Drawing on beliefs, values, and goals to change the meaning of a stressful situation is known as

Summary and Future Directions

Stress and coping research is challenging to conduct with infants and young children who cannot directly tell us how they feeling or what they are thinking. Understandably, currently models of stress and coping in infancy are based on adult models. These models elucidate the processes that may be at work during times of stress and the mechanisms underlying exposure to certain risk and stress and later development. However, future research is needed to enhance and better articulate these models for infants and young children. For example, more evidence for children’s cognitive appraisals during stress would help strengthen current models of stress and coping, or provide direction for modifying models to more accurately capture the processes at work for young infants.

While the precise processes underlying infants’ coping with stress need refining and further development, studies show that coping is a complex, multidimensional process that is constantly changing as infants develop more sophisticated motor, cognitive, emotional, and social skills. Newborn infants possess some abilities to deal with stress, such as reflexes and physiological regulatory abilities; however, the primary coping skills among young infants are signals for caregiver responses. Caregivers play a pivotal role in soothing their infants, as well as helping infants learn effective strategies to cope with stress. As the infants grow older, they are able take a more active role in coping with stress and their repertoire of responses grows and becomes more sophisticated. Additionally, with experience young children learn which strategies are effective. Stress is an inevitable part of life, yet most children do develop a repertoire of effective coping strategies and develop without any adverse consequences.

Stress and coping models

Stress and coping frameworks propose that the extent to which an acute event (e.g., the death of a loved one) or chronic strains (e.g., providing care to a dying family member) affects well-being depends on the context in which the stressor occurs (Pearlin et al., 2005). While early writings typically focused on one stressor at a time, such as a family death or job loss, contemporary research and theory underscores that a single stressor can precede, occur alongside, or emanate from other stressors, amplifying its physical and emotional consequences. A discrete life event may give rise to new and multiple chronic strains; for example, the sudden death of a spouse may trigger financial strains if that spouse had been the family’s primary breadwinner (Umberson, 1992). Likewise, chronic strains may precede a stressful life event; for example, an adult child’s struggle with drug addiction may trigger their untimely and sudden death (Feigelman, Feigelman, & Range, 2018).

The personal impact of a stressor also depends on one’s coping resources and strategies. Coping resources are the personal and contextual attributes individuals draw upon when dealing with a challenge (Pearlin et al., 2005). Social support is widely considered the most important resource, as it encompasses the instrumental, emotional, and informational assistance that may help bereaved older adults adjust to the realities of loss. Coping strategies, alternatively, are the behaviors, cognitive processes, or emotional responses one uses in stressful contexts (Lazarus & Folkman, 1984). The two main types of strategies are problem-focused coping, where one tries to alter the situation that is causing the stress, and emotion-focused coping, where one alters their reactions to and feelings regarding the stressor, such as finding the humor in or denying the situation (Carver, Scheier, & Weintraub, 1989). While problem-focused tactics are generally considered most effective in warding off distress, emotion-focused coping may be particularly effective when the context cannot be altered, as in the case of an irreversible loss, or when age-related physical or cognitive challenges make it difficult if not impossible for a person to alter the situation (Carr, 2020).

Stress and coping models have been particularly instructive in pinpointing risk and protective factors, revealing the importance of coping resources like the widow(er)’s psychological resilience (King, Carr, & Taylor, 2018), and social ties (Ellwardt, Wittek, Hawkley, & Cacioppo, 2019), as well as the behavioral and cognitive strategies one uses to adapt to the loss, such as turning to religion (Brown, Nesse, House, & Utz, 2004; Carr, 2020). Stress process frameworks also recognize the importance of social inequalities, such that persons with fewer economic resources and less social power are vulnerable to a greater number of stressors, and typically have fewer material resources that could facilitate effective coping (Pearlin et al., 2005). For this reason, stress and coping perspectives cast a distinctly sociological lens on bereavement, an outcome that historically has been explored as an individual-level psychological reaction to loss (Stroebe et al., 2008). Attention to the social patterning of stress and coping enables explorations of the ways that bereavement experiences are shaped by one’s race, class, gender, and sexual orientation.

2.1 Transactional model of stress and coping (TSC)

The TSC (Folkman, 2008; Lazarus, 2006; Lazarus & Folkman, 1984) proposes that two prototypical states, challenge and threat, arise from cognitive judgments of the meaning of a situation and one's ability to respond to the situation. In the TSC, primary appraisal refers to the judgment of a situation as being benign or stressful. Benign situations are judged as requiring no instrumental action on the part of the individual to facilitate a positive outcome, whereas stressful situations are judged to require specific action(s). Stressful situations themselves fall into two categories, they can be challenging or threatening. Challenging situations are those perceived to offer the potential for growth, mastery, and gain (e.g., performing well at exams). Threatening situations are those perceived to potentially result in harm or loss (e.g., performing poorly at exams).

