TOC
Coping Skills Training:
A Systematic Approach to Stress Management
Counseling
ROBERT STENSRUD
KAY STENSRUD
This article reviews coping theory and attribution theory to present a systematic approach to stress management
counseling. It shows how to teach stress coping skills.
Few concepts have caught the public’s attention as has stress.
It has become a pervasive contributor to numerous conditions
from physical illness to divorce and child abuse. Many indi-
viduals, organizations, and families who would not have sought
help from counselors for “personal problems” are avidly seek-
ing counselors for “stress management.” Unfortunately, de-
spite a wealth of information on stress and stress management,
little specific work has been directed toward the development
of a counseling approach to stress management. We know what
stress is and how it is caused, but we know little about how
to help people cope with it.
The purpose of this article is to review research pertaining
to stress and coping and then to draw conclusions related to
the nature of stress management counseling. The research of
Lazarus and others (Cohen & Lazarus, 1979; Lazarus, 1980;
and Roskies & Lazarus, 1980) on “coping” as a personal ap-
praisal—problem solving—acting process is especially rele-
vant to the field of counseling because of its implications for
any counseling intervention.
Once it becomes possible to teach clients the skills and in-
formation necessary to cope with environmental stressors, the
next step is to train them in specific techniques of stress man-
agement. Much information exists on this topic, but little in-
formation describes which techniques are appropriate in which
situations. Part of the coping skills training approach, then, is
to determine what specific stress management techniques should
be used in certain person—environment situations.
Stress
Walter Cannon (1939) began conducting research during the
1920s on the physiological “fight or flight” response, which
led to his coining the term stress. (See Figure 1.) The popularity
of the stress concept, however, mostly can be traced to the
work of Hans Selye (1956), who spent over 40 years studying
the physiological stress response and lecturing around the world
about its effect on the body. Early researchers developed a
simple model that explained stress as an organismic response
to noxious environmental stimuli. They found that, regardless
of the environmental stressor, a generalized physiological re-
sponse was activated within the organism. Years were spent
tracing and documenting his General Adaptation Syndrome
(GAS).
214
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Not until the research of Mason and others (Mason, 1974;
Mason, Maher, Hartley, Mougey, Perlou, & Jones, 1976) did
it become apparent that vast individual differences existed be-
tween how individuals responded to stress. Different people
responded to the same stressor with totally different physio-
logical processes. Whereas a stressor would cause one person’s
fight or flight response to be activated, it would cause no
response in another person and a suppression of response in
a third person.
To accommodate the individual differences in the activation
of the stress response, theorists and researchers introduced
cognition as a moderating variable. Cognition was introduced,
however, as a physiological process by describing it in terms
of the reticular activating system of the brain. Up to this point
the physiological stress response tended to be perceived in the
following manner.
Coping and Stress
The work of Lazarus and others demonstrated that a descrip-
tion of the stress response that did not include cognitive pro-
cesses as well as the cognitive mechanism of the reticular activation
system was indequate. Such studies of stress reactivity ex-
amined the coping process that played a mediating role be-
tween environmental stressors and organismic responses. From
these studies evolved a “coping theory” of stress that can be
useful to stress management counselors.
Coping appraisals are made immediately after a stimulus is
introduced to the person as a lived experience. Coping ap-
praisals can be either primary appraisals (evaluations of stimuli
in terms of their significance to people’s well-being) or sec-
ondary appraisals (evaluations of options or resources avail-
able to people in order to respond to the stressors). A primary
cognitive appraisal process evaluates environmental stimuli to
determine whether they are potential sources of (a) harm or
loss,(b) threat, (c) challenge, or (d) irrelevancy. If this appraisal
process results in determination that an environmental stim-
ulus is irrelevant, no stress response is activated and normal
body functioning (homeostasis) is maintained. If any of the
Robert Stensrud is on the clinical faculty of St. Louis University Medical
Center, St. Louis, Missouri, and Kay Stensrud is an assistant professor,
Human Relations Program, University of Northern Iowa.
The PERSONNEL AND GUIDANCE JOURNAL

