SIMRAN CHAWLA & MAHEK BRIJWANI (MA-1)

TITLE: STRESS COPING ACROSS NODUS TEST (SCAN)

OBJECTIVE: To study and understand the coping skills during stress using stress coping
across nodus test.

INTRODUCTION:

As defined by WHO, the changes that cause physical, emotional or psychological strain is
called stress. It is an individual's body response to anything that needs a certain kind of
attention or an action. Everyone, be it a young adult or an elderly person, almost experiences
stress in different tangents in their personal life. Some common behaviour that an individual
displays when undergoing stress are fear, inability to relax, difficulty in breathing,
disturbances in sleeping and eating patterns. How to deal and find a solution for it will result
in the well-being of that person. As stress affects our body as well as brain, little amount of it
can help an individual to perform well in the allocated task but when the measures start to
vary to a higher level than the person may respond in a fight, flight or freeze manner. That
brings us down to why coping up with stress is important.
What is coping? Coping skills are the tactics that people use to deal with stressful situations.
Managing your stress well can help you feel better physically and psychologically and impact
your ability to perform your best. Sometimes, it’s tempting to engage in strategies that will
give quick relief but might create bigger problems for you down the road. It’s important to
establish healthy coping skills that will help you reduce your emotional distress or rid
yourself of the stressful situations you face.  Some healthy ways of coping skills is to
establish and maintain boundaries, making to do lists, practicing relaxation strategies such as
deep breathing, meditation, getting regular physical activity, setting goals etc. Problem-
focused, emotion-focused, social support, religious coping, and meaning making are some
different types of coping as they prove useful in certain situations. Coping skills
increase resilience because they help people learn how to properly handle negative emotions,
panic attacks, and other difficult situations. When you effectively deal with a
negative emotion or situation, you also move on and let go of the negative feelings that are
associated with that experience.  Coping skills help you tolerate, minimize, and deal with
 stressful situations in life. Managing your stress well can help you feel better physically and
psychologically and it can impact your ability to perform your best.

COPING THEORY:

Basically, coping refers to an individual's attempt to tolerate or minimize the effect of the
stress, whether it is the stressor or the experience of stress itself. Coping theories can be
classified according to orientation or focus (trait-oriented or state-oriented) and approach
(macro-analytic or micro-analytic).
Classification of Coping Theories:
Coping theories have been divided into two different parameters:

1.      Trait-Oriented Theories versus State-Oriented Theories

2.      Micro analytic Approach versus Macro Analytic Approach

The trait-oriented theories focus on the early recognition of a person’s resources and
tendencies related to coping, while the state-oriented theories emphasize the actual coping of
an individual and the outcome of his application of coping methods or strategies.
On the other hand, the micro analytic approach studies a wide variety of specific and concrete
coping strategies, while the macro-analytic approach concentrates on fundamental and
abstract coping methodologies.
1. Macro analytic, Trait-oriented Coping Theories:

A. Repression–sensitization
This theory states that there is a bipolar dimension in which a person copes with the stress in
only one of two opposite poles – repression or sensitization. People who tend to be repressers
cope with stress by means of denying or minimizing its existence. They use the avoidance
coping mechanism such that they are unable to realize the potential negative outcomes of the
stressful experience. In contrast to this, sensitizers tend to react to stress with rumination,
excessive worrying, and obsessive search for information on stress-related cues.
 
B. Monitoring and Blunting
According to Miller, monitoring and blunting is a construct that is based on the repression-
sensitization theory due to the similarity in their nature as cognitive informational styles.
However, this construct, particularly blunting, tells us that the impact of uncontrollable
 stressful cues can be reduced by the individual through the use of cognitive avoidance (e.g.
denial, reinterpretation, distraction).
Under controllable stress, monitoring is said to be a more effective coping strategy, as it
includes seeking information related to the stressor.

C. Model of Coping Modes (MCM)

This model originates from the monitoring-blunting construct, and is also related to the
repression-sensitization conception, but expands concepts of vigilance and cognitive
avoidance with an underpinning of a cognitive motivational approach. It emphasizes that a
person is stimulated to avert the situation and perceive the stressor in an ambiguous manner
in the presence of the stressor.

