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8/2/2019 Chapter 3 Coping Religiosity And Suicide
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Chapter 3: Coping Behavior, Religiosity & Suicide 141
Chapter 3
Coping Behavior, Religiosity andSuicide
Definitions of Coping
Coping is defined as constantly changing cognitive and behavioral efforts
to manage specific external and/or internal demands that are appraised as
taxing or exceeding the resources of the person to a stressful situation. It is
the effort to manage and overcome these demands and critical events that
pose a challenge, threat, harm, loss, or benefit to a person (Lazarus and
Folkman, 1984; Seiffge-Krenke, 1995)
Coping is also defined as a process by which an individual manages the
ever-changing environment. Coping may be seen as actions taken by persons
directed at confronting demands, solving problems, and/or altering and
managing stressors. Coping behavior is generally influenced by maturation
and cognitive development such as problem-solving ability, and
understanding peers and adults (Lewis & Brown, 2002).
Koch & Shepperd, (2004); Schlozman et al., (2004); Morling et al., (2006)
further stated that coping is perhaps best defined as a problem-solving
behavior that is intended to bring about relief, reward, quiescence, and
equilibrium. Nothing in this definition promises permanent resolution of
problems. It does imply a combination of knowing what the problems are
and how to go about reaching a correct direction that will help resolution.
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Chapter 3: Coping Behavior, Religiosity & Suicide 142
Yet most approaches in coping research follow Folkman and Lazarus
(1980), who define coping as `the cognitive and behavioral efforts made to
master, tolerate, or reduce external and internal demands and conflicts
among them.'
The Stress Theory
Two concepts are central to any psychological stress theory: appraisal, i.e.,
individuals' evaluation of the significance of what is happening for their
well-being, and coping, i.e., individuals' efforts in thought and action to
manage specific demands (Lazarus, 1993).
Lazarus (1966) illustrated two basic forms of appraisal, primary and
secondary appraisal; these forms rely on different sources of information.
Primary appraisal concerns whether something of relevance to the
individual's well being occurs, whereas secondary appraisal concerns coping
options.
Within primary appraisal, three components are distinguished: goal
relevance describes the extent to which an encounter refers to issues about
which the person cares. Goal congruence defines the extent to which an
episode proceeds in accordance with personal goals. Type of ego-
involvement designates aspects of personal commitment such as self-
esteem, moral values, ego-ideal, or ego-identity.
Likewise, three secondary appraisal components are distinguished: blame or
credit results from an individual's appraisal of who is responsible for a
certain event. By coping potential Lazarus means a person's evaluation of
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Chapter 3: Coping Behavior, Religiosity & Suicide 143
the prospects for generating certain behavioral or cognitive operations that
will positively influence a personally relevant encounter. Future
expectations refer to the appraisal of the further course of an encounter with
respect to goal congruence or incongruence.
Unlike approaches discussed so far, resource theories of stress are not
primarily concerned with factors that create stress, but with resources that
preserve well being in the face of stressful encounters. Several social and
personal constructs have been proposed, such as social support (Schwarzer
and Leppin 1991), sense of coherence (Antonovsky 1979), hardiness
(Kobasa 1979), self-efficacy (Bandura 1977), or optimism (Scheier and
Carver 1992). Whereas self-efficacy and optimism are single protective
factors, hardiness and sense of coherence represent tripartite approaches.
Hardiness is an amalgam of three components: internal control,
commitment, and a sense of challenge as opposed to threat. Similarly, sense
of coherence consists of believing that the world is meaningful, predictable,
and basically benevolent. Within the social support field, several types havebeen investigated, such as instrumental, informational, appraisal, and
emotional support
The recently offered conservation of resources (COR) theory (Hobfoll
1989, Hobfoll et al., 1996) assumes that stress occurs in any of three
contexts: when people experience loss of resources, when resources are
threatened, or when people invest their resources without subsequent gain.Four categories of resources are proposed: object resources (i.e., physical
objects such as home, clothing, or access to transportation), condition
resources (e.g., employment, personal relationships), personal resources
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Chapter 3: Coping Behavior, Religiosity & Suicide 144
(e.g., skills or self-efficacy), and energy resources (means that facilitate the
attainment of other resources, for example, money, credit, or knowledge).
The Concept of CopingEarly conceptualizations of coping centered around the Transactional
Model for Stress Management, put first by Lazarus and colleagues in the
late 1960s (Lazarus, 1966), this conceptualization stressed the extent of
coping to which patients interact with their environment as a means of
attempting to manage the stress of illness. These interactions involve
appraisals of the current medical condition, with psychological and cultural
overlay that varies from patient to patient (Stern et al., 2008).
In the late 1970s a major new development in coping theory and research
occurred (Lazarus, 1993); in which the hierarchical view of coping with its
trait or style emphasis was abandoned in the favor of treating coping as a
process. The term coping is used whether the process is adaptive or non
adaptive, successful or non successful, consolidated or fluid and unstable.
Lazarus (1993) stated that the process of coping employed for the different
threats produced by cancer, or any other complex source of psychological
stress, whether disease-based or not, varies with the diverse adaptational
significance and requirements of these threats. Therefore, when studying
how the patient copes with this illness, it is necessary to specify the
particular threats of immediate concern to the patient and to treat them
separately rather than broadening the focus of attention to the overall illness.
Coping also changes from one time to another in any given stressful
encounter; this is an empirical statement of what means to talk about coping
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Chapter 3: Coping Behavior, Religiosity & Suicide 145
as process. When stressful conditions are viewed by a person as refractory to
change, emotion focused coping predominates; while when they are
appraised as controllable by action, problem focused coping predominates
(Folkman and Lazarus 1980; Lazarus and Folkman1987).