FIGURE 1
The Physiological Stress Response
other determinations are made, certain physiological systems
are altered to respond to the stressor.
These alterations are examples of secondary appraisal. Sec-
ondary appraisal results in coping responses that entail taking
direct action, inhibiting an action, seeking additional infor-
mation before acting, or cognitively coping with the stressor
through such processes as denial, intellectualization, or ra-
tionalization. Secondary appraisal, then, is the determination
of how to respond to the results of primary appraisals.
Coping responses can be either effective or ineffective. If
they are effective, the result is a rapid return to normal phys-
iological functioning. If responses are ineffective, they prevent
a return to homeostasis. Stages of the ineffective response are
activation, resistance, exhaustion, and death. Stages of the
effective response are activation, resistance, and return to ho-
meostasis.
Ineffective coping can occur in three general ways. First, it
can occur because the coping response chosen results in direct
damage to the body. Second, coping can be ineffective if it
mobilizes harmful physiological processes such as a response
that results in chronic high blood pressure or muscle tension.
Finally, coping can be ineffective if it increases the risk of illness
or injury by interfering with adaptive behaviors. People who
cope with crises through denial may inhibit their own fear
response, which would protect them from injury. People who
cope with work pressure by working harder may impair the
immunological system and become more prone to illness.
Studies can be conducted that document the results of in-
effective coping, but effective coping can best be understood
only from within the individual’s frame of reference. The im-
plications of this for counselors is that part of our role is to
study the coping processes as they exist within each person
to determine what is effective and what is ineffective. A coping
response that is effective for one person may be ineffective for
another. A coping response that works for a person in one
situation may not work in other situation. Each situation is
different and each person is different, so coping theory studies
each person-environment interaction as a unique phenome-
non. Only over time can generalizations be made concerning
what is effective or ineffective for a specific person.
The approach of differentiating phenomenologically be-
tween effective and ineffective coping responses is fair to the
data as they exist, but it makes the design of counseling in-
DECEMBER 1983
terventions quite difficult. Unless certain general rules can be
proposed, it becomes difficult to provide clients with the in-
formation and skills necessary to cope effectively with envi-
ronmental stressors.
Attribution Theory
Some current research has been directed toward the study of
stress reactivity as part of an attributional process. In attri-
bution theory, people are understood to respond to their en-
vironments in specific ways depending on the nature of the
attributions they derive from their experiences.
Schachter and Singer (1962) developed a theory of emotion
that suggests that a physiological state of arousal tends to lead
to a causal search for the source of the arousal. This causal
search leads to an attribution of causality or relatedness. Arousal
can be generated by internal or environmental stressors, but
once this process begins, people will seek reasons or the ex-
istence for that state. The theory of Schachter and Singer fo-
cuses primarily on situations in which the specific cause of
arousal could not be identified, but it seems likely that a some-
what similar process also occurs in those cases that have ev-
ident causes (Gochman, 1979).
When coping theory and attribution theory are combined,
it becomes possible to explain the coping process more thor-
oughly. On the basis of experience, people appraise environ-
mental stimuli. On the basis of this appraisal, people attribute
the stimuli’s effect on them to certain factors. More effort is
directed to this attribution process when a stress response is
felt but no stressors are evident in the environment. Some
research, however, has demonstrated that this cognitive pro-
cess does more than understand what is happening within the
body. In many cases, the appraisal, attribution, coping process
actually shapes the body’s response to environmental stimuli.
Kobasa (1979) studied people who were in similar situations
and found that some people coped well and reported a few
illnesses and other people did not cope well and reported
numerous illnesses. The healthy copers were considered by
Kobasa to be higher in “hardiness.” Hardy individuals were
found to have “a stronger commitment to self, an attitude of
vigorousness toward the environment, a sense of meaning-
fulness, and an internal locus of control” (Kobasa, 1979, p. 1).
Hardiness, then, demonstrates an attribution process that
is characterized by a strong sense of personal self-efficacy and
a strong sense of challenge. Such people would tend to ap-
praise environmental stimuli as challenging more often than
they would appraise them as harmful or threatening. Beyond
this, the concept of hardiness implies that a sense of personal
purpose or meaningfulness is necessary in stress management
counseling.
Weiner (1972) demonstrated that the difference between an
internal and an external attribution was not sufficient to explain
the attribution process. He suggested that another dimension
of stable—unstable also was involved in this process. Attri-
butions could be external—stable, external—unstable, inter-
nal—stable, or internal—unstable. These attributions can vary
along a third dimension, however. The third dimension is that
of helpless—powerful as an outcome expectancy (Stensrud &
Stensrud, 1981). It is possible that this third dimension, that
of helpless—powerful, is what integrates the work of Kobasa
with coping theory and attribution theory.
The overall appraisal, attribution, coping process begins with
personal experiences, moves to an appraisal that is based on
outcome expectancies, moves to cognitive attributions, and
results in a coping response. The coping response involves
cognitive, physiological, and behavioral processes that act to
respond in a coherent fashion to what has been perceived as
215
 TABLE 1
Examples of Attribution by Locus, Stability, and Expectancy

