Coping strategy use following computerized cognitive-behavioral therapy for substance use disorders.

Coping strategies are emerging as a predictor of treatment outcome for substance users and may be particularly important among computerized and self-change approaches. We used data from a randomized clinical trial of a computer-based version of cognitive–behavioral therapy (CBT4CBT) to: (1) examine the association between observer ratings of coping skills and self-reported coping strategies; (2) evaluate whether participants assigned to the CBT4CBT program reported greater use of coping strategies compared with those not exposed to the program; and (3) examine the differential effect of coping strategies by treatment group on drug-related outcomes. Individuals (N = 77) seeking treatment for substance dependence at a community-based outpatient substance abuse treatment facility were recruited and randomized to receive treatment-as-usual (TAU), or TAU plus CBT4CBT, with the Coping Strategies Scale administered at baseline and posttreatment. Self-reported coping strategy use was strongly correlated with observer ratings on a role-play assessment of coping skills. Although no significant group differences were found across time for coping strategy use, results suggested that as coping strategy use increased, drug use decreased, and this relationship was stronger for participants who received CBT4CBT. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beliefs and attitudes about bupropion: Implications for medication adherence and smoking cessation treatment.

Beliefs about medication are associated with treatment adherence and outcome. This is a secondary analysis of the role of beliefs and attitudes about bupropion in treatment adherence and smoking cessation outcomes using data from a smoking cessation trial of open-label sustained-release (SR) bupropion therapy reported previously (Toll et al., 2007). Positive beliefs and attitudes were positively correlated with intentions, desire, confidence, and motivation to quit smoking; expectation of quitting success; perceived benefits of quitting; and perceived disadvantages of smoking. Positive beliefs were also associated with greater medication adherence, an increased likelihood of completing treatment and being continuously abstinent, and a delayed latency to smoking lapse. These findings provide preliminary support that positive beliefs and attitudes about bupropion are associated with positive attitudes toward quitting, better treatment adherence, and potentially better treatment response. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Middle cerebral artery occlusion in the rat: consistent protocol for a model of stroke

Coping is important for success at smoking cessation, yet little is known about the natural history of coping with urges to smoke during a cessation attempt. In this study, Ecological Momentary Assessment (EMA) methods were used to gather real-time quantitative and qualitative data. For 3 consecutive days during their first 10 days of smoking cessation, 36 participants used tape recorders and palm-top computers to record details of 389 coping episodes, during which they employed 1,047 coping responses. An average of 3.6 coping episodes per day and an average of 2.7 coping responses per episode were reported. Sixty-seven percent of the responses were behavioral and 33% were cognitive. Gender, location of the episode, nicotine dependence, and quitting history were associated with the use of specific strategies. Results indicate that EMA methods and instruments are feasible for measuring coping responses.     

Silver linings and candles in the dark: Differences among positive coping strategies in predicting subjective well-being.

Ideal coping strategies enhance positive aspects of well-being as well as reduce distress. Although researchers have identified several "positive coping" strategies, it is unclear which are most strongly associated with well-being or whether all strategies are equally appropriate for all kinds of stressors. Participants completed well-being measures, and described the most negative event of the day and their emotion regulation strategies for the next 7 days. Dispositional use of positive emotion-inducing coping strategies was most strongly associated with positive aspects of well-being. Use of positive coping did not decrease with increased objective stress during the week, and use of particular strategies was partly predicted by the types of stressors that were reported. Implications for theories of positive coping are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A high risk recognition program for adolescents in conflict with the law.

Describes a high risk recognition program aimed at reducing recidivism among the heterogeneous young offender population. The program, which is based on cognitive-behavioral relapse prevention programs for adult sexual offenders, was developed for use within an inpatient treatment program for 14–18 yr olds sentenced to secure custody for a variety of crimes. Young offenders identify risk factors or warning signs for various forms of offending behavior based on their analysis of past criminal acts. They then generate strategies for coping with future recurrence of these risk factors. The authors consider the utility and applicability of such an intervention and make recommendations for researching the efficacy of the technique. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting adherence to recommendations by parents of clinic-referred children.

The authors examined predictors of parents' adherence to recommendations made by psychologists after the evaluation of clinic-referred children. Parents or legal guardians of 93 children aged 4 to 12 years participated. The major findings were that (a) child behavior problem severity, parent recall of recommendations, parent satisfaction with the child's psychological evaluation, and locus of control were not significantly associated with adherence; (b) number of perceived barriers was the most salient predictor of adherence to recommendations, regardless of recommendation type; and (c) adherence rates to psychological services recommendations were significantly lower, compared with those for school-based or professional nonpsychological recommendations. Implications for more research on predictors of adherence to recommendations and clinical strategies for overcoming barriers to adherence are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Stress and Coping Model of Medication Adherence and Viral Load in HIV-Positive Men and Women on Highly Active Antiretroviral Therapy (HAART).

