which is characterised by, items reflecting an inability to cope and the occurrence of psychosomatic illness, e.g. I get sick, for example, headache, stomach ache.
In the development of the CSA Frydenberg and Lewis (1997) had noted limitations in Lazarus and Folkman's theory. When the 19 coping scales were explored further with factor analysis, the possibility emerged of combining coping strategies into styles. As a result, four distinct coping styles emerged; these styles, including their respective coping strategies, were:
1. Dealing with the problem directly. Focus on solving the problem, work hard, improve relationships, seek relaxing diversions, physical recreation, protect self, humour.
2. Optimism. Focus on the positive, seek relaxing diversions, seek spiritual support, wishful thinking.
3. Sharing. Seek social support, social action, seek professional help.
4. Nonproductive coping strategies. Worry, wishful thinking, tension reduction; ignore the problem, self-blame, keep to self, not cope. (Frydenberg & Lewis, 1997, p.36).
Grouping coping strategies into styles follows a trait approach to coping, which generally tends to classify people in order to make predictions on how they will cope with various stressful encounters (Lazarus & Folkman, 1984), instead of a process approach to coping.
The rationale for choosing the CSA as the measuring tool in this study lay in its diverse measurement of coping strategies along with the clinical applications of the scale. After reviewing other coping scales, the CSA appeared to be the most comprehensive instrument of its kind and the first to be developed in an
Australian context. It also provides an opportunity for the separate measurement of a comprehensive range of coping strategies that have been confounded in previous research, allowing a more valid measurement of coping strategies than is currently available. The CSA has many features which do set it apart as a valuable instrument for research and clinical purposes and, given the sample under
investigation was a psychiatric population, this was of importance.
Most of the time coping has been categorized by past researchers as either adaptive or maladaptive and, now, by Frydenberg and Lewis (1997) as
“productive” (such as problem solving strategies, seeking social support, focusing on work) and as “non-productive” (avoidance, keeping to oneself). Romi, Lewis and Roache, (2013) reported that much of the non-productive coping label has originated in research linking the use of coping strategies, such as withdrawal and avoidance, to mental health problems in children and adolescents, but this has yet to be investigated in adult populations.
One of the downsides of using the CSA is that there are few published studies that have used the scale by researchers other than Erica Frydenberg and
Ramon Lewis, its developers. Erica Frydenberg has stated that she is aware that people were using the scale clinically in educational and health settings (Personal Communication, 22nd July 2013). However, she was not aware of people actively using the scale for research purposes and publishing the results. All but one of the studies I will be reporting on below are by Frydenberg and Lewis.
Reliability and Validity of the Coping Scale for Adults (CSA)
Given that one of the main aims of the current research was to measure the coping strategies of a psychiatric population, the question needed to be raised “Will the CSA adequately measure the coping strategies of a psychiatric population?”.
Reliability
Frydenberg and Lewis (1997) spent a considerable amount of time on the item reliability of the CSA scale. The authors did a test-retest on items to see if they met reliability to involve subscale inclusion. The subscales comprised of an adequate number of relatively equal items, around 4 items per subscale. All items were responded to by more than 88 per cent of the respondents within one point of measurement on the two testing occasions, thereby satisfying the criteria for response stability.
To ascertain the extent to which responses to the 73 (excluding Not Cope) items of the CSA remained stable over time, 25 respondents in the original study were administered the questionnaire on a second occasion, approximately 14 days after the first administration. The test-retest correlations (Pearson product
moment) were then computed for the individual items. For an item to be
If the test-retest correlation was less than 0.58, an additional criterion had to be satisfied, namely that at least 80% of the responses had to be within one point of measurement on the two occasions. The reason for this was that an item’s response may be poorly correlated on two occasions due to a restricted range of response rather than due to an instability of responses (see Frydenberg & Lewis, 1997, p.25). Only 10 of the items failed to register statistically significant
correlations, however, all were responded to by more than 88 percent of respondents within one point of measurement on the two testing occasions, thereby satisfying the criterion of response stability, as discussed in Chapter 3. From a review of the scale development data, the Cronbach alpha co-efficients of internal consistency (alpha) [range 0.69-0.92] and test-retest stability co-efficients [0.33-0.94] showed that all the scales had response distributions covering almost the entire full range of possible raw scores. Furthermore, the response to items within the scales had sufficient internal consistency in all cases to justify the separate use of these scales (Frydenberg & Lewis, 1997). The developers reported that “the 18 coping strategies revealed high test-retest reliability co- efficients apart from 2 with moderate and one with low. These being co-efficients for Focus on Solving the Problem, Social Action and Work Hard scales.
The authors concluded that the 18 scales of the CSA (excluding the Not Cope scale) were very reliable and compared favourably in this regard with published coping scales, such as those of Folkman and Lazarus (1988) and Moos (1993) (See discussion on Billings and Moo’s scale in Chapter 3).