Locus Stability Outcome expectancy Example

External Stable Helpless This task is impossible
Powerful There is a way to accomplish this
Unstable Helpless Other people interfered with me
Powerful If things go right this task is possible
Internal Stable Helpless I never do anything right
Powerful I can do whatever I set my mind to
Unstable Helpless I am so unlucky
Powerful I will get it right if I try again

is impaired. As one student reported in describing her stress-

management strategy, “I was taught that my body was a ma-
chine, so I drove it as hard and as far as I could. When it broke
down I just called a towtruck.”
Once people present their stress disorders, a useful ap-
proach is to describe the concept of hardiness and explain that
the stress-management process involves taking personal con-
trol of their lives, accepting stress as a challenge rather than
a harm—loss—-threat factor, and finding personal meaning
within stressful situations. People tend to be more willing to
internalize positive statements and they tend to externalize
negative statements. This is part of the cognitive process by
which they retain problems. People can feel personal owner-
ship of their stress if it is a challenge, so they work to manage
it. But, if people experience stress as a problem, they externalize
it so the problem is not their responsibility.
It is useful to listen closely to clients’ descriptions of what
is wrong in their lives. The cognitive attribution process is
reflected in the language people use to describe their percep-
tions of the world. If counselors listen to the exact words clients
use, they will hear them alter the locus of life events (internal
and external), the stability of life events (stable and unstable),
and the personal power of these events (helpless and pow-
erful). People’s language reflects the world as they appraise
it, attribute causality to it, and cope with it.
The role of the counselor is to help clients recognize how
their language reflects the process by which they appraise their
environments and, therefore, how they cause problems to stay
FIGURE 2 unresolvable. In certain cases, external events occur and clients
The Cognitive Attribution Stress Response must be able to appraise them accurately so they know which
coping mechanism is most useful. In other cases, clients have
an environmental stressor. The overall process can be char- control over events and they must be able to appraise these
acterized in the following manner. (See Table 1.) situations accurately, also, so they know how to cope with
Problem Retention and Problem Resolution them. It is as destructive for people to deny personal respon-
From the above models, it becomes possible to develop a pro- sibility for controllable events as it is to accept responsibility
cedure for assessing and treating stress-management clients. for uncontrollable events.
Such a procedure recognizes the central role played by cog- Once clients learn how to apply a systematic procedure to
nition in the development and retention of stress disorders. assessing situations, they are able to choose the most appro-
When people seek counseling for “stress management,” they priate coping response. This helps clients realize that any event
often are communicating implicitly that the problem is in the can result in a felt sense of personal power. Helpless attri-
stress, not in themselves. They have externalized the problem butions, even in cases of externally controlled situations, are
in much the same manner as do people who seek physicians’ the result of ineffective coping responses. All situations can
help with physical illnesses. They tend to communicate that, be coped with successfully if people know how to assess those
“The problem is not within me; it is within some external agent situations accurately. The felt sense of personal power derives
that has infected me. You fix that external agent and I will be from coping effectively. Even if people cannot control events,
fine.” (See Figure 2.) they can derive a sense of personal power from realizing that
It is possible that a reason for the popularity of the stress they can choose their responses to those events. Stress-man-
concept is that it gives an external excuse for what were “per- agement counseling, then, becomes a process of helping peo-
sonal problems.” It seems less of a threat to go to a counselor ple to control those stressors that are under their control and
for stress management than for counseling; there seems to be to cope effectively with those stressors that are not.
less of a personal liability. There also, however, is less personal What is needed is a systematic procedure that can be taught
ownership of the presenting problem so the recovery process to clients to help them cope effectively with any situation.