The coping process approach assumes that coping is flexible, involves
active planning, and is responsive to environmental demands and personal
preferences. Thus coping should be conceptualized as a dynamic and
constantly changing process as stated by Ayers et al.,(1996) who further
added that both cognitions (e.g., the individuals appraisal of the situation)
and behaviors (e.g., what a person actually does) from a situation-specific
perspective should be considered.
The Lazarus (Lazarus 1991; Lazarus and Folkman 1984; Lazarus and
Launier, 1978) model outlined above represents a specific type of coping
theory. These theories may be classified according to two independent
parameters:
(a) trait-oriented versus state -oriented.
(b) microanalytic versus macroanalytic approaches (Krohne, 1996).
Trait-oriented and state-oriented research strategies have different
objectives: The trait-oriented (or dispositional) strategy aims at early
identification of individuals whose coping resources and tendencies are
inadequate for the demands of a specific stressful encounter. An early
identification of these persons will offer the opportunity for establishing aselection (or placement) procedure or a successful primary prevention
program. Research that is stateoriented, i.e., which centers around actual
coping, has a more general objective.
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Microanalytic approaches focus on a large number of specific coping
strategies, whereas macroanalytic analysis operates at a higher level of
abstraction, thus concentrating on more fundamentalconstructs.
The distinction of the two basic functions of emotion-focused and problem-
focused coping proposed by Lazarus and Folkman (1984) represents a
macroanalytic state approach. While S. Freud's (1926) classic defense
mechanisms conception is an example of a state-oriented, macroanalytic
approach. Although Freud distinguished a multitude of defense mechanisms,
in the end, he related these mechanisms to two basic forms: repression and
intellectualization (Freud 1936). The trait-orientedcorrespondence of these
basic defenses is the personality dimension repressionsensitization (Byrne
1964; Eriksen, 1966).
Classification and Types of Coping Behavior
An overview of the perspectives of coping theorists shows that they have
generally categorized coping strategies under three groups: a) strategies
focused on resolving the problem; b) strategies used to alleviate the
emotions triggered by the situation; and c) strategies involving social
support (Snyder, 1999).
Folkman and Lazarus (1980); Taylor et al. (1998) went on to make an
important and now widely accepted distinction between two types of coping.
In one, problem focused; the person attempts to address directly the
problems that he is facing. In the second, emotion focused; the person tries to
dampen or minimize the emotional state itself, without addressing the
problem that elicited the state. Coping efforts may focus on altering ones
environment or emotions , the majority of individuals utilize both types of
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strategies and adapt these strategies to fit specific stressful situations and
achieve successful resolutions (Aldwin & Brustrom, 1997)
Weiten and Lloyd (2006) added the appraisal-focused strategies to the above
2 strategies:
Appraisal-focused strategies occur when the person modifies the
way they think, for example: employing denial, or distancing oneself
from the problem. People may alter the way they think about a
problem by altering their goals and values, such as by seeing the
humour in a situation.
Problem-focused strategies are used by people who try to deal with
the cause of their problem. They do this by finding out information
on the problem and learning new skills to manage the problem.
Emotion-focused strategies involve releasing pent-up emotions,
distracting one-self, managing hostile feelings, turning to religion,
meditating, using systematic relaxation procedures, etc.
Moos and Schaefer (1984) helped better understanding of the previous three
coping categories each with three skills;
1. Appraisal-Focused Coping: These skills involve how we understand
the stressful situation
a) Logical analysis and mental preparation Breaking down anoverwhelming problem down into manageable parts, taking advantage
of past similar experiences, evaluating and rehearsing plausible "what-
if" scenarios
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b) Cognitive redefinition Restructuring or re-framing the situation tofind something favorable
c) Cognitive avoidance or denial Denying or minimizing the severityof the situation
2. Problem-focused Coping: These skills involve doing something about
the problem itself
a) Seeking information and support Getting information about thesituation and evaluating any possible courses of action
b) Taking problem-solving actions Taking deliberate action to dealdirectly with the situation
c) Identifying alternative rewards Trying to replace any losses orsetbacks with new sources of satisfaction
3. Emotion-focused Coping: These skills involves what we do with our
reactions to the situation
a) Affective regulation Working to maintain hope and to controlemotions
b) Emotional discharge Expressing feelings and using humor to helpreduce strain
c)
Resigned acceptanceAccepting the situation for what it is, realizingthe circumstances cannot be altered and submitting to fate.
Typically, people use a mixture of all three types of coping, and coping
skills will usually change over time. All these methods can prove useful, but
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some claim that those using problem-focused coping strategies will adjust
better to life (Taylor, 2006)
Apart from these three categories, theorists such as Billings and Moos
(1981), along with Pearlin and Schooler (1978), have constructed
alternative models by classifying the coping strategies in accordance with
the approach-avoidance dichotomy. At a more practical level, Frydenberg
and Lewis' (1993, 1996) model offers an assessment of coping strategies by
separating them into productive, nonproductive (Zeidner and Endler , 1996)
Endler and Parker (1990) additionally suggest avoidance-focused coping
as a category, which entails person-oriented or task-oriented strategies to
distract away from the stressor at hand. Others have described religious faith
and spiritual beliefs as a means of coping (Dervic et al., 2006; Walker and
Bishop, 2005;Hovey, 1999).