The perception of challenge or threat is determined in a secondary appraisal of one's ability to cope with, and respond to, the stressful situation. Challenge results from the judgment that one has the necessary resources to cope (e.g., I know this exam is important but I have belief in my ability), and threat from the judgment that one does not (e.g., I know this exam is important but I do not think I have the skills to pass it). Although the implication of primary appraisal is that judgments of relevance or importance of a situation precede judgments of coping, this need not be the case. Secondary appraisals may, for instance, determine the initial relevance of a situation (e.g., Blascovich & Mendes, 2010; Jamieson, 2017). For instance, a fear appeal stating that effort may be required to avoid failure could be judged as irrelevant by a student who seems to find a subject naturally easy and seems to achieve high grades with little effort.

The stress and coping paradigm

The stress and coping paradigm (Lazarus and Folkman, 1984) has been the gold standard for understanding stress and coping processes for over 40 years. This theory focuses on the individual's perceptions of the illness—specifically, cognitive appraisals of stress—as essential predictors of coping efforts, which, in turn, affect psychological adjustment. Cognitive appraisals occur when individuals evaluate whether or not an adverse event is a stressor—that is, whether it poses a threat or harm to well-being (primary appraisal) and whether one has the resources needed to cope with the stressor (secondary appraisal). People appraise situations as stressful when environmental demands exceed their personal and social resources. Stress appraisals, in turn, determine how individuals choose to cope with the stressors, although other factors are also involved (e.g., past experience).

Although there are many specific types of strategies, coping comprises both approach and avoidance strategies. Approach strategies may involve seeking information about the illness to make good treatment decisions or planning how to reorganize one's life and work while undergoing treatment. Avoidance strategies may involve minimizing the seriousness of a diagnosis to be able to deal with it in more manageable pieces or refusing to talk with others to make it less real. Research has shown that avoidance strategies may be helpful in the short term, when individuals are flooded with emotion and overwhelmed by what the future presents, but can be harmful in the long run if, for example, denial of the seriousness of the illness delays treatment or refusal to acknowledge it prevents one from getting needed social support.

Within the stress and coping paradigm, coping strategies were described originally as serving either a problem-focused or emotion-focused function. In the former, coping efforts are aimed at managing or eliminating the source of stress; in the latter, coping is directed toward managing the emotional distress that arises from stress appraisals. Coping with a chronic illness involves both types of coping. Some adaptive tasks or stressors may require a solution and others may have to be accepted. Although problem-focused coping (e.g., planning and seeking information) has been linked to better psychological adjustment, it is possible that more well-adjusted people can carry out the problem-focused efforts required of their illness. There is some evidence that low engagement in self-care behaviors that improve health (adherence to treatment, exercise or dietary change, and smoking cessation) may be related to poor psychological adjustment (Cheval et al., 2021).

Emotion-focused coping (which originally included strategies as diverse as taking one's mind off the stressor, expressing anger at loved ones, falling into fantasies about the illness and blaming others) is now conceptualized more broadly as emotion regulation (Scheier et al., 2012). Longitudinal studies (i.e., research where the same individuals are studied repeatedly over time) have found higher emotion regulation, via emotional processing and expression, was related to lower depressive symptoms among older adults when perceived stress was high. However, higher emotional processing was associated with increased depressive symptoms over time (Hoyt et al., 2020). Some studies of written emotional disclosure also suggest that this coping strategy not only affects adjustment to illness but also improves pain self-efficacy in people with irritable bowel syndrome (Laird and Stanton, 2021) and lung function among those with moderate to severe asthma (Smith et al., 2015). Thus, emotions clearly have an adaptive role in the coping process.

Introduction

Research and practice concerning stress and coping processes among family caregivers of frail older adults have grown exponentially in the last 30 years. The interest in this area has been enhanced by the effects on society of population aging which increases the number of frail elders needing care, as well as the decrease in the birth rate and the incorporation of women to the work force, which potentially decrease the pool of family caregivers.

