|Year : 2018 | Volume
| Issue : 1 | Page : 20-26
Stress and coping strategies: The impact on health
Ram Kumar Gupta, Shirley Telles, Nilkamal Singh, Acharya Balkrishna
Patanjali Research Foundation (Trust), Patanjali Yogpeeth, Haridwar, Uttarakhand, India
|Date of Web Publication||11-Jun-2018|
Patanjali Research Foundation, Patanjali Yogpeeth, Haridwar - 249 405, Uttarakhand
Objective: This study was conducted to assess (i) the relationship between stressful life events and coping strategies, (ii) how stressful life events influence stress indicators, and (iii) how variations in stress indicators occur according to the coping strategies adopted.
Materials and Methods: Coping strategies, stressful life events, and stress indicators were assessed in 72 participants (group average age ± standard deviation, 31.9 ± 14.3 years; 36 males) as a single-group, cross-sectional study.
Results: Participants with low, medium, and high stressful life events showed a positive correlation with disengagement (e.g., social withdrawal) (p < 0.01). A high level of stressful life events was positively correlated with physical (p < 0.05) and behavioral indicators (p < 0.05). Coping strategies such as problem-solving (p < 0.05) and cognitive restructuring (p < 0.05) showed a negative correlation with behavioral indicators; wishful thinking (p < 0.01) showed a positive correlation with emotional indicators. Engagement showed a negative correlation with behavioral indicators (p < 0.05) and disengagement was found to be positively correlated with emotional indicators (p < 0.01).
Conclusion: The higher the stressful life event scores, the greater was the chance of using unhealthy coping strategies; (ii) high stressful life events correlated positively with physical and behavioral stress indicators; and (iii) healthy coping strategies (e.g., problem-solving) resulted in lower behavioral indicators of stress.
Keywords: Coping strategies, stress indicators, stressful life events, yoga
|How to cite this article:|
Gupta RK, Telles S, Singh N, Balkrishna A. Stress and coping strategies: The impact on health. Yoga Mimamsa 2018;50:20-6
| Introduction|| |
Stress refers to an organism's response to a challenge (Dimsdale, 2008). In response to certain events or changes which occur in our lives, we are required to make major internal psychological adjustments to cope with these events or changes, which can cause stress (Holmes & Rahe, 1967) and hence they are termed as stressful life events. These events may be desirable or undesirable. Undesirable life events showed a positive correlation with self-reported tension and distress, emotional disturbances manifested by depression, paranoid thinking, suicidal proclivity, and anxiety, as well as with behavioral indications of stress such as drinking and traffic accidents (Amiram & Melvin, 1975). Apart from the effect of stressful life events on mental health, stressful life events have been associated with physical disabilities (Bramwell, Masuda, Wagner, & Holmes, 1975; Cohen, Janicki-Deverts, & Miller, 2007), coronary heart disease (Rahe, Ramo, Benett, & Siltanen, 1974), mental health problems (Marin et al., 2011), psychological distress (Dohrenwend, 1973), psychiatric disorders (Brown, 1974; Hudgens, 1974), negative health behavior and relapses in smoking, alcohol abuse, illicit substance use, and sleeplessness (Kassel, Paronis, & Stroud, 2003; Ellis, Gehrman, Espie, Riemann, & Perlis, 2012).
Certain cognitive and behavioral patterns are adopted to handle stressful situations, and these cognitive and behavioral patterns are known as coping strategies. Coping strategies are used to manage stress by identifying resources to decrease stress and improve the overall quality of life (Lazzarus & Folkman, 1984). Due to individual differences in appraisal and interpretation of change, coping strategies vary from person to person (Holmes & Rahe, 1967). These differences might be due to two reasons; (i) whether the person has a stable coping style or disposition and (ii) the preferred way of coping with stress based on the personality (McCrae, 1982). Earlier studies showed that passive coping strategies during chronic stress may lead to psychopathological problems (Walker, Masters, Dielenberg, & Day, 2009) and hypertension (Dunn & Swiergiel, 2008; Holsboer & Ising, 2008), while active strategies lead to resiliency (Billings & Moos, 1984). Patients with rheumatoid arthritis demonstrated that coping effectiveness is positively related to general health perception and can influence the quality of life (Englbrecht et al., 2012). Another study showed that engagement strategies (such as problem-solving) were negatively associated with depressive symptoms and disengagement strategies (such as social withdrawal) were positively associated with symptoms of depression (Mosley, Perrin, Neral, Bubbert, Grothues, & Pinto, 1994). Seven hundred and ninety-six veterans with lower-limb amputations reported that avoidance was strongly associated with psychological distress and poor adjustment (Zozulya, Gabaeva, Sokolov, Surkina, & Kost, 2008). In contrast, problem-solving was negatively associated with depressive and anxious symptomatology, whereas seeking social support was negatively associated with symptoms of depression and positively associated with social adaptation. Hence, the strategy adopted to cope with stressors can influence the expression of stress indicators. Apart from these coping strategies, mind–body practice such as yoga is gaining popularity as an effective stress management technique. Yoga practitioners have been reported to have higher resilience to stress (Hartfiel, Havenhand, Khalsa, Clarke, & Krayer, 2011) and certain yoga techniques have shown to increase the level of mood-enhancing hormones (Streeter et al., 2010). From these evidences about the effect of yoga on stress, yoga can also be considered as a type of active coping strategy without directly engaging with the stressful event.