The authors tested a structural model that incorporated age, time since diagnosis, social support, coping, and negative mood as predictors of medication adherence and HIV viral load on 188 men and 134 women on highly active antiretroviral therapy (HAART). The authors used psychosocial latent factors formed from baseline measures to predict latent factors of adherence, as assessed by electronic monitoring and self-report, and viral load defined by indicators assessed over a 15-month period. Results from the model indicate that greater negative mood and lower social support are related to greater use of avoidance-oriented coping strategies. Use of these coping strategies by patients on HAART is related to poorer medication adherence and, subsequently, higher viral load. This model advances researchers' understanding of the contribution of psychosocial variables in predicting treatment adherence and disease progression in HIV-positive men and women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correlates of improvement in multidisciplinary treatment of chronic pain.

Although multidisciplinary pain programs have been demonstrated to be effective, the processes of improvement have yet to be clarified. Cognitive-behavioral models posit that improvement is due, in part, to changes in patient pain beliefs and coping strategies. To test the relationships between treatment outcome and changes in beliefs and coping strategies, 94 chronic pain patients (aged 21–64 yrs) completed measures of physical and psychological functioning, health care utilization, pain beliefs, and use of pain coping strategies at admission and 3 to 6 mo after inpatient pain treatment. Improved functioning and decreased health care use were associated with changes in both beliefs and cognitive coping strategies. However, changes in some coping strategies, such as exercise and use of rest, were not associated with improvement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping styles in youths with insulin-dependent diabetes mellitus.

The relationships between two coping styles (i.e., use of personal and interpersonal resources; ventilation and avoidance) and two health outcomes (i.e., adherence and metabolic control) were evaluated in 135 youths with insulin-dependent diabetes mellitus (IDDM). Individual characteristics (i.e., age, duration of illness) and contextual variables (i.e., stress, family relations) were used to predict coping styles. Poor adherence to treatment, older adolescent age, and long duration of IDDM were correlated with ventilation and avoidance coping. Youths with short duration of IDDM were more likely to cope through the use of personal and interpersonal resources, although this strategy was not associated with health outcomes. A multiple regression analysis indicated that high ventilation and avoidance coping was predicted by high stress, low family cohesion, and older adolescent age. In addition, the interaction between family adaptability and duration of IDDM significantly predicted ventilation and avoidance coping. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Avoidance coping strategies moderate the relationship between self-efficacy and 5-year alcohol treatment outcomes.

Both self-efficacy and coping strategies are important determinants of functioning for substance use disorder patients, yet little is known about their interrelationship. This study examined the relationship between abstinence self-efficacy and cognitive components of coping (positive reappraisal, cognitive avoidance) for male participants (n = 2,596) from 15 residential substance use disorder treatment programs who were assessed at treatment entry, discharge, and 5-year follow-up. Cognitive avoidance coping moderated the effects of self-efficacy on alcohol use at 5 years, whereas positive reappraisal coping was largely unrelated to outcomes. Specifically, for patients with low self-efficacy, reliance on avoidance coping strategies was associated with poorer alcohol use outcomes, but as self-efficacy increased, the negative influence of avoidance coping strategies diminished. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interest in smoking cessation among methadone maintained outpatients

The prevalence of cigarette smoking among opiate abusers is extremely high and tobacco related diseases are a major factor associated with morbidity and mortality for this group. Yet, many treatment providers remain reluctant to address smoking cessation with their clients due in part to the belief that substance abusers are not interested in quitting smoking. The present study examined self-reported interest in smoking cessation among methadone maintenance clients (N = 120) in four clinics in Los Angeles. Fifty-eight percent of subjects rated themselves as 'Somewhat' or 'Very Interested' in a smoking cessation program. Overall subjects appeared to accurately perceive the personal risks from tobacco smoking. In conclusion we find that clients in methadone maintenance treatment programs evidence a high level of interest in quitting smoking and may well be suited for a highly structured smoking cessation intervention.     

Coping with treatment-related stress: Effects on patient adherence in hemodialysis.

W Examined 57 hemodialysis patients. The association of a particular type of coping to adherence was predicted to depend on the specific type of stressful encounter being considered. As predicted, coping efforts involving planful problem solving were associated with more favorable adherence when used in response to stressors involving a relatively controllable aspect of the hemodialysis context. For less controllable stressors, coping efforts involving emotional self-control were associated with more favorable adherence. The seeking of informational support in response to an uncontrollable encounter was associated with poorer fluid-intake adherence. Confrontive coping was associated with poorer adherence for both high-and low-control situations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress, coping, and psychological adjustment of adults with sickle cell disease.

Examined a transactional model of psychological adjustment to chronic illness with 109 African-American adults with sickle cell disease (SCD). Good psychological adjustment was associated with lower levels of perceived daily stress and stress regarding SCD illness tasks, higher efficacy expectations, less use of palliative coping methods, less use of negative thinking/passive adherence pain-coping strategies, and family functioning characterized by high levels of support and low levels of conflict and control. Overall, the underlying stress and coping conceptual model accounted for 44–50% of the variance in psychological adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adjustment following spinal cord injury.

