale-Short Form and the Leibowitz Social Anxiety Scale-Short Form at both T1 and Time 2 (3 months after the baseline assessment).

RESULTS

The results of the mediation analyses showed that both approach and avoidant coping at T1 exhibited a significant indirect effect on social anxiety levels at T2 through self-compassion measured at T2 controlling for the effects of gender, self-compassion and social anxiety at T1. These findings suggested that approach coping increases the likelihood of more compassionate views of oneself, which are likely to contribute to less social anxiety; conversely, avoidant coping decreases self-compassionate attitudes, which in turn increase social anxiety symptoms.

CONCLUSIONS

These results provided added evidence to the fact that during the transition from adolescence to adulthood, teaching college students a more self-accepting and kind perspective on one's imperfections could play a significant role in preventing and treating social anxiety.

Developing a measurement instrument for coping with occupational stress in academia

Orientation: Occupational stress leads to devastating consequences for academia, which include teaching below standard, conflict with students and seeking employment elsewhere. The stressors that academics experience will continue to increase unless they adopt strategies to cope with these demands.Research purpose: The objective of this research was to construct a valid and reliable measurement instrument which could be used to explore how academics cope with occupational stress.Motivation for the study: There is no clear consensus about the conceptualisation of the coping construct and the categorisation and measurement of numerous coping strategies. Also, as working in academia is highly stressful, there is a need for developing a measuring instrument that holistically measures coping with occupational stress in South African higher education institutions.Research approach/design and method: A three-phase instrument development process was followed. A quantitative, cross-sectional online survey was administered to a convenience sample of 305 employees employed in a higher education institution in the Gauteng province of South Africa.Main findings: A nine-dimensional, 33-item measuring instrument was developed for exploring how academics cope with occupational stressors.Practical/managerial implications: If industrial and organisational psychologists could appreciate the consequences of occupational stress and comprehend the complexities of the coping process, then they would be able to design and implement wellness practices that should not only promote the health and well-being of academics but also the institution.Contribution/value-add: A psychometrically sound measuring instrument, The Comprehensive Coping Strategies Questionnaire, was developed within the South African higher education context that would allow industrial and organisational psychologists to determine which coping strategies academics adopt in response to occupational stressors.

Feasibility, acceptability and preliminary outcomes of a mindfulness-based relapse prevention program in a naturalistic setting among treatment-seeking patients with alcohol use disorder: a prospective observational study

OBJECTIVES

Cultural differences between the USA and France led us to examine the feasibility, acceptability and preliminary efficacy data on craving, quality of life and psychological flexibility of the add-on Mindfulness-Based Relapse Prevention (MBRP) programme in alcohol use disorder (AUD) in France.

DESIGN

We conducted a prospective observational study with a 6-month follow-up.

SETTING

The study was performed in a naturalistic setting with adult outpatients from an addiction department.

PARTICIPANTS

We included all patients with a current AUD who participated in the MBRP programme (n=52). There was no non-inclusion criterion.

INTERVENTIONS

The intervention was an 8-week MBRP programme, combining elements of traditional relapse prevention cognitive behavioural therapy and mindfulness meditation training. This was an eight-session closed-group programme.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcomes were the number of attended treatment sessions, home practice frequency and dropout rate. Secondary outcomes were changes in craving, quality of life, psychological flexibility, drinking outcomes, depression, anxiety and mindfulness levels.

RESULTS

The average number of completed sessions was 6.6 (SD: 1.9). Most participants introduced mindfulness meditation into their everyday lives: 69% and 49% of included patients maintained formal practice at 3 and 6 months, respectively, and 80% and 64% maintained informal practice at 3 and 6 months, respectively. Most participants used mindfulness techniques to face high-risk situations (56% at 6 months). Participants reported a significant reduction in craving, days of alcohol use, depression and anxiety and an increase in mindfulness and psychological flexibility at 6 months.

CONCLUSIONS

The MBRP programme showed good acceptability and feasibility. MBRP seemed to improve craving, mindfulness and psychological flexibility. Comparative studies are needed to evaluate the programme's efficacy in AUD.

TRIAL REGISTRATION NUMBER

2200863 v 0.