To our knowledge, there are no reports in the Indian population on the relationship between (i) stressful life events and coping strategies; (ii) life events and stress indicators; and (iii) coping strategies and stress indicators. Hence, the present study was conducted in the Indian population to assess (i) the relationship between stressful life events and coping strategies, (ii) how life events can influence stress indicators, and (iii) variations that occur in stress indicators according to the coping strategies adopted.
| Materials and Methods|| |
In the present study, 72 persons participated in the study; their age range was 17–72 years (group average age ± standard deviation [SD], 31.9 ± 14.3 years; 36 males) and 69.4% of them were between 20 and 45 years of age. The participants were attending a 2-day residential program for promotion of positive health in a yoga center in North India. The inclusion criteria were (i) normal health (based on self-reports) and (ii) a minimum of 10 years of education. The exclusion criteria were (i) incomplete or incorrectly filled in questionnaires and (ii) those who were using psychiatric medication. Statistical calculation of the sample size was not done before the experiment. However, post hoc analyses were carried out following Pearson's correlation for the present study. For disengagement coping strategies, with the sample size of 72, power = 0.99 was calculated using G*Power is a statistical software which measures effect size, power based on t-test, ANOVA, Chi-square etc. This software was developed by collaboration of psychology departments of various universities in Germany. The α level was set as 0.05 (Zar, 1999). The details of the questionnaires were described to the participants and their signed informed consent was obtained. The study was approved by the Ethics Committee of Patanjali Research Foundation. The baseline characteristics of the participants are summarized in [Table 1].
The study used a single-group, cross-sectional design. Participants were assessed on the 1st day of the program.
The following assessments were done using three questionnaires.
The coping strategies adopted by the participants in response to stressors were assessed using the coping strategy inventory (Tobin, Holroyd, & Reynolds, 1984). The Coping Strategies Inventory is a 72-item self-report questionnaire designed to assess coping thoughts and behaviors in response to a specific stressor. This inventory categorizes coping responses into three categories: (i) primary strategies, (ii) secondary strategies, and (iii) tertiary strategies. This has been schematically presented in [Figure 1]. Primary coping strategies are of eight types: (a) problem-solving (direct attempts to eliminate the source of stress by altering the situation), (b) cognitive-restructuring (cognitive strategies employed to manage stressful situations by altering their meaning), (c) social support (seeking support from others), (d) express emotions (expression of feelings), (e) problem avoidance (behavioral and cognitive avoidance of the stressor), (f) wishful thinking (wishful thoughts or fantasies that draw attention away from the stressor), (g) social withdrawal (avoidance of others), and (h) self-criticism (blaming or criticizing oneself). Secondary coping strategies are of four types, (a) problem-focused engagement (problem-solving + cognitive-restructuring), (b) emotion-focused engagement (social support + express emotions), (c) problem-focused disengagement (problem avoidance + wishful thinking), and (d) emotion-focused disengagement (social withdrawal + self-criticism). Tertiary coping strategies are of two types: (a) engagement (problem-focused engagement + emotion-focused engagement) and (b) disengagement (problem-focused disengagement + emotion-focused disengagement). Each unit or type of the primary strategies has nine items. There are five possible responses to each item, namely (i) not at all, scored as “0;” (ii) a little, scored as “1;” (iii) somewhat, scored as “2;” (iv) much, scored as “3;” and (v) very much, scored as “4.”
This questionnaire assesses how stress affects the different dimensions of life during a typical week. The questionnaire consists of five indicators, namely (i) physical indicators, having 22 items; (ii) sleep indicators, having 5 items; (iii) behavioral indicators, having 18 items; (iv) emotional indicators, having 21 items; and (v) personal habits, having 9 items. There are five possible responses for each item, namely (i) almost always (on 5 days a week), scored as “5;” (ii) most of the time (on 3 days a week), scored as “4;” (iii) some of the time (on 1½ days a week), scored as “3;” (iv) almost never (<2 h a week), scored as “2;” and (v) never, scored as “1.”