Investigated specific coping strategies associated with psychological adjustment following spinal cord injury with a battery of assessments administered to 57 patients (median age 26.5 yrs) participating in a spinal cord injury rehabilitation program. Ss were divided into 3 groups based on degree of psychological distress. High-distress Ss reported using more Wish-Fulfilling Fantasy, Emotional Expression, Self-Blame, and Threat Minimization Coping strategies relative to the low and moderate distress groups. The Self-Blame Coping strategy was significantly correlated with psychological distress over and above age, time since injury, or level of injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preventing smoking relapse, using an individually tailored skills-training technique.

The effectiveness of a relapse prevention program was studied in a population of 744 smokers. Subjects first attended an intensive 4-day series of 2-hr meetings in which they were trained to use more than 40 behavioral and cognitive cessation techniques. At the 1-week follow-up session, those abstinent from smoking (79%, carbon monoxide verified) were randomly assigned to one of three follow-up conditions: (a) a three-session skills-training program in which subjects developed and actively rehearsed individually tailored coping strategies for likely relapse situations, (b) a three-session discussion control condition in which subjects discussed maintenance but did not develop or rehearse coping strategies, or (c) a no-treatment control condition. Survival analysis indicated higher abstinence rates for the skills-training group than for the control groups throughout the following year. After 12 months, the biochemically confirmed continuous abstinence rate was higher in the skills-training group (41.3%) than in the discussion and no-treatment groups (34.1% and 33.3%, respectively). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of alternative theoretical approaches to smoking cessation and relapse.

139 smokers (mean age 40.6 yrs) were randomly assigned either to (a) a traditional treatment program that used contingency contracting and emphasized the necessity for absolute abstinence (AA) or (b) a relapse-prevention (RP) treatment that focused on gradual acquisition of nonsmoking skills. It was hypothesized that the RP treatment would be less successful initially but would result in better maintenance skills and show a lesser relapse rate during a 1-yr follow-up. Each program was evaluated in 2 formats: group-based treatment and self-help materials. Results indicate comparable 1-yr abstinence rates for all treatments, although more Ss dropped out of the self-help formats. Ss in the RP intervention were more likely to lapse sooner after quitting and were more likely to quit again during the 1-yr maintenance period. Women were more successful in the RP program, and men had greater success with the AA approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anosognosia and denial: Their relationship to coping and depression in acquired brain injury.

Objective: To evaluate relations among denial, anosognosia, coping strategies, and depression in persons with brain injury. Study Design: Correlational. Setting: A Midwest residential, post-acute brain injury rehabilitation center. Participants: Twenty-seven adults with brain injury. Measures: Clinician's Rating Scale for Evaluating Impaired Self-Awareness and Denial of Disability After Brain Injury, COPE, Beck Depression Inventory-I. Results: Denial and anosognosia were related and co-occurred. Use of process coping strategies was associated with greater use of problem-focused coping strategies. Higher levels of denial were associated with greater use of avoidant coping strategies, and greater use of these coping strategies was related to higher levels of depression. Conclusions: Individuals primarily in denial and individuals primarily anosognosic differ in the coping strategies they institute. Avoidant coping strategies are used more frequently by individuals in denial, and use of these strategies is associated with higher levels of clinical depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hope, coping, and social support in combat-related posttraumatic stress disorder

Dispositional hope, coping, and perceived social support were assessed among Vietnam combat veterans upon admission to and discharge from inpatient treatment for posttraumatic stress disorder (PTSD). Veterans reported lower dispositional hope than any previously described sample, and hope did not increase at discharge from treatment. At admission, higher hope was correlated with greater perceived social support coming from family (this relationship persisted when controlling for depression and PTSD symptoms). At discharge, higher hope was associated with greater perceived social support coming from family and friends and the use of adaptive coping strategies. Results indicate that hope confers a beneficial effect once veterans undergo treatment for combat-related PTSD, a finding that suggests that hope may be "gone but not lost" for these individuals.     

Utilization of adverse rapid smoking in groups: Efficacy of treatment and maintenance procedures.

18 Ss who had been smoking for an average of 18.5 yrs and were currently smoking an average of 23.6 cigarettes/day participated in a smoking-reduction program that attempted to assess the initial effectiveness of a rapid-smoking procedure administered to groups. Efficacy of maintenance was investigated through the use of a control procedure and 2 presumed maintenance-enhancing strategies: in vivo booster sessions and telephone booster sessions. Results indicate that although 90% of all Ss were abstinent after treatment, booster sessions had no significant effect on maintenance of treatment gains. Within-group analyses showed that although both experimental groups significantly relapsed between posttreatment and the 3-mo follow-up, control Ss did not. Results are discussed in terms of self-set and the attribution of behavior change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping With Employment Uncertainty: A Comparison of Employed and Unemployed Workers.

This study examined coping with stress associated with employment uncertainty for comparable samples of laid-off and employed high-technology workers. It was expected that different coping strategies would be associated with perceived stress for employed vs. unemployed people. Although unemployed participants reported higher levels of stress compared with employed participants, employment uncertainty mediated the association between employment status and perceived stress. Emotion-focused coping strategies were related to higher perceived stress, whereas problem-focused coping strategies were related to lower perceived stress. The use of emotional avoidance as a strategy moderated the effect of employment uncertainty on perceived stress, such that a greater propensity to endorse avoidance coping strategies was associated with higher levels of stress particularly under low uncertainty conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)