Several studies have focused on coping strategies and other cognitive behavioral factors as they relate to adaptive functioning among individuals with disabilities and chronic illness. Some of the research has been conducted by the author and others on African Americans with sickle cell disease.
Belgrave and Washington (1986) found among adolescents with sickle cell disease that an assertive coping style was linked to their ability to manage painful episodes. Adolescents reported less disruption in activities of daily living when having a painful episode if they had an assertive coping style. This assertive coping style is an active, problem-focused way of dealing with painful sickle cell disease episodes. Adolescents in our study who were able to make requests and to inform others of their needs within the home, school, peer, and community domains fared better.
Gil, Williams, Thompson, and Kinney (1991) found that among patients with sickle cell disease, negative thinking and passive adherence were associated with more severe pain, less activity, and distress. These passive coping strategies were also associated with more health care services utilization. The results of this study suggest that passive adherence to prescribed treatments and rehabilitation regiments is not always good. The person should assume some degree of control over his or her treatment. Control over treatment within the medical and rehabilitation environment is likely to be especially difficult for some African Americans, who may feel intimidated by higher-status professionals. However, these skills can be learned, and strategies for gaining these skills will be discussed in chapter 8.
Tyler (1978) has conceptualized active coping somewhat differently than Lazarus and Folkman (1984) and Carver, Scheier, and Weintraub (1989). Tyler's conceptualization of coping is also useful when thinking of active coping as an intrapersonal resource for African Americans with chronic illnesses and disabilities, and this conceptualization also lends itself nicely to identifying strategies for enhancing adaptive coping.
Active coping, as conceptualized by Tyler (1978), is a cognitive behavioral factor that impacts how an individual functions. According to Tyler, active coping is the way an individual copes with both adverse and favorable conditions: it involves his or her initiative, goal setting, planning, and the effort made to attain goals. An individual who actively copes effectively takes responsibilities for what happens to him or her and actively plans for and carries out behaviors to enhance his or her well-being. Using this definition of active coping, one can see how closely it is akin to the concepts of self-efficacy and psychological control. One can also see how active coping can help one achieve empowerment.
The beneficial effect of coping on adjustment to disability has been demonstrated in several studies (Affleck, Urrows, Tennen, & Higgins, 1992; Brown, Doepke, & Kaslow, 1993; Hanson, Buckelew, Hewett, & O'Neal, 1993; Zea, Belgrave, Townsend, Jarama, & Banks, 1996). In a study of African American and Latinos with disabilities, Zea et al. (1996) found that active coping was a significant predictor of psychological adjustment (i.e., depression) among African Americans and Latinos with disabilities. Persons who scored higher on an active coping scale were less depressed. This finding underscores the value of active coping in improving one's mental health and affective states.
In summary, given that self-efficacious beliefs have positive effects in the emotional, cognitive, and behavioral domains, programs to increase these beliefs are worthy of investigation. Persons who are high in self-efficacy (as compared to low in self-efficacy) try harder, are not as despondent when they fail, and are more likely to succeed eventually.
It is important to remind the reader that self-efficacious beliefs that emphasize individual achievement of goals should be integrated with collective efficacy. Communal and interdependent orientations of African Americans support the attainment of group goals along with individual goals. The West African proverb ''I am because we are, and we are because I am'' implies that people of African descent and people with disabilities will all do well or will all do poorly. This belief suggests that one contributes to and gains from similar others. Therefore, as will be seen in chapters 7 and 8, the author recommends access to and involvement with a group of similar others in the attainment of goals.
When social and environmental conditions are oppressive, as may be the case when discrimination, poverty, racism, and limited employment opportunities exist, active coping can help the individual overcome bar riers and function more effectively. For African Americans with disabilities, strategies to enhance active coping may be beneficial.
As noted, active coping and self-efficacy are related to each other. Persons who use active coping and problem-solving coping strategies are more likely to have high self-efficacy about their ability to achieve a desired outcome. These two constructs are also related to social support. The overlap among these constructs has implications for understanding the mechanisms through which self-efficacy, active coping, and social support influence outcomes such as mental health and employment. Furthermore, these concepts can be used to provide a framework for developing programs to improve outcomes for African Americans with chronic illnesses and disabilities.
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