Coping Styles and Defense Mechanisms

Children and Adolescents

A child's coping style is defined as the set of cognitive, emotional, and behavioral responses to stressors (Van Horn et al. 2001). Coping involves a child's consistent use of particular strategies for managing stressors across contexts. The style a child adopts depends on the coping resources available, including problem-solving skills, social skills, social support, health and energy level, positive beliefs, and material resources (Rudolph et al. 1995). It is also dependent on temperament, developmental level, and family coping patterns.

Children's coping styles have been categorized in a number of ways. Inconsistent data are available as to the frequency of coping efforts. Some investigators have suggested that only a small proportion of children use self-initiated coping strategies when confronted with pain, and that those who use such strategies most frequently try to distract themselves or use physical procedures such as clenching their fists (Ross and Ross 1984). Others have noted that many children are able to identify techniques to cope with pain (Band and Weisz 1988).

One coping strategy classification distinguishes between approach-oriented and avoidance-oriented children (e.g., Hubert et al. 1988). The children in these two groups can also be described as information seeking versus information avoiding, ruminative or attentive versus distracted, and active versus passive. Approach-oriented coping refers to behaviors and thoughts directed at addressing or managing the stressor and/or the feelings it elicits. This style includes asking questions, displaying interest in medical play and equipment, and seeking emotional and social support prior to procedures. Avoidance-oriented coping refers to thoughts and behaviors designed to avoid experiencing the stressor at the physical, cognitive, and/or emotional level. Examples of this coping style include going to sleep, daydreaming, and refusing to ask or answer questions (Rudolph et al. 1995). Some investigators have conceived of the child's approach or avoidance as traitlike, and the styles have been associated with physiological arousal, such that children who have an approaching coping style display higher physiological activation (Melamed 1982).

Another method of categorizing coping responses identifies children's strategies as problem focused versus emotion focused (e.g., Folkman and Lazarus 1988). Problem-focused strategies are directed at altering the stressor or associated external circumstances. Emotion-focused strategies are aimed at regulating emotional responses to the stressor. This is similar to another method of categorization: that of primary control (coping designed to influence objective events) versus secondary control (coping designed to maximize one's fit to current conditions). For acute medical stressors, emotion-focused coping strategies tend to be more adaptive, primarily because the stressor (i.e., medical treatment) is unavoidable (Brown et al. 1986).

Parents

Some researchers have shown interest in the effects of interactions between children's and parents' behavioral characteristics in medical contexts. If a child has an approaching coping style, parental employment of distraction and low informing may lead to increased distress, whereas if a child has an avoidant coping style, parental provision of information is associated with increased child anxiety (Lumley et al. 1990).

Some evidence suggests that a match between the intervention employed and a child's coping style is important. Children characterized as distractors who were provided with guided imagery tolerated more pain than did either distractors or attenders who were provided with mismatched interventions (i.e., sensory focusing for distractors and imagery for attenders) (Fanurik et al. 1993). Many parental challenges, such as providing children with helpful and appropriate information to facilitate adaptive coping, continue to be important during the recovery period and following the child's discharge from the hospital.

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