Folkman and lazarus (1985) used the 2 general dimensions of problem
focused and emotion focused coping as a conceptual guide to develop the
ways of coping checklist which include; Wishful thinking, detachement, self
blame, tension reduction, keeping to self emphasizing the positive, problem
focused and seeking social support,Parker & Endler (1996) added thatboth
types of coping are important, and, if used properly, can have extraordinarily
beneficial consequences for physical and mental health. Matud(2004)
found that men often prefer problem-focused coping, whereas women can
often tend towards an emotion-focused response. Problem-focused coping
mechanisms may allow an individual greater perceived control over their
problem, while emotion-focused coping may more often lead to a reduction
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in perceived control. Certain individuals therefore feel that problem-focused
mechanisms represent a more effective means of coping.
An additional distinction is often made in the coping literature between
active and avoidant coping strategies (Holahan & Moos, 1997).
1-Active coping strategies: Are either behavioral or psychologicalresponses designed to change the nature of the stressor itself or how one
thinks about it.
2-Avoidant coping strategies: Lead people into activities (such asalcohol use) or mental states (such as withdrawal) that keep them
from directly addressing stressful events. Avoidance-oriented coping
has been conceptualized as involving person-oriented and/or task-
oriented responses (Endler & Parker, 1992). Strategies associated
with this approach include seeking out other people (social
diversion) or engaging in a substitute task (distraction) (Sandler et
al., 1997).
Frazier (2002)gives another illustration to the different types of coping:1. Active Coping (e.g., I take additional action to try to get rid of the
problem; I consult others who have had similar problems about
what they did)
2. Emotional Regulation (e.g., I talk to someone about how I feel; Ilearn to accept and live with it; I get upset and let my emotions
out)
3. Distancing(I seek Gods help; I refuse to believe it has happened;I turn to other activities to take my mind off things).
Gupta & Derevensky (2000) stated that positive coping processes
include the utilization of multiple problem and solution-focused
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strategies that allow the individual to consider multiple options in
dealing with difficult problems.
Generally speaking, active coping strategies, whether behavioral or
emotional, are thought to be better ways to deal with stressful events, and
avoidant coping strategies appear to be a psychological risk factor or marker
for adverse responses to stressful life events.
Carver et al. (1989) found among ways which people respond to stress
behavioral disengagement; which is reducing one's effort to deal with the
stressor, even. Giving up the attempt to attain goals with which the stressor
is interfering. In theory, behavioral disengagement is most likely to occur
when people expect poor coping outcome. Mental disengagement is a
variation on behavioral disengagement, postulated to occur when conditions
prevent behavioral disengagement (Carver et al., 1983), which include using
activities to take one's mind off a problem (e.g. day dreaming, escaping
through sleep, watching T.V.).
Rumination or self-focused attention may be defined as a stable, emotion-
focused coping style that involves responding to problems by directing
attention internally toward negative feelings and thoughts. Ruminating about
problems includes both cognitive (self-focused cognitions) and affective
(increased emotional reactivity) elements (Broderick & Korteland, 2002)
While faulty coping processes may include the use of a high number of
emotion-focused responses to stressful situations that usually involve
avoidance, rumination, and negatively centered affective strategies (Gupta
& Derevensky, 2001). It is important to note that, although women are more
likely to ruminate than men, rumination is not an exclusively female
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behavior. Similarly, avoiding or distracting oneself from problems is not a
coping strategy unique to males (Tavris, 1999).
Function of Coping
Lazarus (1999); Lazarus (1983) documented the unsuspected benefits of
the coping process. He demonstrated experimentally that patients who
engage in forms of denial (for example, refusing to believe that a serious
medical problem exists or to accept that the problem is as severe as it, in
fact, is) recover better and more quickly than patients who do not engage in
such denial. Lazarus thus came to believe, contrary to orthodox wisdom, that
under certain conditions, false beliefs can have very beneficial consequences
to one's health and well-being.The study on the benefits of denial has now
been replicated by others, and its findings are taken into consideration in
health psychology and psychosomatic medicine.
Pearlin and Schooler (l978) stated that coping is seen as having three main
(protective) functions: Management of the problem causing the distress
through elimination or modification of the conditions giving rise to it,
alteration of (perceptually controlling) the meaning of the experience so as
to neutralize its problematic character and, regulation of the emotional
distress produced by the problem. These functions have been supported and
are widely recognized by others (Mechanic, 1977; Kahn et al., 1964;
Folkman and Lazarus, 1980).
Hamburg et al. (1967) stated that the goals of Effective Coping Behavior
are: To keep distress within manageable limits, to maintain a sense of
personal worth, to restore relations with significant other people, to increase
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the likelihood of working out a personally valued and socially acceptable
situation.
Folkman and Lazarus(1988) assessed subjects' emotional state at the
beginning and end of a number of stressful encounters, focusing on amount
and direction of change as a function of the coping strategy reported. Some
coping strategies, such as planful problem solving and positive reappraisal
were associated with changes in emotion from negative to less negative or
positive while other coping strategies such as confrontive coping and
distancing, correlated with emotional changes in the opposite direction that
is toward more distress (Haan, 1969).
Individuals vary in the extent to which they use humor to cope with
stressful situations. Those with greater tendencies to cope with humor report
greater daily positive mood (Dillon et al., 19851986;Lefcourt, 2001).
Consequently, in response to stress, those with greater propensities to cope
with humor show increases in levels of immunoglobulin A (S-IgA), a vital
immune system protein.