2. Macro analytic, State-Oriented Theories

The Defense Mechanisms constructs by Sigmund Freud in 1926 is one of the few macro
analytic, state-oriented theories of coping. A number of defense mechanisms were basically
related to intellectualization and repression, the two basic forms that Freud emphasized in
1936.
Richard Lazarus and Susan Folkman proposed yet another theory of coping in a macro
analytic approach, concentrating on the coping strategies that are focused on emotion or on
the problem itself, as well as the functions related to them.
While the theory of Lazarus and Folkman was macro analytic in its origin, it was expanded to
the micro analytic approach, wherein Lazarus, et.al. Was able to specify coping strategies and
classify them into eight groups. These include self-controlling, confrontative coping, seeking
social support, distancing, escape-avoidance, accepting responsibility, positive reappraisal
and planful problem-solving.
 
Factor analysis:
1.  (Folkman & Lazarus, 1980), Seventy-five married couples were interviewed in their homes
once a month for five months. Subjects were asked to describe the most stressful encounter
they had experienced in the previous week and then fill out the revised Ways of Coping.
Observations from the five interviews were pooled. The Ways of Coping items were analyzed
using alpha and principal factoring with oblique rotation. Three separate factor analyses were
completed using different strategies for combining person occasions, or observations. The
three-factor analyses yielded very similar factor patterns. Thirty-seven items consistently
 loaded high on the same factor across all 3 analyses. Twenty-two items loaded on the same
factor fairly consistently; 9 of these were eliminated on the basis of marginal factor loadings
or lack of conceptual coherence with their scale. Seven items did not consistently load on any
factor and were therefore eliminated. Because multiple factors had been conducted, we had
several estimates of each item’s factor loading. A final principle factor analysis, calling for
eight factors, was therefore performed on the 750 observations with the final 50 items in
order to get an estimate of each item’s factor loading. The coping scales are derived from the
factor analytic procedures described.
 
2.      (Folkman & Lazarus, 1980), Data were gathered from 108 undergraduates who completed
the Ways of Coping (Folkman & Lazarus, 1985) three times as part of a study of examination
stress. Observations from the three occasions were pooled. Nine items were eliminated from
the analysis because they showed high skewness and restricted variance. The remaining 57
items were submitted to common factor analysis with oblique rotation. A six-factor solution
yielded the most conceptually interpretable set of factors. Fifteen items that did not load
clearly on any one factor were deleted. One of the six factors contained three distinguishable
groups of items. The three groups were rationally assigned to three factors to provide greater
theoretical clarity. The procedure produced eight scales, including one problem-focused and
six emotion-focused scales, and an eighth scale containing both problem and emotion-
focused items.
Lazarus and Folkman (1984), one of the pioneers of the coping theory, defined coping as:
“Constantly changing cognitive and behavioural efforts to manage specific external and
internal demands that are appraised as taxing or exceeding the resources of the person.”
Lazarus and Folkman (1984) distinguished two fundamental kinds of coping: problem-
focused coping and emotion-focused coping. In problem-focused coping, one attempts to
manage or alter the problem that is causing one to experience stress (i.e., the stressor).

Problem-focused coping strategies are similar to strategies used in everyday problem-

solving: they typically involve identifying the problem, considering possible solutions,
weighing the costs and benefits of these solutions, and then selecting an alternative (Lazarus
& Folkman, 1984). As an example, suppose Bradford receives a midterm notice that he is
failing statistics class. If Bradford adopts a problem-focused coping approach to managing
his stress, he would be proactive in trying to alleviate the source of the stress. He might
contact his professor to discuss what must be done to raise his grade, he might also decide to
set aside two hours daily to study statistics assignments, and he may seek tutoring assistance.
A problem-focused approach to managing stress means we actively try to do things to address
the problem.

Emotion-focused coping, in contrast, consists of efforts to change or reduce the negative

