Stress and coping: The role of mindfulness. Jessica Finocchiaro and Kathleen A. Moore. Charles Darwin University, Darwin, Australia

Transcription

1 Finocchiaro, J., & Moore, K.A. (2013. Stress and coping: the role of mindfulness. In K.A. Moore, K. Kaniasty, P. Buchwald & A sese (Eds). Stress and Anxiety: Applicatiion to Health and Well-being, Work Stressors and Assessment (pp.41-48). Berlin: Logos. Stress and coping: The role of mindfulness Jessica Finocchiaro and Kathleen A. Moore Charles Darwin University, Darwin, Australia kate.moore@cdu.edu.au Abstract Stress can have negative implications not only for the individual but also the family, organisation and society as a whole. The way in which individuals perceive their environment directly influences their coping response. The use of mindfulness in daily life may promote more adaptive coping styles by mitigating the rumination and overlay of habitual cognitions and behaviours. The aim of the current study is to investigate the relationship between mindfulness and levels of perceived stress and use of coping strategies in a sample from the general population. A total of 112 participants (41 males) were recruited via snowball sampling through the social network website Facebook. All participants completed an online questionnaire consisting of the Mindfulness Attention Awareness Scale (Brown & Ryan, 2003), the Perceived Stress Scale (Roth & Cohen, 1986), and the Deakin Coping Scale (Moore, 2003). Results using Multidimensional Scaling show that mindfulness was separate from perceived stress and use of avoidant coping strategies, while the positive coping strategies clustered between mindfulness and stress and avoidance. Correlational techniques add support to the finding that mindfulness is related to appraisal of the demand/situation while negatively related to avoidant coping and stress. Limitations of the current study and directions for future research are discussed. Life changes and demands are part of life and are often stressful but our ways of thinking can affect our response to such changes and demands (Roth & Cohen, 1986). The idea that our thinking or, in Lazarus and Folkman s (1984) terms appraisal, influences outcomes is not new and can be seen in the writings of the ancient Greek stoics such as Epictetus.

2 In more recent times, Beck (1976) suggested that the way in which individuals learn to think about things provides the foundation for their opinions, beliefs and consequent behavioural responses. Thus, he argued the associations between life experiences and thought processes are often automatic and influence how individuals perceive their environment and, by extrapolation, how they cope with demands. Piaget (1961) too proposed that individuals have the ability to perceive and interpret their environment through the adaptive process of assimilation (when an individual attempts to interpret new experiences by relating to previous ones) or accommodation (when individuals seek to modify their current thought processes to account for new experiences). Clearly our thoughts are highly influential on further thought processes as well as behaviour and no less so on how we perceive and then cope with demands. In sum, people can adopt a positive approach to cope with demands, such as appraising demands as a challenge thus approaching them in an active and dynamic way which allows for the generation and implementation of effective coping strategies (Baker & Berehbaum, 2007). It might be that part of this positive approach involves utilising available resources, both instrumental and social, as well as the ongoing appraisal and re-appraisal of the situation in accord with the dynamic nature of the situation (Lazarus, Folkman, Dunkel-Schetter, Delongis, & Gruen, 1986). While these attitudes and behaviours might in general terms be labelled approach coping where the demand may be seen as a challenge to be overcome, the reverse is often avoidant coping which involves directly escaping or ignoring the source of the perceived demand or stressor in attempts to alleviate the associated discomfort (Roth & Cohen, 1986). Often labelled as emotionfocused coping, it can involve denial, wishful thinking, as well as cognitive and behavioural disengagement (Prati, Pietrantoni, & Cicognani, 2011). It is important to note also that some social support may not be pro-active, that is supporting a resolution, but a source of emotional comfort such as sympathy (Carver, Scheier & Weintraub, 1989) which is sometimes more related to avoidant coping. However, the distinction between positive and avoidant strategies is not so clear cut, as Folkman and Lazarus (1984) found that 94% of participants in their study utilised both

3 problem and emotion focused coping strategies during a stressful encounter to regulate their physiological and physical responses to stress. Although not appraisal or challenge per se, the concept of mindfulness derived from Buddhist meditation is said to allow individuals to focus attention on bodily sensations and inner experiences as a way to refocus the mind (Baer, 2003; Thompson & Waltz, 2007). By being mindful in daily life, individuals are able to increase awareness whilst taking into account the changing sequence of immediate experiences (Austin, 1999). Bishop et al. (2004) stated that such an increased awareness allows individuals to improve their decision making abilities as it allows them to respond more reflectively and skillfully to situations, rather than responding reflexively to them. It might be argued that such an approach would be adaptive in coping with life demands and changes. Certainly, mindfulness has been shown to have various benefits including promoting a greater sensitivity to the present environment, openness towards new information, and an enhanced awareness of various problem solving approaches and perspectives (Langer & Moldoveanu, 2000). By being fully open to experience, individuals can disregard habitual dysfunctional and judgmental cognitions and adopt a more objective perception, potentially approaching a situation in a more positive and problem focused manner (Dekeyser, Raes, Leijssen, Leysen, & Dewulf, 2008). According to Chiesa, Calati and Serretti (2011) individuals who are mindful experience an increase in acceptance and a reduction of experiential avoidance. In a one-month study of students leading up to an exam, Weinstein et al. (2009) found that individuals high in mindfulness used more approach coping strategies and less avoidant coping strategies than people scoring low on mindfulness. They suggested that mindfulness might mitigate habitual negative thoughts during cognitive appraisal thus altering the stress process and facilitating more adaptive and flexible forms of coping. Mindfulness incorporated into cognitive behavioural therapies has received increased attention in recent decades and has been utilised as a way to manage stress, anxiety and other ailments (Chiesa, et al., 2011). Interventions such as Mindfulness-Based Cognitive Therapy