In this chapter, we review the literature on family caregiving to assess the current status of stress and coping models of the effects of caregiving on physical and mental health and the efficacy of interventions to assist stressed family caregivers. As caregivers become more culturally diverse within nations and caregiving research becomes more transnational, there has been increased attention to the role of culture in stress and coping process among family caregivers, so we next turn our attention to cultural and individual diversity issues as they influence the caregiving process. Finally, we discuss less commonly explored issues including research on whether abuse within caregiving dyads is related to caregiving stress and to whether the stress processes cease when in-home caregiving ends by institutional placement or by the death of the care recipient. Throughout the review, we give priority to longitudinal studies of caregiving and to meta-analyses.

Coping skills

The transactional model of stress and coping developed by Lazarus and Folkman (1987) explained coping as a phenomenon that involves both cognitive and behavioral responses that individuals use in an attempt to manage internal and/or external stressors perceived to exceed their personal resources. It is safe to say that coping with stressful and anxiety-provoking situations is first on the list of an athlete’s job description; and failure to do so will most likely result in subpar athletic performance. Omar-Fauzee, Daud, Abdullah, and Rashid (2009) observed that athletes at various at various levels of sport participation made use of a variety of effective coping strategies to help deal with the multiple stressors they encounter.

The Athletic Coping Skills Inventory (ACSI-28) developed by Smith, Schultz, Smoll, and Ptacek (1995) is a popular self-report measure used to assess the various coping techniques implemented by athletes. The ACSI-28 measures the following domains: Coping with Adversity, Peaking Under Pressure, Goal Setting and Mental Preparation, Concentration, Freedom from Worry, Confidence and Achievement Motivation, and Coachability. Spieler et al. (2007) studied coping differences between starters and non-staring collegiate varsity football players and concluded that when combined with other factors such as size of high school when growing up as well as age, athletes who were part of the starting line-up scored higher on the Coping with Adversity domain.

The Coping Inventory for Stressful Situation (CISS), a 48-item self-report measure developed by Endler and Parker (1999), uses a multidimensional approach to asses coping across three distinct orientations: Task-Focused, Emotion-Focused, and Avoidance-Focused. Philippe, Seiler, and Mengisen (2004) assessed male and female elite athletes using the CISS and found female athletes scored higher in the use of Emotion and Avoidance Orientation compared to their male counterparts who scored higher in the use of Task Orientation as a coping approach. The authors attributed these observed coping behavior differences to the effect of social and gender norms, yet explained these observed differences were not substantial and only partly supported the “socialization model” (Philippe et al., 2004). Additionally, when comparing elite and non-elite athletes, they found elite athletes scored higher on the Avoidance Orientation Scale, and explained that these athletes may engage in the use of evasive techniques to discount or ignore particular stressors (i.e., money and expectations) in order to maintain top performance levels.

Another commonly used tool is the Coping Inventory for Competitive Sport (CICS; Gaudreau & Blondin, 2002). This instrument is a 39-item self-report measure that utilizes a 5-point Likert Scale to assess 10 different athletic coping strategies under three main scales that include: Task Orientation, Distraction Orientation, and Disengagement Orientation. Andrews and Chen (2014) utilized the CICS to study 478 runners of varying competencies to assess gender differences in coping styles during recovery from injury. They concluded that men used the Task-Oriented approach, particularly visualization, to cope with their respective injuries (“I can see myself getting better”). On the other hand, women more commonly adopted a Disengagement-Oriented approach to manage their recovery from injury (“I wish my injury would go away”). Nonetheless, they noted that the significant differences found in this study had low effect sizes.

Racial and Ethnic Diversity Issues

The sociocultural adaptation of the stress and coping model suggests that the role of ethnicity is greater than merely being an indicator of disadvantaged socioeconomic status of members of certain ethnic minority groups. This view asserts that one's ethnicity and culture exert influence on almost all domains and stages of the stress process model including: (1) who provides care, (2) how caregiving demands are expected to be handled and shared among family members, (3) how caregiving experience is interpreted and perceived, (4) how people cope with stress during caregiving, and (5) what stress outcomes are expected. As to why caregiving experiences differ by race or ethnicity, some studies suggest that racial and ethnic differences in values and beliefs about aging and caregiving may be responsible for the observed differences. While it is dangerous to generalize about racial or ethnic differences because of the risk of stereotyping, the existing literature suggests that there may be important cultural differences in caregiving, although the individual must clearly be viewed in his or her totality and not just as a member of a racial or ethnic group.