Stressful Life Events Scale
This scale measures the amount of stress in the previous 12 months. In this scale, 43 life events are listed in order of rank, each event is given a particular score that indicates the amount of stress induced by that life event. For example, death of a spouse is given 100 units. After totaling of the scores, the scores are labeled as follows: (i) 300+, predicts high susceptibility to stress-related illness, (ii) 150–299, predicts medium susceptibility to stress-related illness, and (iii) <150, predicts low susceptibility to stress-related illness (Holmes & Rahe, 1967).
Pearson's correlation analyses were performed using SPSS (Statistical Package for the Social Sciences) is a software which is used for statistical analysis. This software is manufactured by an IBM company and headquarter is located in Hong Kong. The address of the headquarter is given below: 1804, (Westlands Centre, Westlands Road, Quarry Bay, HK) to assess stressful life events, coping strategies, and stress indicators.
| Results|| |
In the present study, out of 72 participants, 56 (77.8%) experienced high stressful events, 7 (9.7%) experienced medium stressful events, and 9 (12.5%) experienced low stressful events. The group mean values ± SD for scores of the three questionnaires are summarized in [Table 2].
|Table 2: Group mean values±standard deviation for scores of the questionnaires|
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Correlation between stressful life events and coping strategies
Low stressful life events
Low stressful life event scores were found to be positively correlated with disengagement scores, which are a form of tertiary coping strategies (p< 0.01).
Medium stressful life events
Medium stressful life event scores were found to be positively correlated with problem avoidance scores (p< 0.05), emotion-focused disengagement scores (p< 0.05), and disengagement scores in general (p< 0.01).
High stressful life events
High stressful life event scores were found to be negatively correlated with the ability to express emotions (p< 0.05) and were found to be positively correlated with high levels of disengagement scores in general (p< 0.01).
Total stressful life events
Total stressful life event scores showed a negative correlation with the ability to express emotions (p< 0.05), while these scores were found to be positively correlated with problem-focused engagement scores (p< 0.05) and with the level of disengagement scores (p< 0.01). Correlation of “r value” between stressful life events and coping strategies is summarized in [Table 3].
|Table 3: Correlation between stressful life events and coping strategies: The correlation coefficient (r) for low, medium, high, and total stress are mentioned|
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Correlation between stressful life events and health indicators
A high level of stressful life event scores was found to be positively correlated with physical indicators (p< 0.05) and behavioral indicators (p< 0.05).
Total stressful life event scores were found to be positively correlated with behavioral indicators (p< 0.05). Correlation of “r value” between stressful life events and health indicators is summarized in [Table 4].
|Table 4: Correlation between stressful life events and health indicators: The correlation coefficient (r) for health indicators are mentioned|
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Correlation between coping strategies and health indicators
Primary coping strategies
Problem-solving and cognitive restructuring showed a negative correlation with behavioral indicators' scores (p< 0.05), while wishful thinking (p< 0.01) and self-criticism scores (p< 0.05) showed a positive correlation with emotional indicators. Social withdrawal scores showed a positive correlation with emotional indicators (p< 0.05) and behavioral indicators (p< 0.05).
Secondary coping strategies
Problem-focused engagement showed a negative correlation with behavioral indicators (p< 0.05). Problem-focused disengagement showed a positive correlation with emotional indicators (p< 0.05). Similarly, emotion-focused disengagement also showed a positive correlation with high levels of emotional indicators (p< 0.01).
Tertiary coping strategies
Engagement scores showed a negative correlation with behavioral indicators' scores (p< 0.05), while disengagement scores were positively correlated with emotional indicators' scores (p< 0.01). Correlation of “r value” between coping strategies and health indicators is summarized in [Table 5].
|Table 5: Correlation between coping strategies and health indicators: The correlation coefficient (r) for health indicators are mentioned|
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| Discussion|| |
In the present study, participants having low, medium, and high stressful life events showed increased use of disengagement coping strategies, while participants with high stressful life event scores showed only an inability to express their emotions.
Disengagement coping strategies either involve ignoring the problem or withdrawing from social interaction. Disengagement coping strategies include different ways of distancing oneself from the stressor or related feelings, thus the giving up of efforts to control or adjust to a situation and associated emotions (Kvillemo & Bränström, 2014). Disengagement may provide short-term relief, particularly when one feels helpless or a lack of control in the face of stressors. It is not considered a healthy approach for long-term adaptation (Ntseane, 2004). This short-term stress-relieving effect of disengagement may be the reason why participants in the present study chose it as a coping strategy most often.
