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6480303 Coping and Health NEPRINTAT

6480303 Coping and Health NEPRINTAT

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Published by Varga Timi

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Published by: Varga Timi on Jun 18, 2012
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Coping and Health:A Comparison of the Stress and Trauma LiteraturesCarolyn M. Aldwin and Loriena A. YancuraDept. of Human and Community DevelopmentUniversity of California, DavisChapter prepared for P. P. Schnurr & B. L. Green (Eds.),
Physical Health Consequences of  Exposure to Extreme Stress
. Washington, DC: American Psychological Association.
COPING AND HEALTH2Even a cursory review of 
reveals that well over 20,000 articles on stress andcoping processes have been published in the past two decades (Aldwin, 1999). A smallerproportion of these has specifically examined how individuals cope with trauma. Due todifferences between researchers in how trauma is defined, a definitive number is difficult todetermine. However, a search for the key words trauma and coping yielded 1,000 articles. Giventhe magnitude of this literature, we will not attempt to provide a full review. However, we willbriefly outline the different theoretical and methodological approaches to coping (for morecomplete reviews see Aldwin, 1999; Lazarus, 2000; Parker & Endler, 1996; Schwarzer &Schwarzer, 1996). Then we will examine the similarities and differences between coping withgeneral problems and coping with trauma. Finally, we will provide whether a brief review of therelationship between coping and health outcomes, and focus on whether coping strategies canaffect both the psychological and physical outcomes of trauma.THEORETICAL AND METHODOLOGICAL APPROACHES TO COPINGThere are four basic theoretical and methodological approaches to coping. Psychoanalyticapproaches focus on the use of defense mechanisms, while personality approaches focus oncoping styles. Both of these assume that adaptation is primarily a function of personalcharacteristics. In contrast, the coping process approach draws upon cognitive behavioralmodels, and is more likely to emphasize environmental demands and influences on coping.Coping process approaches tie the coping strategies to a particular stressful episode. Finally,
COPING AND HEALTH3daily coping processes use experience sampling techniques to examine how individuals copethroughout the course of the day with a wide variety of problems.Psychoanalytic ApproachesResearch on how individuals adapt grew out of early psychoanalytic studies of defensemechanisms, which are considered to be unconscious ways of warding off anxiety. DSM-IV(American Psychiatric Association, 1994) currently identifies seven major types of defensemechanisms, and orders them hierarchically from more to less severe. The most severe isdefensive dysregulation, which refers to frankly psychotic processes involving projection, denial,and delusion. Action refers to acting out, passive aggression, or apathetic withdrawal, and majorimage-distorting mechanisms include autistic fantasy, projective identification, and splitting.The less severe or "immature" mechanisms include disavowal (denial, projection, andrationalization), minor image-distorting (devaluation, idealization, and omnipotence), and mentalinhibitions (displacement, dissociation, intellectualization, repression, and the like). Highadaptive or "mature
defense mechanisms include altruism, humor, and sublimation, as well assuppression.Cramer (2000) compared the similarities and differences between defense mechanisms andcoping processes. Defense mechanisms are unconscious, nonintentional, dispositional,hierarchical, and associated with pathology, while coping processes are conscious, usedintentionally, situationally determined, nonhierarchical, and associated with normality. In otherwords, defense mechanisms are designated
a priori
as being more or less adaptive, and are not

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