Coping

Coping refers to the many strategies (cognitive, behavioural and emotional) used to manage specific stressors. Lazurus and Folkman's (1984) transactional model is currently the predominant model of coping. This model suggests that through a process of primary and secondary appraisal, an individual will make use of a range of coping strategies. The available range can be broadly split into those that are aimed either at directly tackling the stressor itself, so-called problem-focused strategies (e.g. confronting someone who is staring), or those that are aimed at regulating the emotional impact, so-called emotion-focused strategies (e.g. denial). A simplified picture is that situations that can become controlled are best dealt with by the former strategies, whilst those that are not changeable are best addressed by emotion-focused strategies.

All of the personality and cognitive factors described above have clear links to the types of coping strategies deployed by individuals. Shame-proneness, alex-ithymia, and avoidant-attachment style have all been linked to avoidant-coping strategies. For example, vitiligo and alopecia areata participants with higher levels of insecure and avoidant-attachment styles also had poorer levels of social support and it was hypothesised that this might result from difficulties in being able to access social support (Picardi et al., 2003b, c, d).

Avoidance, concealment, escape, and the use of subtle safety behaviours (such as turning one's body so as to hide one's perceived worse side in social situations) are all common shame and social anxiety-related coping strategies. Such coping mechanisms have frequently been linked to poor adjustment (Rapp et al., 2001; Hill & Kennedy, 2002; Kent, 2002). However, this picture is not clear cut, in so much as people may recognise the limitations of using such strategies and feel ambivalent in their use of them, but nevertheless feel recourse to do so as other strategies (such as being socially proactive) may be more demanding of personal resources (Thompson, 1998). Nevertheless, coping factors are clearly important in accounting for differences in adjustment and warrant further study. Importantly, there is growing evidence that interventions aimed at helping people to develop coping skills to manage the reactions of other can be useful (Robinson et al., 1996).

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