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The Danish Center of Psychotraumatology

The negative impact of trauma, whether natural or man-made, is well documented for both children and adults. However, less is known about the factors that influence the post-traumatic developmental process. However, it is this knowledge that can be crucial for family members and professionals who want to help and support traumatised people. Coping strategies is one thing that the literature has shown to be a relevant variable in this context.

Lazarus and Folkman defined coping as 'constantly changing cognitive and behavioural attempts to deal with specific external and/or internal demands that are judged challenging or exceeding the resources available to the person'. In many ways, this definition still seems to be at the core of the concept and covers a wide range of different ways of trying to cope. 
Skinner and colleagues have identified a wide range of coping strategies which they distinguish as being styles of approach vs. avoidance, emotion-focused vs. problem-focused and engaged vs. disengaged. 

There is a wide range of additional coping styles in the literature that the Danish Center for Psychotraumatology has been involved in investigating. One example of this is studies of the correlation between children's coping styles and their self-reported levels of trauma and stress symptoms after an explosion accident in a residential neighbourhood.



The purpose of the study was to investigate Wallander and Varni's (1998) disability-stress coping model in a sample of 105 Icelandic parents of chronically ill children. The Revised Adult Attachment Scale (RAAS), the Attributional Scale (AS), the Defence Style Questionnaire (DSQ), the Sense of Coherence Scale (SOC), the World Assumption scale (WAS), The Coping Style Questionnaire (CSQ), The Impact on Family scale (IFS), the Trauma Symptom Checklist (TSC), and the Harvard Trauma Questionnaire (HTQ), were completed by the parents of children with various diseases. Despite the heterogeneity of the sample in terms of disease type, PTSD was present in 13.2% of the parents and an additional 28.6% had subclinical PTSD. Emotional coping, extent of daily care, time since diagnosis, and changes in employment due to the disease explained 71% of the variance in HTQ total score.


Guðmundsdóttir, H., Guðmundsdóttir, D., & Elklit, A. (2006). Risk and resistance factors for psychological distress in Icelandic parents of chronically ill children: An application of the the Wallander and Varni’s disability-stress coping model. Clinical Psychology in Medical Settings, 13, 299-306


Background: The negative impact of trauma on children and adolescents is well documented. However, few studies have investigated the relationship between coping and trauma and distress symptoms after man-made disasters, especially those not related to war. Objective: This study investigated the relationship between children’s coping styles and their self-reported levels of trauma and distress symptoms after an explosion disaster in a residential area. Method: Participants were recruited through the local public school that served the affected residential area. A total of 333 children and adolescents from grades 3 through 10 participated in the study 16 months after the explosion. All participants filled out questionnaires to assess their trauma and distress symptoms as well as their coping strategies. The adolescents answered additional questions about pre-, peri-, and post-traumatic factors and filled out questionnaires about their trauma and distress symptoms, including aspects of somatization and negative affectivity. Results: The following variables were associated with a higher degree of trauma symptoms for children in grades 6 through 10 and explained 39% to 48% of the unique variance in these symptoms: female gender; the experience of traumatic events pre-disaster; the destruction of property or danger to life occurring during the disaster; the experience of traumatic events post-disaster; and the use of self-blame, emotion regulation, wishful thinking, and cognitive restructuring. For the younger children, pre-, peri-, and post-disaster factors were not measured. However, female gender and the use of self-blame as a coping strategy explained 26% of the variance in trauma symptoms. Conclusions: This study generally supports the findings of the limited literature addressing coping skills after man-made disasters. However, contrary to previous findings in community samples after episodes of terrorism, adaptive coping strategies such as cognitive restructuring were found to influence the variance of trauma and distress symptoms.


Elmose, M., Elklit, A. & Duch, Christina. (2016) Children’s coping styles and trauma symptoms after an explosion disaster. Scandinavian Journal of Child and Adolescent Psychiatry and Psychology, 4(3), 132-140

This paper examines degree of traumatisation, defence styles, coping strategies, symptomatology, and social support in a small sample of HIV‐positive men and women in an effort to ascertain the psychological implications of living with Human Immunodeficiency Virus (HIV). Traumatisation and the potentially mediating effects of defence styles have only been the subject of a few studies of HIV positives. The study is based on a socio‐demographic questionnaire, the Impact of Event Scale, the Defence Style Questionnaire, the Coping Styles Questionnaire, the Trauma Symptom Checklist, and the Crisis Support Scale. A degree of traumatisation that warrants treatment was found together with an association between particular coping strategies and symptomatology, and particular defence styles and symptomatology, respectively. Social support had increased over time, which is contrary to other research findings on social support.