Disengagement as a coping strategy was found to increase both psychological (i.e., psychological and cognitive distress and somatic anxiety) and physiological symptoms (i.e., chronic fatigue and digestive and cardiovascular symptoms) (Barton, Spelten, Totterdell, Smith, Folkard, & Costa, 1995).
Participants with high stressful events showed an inability to express their emotions. This is in line with the findings of earlier studies which showed expression of emotion to be negatively correlated with higher self-reported stress-related symptoms (Moore, Zoellner, & Mollenholt, 2008). This was confirmed by another study which reported that early life stress was positively correlated with emotion suppression (Mohiyeddini, Opacka-Juffry, & Gross, 2014). Emotion suppression is associated with reduced positive affect, life satisfaction with greater depression, social anxiety, greater negative emotion (Kashdan & Steger, 2006), impaired interpersonal communication (Butler, Egloff, Wilhelm, Smith, Erickson, & Gross, 2003), increased sympathetic nervous system arousal (Harris, 2001), and impaired memory (Richards, Butler, & Gross, 2003).
In the present study, participants with high stressful life event scores showed a positive correlation with physical and behavioral indicators of health. An earlier study showed a positive correlation between stressful life events; high levels of aggression; exposure to violence (Beth, Nancy, & Patrick, 1994); and symptoms of obsessive-compulsive disorder such as symmetry obsessions, repeating, counting, and checking compulsions (Rosso, Albert, Asinari, Bogetto, & Maina, 2012). It is believed that adverse events which are processed cognitively can be associated with physical symptoms and behavioral symptoms (Aybek et al., 2014).
Another finding of the present study was that behavioral indicators were found to be negatively associated with increased use of problem-focused engagement and engagement coping strategies. In earlier studies, problem-focused strategies were found to be associated with lower level of depressive symptoms (Li, DiGiuseppe, & Froh, 2006) and a better physical and psychological state (Penley, Tomaka, & Wiebe, 2002). It is believed that problem-solving and engagement could lead to improved long-term adjustment (Pheko, Mphele, Tlhabano, & Monteiro, 2014) and more effective coping resources (Hamarat, Thompson, Zabrucky, Steele, Matheny, & Aysan, 2001).
Emotional indicators were found to be positively correlated with increased use of wishful thinking, problem-focused disengagement, and emotion-focused disengagement as secondary strategies, and disengagement in general.
Problem-focused disengagement and emotion-focused disengagement were positively correlated with emotional indicators. Similar results were found in a study where 64 males and 64 females were assessed (Nicole, Shyngle, & Kutlo, 2014). This study showed emotion regulatory difficulties such as impulse control difficulties, lack of emotional awareness, limited access to emotion regulation, and lack of emotional clarity, with increased use of problem-focused disengagement strategies and emotion-focused disengagement. As primary coping strategies, self-criticism and social withdrawal strategies involve shutting oneself off from social support and blaming oneself for the situation, this pattern leads to ineffective management of emotions. This might be due to a critical role of controlling, adjusting, and adapting in coping strategies. The coping process and positive affect are interconnected (Folkman & Moskowitz, 2000).
Wishful thinking showed a positive correlation with emotion indicators. Similar results were found in a study, which was conducted on 15 depressed and nondepressed middle-aged persons. In this study, depressed persons were characterized by wishful thinking as coping strategies (Coyne, Aldwin, & Lazarus, 1981). Wishful thinking is associated with negative health state (Penley et al., 2002).
Engagement has been associated with better psychological well-being (Segerstrom, Taylor, Kemeny, & Fahey, 1998; Stanton & Snider, 1993) as well as physiological well-being as reflected in qualities of the cardiovascular (Raikkonen, Matthews, Flory, Owens, & Gump, 1999) and immune systems (Segerstrom et al., 1998; Cohen, Kearney, Zegans, Kemeny, Neuhaus, & Stites, 1999) and reduction of eating disorder symptomatology such as emotional eating, bulimia symptomatology, ineffectiveness, and introspective awareness (Davies, Bekker, & Roosen, 2011).
The findings of the present study were limited by factors such as (i) the study design, which was a one-time cross-sectional study and (ii) the age group of the participants varied widely (18–70 years). These limitations suggest directions for future study.
| Conclusion|| |
The results suggest that (i) the higher the stressful life event scores, the greater was the chance of using unhealthy coping strategies; (ii) high stressful life events correlated positively with physical and behavioral stress indicators; and (iii) healthy coping strategies (e.g., problem-solving) resulted in lower behavioral indicators of stress.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]