Ineffective Coping
Ineffective coping is an inability to for a valid appraisal of stressors,
inadequate choices of practiced responses, and/or inability to use available
resources(Gordon, 2002)
House (2009) stated that coping responses may be ineffective. There are few
rules about what makes effective coping. In general, a broad and flexible
repertoire is desirable, with a strong element of active problem focused
techniques. However not all illnesses, nor all aspects of a particular illness,
http://www.ncbi.nlm.nih.gov/pubmed/4055243http://www.ncbi.nlm.nih.gov/pubmed/4055243http://www.ncbi.nlm.nih.gov/pubmed/4055243http://www.ncbi.nlm.nih.gov/pubmed/4055243http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1201429/#R66http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1201429/#R66http://www.ncbi.nlm.nih.gov/pubmed/40552438/2/2019 Chapter 3 Coping Religiosity And Suicide
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are likely to be amenable to problem-focused coping. Probably the most
effective coping is matched to the situation. That is, the coping matches the
demands, so that heavy reliance is not placed on problem-focused coping
when little in the situation can change, nor excessive use made of emotion-
focused coping when active involvement in illness management is needed.
Sharpe and Curran (2006) stated that demands of the situation may be
overwhelming. The news that one has a terminal illness takes time to
assimilate-to understand all its meanings, grasp all the threats and losses
involved. While that process of appraisal is going on, it is difficult to
marshal resources and use them effectively. This explains, in part, why
mood disorder is more commonly associated with acute than chronic illness.Also, resources may be inadequate or missing. One problem associated
with physical illness is that it may impair personal resources as a primary
effect of the disease process-most importantly when the illness has effects on
the central nervous system by virtue of the direct involvement of the brain or
through the neurological effects of systemic disturbance.
A common problem of failure to match coping to the situation is found in
patients with chronic illness, who are responding to their circumstances as if
they none the less have an acute illness. In acute illness, problem-focused
coping often involves seeking reversal or even cure of the illness process,
while emotion focused coping involves dealing with the anxiety of
uncertainty, or grieving if the prognosis is clearly poor. On the other hand, in
chronic illness, problem-focused coping involves symptom management and
maximizing function, while emotion-focused coping requires a degree of
acceptance. (House, 1988)
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Mental Illness and Coping
Schomerus and Angermeyer (2008) stated that many people suffering from
serious mental illness do not seek appropriate medical help. The stigma ofmental illness has often been considered a potential cause for reluctance in
seeking help; intervention studies show that destigmatisation may lead to
increased readiness to seek professional help and thus a better coping.
Recent research conducted by Wu et al.(2010) has found that people with
psychiatric disabilities tended to utilize passive and emotional-focused
strategies to cope with their illness ; analysis of survey data found the sense
of helplessness and the overall illness adaptation significantly impact
negative emotion coping utilization. Those who felt highly impact by the
illness, more sense of helplessness, less actively managing their illness, and
more social support availability were more likely to use positive emotion as
a coping strategy.
Broderick & Korteland (2002) stated that ruminative strategies including
isolating oneself to think out a problem, writing in a diary about how sad one
feels, or talking repetitively about a negative experience with the purpose of
gaining increased personal insight; may actually make the depression worse.
Broderick & Korteland (2002) have found that the use of distraction, that
is, the deliberate focusing on neutral or pleasant thoughts or engaging in
activities that divert attention in more positive directions, can attenuate
depressive episodes
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Both depressed suicide attempters and depressed individuals without a
suicide attempt displayed higher levels of hopelessness and poorer problem
solving abilityin a study conducted byRoskar et al. (2007)
Kolla et al. (2008) found that borderline personality disorder as a chronic
psychiatric condition is characterized by a pervasive pattern of instability in
affect regulation and impulse control. These maladaptive coping strategies
predispose these individuals to suicidal behavior.
A recent study was conducted by Cukrowicz et al. (2008) the purpose of
this study was to examine coping styles and thought suppression as
predictors of a suicide risk in a sample of depressed older adults with co-
occurring personality disorders. Based on the extant literature, it was
hypothesized that maladaptive coping (i.e. emotional and avoidance coping)
and chronic thought suppression would significantly predict suicide risk.
The results of this study indicated that elevated emotional coping and
thought suppression were associated with increased suicide risk. Contrary to
hypotheses, lower avoidance coping was associated with increased risk.
Coping style of suppression was significantly and positively related to
suicide risk, as were several other coping styles (Josepho and Plutchik
,1994).Thus, treatments that focus on decreasing emotional coping and
chronic thought suppression may result in decreased suicidal ideation and
hopelessness for older adults with depression and Axis II pathology
(Cukrowicz et al., 2008)
Also there is consistent evidence that dimensions of active coping that
include problem-solving in a stressful situation is related to lower mental
health and substance use problems (Sandler et al., 1997). Also individuals
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with substance abuse problems demonstrate an avoidance-oriented coping
style that often focuses on strategies such as daydreaming, helplessness,
distraction, and diversion (Winters & Anderson, 2000).
The robust and isolated representation of suicidal ideas and attempts
associated with maladaptive coping strategies with younger age confirms the
specificity of coping qualities, and also confirms the association of
depression with dysfunctional attitudes and with maladaptive coping
distinctly, but risky problem solving, maladaptive coping and dysfunctional
attitudes seem to characterize different groups of depressive syndromes with
only a moderate overlap (Csorba et al., 2007).
Roskar et al. (2007) stated that next to feelings of hopelessness, certain
cognitive features such as problem solving deficiency, attentional bias and
reduced future positive thinking are involved in the development and
maintenance of suicidal behavior.