emotions associated with stress. These efforts may include avoiding, minimizing, or
distancing oneself from the problem, or positive comparisons with others (“I’m not as bad off
as she is”), or seeking something positive in a negative event (“Now that I’ve been fired, I
can sleep in for a few days”). In some cases, emotion-focused coping strategies involve
reappraisal, whereby the stressor is construed differently (and somewhat self-deceptively)
without changing its objective level of threat (Lazarus & Folkman, 1984). For example, a
person sentenced to federal prison who thinks, “This will give me a great chance to network
with others,” is using reappraisal. If Bradford adopted an emotion-focused approach to
managing his midterm deficiency stress, he might watch a comedy movie, play video games,
or spend hours on Twitter to take his mind off the situation. In a certain sense, emotion-
focused coping can be thought of as treating the symptoms rather than the actual cause.
While many stressors elicit both kinds of coping strategies, problem-focused coping is more
likely to occur when encountering stressors we perceive as controllable, while emotion-
focused coping is more likely to predominate when faced with stressors that we believe we
are powerless to change. Clearly, emotion-focused coping is more effective in dealing with
uncontrollable stressors. For example, the stress you experience when a loved one dies can be
overwhelming. You are simply powerless to change the situation as there is nothing you can
do to bring this person back. The most helpful coping response is emotion-focused coping
aimed at minimizing the pain of the grieving period.
Fortunately, most stressors we encounter can be modified and are, to varying degrees,
controllable. A person who cannot stand her job can quit and look for work elsewhere; a
middle-aged divorcee can find another potential partner; the freshman who fails an exam can
study harder next time, and a breast lump does not necessarily mean that one is fated to die of
breast cancer.
The appraisal literature explains the response or coping process in terms of problem-focused
coping or emotion-focused coping, Lazarus & Folkman also referred to as active and passive
coping styles. As well, approach and avoidance-style measures of coping exist involving
assertiveness or withdrawal. When faced with a challenge, an individual primarily appraises
the challenge as either threatening or non-threatening, and secondarily in terms of whether he
or she has the resources to respond to or cope with the challenge effectively. If the individual
does not believe he or she has the capacity to respond to the challenge or feels a lack of
control, he or she is most likely to turn to an emotion-focused coping response such as
wishful thinking (e.g., I wish that I could change what is happening or how I feel), distancing
(e.g., I’ll try to forget the whole thing), or emphasizing the positive (e.g., I’ll just look for the
silver lining) (Lazarus & Folkman, 1987). If the person has the resources to manage the
challenge, he or she will usually develop a problem-focused coping response such as analysis
(e.g., I try to analyse the problem in order to understand it better; I’m making a plan of action
and following it). It is theorized and empirically demonstrated that a person’s secondary
appraisal then determines coping strategies.
 Folkman and Lazarus (1980) as cited in Carver et al. (1989) are of the opinion that even
though most stressors elicit both types of coping, problem-focused coping tends to
predominate when individuals feel that something constructive could be done. Emotion-
focused coping tends to predominate when people feel that the stressor must be endured.
Moos (1986) as cited in Carver et al. (1989) pointed out that the interest in the process of
coping with stress had grown dramatically. Lazarus and Folkman (1984) as cited in Carver et
al. (1989) argued that stress was made up of three processes, namely, primary appraisal,
which was the process of perceiving a threat to oneself, secondary appraisal which was the
process of bringing to mind a potential response to the threat, and coping, which talked about
the process of executing that response. In the view of Lazarus and Folkman (1984): Miller
(1982) in suggesting ways of coping with stress indicated that relaxation, breathing, refuting
illogical or irrational ideas, assertiveness, time management, maintaining good nutrition,
exercise, recreational activities and changing usual routines could go a long way to help
people manage stressful situations they went through.

 Existing instruments to measure an individual’s coping strategy:

1.  Ways of coping checklist (WCCL):

The Ways of Coping Checklist (WCCL) is a measure of coping based on Lazarus and
Folkman's (1984) stress and coping theory. The WCCL contains 68 items that describe
thoughts and acts that people use to deal with the internal and/or external demands of
specific stressful encounters. It contained two rationally derived scales: problem-focused-
the management of the sources of stress and emotion-focused coping regulation of
stressful emotions. WCCL contains seven scales - problem-focused, wishful thinking,
 growth, minimize threat, seek social support, and self-blame, the mix scale contains both
avoidant strategy and help seeking strategy. In addition to 68 coping items, the WCCL
contains four items which allow the subject to appraise his or her current serious stressor
in terms of four dimensions.