Frydenberg and Lewis (1997) contend that the CSA allowed for a more valid measurement of coping strategies than previous scales and they reported that “Adults enjoyed completing the questionnaire, as it provided a stimulus for
thinking about behaviour” (p. 12). Frydenberg and Lewis (1997) stated that the questionnaire also has good content validity in that as a measure of coping the CSA represents a wide range of coping strategies. The authors identified consistent patterns across studies carried out using the CSA that linked more positive outcomes and less negative ones to the “productive strategies” listed in the CSA. The authors also reported on the construct validity of the CSA, noting that it was helpful in uncovering significant relationships between a number of undesired outcomes, such as low self esteem, feeling overwhelmed, stress and coping strategies that have been considered non-productive. These findings were consistent with their previous work (Frydenberg & Lewis, 1997) that reported that maladaptive coping styles and negative outcomes are stronger than those between productive coping styles and productive outcomes.
Published Studies Using the Coping Scale for Adults
As indicated previously, the CSA has not been independently assessed for its psychometric properties. To date there are no reported studies of the CSA measuring coping in a psychiatric population. Indeed, there are few published studies using the CSA, but those of note will be reported on below.
The CSA has been has been used to investigate teachers’ coping with the stress of classroom discipline. For example, Lewis, Romi, and Roache (2011) investigated 515 teachers from Australia and identified the unproductive coping styles which lead to a greater tendency for teachers to become sick. The CSA has
also been used to investigate the relationship between workplace contexts and how people cope with their concerns (Frydenberg & Lewis, 2002b). The findings from this study indicated that managers, irrespective of age and gender, were more likely to respond by utilising problem solving or applying themselves and were less likely to use non-productive strategies, such as worry, letting off steam and wishful thinking.
More recent uses of the CSA have been by Romi et al. (2013) who investigated 772 teachers’ coping strategies and classroom management techniques across Australia, China and Israel. The findings across the three different cultures were confounded, partly due to the different cultural notions of coping and different understandings and meanings of the various cultural coping constructs. The authors highlighted this in the Israeli teachers’ notions of
worrying: “In Israel, the use of Worry relates to what might be characterized as under-assertion (hinting, but not punishment) and aggression” (Romi, Lewis & Roache, 2013, p.224). This study highlighted the role of cultural differences between the nations of teachers. What is seen as a coping strategy in Australia is not universally applicable across other nations, a finding that has implications for the use of such coping scales with different nationalities.
Frydenberg and Lewis (2002a) in their article reviewed six unpublished studies (Evert, 1996; Goble, 1995; Jones, 1997; Lyneham, 1997; McDonald, 1996; Spanjer, 1999), that are predominantly masters dissertations, all which have used the CSA. In their review the studies were examined for their utility and validity. Frydenberg and Lewis concluded that the findings appeared to provide support for the view that the link between maladaptive styles and negative
outcomes is stronger than the link between productive styles and productive outcomes. They suggested that while the therapeutic enhancement of productive coping strategies may be seen as the way forward, removing or minimising the dysfunctional (non productive) coping mechanisms “does not necessarily promote the good” (p. 15). The authors advocate for “tackling” both sets (productive and non productive) strategies to build up peoples’ coping resources and to help them develop resilience (Frydenberg & Lewis, 2002a). They raise a good point here and one that could transfer over well to mental health settings. Undoubtedly, the combination of increasing productive coping and reducing non-helpful coping strategies is a potentially useful approach within clinical settings. However, it is implausible that questionnaire results alone would facilitate this, and, more likely, the success would come if used alongside a detailed clinical formulation,
incorporating the many contextual factors impacting on patient coping.
One study of the CSA that is independent of the Frydenberg and Lewis research group was carried out by McGreal, Evans and Burrows (1997). The authors utilised the specific form of the CSA in a pilot study to assess gender differences in coping strategy use following loss of a child through miscarriage or stillbirth. The results suggested differences between men and women in chosen coping strategies. Women were more likely than men to use worry, tension reduction, wishful thinking, and spiritual support. Men were more likely than women to use ignore the problem. However, these results need to be interpreted with caution due to the small sample size (N=52, 37 females and 17 males), the wide variety of age cohorts, uncontrolled variables, such as knowledge of whether the subject’s experience was of the first or second miscarriage or stillbirth, and
acknowledgement of the differences in loss at early stages of the pregnancy vs. later stages, e.g., giving birth.
Conclusions
The CSA, based on Lazarus’s theory of stress and coping, has been used
extensively in Australia and has clear items combined with a Likert rating scale. The scale has been found to have good reliability and validity when used within adult groups. As a measurement tool the CSA provides information that only describes what people use or, more precisely, what coping strategies people say they use, rather than whether these strategies are functionally useful. The CSA was thought to be a good choice to use with a clinical sample to assess whether it has any clinical utility for the measurement of coping.