Impact of pre-diagnosis awareness of HIV-related stigma and dispositional coping on linkage to HIV care among newly diagnosed HIV+ Peruvian patients

A substantial body of literature has characterized how psychosocial factors, including HIV-related stigma and coping, are associated with HIV testing and HIV care utilization post-diagnosis. Less is known about if certain psychosocial characteristics pre-diagnosis may also predict linkage to care among individuals who receive an HIV-positive diagnosis. We examined if pre-diagnosis awareness/perception about HIV-related stigma and dispositional coping styles predicted linkage to HIV care within three months post-diagnosis with a secondary analysis of 604 patients from a randomized controlled trial (Sabes Study). Awareness/perception about HIV-related stigma, dispositional maladaptive and adaptive coping were measured before patients underwent an HIV test. Linkage to care was measured as receipt of care within three months of receiving the diagnosis. After adjusting for covariates, individuals who reported greater dispositional maladaptive coping pre-diagnosis had lower odds of linking to care, OR = 0.82, 95%CI [0.67, 1.00], p = .05. There was also a non-significant inverse association between dispositional adaptive coping pre-diagnosis and linkage to care. These preliminary data suggest the need for further longitudinal research and highlight the potential utility of pre-diagnosis psychosocial assessment and tailored counseling when providing positive HIV diagnosis results.

Differences in Coping Strategies Between Young and Older Adults: The Role of Executive Functions

Executive functions (EFs) have been identified as processes in the ability to select and apply adaptive strategies for coping with stress. This study compares executive functioning, short-term memory, and coping in a sample of young and older adults with no prior diagnosis of depression and with normal cognitive function ( N = 216). The study collected measures of depression, EFs, short-term memory, and coping. Young participants scored higher than older adults on EFs and short-term memory. Moreover, in young adults, there was a prevalence of avoidance coping strategies. Scores on depressive symptomatology were found to be related to avoidant coping strategies. Older adults with higher score on inhibition used less avoidant coping. Thus, it seems that executive deficits might contribute to depression, as they affect processes for coping with stress. This finding may have implications for the role of EFs and coping in psychological well-being and successful adaptation of individuals to stressful situations.

Coping flexibility and eudaimonic well-being in university students

Despite the growing interest in the relationship between coping strategies and eudaimonic well-being, few studies have examined this issue from the perspective of coping flexibility. Therefore, the present study aimed to: (1) identify approach coping profiles in the university context and (2) analyze the differences between these profiles in terms of eudaimonic well-being. A prospective ex post facto design was used and 1,402 university students were selected through convenience sampling. Data were collected using validated self-reported instruments. A latent profile analysis was conducted to identify the participants' coping profiles. The relationship between profiles and eudaimonic well-being was determined using a multivariate analysis of covariance (MANCOVA), with gender, age, and university degree as covariates. Six student profiles were identified based on the degree to which they combined positive reappraisal, support seeking, and planning strategies. The profiles that involved the use of these three strategies to a greater extent experienced more eudaimonic well-being, and vice versa. To analyze the impact of coping on eudaimonic well-being, it is necessary to consider students' ability to combine different approach coping strategies.

Expressive suppression is associated with state paranoia in psychosis: An experience sampling study on the association between adaptive and maladaptive emotion regulation strategies and paranoia

OBJECTIVES

Although emotional instability and problems in emotion regulation (ER) are known to be linked to the formation and maintenance of psychosis and paranoia, it remains unclear whether the use of specific ER strategies is associated with it. The first aim of the study was to explore the association between emotional instability and paranoia. The second and third aims were to investigate whether the use of maladaptive ER strategies leads to paranoia in patients with psychosis in daily life and whether the use of more adaptive ER strategies reduces paranoia.

DESIGN

A prospective momentary assessment study over the course of 6 days was performed.

METHOD

Participants with psychosis (n = 32) reported repeatedly over six consecutive days on the presence and instability of positive and negative emotions, their use of adaptive (reappraisal, acceptance, distraction, social sharing, reflection) and maladaptive ER strategies (rumination, expressive suppression) and momentary paranoia in their daily life.

RESULTS

Hierarchical linear regression analysis revealed that patients with psychosis who presented pronounced instability of negative emotions showed more severe levels of state paranoia. In addition, patients with psychosis who used expressive suppression when confronted with negative emotions at one point in time presented more pronounced levels of state paranoia at the following point in time.

CONCLUSION

The results presented here suggest that both emotional instability and the use of expressive suppression might cause state paranoia and thus add to our understanding of causal mechanisms related to paranoia such as instability of negative emotions and the use of less adaptive ER strategies.

PRACTITIONER POINTS

Maladaptive emotion regulation strategies and more pronounced instability of negative emotions are relevant to paranoia in patients with psychosis and should be a special focus of CBTp interventions. Future interventions designed for patients suffering from paranoia should promote coping with unstable negative emotions and replacing or reducing maladaptive emotion regulation strategies with adaptive ones.

Do depressive symptoms predict paranoia or vice versa?