2.  Ways of coping questionnaire (WCQ):

The Ways of Coping (Revised) is a 66-item questionnaire containing a wide range of

thoughts and acts that people use to deal with the internal and/or external demands of
specific stressful encounters. Usually, the encounter is described by the subject in an
interview or in a brief written description saying who was involved, where it took place,
and what happened. Sometimes a particular encounter, such as a medical treatment or an
academic examination, is selected by the investigator as the focus of the questionnaire.
Many investigators have asked if the Ways of Coping can be used to assess coping styles
or traits. The measure is not designed for this purpose but as a process measure. It is
possible though to look for consistency (style) across occasions by administering the
measure repeatedly and then doing individual analyses. Each administration, however, is
focused on coping processes in a particular stressful encounter and not on coping styles or
traits. The revised Ways of Coping (Folkman & Lazarus, 1985) differs from the original
Ways of Coping Checklist (Folkman & Lazarus, 1980) in several ways. The response
format in the original version was Yes/No; in the revised version the subject responds on
a 4-point Likert scale (0 = does not apply and/or not used; 3 = used a great deal).
Redundant and unclear items were deleted or reworded, and several items, such as prayer,
were added.  Lazarus and co-workers distinguish eight groups of coping strategies:
confrontative coping, distancing, self-controlling, seeking social support, accepting
responsibility, escape avoidance, planful problem-solving and positive reappraisal.

3.  Coping Orientation to Problems Experienced (COPE):

The COPE inventory was created by Carver (1989). It is a multi-dimensional inventory

developed to assess the different coping strategies people use in response to stress. COPE
stands for Coping Orientation to Problems Experienced. The inventory is a list of
statements that participants review and score. There are two main components to the
COPE inventory: problem-focused coping and emotion-focused coping. Five scales aim
to measure each of these: Problem-focused coping-Active Coping, Planning, Suppression
 of Competing Activities, Restraint Coping & Seeking of Instrumental Social Support,
Emotion-focused coping-Seeking of Emotional Social Support, Positive Reinterpretation,
Acceptance, Denial & Turning to Religion. The Brief-COPE is a 28-item self-report
questionnaire designed to measure effective and ineffective ways to cope with a stressful
life event. “Coping” is defined broadly as an effort used to minimize distress associated
with negative life experiences. The scale is often used in healthcare settings to ascertain
how patients are emotionally responding to a serious circumstance. It can be used to
measure how someone is coping with a wide range of adversity, including a cancer
diagnosis, heart failure, injuries, assaults, natural disasters, financial stress, or mental
illness. The scale is useful in counselling settings for formulating the helpful and
unhelpful ways someone responds to stressors. 

 Stress Coping Across Nodus Test (SCAN) :

SCAN is a 44-item self-report questionnaire designed to measure effective and ineffective

ways to cope with any stressful/ difficult events.  It can be used to measure how someone is
coping with a wide range of adversity, including a cancer diagnosis, injuries, assaults, natural
disasters, financial stress or mental illness. The scale can be useful in healthcare settings to
ascertain how patients are emotionally responding to a serious circumstance. 

The scale can determine someone’s primary coping styles with scores on the following two
sub scales:

 Problem-Focussed Coping
 Emotion-Focussed Coping

There are 4 subscales of Problem-focused coping-

1. Time management (Time management is the process of organizing and planning  how to
divide your time between different activities) 
2. Acceptance (The act of accepting something or someone)
3. Error detection (Analysing mistakes)
4. Ask for professional support (Looking up to mentors for help)
 
 There are 4 subscales of emotion-focused coping-

1. Journaling (Writing down / venting your thoughts and feelings to understand them more
clearly)
2. Social support (State of mind where a person is incapable of taking full responsibility for
their own feelings and is emotionally dependent)
3. Devotional (An act of prayer or private worship)
4. Projection (The unconscious transfer of one's desires or emotions to another person.)

Recent research:
Cicognani (2011) study was done to understand coping strategies in Italian teens and how
they relate to mental health. It was a Sample of 342 high school students (14-19 years old) in
Northern Italy. Coping was measured using a questionnaire (Coping across Situations
Questionnaire – CASQ). Mental health was measured using a questionnaire on subjective
well-being (including depressed mood).  Data was also gathered on levels of self-efficacy and
social support. The results showed significant correlations between coping strategies and
psychological well-being. The results also showed that girls were more likely to use these
emotion-focused coping strategies more than boys. Self-efficacy and family support
influenced which coping strategies were used (e.g. reducing the use of emotion-focused
strategies like withdrawing) and this improved well-being. This shows how emotion-focused
coping could have a negative effect on mental health. However, it also shows that factors like
self-efficacy and social support can influence the choice of coping strategies and thus affect
mental health also. The results could explain the common finding that girls report higher
levels of subjective stress in stress studies.

