Coping

Coping

Each day we are confronted with stress, and in order to handle that stress we must have the ability to cope. You are probably familiar with what it means to cope, but for this article I would like to give it a formal definition:

Coping is the response that we have to deal with adversity such as pain and stress.

Healthy coping is the use of the sufficient energy required to deal with stress in the most efficient manner and with the least impact on our allostatic load (“stress basket”).

Our ability to cope is a strong determinant of how well we will do in life. Our coping ability also determines how we will handle pain, especially if the pain is prolonged and becomes chronic. Personality plays an important role in how well we cope. Of course, like the word cope, we hear the term personality a lot, but it also needs a formal definition:

Personality is the dynamic organization of psychological and physiological qualities that underlie an individual’s patterns of thoughts, actions, and feelings.

More broadly, personality is what makes a person the individual that they are. Studies have shown that certain personality types are better at coping than others. For example, people with traits such as conscientiousness, extraversion, positive attitude (optimism), and openness to new challenges are more successful at coping with adversity. In contrast, people with traits such as anxiety, fear, moodiness, and worry are often less successful at coping.

Personality and coping are independent concepts, yet they are interactive and they can influence your response to adversity and your physical, mental, and spiritual health. The type of personality you have may determine how you cope with pain.

In this article, we will look at the relationship between coping and personality and will also explore how to identify your own coping style.

Coping with Adversity

Each time you attempt to accomplish a task, you use your ability to pay attention to the task and keep attention on that task. This ability is referred to as cognitive control. The executive areas of the brain (the prefrontal cortex) use cognitive control to allow our mind to make the best choice possible with the information and perceptions we have available at any given moment. Cognitive control mechanisms allow us to override impulses such as fear, anger, shame, avoidance, and craving.

For example, try to remember a time when you were embarrassed by something someone said. Your immediate reaction may have been to run away or to strike back verbally or physically. But instead, you considered things such as the situation, the other person’s behavior, the context of the embarrassing comment, the potential consequences of your action, and your future goals. You made a better choice that fit the circumstances. This was you using cognitive control. Cognitive control involves the mental ability to consider the bigger picture, the broader concerns, and acting accordingly. Different people have different degrees of cognitive control, and the amount of control varies depending on other factors.

Impulsiveness can be described as the opposite of cognitive control, because to be impulsive means to act reflexively (without contemplation). For example, when one experiences emotional pain, the first impulse may be to seek the easiest way to avoid the pain at any cost and without consideration of consequences. In the example above, an impulsive person might have run off immediately (avoiding the emotional pain of embarrassment) or slapped the person (trying to avoid a future insult).

We have all had these experiences of what is called avoidant behavior, but by learning to use healthy coping skills that increase our cognitive control, we come to see that our old way of approaching the stressor (the pain) was, for the most part, responsible for the pain. We may also realize that much of the pain had been fueled by the anxiety our behavior provoked. Try looking back at some of the times you have used avoidant behavior and see if you can think of ways you could have used your cognitive control to create a better outcome.

Cognitive control mechanisms, for the most part, have executive control privilege in the brain. This means that they take precedence over and can inhibit any other thoughts or impulses. As noted above, cognitive control can gather sufficient mental resources to overcome most any adversity, but using cognitive control takes practice and, most important, the motivation to practice. The ability to override impulses and to act or think in an appropriate manner determines what we pay attention to and what we can accomplish. When we succeed at this, we are acting from our I, or objective self, and exercising our capacity for agency (taking action). When we gain the ability to control attention, we gain the ability to engage in situations that, at first, may be perceived as overly difficult, unachievable, and threatening. When we are able to take on situations that we once might have avoided, we can move forward in a goal-directed manner and avoid reflexive (or impulsive) behaviors. Using cognitive control helps us avoid poor decisions that can result from misperceptions of certain situations.