BACKGROUND AND OBJECTIVES

Affective versus nonaffective psychoses are today no longer regarded as mutually exclusive disorders. Theorists have recently highlighted the role of affective symptoms in the formation of paranoid beliefs, particularly negative beliefs about the self, interpersonal sensitivity, sleep disturbances, and worrying, which exist along a continuum in the general population. For the present study, we tested the bidirectional causal relationships between paranoia and affect.

METHOD

A large population sample (N = 2,357) was examined at three time-points (baseline, six months, two years) as to the severity of subclinical paranoid beliefs (Paranoia Checklist, PCL) and depressive symptoms (Patient Health Questionnaire-9, PHQ-9). Worrying and avoidance were measured with items from the Maladaptive and Adaptive Coping Style Questionnaire (MAX).

RESULTS

Depression and paranoid symptoms were strongly cross-sectionally related (r = 0.69) and showed high stability (r > 0.72). Depressive symptoms at T2 predicted paranoid symptoms at T3 (beta = 0.16; no significant relationship from T1 to T2), whereas paranoid symptoms predicted depressive symptoms from T1 to T2 (beta = 0.09; no significant relationship from T2 to T3).

LIMITATIONS

Results should be replicated in a sample of paranoid patients, as risk factors for subclinical versus manifest paranoia may differ. Some constructs were measured with single items derived from a new scale.

CONCLUSIONS

The predictive association of depression to subsequent paranoia was small and confined to the long interval from T2 to T3. Treatments should target both paranoia and depression - irrespective of their causal relationship - particularly as patients with psychosis consider treatment of their emotional problems a priority.

Associations Between Trauma Type, Timing, and Accumulation on Current Coping Behaviors in Adolescents: Results from a Large, Population-based Sample

The development of adolescents' coping in response to stress is critical for adaptive functioning; these coping strategies may be shaped by numerous environmental factors during childhood, including experiences such as exposure to trauma. Childhood trauma has been shown to undermine contemporaneous coping, but how does a history of exposure to trauma and the characteristics of that trauma (type, timing, and accumulation) relate to current coping among adolescents? We addressed this question using a nationally-representative sample of 9427 adolescents (ages 13-18; 48.9% female; 66% White). Adolescents reported on their lifetime exposure to 18 different traumas, including witnessing or experiencing interpersonal violence, accidents, disasters, and violent or accidental loss of loved ones, as well as their current use of coping behaviors when under stress (problem-focused, positive emotion-focused, and negative emotion-focused coping strategies). The study's results highlight that exposure to nearly all forms of trauma was unrelated to problem-focused and positive emotion-focused coping behaviors, but strongly associated with increased negative emotion-focused coping. Use of each coping style did not vary with age at first exposure to trauma, but increased with the number of lifetime traumatic events experienced. The findings suggest that the extent of prior exposure to trauma, including variations across type and timing, may be related to a particular form of coping that has been linked to increased risk for mental health problems. Study results highlight coping strategies as a potential target for prevention and treatment efforts, and indicate a need to better understand the malleability and trajectory of coping responses to stress for promoting healthy youth development.

Dysfunctional coping with stress in psychosis. An investigation with the Maladaptive and Adaptive Coping Styles (MAX) questionnaire

OBJECTIVE

Psychotic episodes have long been conceptualized as inevitable incidents triggered by endogenous biological impairments. It is now well-accepted that the ability of an individual to deal with social and environmental challenges plays an important role in regard to whether or not a vulnerability to psychosis translates into symptoms. For the present study, we examined symptomatic correlates of dysfunctional coping in psychosis and aimed to elucidate a profile of coping strategies that distinguishes patients with schizophrenia from those with depression.

METHOD

The newly devised Maladaptive and Adaptive Coping Styles Scale (MAX) was administered to 75 individuals with psychosis, 100 individuals with depression and 1100 nonclinical controls.

RESULTS

Schizophrenia patients showed compromised coping abilities relative to nonclinical controls, particularly a lack of engaging in adaptive coping. Depression was more closely tied to dysfunctional coping than were positive symptoms as indicated by group comparisons and correlational analyses. Correlations between positive symptoms, particularly paranoid symptoms, and avoidance and suppression remained significant when depression was controlled for.

CONCLUSIONS

Although maladaptive and adaptive coping are unlikely to represent proximal mechanisms for the pathogenesis of positive symptoms, fostering coping skills may reduce positive symptoms via the improvement of depressive symptoms, which are increasingly regarded as risk factors for core psychotic symptoms. Furthermore, the reduction of avoidance and suppression may directly improve positive symptoms.