Application:
1. Coping scales questionnaire are useful in school settings to measure student’s coping ability
2. It is used to assess the coping skill of a person going through a mental illness such as
depression, PTSD & anxiety, etc.
3. It can be beneficial in counselling settings to keep track of the client’s coping ability.
  
METHOD

a) Participant:

   NAME AGE   GENDER EMOTIONAL STATE

( Write only initials of

participant here)

 
b) Material:
1. SCAN Questionnaire
2. Answer sheet
3. Stationery
4. Screen
5. Scoring key
6. Norm table
 
c) Procedure: The tester arranged the table and called the participant in the laboratory.
Rapport was established. Instructions were read from the booklet. After the
Participant answered all the questions on the separate answer sheet provided, Post
Task Questions were asked. The participant was debriefed and escorted out of the
Laboratory.
 
d) Instructions: Instructions were read from the booklet.

e) Scoring and interpretation:

There are 2 options for every question (Agree & disagree). Each answer will be scored 1 if
the response given by person is ‘AGREE’. There are 20 questions for problem focused
coping which has 4 subscales and 5 questions on each subscale, same goes with emotion
 focused coping. Scoring key will be used to score question of each subscale. Total number of
‘AGREE’ responses will be calculated in subscales of both the scales i.e. problem focused &
emotion focused. Scale with more number of ‘Agree’ response will indicate the coping
strategy that is most used by a person.

The acquired scores can be interpreted as follows:

  SCALE
TOTAL NO. OF AGREE       INTERPRETATION

RESPONSES

      Problem focused coping             1  -  9        Low

      10  -  12        Average

      14  -  20        High

      Emotion focused coping            1  -  9        Low

      10  -  12        Average

      14  -  20        High

BOOKLET:
INSTRUCTIONS:

Inside this booklet are some questions to see how people respond when they confront difficult
or stressful events in their lives. The questionnaire will be given to you that ask you to
indicate what you generally do and feel when you experience stressful events. Obviously,
different events bring out somewhat different responses but think about what you usually do
when you are under a lot of stress. There are no "right" or "wrong" answers because everyone
has the right to his own views. To get the best advice from your results, you will want to
answer them exactly and truly.
Write your name and all other information asked for on the top of the sheet.
First, you should answer four sample questions below so that you can see whether you need
to ask anything before starting. There are two possible answers to each question. Read the
following examples and mark your answer to each of the following items by blackening the
option for each, using the response choices listed just below.
 
EXAMPLES:

1. I concentrate on my efforts to constantly improve myself.

O   AGREE
O   DISAGREE

2. I engage in work or any other activities to distract myself from negative emotions.

O   AGREE
O   DISAGREE

3. I learn from my past experiences and avoid those mistakes in future.

O   AGREE
O   DISAGREE

4. I let my emotions out whenever i feel low about anything that affects me.

O   AGREE
O   DISAGREE
In this way you have to answer other questions as well. Ask now if anything is not clear.
The examiner will tell u in a moment to start after providing a sheet of questionnaire.

When you answer, keep these four points in mind:

1. Please try to respond to each item separately in your mind from each other item.

2. Choose your answers thoughtfully, and make your answers as true FOR YOU as you can.

3. Please answer every item.

4. Choose the most accurate answer for YOU--not what you think "most people" would say
or do. Indicate what YOU usually do when YOU experience a stressful event or any kind of
difficulty.

DO NOT TURN THE PAGE UNTIL TOLD TO DO SO

[Fill the following details before starting the test]

NAME: _____________   AGE: ________ GENDER:  _________    CLASS: _________ 
 
1) I plan my day with a schedule to manage all tasks and have a systematic lifestyle.

O   AGREE
O   DISAGREE

2) I often have a habit of writing down my thoughts in a diary to escape unpleasant feelings
& vent it out whatever i feel.

O   AGREE
O   DISAGREE

3) I accept the outcomes of my actions rather than complaining about them.

O   AGREE
O   DISAGREE

4) Parents are my biggest cheerleader when I am at my lowest.

O   AGREE
O   DISAGREE

5) Whenever I find out my fault I briefly analyse them.

O   AGREE
O   DISAGREE

6) I feel warmth in my spiritual beliefs/religion.

O   AGREE
O   DISAGREE

7) I would choose to seek professional help if i face any issues regarding my mental health at
times of emotional distress.  