Pedersen, S.S. & Elklit, A. (1998). Traumatisation, Psychological Defense Style, Coping, Symptomatology, and Social Support in HIV-positive: A Pilot Study. Scandinavian Journal of Psychology, 39 (2), 55-60. Doi:

Individuals generally use the same coping styles across situations. It is important to identify maladaptive coping in adolescents as coping patterns may persist into adulthood, and are associated with mental health. The present study used a cross-sectional design to investigate the combined effect of personality traits, attachment, locus of control, and social support on rational (problem-focused), avoidant, and emotion-focused coping in 320 trauma-exposed adolescents. The combined variables only explained 20-23 % of the variance in avoidant and rational coping, and 49 % of the variance in emotion-focused coping. The largest contributing variable for emotion-focused coping was neuroticism, possibly due to a confounding of emotion-focused coping with distress. Thus, other variables are needed to fully account for coping style choice.


Christiansen, D., Hansen, M. & Elklit, A. (2014). Correlates of coping styles in an adolescent trauma sample. Journal of Child & Adolescent Trauma, 7, 75–85. Doi 10.1007/s40653-014-0011-2

Parents bereaved by infant death experience a wide range of symptomatology, including posttraumatic stress disorder (PTSD) that may persist for years after the loss. Little research has been conducted on PTSD in fathers who have lost an infant. Mothers report most symptoms to a greater extent than fathers, but not much is known about other sex differences following infant death. The present cross-sectional study examined sex differences in PTSD and sex differences in the relationship between PTSD severity and related variables. Subjects were 361 mothers and 273 fathers who had lost an infant either late in pregnancy, during birth or in the first year of life. Participants filled out questionnaires between 1.2 months and 18 years after the loss (M = 3.4 years). Mothers reported significantly more PTSD symptoms, attachment anxiety, emotion-focused coping and feeling let down, but significantly lower levels of attachment avoidance than fathers. Attachment anxiety, attachment avoidance and emotion-focused coping were significantly more strongly associated with PTSD severity in mothers than fathers, but only when examined alone. When all variables and time since the loss were examined together, there were no longer any significant moderation effects of sex. Persistent posttraumatic symptomatology exists in both mothers and fathers long after the loss. There are several sex differences in severity and correlates of PTSD, and a few moderation effects were identified for attachment and emotion-focused coping. Overall, more similarities than differences were found between mothers and fathers in the associations between PTSD and covariates.


Christiansen, D., Olff, M. & Elklit, A.: (2014). Parents bereaved by infant death: Sex differences and moderation in PTSD, attachment, coping, and social support. General Hospital Psychiatry, 36, 655–66136. Doi: 10.1016/j.genhosppsych.2014.07.012

We present PTSD-trajectories of resilience, delayed onset, recovery, and chronicity.•We investigate the predictive role of locus of control and coping style related to membership of these trajectories.•Internal locus of control decreases the risk of belonging to the symptomatic trajectories.•Less use of emotion-focused coping decreases the risk of symptomatic trajectory membership.•Less use of problem-focused coping increases the risk of membership of symptomatic trajectories. While longitudinal posttraumatic stress responses are known to be heterogeneous, little is known about predictors of those responses. We investigated if locus of control (LOC) and coping style are associated with long-term PTSD-trajectories after exposure to combat. Six hundred and seventy five Israeli soldiers with or without combat stress reaction (CSR) from the Lebanon war were assessed 1, 2, and 20 years after the war. Combat exposure, LOC, and coping style were then investigated as covariates of the trajectories of resilience, recovery, delayed onset, and chronicity. Symptomatic trajectories in the CSR and the non-CSR group were significantly associated to varying degrees with perceived life threat during combat (ORs: 1.76–2.53), internal LOC (0.77–0.87), emotional coping style (0.28–0.34), and low use of problem-focused coping (2.12–3.11). In conclusion, assessment of LOC and coping can aid prediction of chronic PTSD outcomes of combat exposure.


Karstoft, K-I., Armour, C., Elklit, A. & Solomon, Z. (2015). The role of locus of control and coping style in predicting longitudinal PTSD-trajectories after combat exposure. Journal of Anxiety Disorders, 32, 89-94. Doi: 10.1016/j.janxdis.2015.03.007

In the current study, we aim to examine the link between exposure to multiple traumatic events (polyvictimization), posttraumatic stress disorder (PTSD) symptoms (PTSS), and psychiatric symptomatology in early adolescence. Furthermore, we aim to explore the mediating roles of defense styles and coping styles in the associations between polyvictimization, PTSS, and psychiatric symptomatology. Data from a Danish national representative sample of 390 eighth-grade students with a mean age of 13.95 (SD= 0.37) years were used. Participants responded to validated self-report questionnaires in 2001. The dimensions of immature defense styles and emotional and avoidance coping mediated the positive associations between polyvictimization, PTSS, and psychiatric symptomatology. Serial multiple mediation indicated that the sum of exposure to traumatic events was significantly associated with more immature defense styles, associated with both high levels emotional and avoidance coping, which, in turn, were associated with high levels of PTSS and psychiatric symptomatology. Polyvictimization is related to adverse outcomes in early adolescence. Both immature defense styles and emotional and avoidance coping styles should be considered as risk factors for the development of psychological distress following exposure to multiple traumas.


