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.
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
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
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
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
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
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