The literature indicates that African Americans often hold different role expectations and attitudes about providing care and coping mechanisms than European Americans. African Americans tend to hold more positive attitudes toward older adults and perceive cognitive and/or physical decline in health among elders as part of a normal process of aging. In terms of caregiving experience, African Americans report heavier workload and more unmet needs than European Americans; however, African American caregivers also report that they experience lower levels of stress and burden and higher levels of satisfaction as well. Moreover, African American caregivers report increased levels of religiosity in response to caregiving. They are more likely to use their religious faith and activities such as prayer as a coping strategy than European American caregivers.

Although studies on Hispanic caregivers are limited and there is great diversity among this ethnic group, traditional values of Hispanic families influence their caregiving experience. One of these traditional values is familism, which emphasizes the importance of the family connection and interaction as well as the family serving as the core of the social support system. Thus, the kinship network is considered to be a very important source of social support for Hispanic elders. Family loyalty and filial piety of Asian Americans, and importance of relational networks among Native Americans though as diverse as Hispanic Americans, are known to be other important cultural values of ethnic groups that help create a strong support system among them.

1.1 Contrast to Other Approaches to the Study of Stress and Coping

The typical approach to the study of stress and coping examines how people try to solve existing problems and to manage the psychological distress they bring. The proactive coping approach, in contrast, focuses on people's efforts to identify potential sources of stress and take steps ahead of time either to prevent them or to mute their impact. For example, whereas a study of stress and coping might ask how students would manage if they had three final exams on the same day, a study of proactive coping might ask what students in such a position did ahead of time to alter their situation (for example, by asking one of their professors for an extension or by dropping one of the classes to avoid such a situation).

In the domains of aging and work, the proactive coping concept has been used to examine situations in which people, rather than being passively shaped by their environments, respond to actual or potential environmental changes by gathering information about new environments and selecting and modifying environments to meet their needs. For example, studies of proactivity in aging take as their starting point people's efforts to learn about their residential options, to select a particular retirement community in the first place (for example, by selecting one with opportunities for health-enhancing recreational activities), and to develop social resources once they arrive (Kahana and Kahana 1996). Similarly, studies of workplace entry suggest that new employees engage in several strategies to learn about their new environments and to develop social resources and that these strategies are often related to subsequent job performance and satisfaction (Ashford and Black 1996).

As these examples illustrate, proactive coping efforts may be applied to short-term, discrete situations or to developmental challenges and losses that are anticipated by the individual. In both cases, activities critical to understanding people's outcomes in educational, residential, and work settings occurred prior to or early in the course of some event or transition and served to change their experience of the situation. This signal property of proactive coping—the possibility of changing or altering one's outcomes in potentially stressful situations—is one of the principal distinctions between proactive coping and anticipatory coping. Anticipatory coping refers to efforts to brace oneself for the expected consequences of a known, imminent stressor. In proactive coping, the outcome of a situation may be unknown, and there is also room for one's actions to affect one's outcomes. Thus, proactive coping may involve a wide range of processes involved in trying to understand and alter various future possibilities (see Aspinwall 1997, Gollwitzer and Bargh 1996).

Summary

The literature on age-related changes in stress and coping and coping processes is highly complex, reflecting developmental, cohort, and period effects. Nonetheless, some overall observations can be made. First, despite the fact that older adults have lower physiological and often financial resources than middle-aged or younger adults do, they often report fewer life events and hassles, due to complex biological, sociological, and psychological processes. Both the decrease in social role participation and the increase in psychological perspectives may partially account for this decrease. However, there may also be age-related changes in coping, reflecting both changes in motivation toward greater interiority and in the desire to conserve resources with age. Nonetheless, it cannot be overemphasized that there are individual differences in stress and coping with age. Some individuals report chronically high stress levels, and others struggle with effective coping throughout their lives. Nonetheless, suggestions in the literature of decreased stress and more efficient coping with age are quite encouraging for the possibility of successful aging.

See Also the Following Articles

Anxiety; Circadian Rhythms, Genetics of; Coping and Stress: A Lens and Filter Model; Drosophila Genes and Anoxia; Genetic Factors and Stress; Genetic Predispositions to Stressful Conditions; Heat Shock Genes, Human; Heat Shock Proteins: HSP60 Family Genes; Circadian Clock Genes as Modulators of Sensitivity to Genotoxic Stress; Expression Profiling of Stress Responsive Gene Patterns; Gene–Environment Interactions in Early Development; Genetic Variation of HPA Axis Activity and Function in Farm Animals; Genetic Polymorphisms in Stress Response; Genetic Testing and Stress; Neuroticism, Genetic Mapping of; Neuroticism Response to Stress, Genetic Mapping of Mice; Serotonin Transporter Genetic Modifications