216 The PERSONNEL AND GUIDANCE JOURNAL

Clients can be taught to diagnose life events in terms of con-
trollability stability, and appraisal. Once they have diagnosed
a situation, they can choose the coping response that is most
useful for them. The following chart describes how a person
may choose to respond. The X’s offer only possible responses,
and clients should be encouraged to choose their own coping
responses.
People can choose their own coping responses from within
three general areas: passive—avoidant, cognitive—palliative,
or active. Over time, people tend to derive most of their re-
sponses from one of these three areas. When coping responses
are drawn excessively from one area, physical symptoms tend
to develop that are specific to that coping strategy. Some re-
search has begun to correlate physical disorders with coping
style (McNamara, 1979). People who overuse the passive—
avoidant coping style tend to develop respiratory disorders.
People who overuse the cognitive—palliative coping style tend
to develop digestive disorders. People who overuse the active
coping style tend to develop circulatory disorders. This does
not always hold true, obviously, but it offers a hypothesis for
counselors to consider when physical symptoms are present
in clients. (See Table 2.)
All coping styles must be used, but they must be used only
when appropriate. The key is flexibility; clients may be taught
how to be flexible enough to choose and use the best coping
strategy for each situation. The authors worked with a student
who felt powerless in his job but told himself that he needed
the money to support his family (rationalization). This coping
strategy immobilized him and caused a feeling of powerless-
ness, and he developed an ulcer. Shortly after we met him,
he was promoted to a managerial position and he began at-
tempting to control all aspects of the business (mastery). His
ulcer disappeared, but he developed high blood pressure. Once
he was taught this systematic coping process he became better
able to choose his coping strategy and no longer had either an
ulcer or high blood pressure.
Few clients will present such an exact replica of this model.
College and school counselors may note, however, how many
students develop respiratory disorders such as colds before or
during midterm and final exam periods. Organizational and
rehabilitation counselors may note how many executives de-
velop heart disease and how many middle managers have
ulcers. Physical symptoms seem to develop when people use
a single coping strategy, regardless of which strategy it is. The
role of the counselor, then, is to help clients to cope more
flexibly.
Stress Management Techniques
A multitude of stress management techniques exist from au-
togenic training to zone therapy. Techniques such as these
play a central role in stress management, but they seem sec-
ondary to coping skills training. Once clients have learned how
to diagnose and cope with stressful situations, they can be
taught specific techniques to counterbalance their preferred
(overused) coping strategy. If people overuse passive—avoid-
ant coping strategies, they can be taught such skills as asser-
tiveness, goal setting, problem solving, and exercise as stress
management techniques. If people overuse the cognitive pal-
liative strategies, cognitive therapy is an excellent choice of
technique. If people use the active coping strategies to excess,
techniques such as meditation, autogenic training, massage,
biofeedback, and yoga seem most useful.
Ironically, people tend to be most resistant to practicing the
stress management techniques they need most to learn. This
is another reason to teach coping strategies first. Once people
understand the broader context of why they are being taught
a specific technique, they tend to be more willing to practice
DECEMBER 1983
it. For too long, stress management consultants have taught
techniques with little understanding of what techniques are
appropriate for what people. The result has been poor client
performance, which has been blamed on “unmotivated ”clients.
The broader context of specifying certain techniques for certain
clients may offer an approach that meets with greater success.
Counselors must become proficient in numerous stress-
management techniques if they are to teach them. Typically,
we are most proficient in those techniques that work best for
ourselves, but this is not an appropriate basis on which to
determine what techniques should be taught to clients. In-
numerable stress-management techniques exist, and the more
counselors are proficient in practicing and teaching all of them,
the more apt they are to be of benefit to their clients.
