The importance of assessing clients’ coping strategies

By Nadia Garnefski and Vivian Kraaij, Department of Clinical Psychology, Leiden University, The Netherlands

Rob has just heard that he has HIV (negative event). He thinks that he is the one to blame for this (self-blame) and he avoids seeing his friends (withdrawal). The situation makes him sad. When sitting at home, he cannot stop thinking about his feelings (rumination) and believes that what has happened to him is a complete disaster (catastrophizing). Because he feels sad, he has little energy. As a result, he withdraws even more. This makes him even sadder. In this way, Rob is drawn into a downward spiral.

People experience a range of strong emotions in response to negative life events. To deal with these emotions people may use various cognitive and behavioral strategies. This process is also called coping. Lazarus defines coping as an individual’s efforts to manage the psychological stress associated with conditions of harm, threat or challenge. In the example of Rob, above, the negative event was hearing the news that he was infected with the HIV virus. Many other examples of stressful events might occur, ranging from single events such as death, divorce or job loss, to more enduring stressful life circumstances such as bullying, high work load or relationship problems. Thus, coping relates to managing all kinds of stressful life conditions.

Coping strategies can be divided into cognitions (what you think) and behaviors (what you do). An example of a cognitive coping strategy (thought) is self-blame. People who use this coping strategy blame themselves for what they have experienced (Rob blamed himself for having been infected by the HIV virus). Other examples of cognitive strategies are rumination and catastrophizing. Rumination means that one keeps thinking over and over about the emotions, feelings and thoughts that are associated with the negative experience. Catastrophizing refers to explicitly focusing on the disastrous aspects of the experience. Rob applied both these strategies. More examples of cognitive strategies are: blaming others, acceptance, refocusing on other more pleasant matters, planning which steps to take, positive reappraisal or attaching a positive meaning to the event, and putting the event into perspective (by comparing it to other, worse events). In total, nine cognitive coping strategies are distinguished in the literature. An example of a behavioral coping strategy is withdrawal, which refers to drawing yourself back from situations and social contacts, which happened to Rob. Other behavioral coping strategies are seeking distraction, actively taking steps to handle the experience, seeking social support, and ignoring, which refers to behaving like nothing has happened. In total, five behavioral strategies are distinguished.

Two instruments have been developed and validated for the assessment of cognitive and behavioral coping, respectively the Cognitive Emotion Regulation Questionnaire (CERQ) and the Behavioral Emotion regulation Questionnaire (BERQ). The CERQ has been translated and validated in numerous languages. The BERQ is being translated in various languages at present.

Research that investigated the role of cognitive and behavioral coping strategies (by using the CERQ and the BERQ) has identified helpful and less helpful coping strategies. With regard to cognitive strategies: rumination, catastrophizing, and self-blame can be considered as less helpful and positive reappraisal, putting into perspective and positive refocusing as more helpful. With regard to behavioral strategies: withdrawal and ignoring can be considered as less helpful, and actively approaching, seeking distraction, and seeking social support as more helpful. These are general conclusions, in specific situations with specific stressors, other observations may be true.

Knowledge about clients’ specific cognitive and behavioral coping strategies may help to understand the vicious circle of people’s psychological problems and might provide clues for changing maladaptive patterns into more adaptive ones.

Rob has started with therapy. The therapist assessed Rob’s cognitive and behavioural coping strategies and found that he scored high on self-blame, rumination, catastrophizing and withdrawal. He explains to Rob that these strategies are not helpful and can even worsen his depression, by bringing him into a downward spiral. They start working on breaking through the withdrawal and changing the negative thought patterns by using techniques from Cognitive Behavioural Therapy. After a couple of sessions, Rob started seeing his friends again and now feels a lot better.”

Practical recommendations

  • Always assess clients’ coping strategies next to their psychopathology. This may provide important information for the focus of therapy.
  • Provide psychoeducation about the fact that people’s cognitive and behavioural coping strategies may be part of a downward spiral towards depression.
  • General techniques from Cognitive Behavioral Therapy may be used to change maladaptive cognitive and behavioral coping strategies, such as behavioral activation and challenging negative thoughts.

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