O   AGREE
O   DISAGREE

8) I tend to over-react sometimes and unnecessarily say things that I should not.

O   AGREE
O   DISAGREE

9) I believe in organizing and managing my time to get my work done beforehand rather than
piling it up. 

O   AGREE
O   DISAGREE

10) I prefer to keep things to myself in the form of writing it down in my diary about
whatever I go through rather than conveying it to others.

O   AGREE
O   DISAGREE

11) I admit my flaws and I always try to improve them.

O   AGREE
O   DISAGREE

12) If something goes wrong, i prefer to ask for a solution to my friends/ parents/ partner.

O   AGREE
O   DISAGREE

13) I am always aware about the mistakes I make.

O   AGREE
O   DISAGREE
14) I try to find comfort in devotional songs/videos, whenever i feel demotivated.

O   AGREE
O   DISAGREE
15) I ask for solutions from my professors/teachers when I find a particular aspect difficult
rather than unseeing or ignoring it.

O   AGREE
O   DISAGREE

16) I tend to make assumptions a lot, about everything and everyone.

O   AGREE
O   DISAGREE

17) I am always focused & prioritized towards my goals.

O   AGREE
O   DISAGREE

18) I have a great ability to express my feelings, emotions & situations in words.

O   AGREE
O   DISAGREE

19) I always acknowledge people’s apologies for their actions towards me that are
emotionally hurtful.

O   AGREE
O   DISAGREE

20) I like to share my feelings and thoughts with my friend, as he/she can understand me like
no other person.

O   AGREE
O   DISAGREE

21) I have habit to recheck or reanalyse to avoid any kind of error.

O   AGREE
O   DISAGREE

22) I strongly believe that prayers are always heard.

O   AGREE
O   DISAGREE

23) I always obey my counsellor’s/ mentor’s/ parents suggestions as I respect their opinions.

O   AGREE
O   DISAGREE

 24) I often ignore my insecurities and blame others for it.

O   AGREE
O   DISAGREE

 25) I managing my work and personal interest in order to create work-life balance.

O   AGREE
O   DISAGREE

26) I’ve been reading self-help books to direct my emotions in a positive way and journaling
the learning’s from it to reflect on my actions. 

O   AGREE
O   DISAGREE

27) I accept the reality of the fact that it happened.

O   AGREE
O   DISAGREE

28) My spouse/partner has been a strong supporter of mine.

O   AGREE
O   DISAGREE

29) I reflect on any inappropriate behaviour done by me in any situation.  

O   AGREE
O   DISAGREE

 30) I believe praying to my religious deity/god has helped me to make peace with my
thoughts.

O   AGREE
O   DISAGREE

31) In order to select the right career for myself, I seek the help of a career counsellor/mentor.

O   AGREE
O   DISAGREE

32) I don’t think I am faulty in any situation.

O   AGREE
O   DISAGREE

33) I plan to come up with a strategy about what & how to do.

O   AGREE
O   DISAGREE

34) I like to have a record of what happens to me throughout the day.

O   AGREE
O   DISAGREE

35) I learn to accept myself the way I am.

O   AGREE
O   DISAGREE

36) Whenever I have a breakdown I always go to my closed ones, as I am emotionally

connected to them.

O   AGREE
O   DISAGREE

37) I try to understand what’s right or wrong for me in any given situation.

O   AGREE
O   DISAGREE

38) I often seek God's help when things go out of my hand.

O   AGREE
O   DISAGREE

39) I always go up to my mentor to ask for their opinion whenever I am unsure of anything.

O   AGREE
O   DISAGREE

40) If I can do it, other people can as well.

O   AGREE
O   DISAGREE

 
 
 

SCORING KEY:
To score the total no. of ‘Agree’ responses; refer to these particular questions mentioned for
each subscale-

Problem focused coping:

1. Time management- 1, 9, 17, 25, 33

2. Acceptance- 3, 11, 19, 27, 35

3. Error detection- 5, 13, 21, 29, 37

4. Ask a professional support- 7, 15, 23, 31, 39

Emotion focused coping:

5. Journaling- 2, 10, 18, 26, 34

6. Social support- 4, 12, 20, 28, 36

7. Devotional- 6, 14, 22, 30, 38

8. Projection- 8, 16, 24, 32, 40

 
 

 Results of the assessment:

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

REFERENCES:
 
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