Horesh et al. (2007) added that suicidal patients were significantly lesslikely to use the coping styles of minimization and mapping. They were
unable to de-emphasize the importance of a perceived problem or source of
stress. They also lacked the ability to obtain new information required to
resolve stressful life events. Four coping styles correlated negatively with
the suicide risk (minimization, replacement, mapping and reversal), while
another three (suppression, blame and substitution) correlated positively,
also female who used emotion-focused coping were more likely to
experience suicidal ideations (Edwards and Holden, 2001)
In a study conducted by Gould et al. (2004); Dinya et al. (2009) to
identify youths' attitudes about coping and help-seeking strategies for
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Chapter 3: Coping Behavior, Religiosity & Suicide 158
suicidal ideation and behavior; it was found that they use maladaptive
coping strategies in response to depression and suicidal thoughts and
behaviors such as avoidance and approach coping responses respectively.
Dinya et al. (2009) further added that future research is needed to identify
possible variation in the coping strategies among different adolescent
suicidal patients.
Gonzalez et al. (2009) stated that drinking to cope was a significant
intervening variable in the relationships between suicidal ideation and
alcohol consumption, heavy episodic drinking, and alcohol problems, even
while controlling for depression. These results suggest that the relationship
between suicidal ideation and alcohol outcomes may be due to individuals
using alcohol to regulate or escape the distress associated with suicidal
ideation.
Further research studies on the psychological processes underlying suicidal
behavior have highlighted deficits in social problem-solving ability, and
suggest that suicide attempters may, in addition, be passive problem-solvers
(Pollock and Williams,2004)
Orbach et al. (1990) compared qualitative aspects of problem solving
among suicide attempters, suicide ideators, and nonsuicidal patients.Problem
solving was analyzed along eight qualitative categories: versatility of the
various solutions, reliance on self versus others, activity versus passivity,confrontation versus avoidance, relevance of the solution to the problem,
positive versus negative affect, reference to the future, and extremity of the
solution. The solutions of suicidal patients showed less versatility, more
avoidance, less relevance, more negative affect, and less reference to the
http://www.ncbi.nlm.nih.gov/pubmed?term=%22Pollock%20LR%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Williams%20JM%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Williams%20JM%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Pollock%20LR%22%5BAuthor%5D8/2/2019 Chapter 3 Coping Religiosity And Suicide
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Chapter 3: Coping Behavior, Religiosity & Suicide 159
future than the solutions of the non suicidal patients. The suicide attempters
and non suicidal patients offered more active solutions than did the suicide
ideators.
Several researchers have reported the importance of avoidance-
focused and emotion-focused coping as predictors of suicidal ideations.
In HIV positive patients, suicidal ideations were more likely to be
experienced by individuals who cope through avoidance and escape
strategies. (Kalichman et al.,2000) , the relationship between greater
reliance on avoidance coping and suicidal ideations has also been
demonstrated among psychiatric inpatients (Orbach et al.,1990;DZurilla
et al.,1998)
Overall, avoidance-focused and emotion-focused coping are often
reported to be less effective strategies, primarily because these
approaches do not address the direct management of the problem at
hand. This exacerbates the stressful experience, and in turn can lead to
suicidal behaviors as a means to escape (Edwards and Holden, 2001)
Alexander et al.(2009)conducted a study examined how individuals with
serious mental illness and a history of suicidal behavior cope with suicidal
thoughts; the respondents in the study wrote up to five strategies they use to
deal with suicidal thoughts; included spirituality, talking to someone,
positive thinking, using the mental health system, considering consequencesof suicide to family and friends, using peer supports, and doing something
pleasurable.
In a present study of adult survivors of suicide to examine their natural
coping efforts; results indicated that participants experienced high levels of
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psychological distress since the suicide, including elevated symptoms of
depression, guilt, anxiety, and trauma, they also experienced substantial
difficulties in the social arena (e.g., talking with others about the suicide)
,they also reported higher levels of psychological distress, social isolation,
and barriers to seeking help, also depression and a lack of information about
where to find help served as barriers to help-seeking behaviors. Future
research is needed to build on these preliminary findings and to provide a
solid foundation for evidenced-based interventions with survivors
(McMenamy et al., 2008)
DeAngelis (2001) stated that suicide experts are beginning to recognize
common emotional threads that may underlie some suicides. Prominent
among these, they say, are a perceived sense of isolation, a lack of personal
attachments and a dearth of coping skills. Healthy coping, according to crisis
theory, involves four dimensions: involvement in daily activities, a
supportive community, physical well-being and good quality of life; suicide
attempts, on the other hand, can be seen as maladaptive efforts to cope.
Since feelings of hopelessness decreases over time and problem solving
ability nevertheless remains stable it is important that treatment not only
focuses on mood improvement of depressed suicidal and depressed non-
suicidal individuals but also on teaching problem solving techniques.
(Roskar et al., 2007)
These findings may have important implications for therapists and primary
prevention workers, and might pave the way towards recognition of the role
played by coping styles in predicting suicide and its use for cognitive
intervention in high-risk patients (Horesh et al., 2007)
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Religiosity and Psychiatry
The relationship between religion and mental health has been debated for
centuries, since Freud and other famous mental health scholars have put
forth their postulations concerning the neurotic influences of religion in
mental health, many of the 20th
century mental health professionals have
been influenced to hold skeptical and even hostile attitudes toward religion.
However, the past two decades have increasingly found more empirical
evidence supporting the beneficial effects of religiousness on mental health
that apparently contrasts with the postulations of Freud (Yeung & Chan,
2007)
The definition and meaning of spirituality and religion remains a grey area,
they are often regarded as 2 sides of the same coin. However in both the
psychological and religious arenas spirituality is distinct from the traditional
concepts of religion (Emmons and paloutzian, 2003) spirituality refers to
matters concerning god and the human need to find a higher meaning and
the relationship with the metaphysical such as soul, spirit, after-life and
angels(Elkins, et al., 1988; Emmons and paloutzian, 2003). While religionrefers to organized and institutionalized beliefs and system of faith which
serves as a means of spiritual expression and includes: Islam, Christianity,
Buddhism, Judaism, and Hinduism (Piedmont et al., 2001; Piedmont et al.,
2003; Emmons and paloutzian, 2003)
Evidence suggests that the religious and spiritual dimensions, while
sometimes overlapping, often correlate differentially to psychosocial
outcomes thereby yielding more robust information (Hill & Pargament,
2003; Piedmont, et al., 2003).