Goal-directed behaviors usually have expectancies. That is, we expect our action will result in an outcome that, to a great extent, can be predicted. However, not everything that is expected occurs and when it does not, we often feel distress and pain. It is not always possible to predict when this will occur. So, for example, you may expect that your action of sending flowers to a friend will result in something in return for you, such as a thank you or increased feelings of goodwill between you and your friend. But let’s say you send the flowers and get no thanks or no acknowledgment. That is an unexpected and unpredicted outcome of your goal-directed behavior. Your immediate reaction might be anger, feelings of rejection, or other emotional pain from lack of acknowledgment.

It is the ability to change or shift mentally (an ability called cognitive flexibility) that allows us to achieve a given goal despite the adversity that occurs when the expectancy is not predictable—that is, when what we expect does not occur. If, in the example above, you were a person who had inflexible thinking, you might stay in a state of anger and disappointment. But if you had the capacity to shift mentally and use cognitive flexibility, you might imagine other causes for your friend’s lack of acknowledgment, from the flowers not arriving, to your friend being ill, being out of town, or having another unknown problem. You might even realize that you could continue to care for your friend, even if your friend’s actions were deliberately neglectful. Cognitive control improves our ability to shift mentally when our expectations are not realized. Without this ability, we become overburdened with failed attempts to achieve a goal.

This can often lead to feelings of sadness, despair, isolation, inadequacy, and seeing ourselves as a failure. It can also cause us to avoid certain situations that may lead to negative feelings.

Cognitive control, cognitive flexibility,
and chronic pain

Chronic pain reduces both cognitive control and cognitive flexibility since chronic pain is often perceived as uncontrollable and untreatable. Recall from earlier chapters that people who have experienced both chronic pain and past adversity have a reduced capacity to exercise the kind of cognitive control I have just described. Constant stress has kept them in a fight-or-flight state for too long; their “stress basket” is overburdened or broken. This means they are more likely to be impulsive—to be unable to use the cognitive control just described. More real and perceived situations trigger stress, which means more pain, which they want to avoid, adding yet more stress due to the avoidance. Because the outcomes (expectancies) of new and novel experiences are less predictable, people with chronic pain are more likely to avoid such experiences. So, for example, when former college tennis player J. began experiencing severe back pain, the idea of trying to move in a new and novel way by sweeping her tennis racket very slowly in the same motion she had used to defeat challengers seemed like an activity to avoid. The outcome was unpredictable and that unpredictability caused fear and stress. She was (at first) not open to the new and novel behavior.
Lack of openness to new behavior is a characteristic of people who have had chronic adversity, chronic stress, and chronic pain. This is understandable and has a certain sort of logic to it: new behaviors are likely to result in unfamiliar, unpredictable, and possibly unsuccessful outcomes. Yet the alternative is worse: repeating the same behaviors is only going to repeat the same or worse outcomes. Moreover, openness to new and novel experiences is essential to improving cognitive control and flexibility, thereby improving coping skills.

When people have become fearful of new experiences, they may nonetheless find the willingness to attempt them by becoming open to the idea that first attempts at novel experiences will simply not be successful and not to take this as a personal failure. We can also break up new activities into smaller, more achievable (less unpredictable) goals and plan sub-goals that can be flexible and changeable. Sub-goals are stepwise strategies that lead to the eventual attainment of a given goal. For example, J. could break her goal of returning to tennis play into many subgoals.

One might be to first rehearse her serve in her head, many times. That is a very predictable sub-goal. Presumably, it cannot hurt if it is only in her head. Or, her first goal could be to hold the racket and squeeze it gently. With flexible thought, any number of achievable sub-goals can be imagined that will help her begin to regain her lost confidence.

The ability to engage in sub-goals and disengage when the expectancy changes is an important aspect of our ability to cope and can lead to positive future experiences and help us avoid negative outcomes and emotions.

(Excerpted from CONQUER CHRONIC PAIN: An Innovative Mind-Body Approach)

Peter Przekop