Beyond Information and Techniques
There is more to stress management than teaching information
and skills. Counselors also must be able to help clients rec-
ognize the transpersonal dimension of stress. This is the di-
mension described by Kobasa (1979) as “vigorousness toward
the environment” and “meaningfulness.“ To intervene at this
level requires an entirely different level of counseling (Stensrud
& Stensrud, 1982). Counselors who wish to be of optimal value
to their clients must be able to share with clients their life
meanings, sense of purpose, and presence.
Information and skills can take people only so far. Without
this, other dimension of intervention counselors offer only,
“(L)aundry lists of techniques all of which work and none of
which really deepen” (Houston, 1978, p. 21). For optimal func-
tioning to become integrated into their belief systems, clients
need to move toward a hardy lifestyle that goes beyond stress
control techniques to one of personal responsibility and chal-
lenge. Once this occurs, the stress management strategies peo-
ple adopt become integral aspects of their lifestyles and less
apt to be discontinued at some later date.
REFERENCES
Cannon, W. (1939). The wisdom of the body. New York: Norton.
Cohen, F., & Lazarus, R. (1979) Coping with the stresses of illness.
In G. Stone, F. Cohen, & N. Adler (Eds.), Health psychology—a hand-
book (pp. 217-254). San Francisco: Jossey-Bass.
Gochman, I. (1979). Arousal, attribution, and environmental stress.
In I. Sarason & C. Spielberger (Eds.), Stress and anxiety (Vol. 6) (pp.
325-362). New York: John Wiley & Sons.
Houston, J. (1978). Re-seeding America: The American psyche as a
garden of delights. Journal of Humanistic Psychology, 18, 6-22.
Kobasa, S. (1979). Stressful life events, personality, and health: An
inquiry into hardiness. Journal of Personality and Social Psychology, 37,
1-11.
Lazarus, R. (1980). The stress and coping paradigm. In L. Bond & J.
Rosen (Eds.), Competence and coping in adulthood (pp. 28-74). Han-
over, NH: University Press of New England.
Mason, J. (1974). Specificity in the organization of neuroendocrine
response profiles. In P. Seeman & G. Brown (Eds.), Frontiers in
neurology and neuroscience research: First International Symposium of the
Neuroscience Institute (pp. 108-131). Toronto: University of Toronto
Press.
Mason, J., Maher, J., Hartley, L., Mougey, E., Perlow, M., & Jones,
L., (1976). Selectivity of corticosteroid and catecholamine responses
to various natural stimuli. In G. Serban (Ed.), Psychopathology of
human adaptation (97-119). New York: Plenum.
McNamara, J. (1979). Behavioral approaches to medicine: Application and
Analysis. New York: Plenum.
Roskies, E., & Lazarus, R. (1980). Coping theory and the teaching of
coping skills. In P. Davidson & S. Davidson (Eds.), Behavioral med-
icine: Changing health lifestyles (38-69). New York: Brunner/Mazel.
Schachter, S., & Singer, J. (1962). Cognitive, social, and physiological
determinants of emotional state. Psychological Review, 69, 379-399.
Selye, H. (1956). The stress of life. New York: McGraw-Hill.
Stensrud, R., & Stensrud, K. (1981). Counseling may be hazardous to
your health: How we teach people to feel powerless. Personnel and
Guidance Journal, 59, 300-304.
Stensrud, R., & Stensrud, K. (1982). Holistic health through holistic
counseling: Toward a unified theory. (manuscript under review).
Weiner, B. (1972). Theories of motivation. Chicago: Markham.
217
 TABLE 2
Coping Strategy Options

Passive-avoidant Cognitive Palliation Active

Comple- Supple-
Intellec- mentary m e n t a y Seach
Resigna- With- Detach- tualiza- Rational- Projec- Projec- for Infor- Mental
Locus Stability Appraisal tion Denial drawal ment tion ization tiona tionb mation Worry c Mastery Rehearsal Example
External Stable Harm-loss X Death of loved one
Threat X Innoculation-dental work (pain)
Challenge X Environmental stressors, i.e. pollution
Unstable Harm-loss X Divorce
Threat X Prejudice
Challenge X Severe weather
Internal Stable Harm-loss X Aging
Threat X Male pattern baldness
Challenge X High blood pressure
Unstable Harm-loss X Acute illness
Threat X Mid-life crisis
Challenge X Type A behavior patterns

a
Complementary projection refers to the projection of intent onto some external source. “I felt hurt because that person meant to hurt me.”
b
Supplementary projection refers to the projection of similar experiences or affective states onto peers. “Everybody hated that test.”
c
Worry in this sense is similar to mental rehearsal, except that worry refers to the creation of totally negative consequences. Mental rehearsal refers to a more “objective” creation of both positive and nega-
tive consequences.