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Definition of Religion
Paloutzian& Santrock (2002) stated that religion is defined as the
institutional, the organizational, the ritual, and the ideological, whereasspirituality is defined as the personal, the affective, the experiential, and the
thoughtful. This contrast includes the idea that an individual can be spiritual
without being religious or religious without being spiritual.
A second contrast between religion and spirituality involves reserving the
term spiritual for the loftier side of life with spiritualitythe search for
meaning, for unity, or connectedness, for transcendence, and for the highest
level of human potential. While the term religion is correspondingly
reserved for institutionalized activity and formalized beliefs, things that can
be seen as peripheral to spiritual tasks (Paloutzian& Santrock, 2002)
The trend in defining religion is moving away from a broad
conceptualization of the institutional and the individual toward a more
narrow definition in terms of the institutional side of life. The trend in
defining spirituality is to describe it in terms of individual expression that
speaks to a persons highest level of human functioning (Emmons, 1999).
Despite such trends, there is still a great deal of controversy about how to
define religion and spirituality.
Religion and Mental Health
Paloutzian& Santrock (2002) stated that a common stereotype is that
religion is a crutch for weak people and that unconscious feelings of guilt are
the reasons that people become religious. Just because some religious
individuals show signs of a mental disorder does not mean that their
religious beliefs caused the disorder or that they adopted their beliefs as an
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Chapter 3: Coping Behavior, Religiosity & Suicide 163
escape. Similarly, just because individuals with a severe mental disorder,
such as schizophrenia, use the word God or have a vision that they are Jesus
or another charismatic religious leader does not mean that religion caused
their severe mental disorder or that they became religious to try to cure
themselves. All that such illustrations do is inform us that aspects of religion
and mental disorder co-occur in a small number of individuals. They tell us
nothing about religion causing mental disorders or mental disorders causing
religiousness.
Role of Religious Coping in Mental Health
Some psychologists have categorized prayer and religious commitment as
defensive coping strategies, arguing that they are less effective in helping
individuals cope than are life-skill, problem-solving strategies (Paloutzian&
Santrock, 2002)
However, recently researchers have found that some styles of religious
coping are associated with high levels of personal initiative and competence,
and that even when defensive religious strategies are initially adopted, they
sometimes set the stage for the later appearance of more-active religious
coping (Pargament & Park, 1995). In one recent study, depression
decreased during times of high stress when there was an increase in
collaborative coping (in which people see themselves as active partners with
God in solving problems) (Brickel et al., 1998). Also, in general, an intrinsic
religious orientation tends to be associated with a sense of competence and
control, freedom from worry and guilt, and an absence of illness, whereas an
extrinsic orientation tends to be associated with the opposite characteristics
(Ventis, 1995).
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Instead of disintegrating during times of high stress, religious coping
behaviors appear to function quite well in these periods (Koenig, 1998). In
one study, individuals were divided into those who were experiencing high
stress and those with low stress (Manton, 1989). In the high-stress group,
spiritual support was significantly related to personal adjustment(indicated
by low depression and high self-esteem). No such links were found in the
low-stress group.
In the research on religious coping, growing body of literature documents
beneficialoutcomes of religious coping(Ahrenset al., 2009; Yeung &Chan
, 2007), and as a result of their efforts in the past two decades, social
scientists have gradually come a consistent view on the positive relationship
between religiousness and mental health.
Turning to religion is an important way of coping; data collected by
(McCrae and Costa, 1986) suggest that such a coping tactic may be
important to many people. One might turn to religion when under stress
widely varying reasons, religion might serve as a source of emotional
support , as a vehicle for positive reinterpretation and growth, or as a tactic
of a coping with a stressor.
Koenig et al. (2001) have recently completed a systematic review of
studies on religion and mental health. They identified 850 relevant studies
conducted in the 20th
century addressing the relationship between religious
involvement and mental health. Although they used a broad term to define
mental health and well-being, which include psychologically perceived well-
being, life satisfaction, hope, optimism, purpose and meaning in life,
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Chapter 3: Coping Behavior, Religiosity & Suicide 165
depression, anxiety, and suicidal ideation, most of the studies reported the
positive role of religious involvement in maintaining mental health.
George et al. (2002) stated that the social and psychological factors that
have been hypothesized to explain the mental health promoting effects of
religious involvement are health practices, social support, psychosocial
resources such as self-esteem and self-efficacy, and belief structures such as
sense of coherence.
Similarly, Jones (2004) also proposed a set of mediators through which
religiousness could enhance mental and physical outcomes. They are the
increase in relaxation response to stress, decrease in unhealthy behaviors,
increase in social support, more compliance with physicians treatment, a
sense of coherence, more positive self-concept (e.g. higher self-esteem and
less anxiety), and the positive interaction between mental and physical well-
being (a potentiating interaction effect).
Yeung &Chan (2007) (as shown in figure E) stated that religiousness can
promote various resources, including spiritual, cognitive, psychological and
social resources. Not only do these resources have unique positive effects on
mental health, they also interact and mutually reinforce each other. Spiritual
resources could be something particular to religious involvement.
