Copingstyles 1

Section 6: Psychosocial and Cultural Aspects of Pain: Chapter 2: Coping Styles
Coping Styles
Zoey Malpus, DClinPsy, CPsychol, AFBPsS
Corresponding author: zoey.malpus@mft.nhs.uk
Abstract:
Coping styles relates to the way that people attempt to manage their pain and there is wide
variation in the strategies used. This is important because passive avoidant and catastrophic
coping strategies have been associated with poor outcomes. Psychologically-based Pain
Management encourages active problem solving, and uses Cognitive Behavioural Therapy
(CBT) or acceptance based techniques to improve functioning, mood and quality of life.
Keywords:
Coping styles, strategies, passive, avoidant, catastrophic, emotion-focused, problem-focused
Introduction:
Coping styles is term derived from the early stress literature (1) and describes the process by
which people appraise and respond to stressful situations.
Coping has been defined as:
“ongoing cognitive and behavioural efforts to manage specific external and/or internal
demands that are appraised as taxing or exceeding the resources of the person”(1- p237)
Thus, ‘coping’ includes a person’s thoughts and actions that are aimed at reducing the negative
effects of stress, to return them to their previous stress-free physical state and emotional well-
being. The way that a person copes in any given situation is influenced by broad range of factors
including previous experience, beliefs, biological drives, social settings and cultural norms.
Coping is key to pain management because it determines whether people are able to live well
with pain, continuing to function and to have a good quality of life despite their persistent pain.
Pain-related coping will be determined by the person’s beliefs about their pain and their self-
efficacy, their confidence that they have the ability to influence their pain.
Coping Styles:
Pain-related coping styles have been described as either ‘avoider’ or ‘approacher’ (confronter)
and this distinction has been supported by the fear-avoidance literature (2), where people with
pain develop pain-related disability due to avoiding activities for fear of increasing their pain.
Confronters continue with important activities that are in line with their valued goals and thus are
more accepting and have a better quality of life, despite the persistence of their pain.
A further distinction has been made between assimilative and accommodative coping styles:
assimilative (tenacious pursuit of goals) refers to continued attempts to change the situation to fit
with personal preferences whereas accommodative (flexible goal adjustment) relates to reducing
goals and expectations when they seem unrealistic and no longer achievable. Accommodative
coping can lead to a reduction in pain-related disability, when people are able to be flexible and
realistic with their expectations, but still make choices in line with their values. However, both
approaches can be adaptive and thus helpful, depending upon whether the problem actually has a
resolution and can be solved. For this reason, acceptance-based approaches are gaining evidence
within the chronic pain literature.
Coping Strategies:
Coping strategies have been understood and categorized in a number of ways, usually identified
by specific coping checklists: e.g. Coping Strategies Questionnaires (3). However, there is
considerable overlap between categories and no single questionnaire has been found to be
superior for distinguishing effective pain-related coping.
1) Active and passive:

Active strategies are those where the person is taking steps to control their pain or live
well despite the pain. This includes choosing to exercise regularly or practice relaxation.
Passive strategies are those where the person is not taking responsibility for their own
pain management, such as engaging in excessive rest and social withdrawal. Generally
passive strategies are associated with reduction in mood, functioning and quality of life.
2) Emotion-focused and problem-focused:

There is a distinction between emotion-focused strategies that aim to control the stress
and problem-focused strategies which aim to solve the problem. People with pain who
have a negative appraisal about the pain and their ability to cope will experience pain as
threatening, leading to more passive emotion-focused coping. Alternatively, considering
pain a challenge leads to more problem solving behavior. Generally active problem-
focused coping strategies are associated with better physical and psychological outcomes.
3) Avoidant and attentional:

Coping strategies have also been split into ‘attentional behaviour’ such as seeking
information and ‘avoidant coping’ such as using distraction to not focus upon the pain.
Both approaches have been associated with reduced distress but at different stages of the
pain pathway. Avoidant coping strategies are effective in reducing distress early during
the acute pain phase but are associated with greater distress in the longer term.
4) Adaptive versus maladaptive:

Coping strategies have also been described as adaptive or positive versus maladaptive or
negative. However specific coping strategies are not fixed as positive or negative and can
be useful at different times or in different situations. For example, resting is not a
maladaptive strategy in itself but it can become so when used excessively and to the
exclusion of more active strategies.
5) Catastrophising:
This is an exaggerated negative cognitive distortion, assuming the situation is much
worse than it actually is. This might include the belief that pain is always a sign of harm
or damage, or a lack of confidence that the person can take any steps to improve their
own pain management. There is considerable debate as to whether catastrophising should
be categorised as a pain coping strategy or a negative appraisal, but this factor has
consistently been shown to be a strong predictor of physical and psychological outcomes,
lower pain tolerance, greater disability and depression. This consistent finding was the
basis for the development of the Pain Catastrophising Scale (PCS).
Clinical Findings:
People vary in their coping style and the strategies that they adopt to cope with their pain and its
impact on their lives. Whilst current research is divided as to the best terminology, there is
general concensus that passive, avoidant and catatrophic coping is associated with poor
outcomes in terms of long term functioning, mood and quality of life.
Acceptance and Psychological flexibility are key concepts to understanding how people with
pain can live well and maintain a good quality of life, despite their pain. Pain Management
Programmes have historically used Cognitive Behavioural Therapy (CBT) principles to promote
active self-management. Recent developments in psychologically based pain rehabilitation also
include acceptance-based strategies aimed at promoting adjustment and flexibility.
Diagnostics:
Coping Styles Questionnaire (CSQ)
Pain Catastrophising Scale (PCS)

Treatment:
 Current guidelines recommend a Pain Management Programme, a combined physical and

psychological treatment, promoting active problem solving, via psychoeducation,
physical activation, behavioural stress reduction and cognitive restructuring.
High yield points:
 Passive avoidant coping and catastrophising is associated with poor outcomes.

 Psychologically based pain rehabilitation teaches self-management strategies to
encourage active problem-solving and increase self-efficacy.
Questions:
A. A 52-year-old ex-carpenter has a 12-year history of widespread pain. He copes with his
pain by avoiding any activity that might increase the pain and he spends most of his day
resting, lacking any confidence that he might ever be able to do anything to improve the
management of his pain.
His main coping strategies are:
a. Passive
b. Avoidant
c. Catastrophic
d. All of the above
Answer: d (All of the above)
B. A 38-year-old lawyer has a six-year history of low back pain. She has coped with her
pain by refusing to make any adjustments to her career, she has continued to have high
aspirations and work long hours to gain promotion. Over time she has found that she has
become trapped in a boom and bust cycle, she works hard but then spends all of her time
outside of work resting, trying to recover from her pain flare-ups.
In her tenacious pursuit of her goals, her coping style is:
a. Assimilative
b. Flexible
c. Accommodative
d. Catastrophic
Answer: A - Assimilative
C. A 46-year-old teacher has a 5-year history of neck pain. She has noticed that working full
time hours causes increased neck tension and pain by the end of the day. She practices
regular breathing and neck stretching exercises and attends yoga classes twice per week.
She finds her job to be very rewarding but she has decided to reduce her hours to help
with managing her pain.
Her coping strategies are:
a. Active
b. Problem-focused
c. Adaptive
d. All of the above
Answer: d. all of the above
References:
1. Lazarus, R S (1993) Coping theory and research: past present and future Psychosomatic
Medicine 55: 234-247
2. Vlaeyen J W & Linton S J (2012) Fear-avoidance model of chronic musculoskeletal pain:
12 years on. Pain 153(6) 1144-7
3. Rosenstiel A K & Keefe F J (1983) The use of coping strategies in chronic low back pain
patients: relationship to patient characteristics and current adjustment Pain 65 33-44
4. Jensen MP, Turner JA, Romano JM. (2007) Changes after multidisciplinary pain
treatment in patient pain beliefs and coping are associated with concurrent changes in
patient functioning. Pain. 131:38–47.
5. Guidelines for Pain Management Programmes for adults: An evidence-based review

prepared on behalf of the British Pain Society, October 2013
Author:
Dr Zoey G. Malpus DClinPsy, CPsychol, AFBPsS

Consultant Clinical Psychologist, Pain Team
Department of Anaesthetics,
5th Floor Manchester Royal Infirmary
Oxford Road Manchester M13 9WL
Tel: 0161 276 8678
Email: zoey.malpus@cmft.nhs.uk

Copingstyles 1

Uploaded by

Copyright:

Available Formats

Copingstyles 1

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Copingstyles 1

Uploaded by

Copyright:

Available Formats

Section 6: Psychosocial and Cultural Aspects of Pain: Chapter 2: Coping Styles

Corresponding author: zoey.malpus@mft.nhs.uk

Coping styles, strategies, passive, avoidant, catastrophic, emotion-focused, problem-focused

Coping has been defined as:

1) Active and passive:

2) Emotion-focused and problem-focused:

3) Avoidant and attentional:

4) Adaptive versus maladaptive:

Coping Styles Questionnaire (CSQ)

Pain Catastrophising Scale (PCS)

 Current guidelines recommend a Pain Management Programme, a combined physical and

High yield points:

 Passive avoidant coping and catastrophising is associated with poor outcomes.

His main coping strategies are:

In her tenacious pursuit of her goals, her coping style is:

Her coping strategies are:

Answer: d. all of the above

5. Guidelines for Pain Management Programmes for adults: An evidence-based review

Dr Zoey G. Malpus DClinPsy, CPsychol, AFBPsS

You might also like