Zerach, G. & Elklit, A. (2017). Polyvictimization and psychological distress in early adolescence: A mediaton model of defense mechanisms and coping styles. Journal of Interpersonal Violence, Doi: 10.1177/0886260517716944

This study aimed to (a) identify posttraumatic stress disorder (PTSD) trajectories in a sample of Danish treatment-seeking childhood sexual abuse (CSA) survivors and (b) examine the roles of social support, coping style, and individual PTSD symptom clusters (avoidance, reexperiencing, and hyperarousal) as predictors of the identified trajectories. We utilized a convenience sample of 439 CSA survivors attending personalized psychotherapy treatment in Denmark. Four assessments were conducted on a six monthly basis over a period of 18 months. We used latent class growth analysis (LCGA) to test solutions with one to six classes. Following this, a logistic regression was conducted to examine predictors of the identified trajectories. Results revealed four distinct trajectories which were labeled high PTSD gradual response, high PTSD treatment resistant, moderate PTSD rapid response, and moderate PTSD gradual response. Emotional and detached coping and more severe pretreatment avoidance and reexperiencing symptoms were associated with more severe and treatment resistant PTSD. High social support and a longer length of time since the abuse were associated with less severe PTSD which improved over time. The findings suggested that treatment response of PTSD in CSA survivors is characterized by distinct patterns with varying levels and rates of PTSD symptom improvement. Results revealed that social support is protective and that emotional and detached coping and high pretreatment levels of avoidance and reexperiencing symptoms are risk factors in relation to PTSD severity and course. These factors could potentially identify patients who are at risk of not responding to treatment. Furthermore, these factors could be specifically addressed to increase positive outcomes for treatment-seeking CSA survivors.


Fletcher, S., Elklit, A., Shevlin, M. & Armour, C. (2017): Predictors of PTSD treatment response trajectories in a sample of childhood sexual abuse survivors: the roles of social support, coping and PTSD symptom clusters. Journal of Interpersonal Violence, 1-25. Doi: 10.1177/0886260517741212

The aim of the present study was to examine specifically whether the relationship between coping style and symptoms of whiplash injury change as a function of gender. A total of 1709 sufferers of whiplash associated disorder (1349 women, 360 men) belonging to the Danish Society for Polio, Traffic and Accident Victims completed questionnaires measuring demographic and psychological factors (including coping style), and symptoms of whiplash trauma (including pain). Men and women were not found to differ significantly in their use of coping strategies, however emotion focused coping strategies were related significantly more strongly to whiplash related symptoms in men compared to women. Women were found to display more symptoms related to whiplash injury compared to men. Possible reasons for the present findings are discussed in light of related research indicating mood as a potential moderating variable in the relationship between maladaptive coping style and degree of symptoms related to injury in men.

Jones, A. & Elklit, A. (2007). The Association between Gender, Coping, and Whiplash Related Symptoms in Sufferers of Whiplash Associated Disorder. Scandinavian Journal of Psychology,48 (1), 75-80. Doi: 10.1111/j.1467-9450.2006.00543.x
Young refugees from the former Yugoslavia commonly testify to having been exposed to multiple, traumatic experiences, which may contribute to the development of serious mental health problems such as posttraumatic stress disorder (PTSD), anxiety, and depression. Using selfreport scales the present study investigated the prevalence of PTSD as well as factors associated with PTSD in a group of 119 Bosnian refugee youths (mean age 18.5). The group was special in that they had no right to seek asylum in the host country for the first couple of years of their stay. It is suspected that this circumstance had an effect on their wellbeing. Between 35-43% of the youth were found to be in the clinical range for a PTSD diagnosis. Female gender, problem-focused, and avoidant coping strategies, were significant predictors of PTSD. The protective effects of social support were, however, not observed for this group. There is a need for more studies, which address the factors that mediate and moderate effects of social support and effectiveness of different coping strategies in refugee youth dealing with different circumstances of the refugee experience.


Elklit. A., Palic, S., Lasgaard, M. & Kjær, K. (2012). Social Support, Coping and Posttraumatic Stress Symptoms in Young Refugees. Torture, 22(1), 11-23

Twelve Kosovo-Albanian interpreters at the Danish Red Cross (DRC) asylum reception centre participated in an interview about their background and work. The majority had fled from the Serbian persecution in Kosovo, which involved living in a permanently hypervigilant stat, with intense fear of rape, ethnic suppression and civil war. All of the interpreters reported a heavy workload and a high level of distress. The most distressing part was interpreting at interviews for psychologists, where stories of torture, annihilation, persecution, and loss were told. A considerate and respectful treatment of this staff group may enhance the quality of therapeutic work as the interpreters get an opportunity to contribute with their culture specific knowledge. Stress and coping in traumatized interpreters - a pilot study of refugee interpreters working for a humanitarian organization.


Holmgren, H., Søndergård, H., & Elklit, A. (2003). Stress and coping in traumatized interpreters – a pilot study of refugee interpreters working for a humanitarian organization. Intervention – International Journal of Mental Health, Psychosocial Work and Counselling in Areas of Armed Conflict, 1, (3), 22-27


Last Updated 29.09.2023