They may be hope, ultimate concern, eternal life after death, spiritual
support, and assistance from an omnipotent GOD. These spiritual resources
could be helpful and beneficial enough to change ones worldview and
cognition from an apathetic, competitive and meaningless worldview to a
world with hope, warmth, and meaningfulness (Yeung &Chan, 2007).
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Chapter 3: Coping Behavior, Religiosity & Suicide 166
Figure (E): Mediational channels of the positive effects of religious
involvement on mental health (Yeung &Chan, 2007)
Research pointed out that many people who were not religious previously
might turn to religion for comfort (Koenig, 2001; Koenig & Larson, 2001).
This often involves in beliefs in a living and caring God, private religiousactivities, reading religious scriptures for direction and encouragement, or
looking for support from pastors or members of faith community. In fact,
many studies commonly reported that religiousness was powerful resources
of hope, meaning and purpose in life. These protective and beneficial effects
are particularly strong in people with illness and disability (Ehman et al.,
1999; King, 2000; Koenig et al., 1998; Koenig et al., 2004; Mueller et al.,
2001).
George et al.(2002); Mueller et al.( 2001) stated seven dimensions of
religious involvement: public religious participation (e.g. church
attendance), religious affiliation (e.g. involvement in a religious
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Chapter 3: Coping Behavior, Religiosity & Suicide 167
organization/ denomination), private religious practices (e.g. prayer and
reading religious materials), and religious coping (turn to his/her
religion/belief system for assistance), daily religion-related spiritual
experiences (e.g. ones subjective perception of the transcendent in daily
life), religious commitment (times and resources involved in religious
activities and beliefs), and self-rated overall salience of religion (importance
of religion in ones life).
Pargament (2001) stated that in the eyes of many mental health
professionals comfort, solace and relief are the basic functions of religion;
similarly some coping researchers described religion as a form of emotion
focused coping. He further added that religious beliefs and experiences act
as immediate coping devices for current problems, but also as spurs to
further psychological and emotional growth.
Lewis et al. (2005) found that there are presently two dominant research
perspectives within the psychology of religion and well-being literature. The
first dominant construct within contemporary psychology of religion relates
to religious orientation. Individuals described as having an intrinsic
orientation toward religion are described as wholly committed to their
religious beliefs, and the influence of religion is evident in every aspect of
their life (Allport, 1966). On the other hand, those who demonstrate an
extrinsic orientation toward religion have been describe as using religion to
provide protection, consolation, and social status (Allport & Ross, 1967), inother words Intrinsic religious orientation involves religious motives that lie
within the person; the person lives the religion. By contrast, extrinsic
religious orientation involves personal motives that lie outside the religion
itself; using the religion for some nonreligious ends (Hill &Hood, 1999).
http://www.guilford.com/cgi-bin/search.cgi?type=author&pattern=Kenneth%20I.%20Pargament&authlinks=1&cart_id=411054.8000http://209.85.129.132/search?q=cache:u3H3f67ygEsJ:www.infm.ulst.ac.uk/~chris/100.pdf+model+of+religious+coping&cd=2&hl=en&ct=clnk&gl=eg#9http://209.85.129.132/search?q=cache:u3H3f67ygEsJ:www.infm.ulst.ac.uk/~chris/100.pdf+model+of+religious+coping&cd=2&hl=en&ct=clnk&gl=eg#9http://209.85.129.132/search?q=cache:u3H3f67ygEsJ:www.infm.ulst.ac.uk/~chris/100.pdf+model+of+religious+coping&cd=2&hl=en&ct=clnk&gl=eg#9http://209.85.129.132/search?q=cache:u3H3f67ygEsJ:www.infm.ulst.ac.uk/~chris/100.pdf+model+of+religious+coping&cd=2&hl=en&ct=clnk&gl=eg#9http://209.85.129.132/search?q=cache:u3H3f67ygEsJ:www.infm.ulst.ac.uk/~chris/100.pdf+model+of+religious+coping&cd=2&hl=en&ct=clnk&gl=eg#9http://www.guilford.com/cgi-bin/search.cgi?type=author&pattern=Kenneth%20I.%20Pargament&authlinks=1&cart_id=411054.80008/2/2019 Chapter 3 Coping Religiosity And Suicide
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Chapter 3: Coping Behavior, Religiosity & Suicide 168
However, due to a number of studies investigating the extrinsic orientation
toward religion (Gorsuch & McPherson, 1989; Gorsuch &Venable, 1983;
King & Hunt, 1969; Leong & Zachar, 1990; Maltby, 1999), there is the
strong suggestion that the extrinsic orientation towards religion comprises
two dimensions, extrinsic-personal (protection, consolation) and extrinsic-
social (religious participation, social status).
Religious coping has been conceptualized as a mediator, accounting for
the relationship between religiousness and mental health in times of stress,
and as a moderator, altering the relationship between stressors and mental
health. 2 forms of religious coping were described:
Collaborative religious coping which is active, refers to sharing the
responsibility for problem solving with God.
The deferring approach is more passive and is characterized by giving
the responsibility for problem solving to God (Fabricatore et
al.,2004)
Pargament et al. (1988) also described three problem solving styles in
religious coping: self-directing, deferring, collaborative. A self-directing
style stresses personal agency and involves lower levels of traditional
religious involvement. Deferring problem-solving implies awaiting solutions
from God, and shows lower levels of coping competence. The collaborative
style of problem-solving involves active personal exchange with God,
internalized commitment and higher levels of personal competence.
Religious coping appears to decrease the risk of suicidal ideations.