Comparative Group – College students
When reviewing the coping literature, the majority of studies have focused on the benefits of positive coping amongst college and university students (e.g., Brown, 1994; Epstein, & Katz, 1992; Folkman, & Lazarus, 1985; Lawrence, Ashford & Dent, 2006; McCarthy, Lambert & Moller, 2006; Shankland, Genolini, Franca, Guelfi, & Ionescu, 2010).
Epstein and Katz (1992) found that a productive workload in everyday life was found to be positively associated with coping ability and unrelated to stress. Lawrence, Ashford and Dent (2006) carried out a study to investigate coping strategies adopted by men and women who were first-year students in higher education. The York Self-Esteem Inventory (YSEI), the Emotional Control Questionnaire (ECQ) and the Coping Styles Questionnaire (CSQ) were used to measure men’s and women’s’ coping. One hundred and sixty (N=58 female,
N=102 male) first-year sport sciences undergraduate students completed the questionnaires with one of the authors present at the end of their academic year. The results indicated that men reported coping strategies, such as “bottling up,” and tended to detach themselves from situations, in contrast to the women, who were more likely to use emotion-focused coping.
Folkman and Lazarus (1985) examined emotion and coping of college students (N=108, gender distinctions not specified), measuring the coping process at three stages of a mid-term examination, which were: an anticipation stage, the waiting period and waiting for their results after their exams. They found that different forms of coping were evident during the waiting and anticipatory stages of an exam. Problem-focused coping strategies and emphasizing the positive were present before an exam and distancing more prominent after the exam. The
authors reported that despite the normatively shared emotional reactions at each stage, individual differences were evident at each stage of the examination period.
Overall, the studies of coping in university students have also focused on particular subgroups of university students. For example, Williams, Arnold, and Mills (2005) investigated how veterinary students coped with stress. However, most studies have used within-groups procedures and not done comparative studies (Felsten, 1998; Porter, Marco, Schwartz, Neale; Shiffman & Stone, 2000). In general, some studies into the coping mechanisms of university students have found that men tend to use avoidance and detach themselves (e.g., Lawrence, Ashford & Dent, 2006), however, others (e.g., Felsten, 1998; Porter, Marco, Schwartz; Neale, Shiffman, & Stone, 2000) have found no differences in coping strategies in men and women.
Study A: The Psychometric Adequacy of the Coping Scale for Adults (CSA)—An Examination With a Psychiatric Sample
Preamble
The central research aim of this thesis was to investigate the meaning and measurement of coping in a psychiatric population. An extensive review of the measurement research on coping concluded that an entire coping repertoire of “coping” for psychiatric patients has yet to be captured by current psychometric scales. However, the literature examined to date also suggests that those
diagnosed with a mental illness lack adequate coping resources for managing the challenges of daily living (Piccinelli & Wilkinson, 2000; Taylor & Stanton, 2007). Introduction
Study A examines the psychometric adequacy of an existing coping scale, The Coping Scale for Adults (CSA; Frydenberg & Lewis, 1997), and, in particular, its ability to measure the coping strategies of a psychiatric sample (n=110).
Comparisons are made across the 19 coping strategies, in terms of factor structure, gender and age. The objective is to evaluate the CSA’s ability, as measured by its 19 subscales, to discriminate a psychiatric sample’s coping strategies when viewed against information from the normative sample of the CSA. The study is a cross-sectional design, comparing the similarities and differences in coping strategies of both groups. Given “not coping” is of particular interest in those diagnosed with a mental illness, in the analyses special consideration is given to the “not cope” scale on the CSA.
The CSA scale is made up of 18 coping strategies, which are “productive and non-productive,” plus one “not coping” strategy. Previous research has
suggested that those diagnosed with a psychiatric illness use more maladaptive than adaptive coping strategies and the current study set out to test this
assumption (Aldwin & Revenson, 1987; Fledderus, Bohlmeijer & Pieterse, 2010; Frydenberg & Lewis, 2002a). It should be noted that, as discussed in Chapter 2, “not coping” may be a functional coping strategy, not maladaptive but adaptive, and entirely appropriate, depending on the patient’s circumstance.
Hypotheses
The first hypothesis was based on the oft-stated claim in the literature (e.g., Aranada, & Lincoln, 2011; Carver, Scheier, Weintraub, & Jagdish, 1989;
Frydenberg & Lewis, 1997, 2002a; Skinner, Edge, Altman & Sherwood, 2003; Snyder, 1999) that psychiatric samples use more maladaptive coping strategies. Therefore, it is proposed:
Hypothesis 1. The psychiatric sample will endorse more non-productive