Among depressed adults with a history of child abuse, an inverse
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Chapter 3: Coping Behavior, Religiosity & Suicide 169
relationship was demonstrated between the severity of suicidal ideations
and religious beliefs. (Dervic et al., 2006)
Religious coping decreased the risk of suicidal ideation among
African American and White college students(Walker and
Bishop,2005)and Latin American immigrants.
Hovey (1999) added that religion may protect against suicidal thoughts
by providing meaning in peoples lives, as well as by fostering a sense of
hope for the future.
It needs to point out that religiousness does not necessarily bring about
positive mental health outcomes in patients. A two-year longitudinal study
indicated that use of negative religious coping, such as viewing God or a
higher power as punitive, would have hazardous effect on patients
psychological and physical health (Pargament et al., 2004). On the other
hand, patients who adopted positive religious coping to deal with their
illness, such as seeking spiritual support and religiously benevolent
reappraisal of their situations, showed concrete improvements in mental and
psychical health two years later. The relationships between positive religious
coping and better mental and physical health outcomes was significant.
Religion and spirituality have been linked, positively and negatively, to a
host of outcomes across multiple domains of physical and mental health
(Baumeister, 2002; Pargament, 1997). As religious attendance, did not
predict subjective well being, replicating previous research in the area of
positive psychology and spirituality (Ciarrocchi & Deneke, 2005).
Negative religious coping, commonly referred to now as spiritual
struggles(Murray-Swank, et al., 2005) on the other hand, can be viewed as
having a less secure relationship with God, with a greater struggle with
meaning and belief in God, with a more disconnected congregational
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Chapter 3: Coping Behavior, Religiosity & Suicide 170
relationship, and more spiritual discontent (Pargament et al., 1998;
Zinnbauar & Pargament,1998).
Depressive patients may derive consolation as well as struggle from their
religion, Braam et al. (2010) found that the more or less universal finding
about 'feeling abandoned by God' may suggest how depression represents an
existential void, irrespective of the religious background.
Negative religious coping strategies had several positive associations with
depressive symptoms, sub-threshold depression, and major depressive
disorder: the most robust association was found for the item 'wondered
whether God has abandoned me'. Other significant associations were found
for interpreting situations as punishment by God, questioning whether God
exists, and expressing anger to God (Braam et al., 2010).
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Summing Up
Coping is also defined as a process by which an individual manages the
ever-changing environment. Coping may be seen as actions taken by personsdirected at confronting demands, solving problems, and/or altering and
managing stressors. Coping behavior is generally influenced by maturation
and cognitive development such as problem-solving ability, and
understanding peers and adults.
Two concepts are central to any psychological stress theory: appraisal, i.e.,
individuals' evaluation of the significance of what is happening for their
well-being, and coping, i.e., individuals' efforts in thought and action to
manage specific demands. There are two basic forms of appraisal, primary
and secondary appraisal.
Resource theories of stress are not primarily concerned with factors that
create stress, but with resources that preserve well being in the face of
stressful encounters. Several social and personal constructs have been
proposed, such as social support, sense of coherence, hardiness, self-
efficacy, or optimism.
An overview of the perspectives of coping theorists shows that they have
generally categorized coping strategies under three groups: a) strategies
focused on resolving the problem; b) strategies used to alleviate the
emotions triggered by the situation; and c) strategies involving social
support.Lazaruswent on to make an important and now widely accepted distinction
between two types of coping. In one, problem focused; the person attempts
to address directly the problems that he is facing. In the second, emotion
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Chapter 3: Coping Behavior, Religiosity & Suicide 172
focused; the person tries to dampen or minimize the emotional state itself,
without addressing the problem that elicited the state.
Coping has three main (protective) functions: Management of the problem
causing the distress through elimination or modification of the conditions
giving rise to it, alteration of (perceptually controlling) the meaning of the
experience so as to neutralize its problematic character and, regulation of the
emotional distress produced by the problem.
Ineffective coping is an inability to for a valid appraisal of stressors,
inadequate choices of practiced responses, and/or inability to use available
resources.
Recent research conductedhas found that people with psychiatric disabilities
tended to utilize passive and emotional-focused strategies to cope with their
illness.
Next to feelings of hopelessness, certain cognitive features such as problem
solving deficiency, attentional bias and reduced future positive thinking are
involved in the development and maintenance of suicidal behavior.
Suicide experts are beginning to recognize common emotional threads that
may underlie some suicides. Prominent among these are a perceived sense of
isolation, a lack of personal attachments and a dearth of coping skills.
Healthy coping, according to crisis theory, involves four dimensions:
involvement in daily activities, a supportive community, physical well-being
and good quality of life; suicide attempts, on the other hand, can be seen as
maladaptive efforts to cope.
These findings may have important implications for therapists and primary
prevention workers, and might pave the way towards recognition of the role
played by coping styles in predicting suicide and its use for cognitive
intervention in high-risk patients.
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Chapter 3: Coping Behavior, Religiosity & Suicide 173
Turning to religion is an important way of coping; data collected by suggest
that such a coping tactic may be important to many people. One might turn
to religion when under stress widely varying reasons, religion might serve as
a source of emotional support , as a vehicle for positive reinterpretation and
growth, or as a tactic of a coping with a stressor.
The definition and meaning of spirituality and religion remains a grey area,
they are often regarded as 2 sides of the same coin. However in both the
psychological and religious arenas spirituality is distinct from the traditional
concepts of religion.
Spirituality refers to matters concerning god and the human need to find a
higher meaning and the relationship with the metaphysical such as soul,
spirit, after-life and angels. While religion refers to organized and
institutionalized beliefs and system of faith which serves as a means of
spiritual expression and includes: Islam, Christianity, Buddhism, Judaism,
and Hinduism.