4 (MBCT) (Segal, Williams, & Teasdale, 2002) and Mindfulness-Based Stress Reduction (MBSR) techniques (Kabat-Zinn, 2003) have emphasised traditional meditation practices such as yoga and breathing exercises to refocus the mind and body (Thompson & Waltz, 2007). Meditation techniques are taught in these therapies with the intention of using them in daily life in order to improve overall well-being (Thompson & Waltz, 2007). Although there is a growing body of research that suggests mindfulness based psychological therapies can assist in alleviating psychological discomfort and increase perceptual abilities, Thompson and Waltz found that mindfulness in daily life was not predictive of mindfulness during formal meditation, suggesting that these might in fact be two different constructs. In fact, they suggested that some individuals might have a more natural ability to be mindful although acknowledging that mindfulness meditation practices might enhance this ability: Ryan and Brown (2004) too proposed that mindfulness is not only a product of meditation practice but an inherent ability in some individuals. The relationship between mindfulness, coping and stress in a non-clinical sample requires investigation. It is the aim in this study to explore the relationship between mindfulness, perceived stress and positive and avoidant coping strategies to determine if mindfulness is indeed a separate process from that involved in the use of approach coping involving appraisal, challenge and use of resources in a sample from the general population. Method Participants One hundred and twelve volunteers participated in this cross-sectional study (41 males) all of whom were over 18 years of age; 63 participants indicated they work fulltime, 30 were employed on a part-time basis, and 12 were unemployed. No participant was engaged in the regular practice of meditation or yoga. Procedure Ethics approval was obtained from the University s Human Ethics Committee. A convenience snowball sample was recruited by invitations on the social network site Facebook which referred

5 interested persons to an online questionnaire about their perceptions of stress, mindfulness and use of coping strategies. Materials The Mindfulness Attention Awareness Scale (MAAS) (Brown & Ryan, 2003) is a 15 item questionnaire rated on a 6-point Likert scale from 1 = almost always to 6 = almost never to assess people s attention to the present (e.g., I am able to focus on what s happening in the present). The MAAS has good internal reliability α =.87. The Perceived Stress Scale (PSS) (Roth & Cohen, 1986) is a 10-item scale answered on a 5- point Likert scale from 0 = never experience to 4 = very often (e.g., felt that you were not on top of things) to assess people s appraisal of life situations over the past month. Internal reliability is good α =.78. The Deakin Coping Scale (DCS) (Moore, 2003) is a 19-item questionnaire to assess how often individuals use cognitive appraisal, challenge/commitment, avoidance coping and resources as coping strategies (e.g., seek advice from others; hope for a solution to appear) answered on a 5- point Likert scale from 1 = never to 5 = always. Reliability ranges from α.68 to.88. Results and Discussion The data were analysed using SPSS (Version 19). As the primary focus was on mindfulness and gender reports on this are minimal we tested the data and confirmed there was no difference between males and females on their scores for mindfulness (t 104 =.12, p =.90) enabling the data to be treated as one sample. We also used a MANOVA to confirm no gender differences across the other variables included in the study at p >.01 (Pillai s Trace F 5, , p =.035, Eta Square 10%). In order to investigate relationships among the variables two techniques were utilised: Multidimensional Scaling (MDS) which provides a visual representation of similarities among variables in a perceptual map (Kruskall & Wish, 1977) and Pearson s Product Moment Correlations. The data were standardised to z-scores and submitted to MDS (Figure 1).

6 Limitations Challenge Resources Appraisal Positive Coping Stress Negative Coping Avoidance Mindfulness Openness Figure 1 Multidimensional scaling map indicating relationship among variables There are several ways in which to interpret MDS maps. The neighbourhood approach where, as seen in Figure 1, avoidant strategies and perceived stressors are located in a similar neighbourhood, the positive coping strategies Challenge, Appraisal and Use of Resources cluster together in a second neighbourhood while mindfulness stands alone in a different neighbourhood. This neighbourhood approach can be interpreted to suggest that perceptions of stressful demands and an inclination to avoid dealing with them are related; the clustering of the positive coping strategies suggests that these might be used simultaneously while mindfulness was revealed as a distinct construct beyond coping. Using a horizontal linear approach from right to left it can be argued that mindfulness might contribute to positive coping strategies, where all four of these variables are in the same positive quadrant on the vertical plane, in response to stressors and avoidance. This interpretation provides some support for the proposition that mindfulness, that is the ability to be present in the moment, might influence one s positive appraisal of the stressor so as to see it as a challenge and hence utilise resources to deal with it rather than avoid it. The relativity among the data points can also be viewed in terms of meaningful axes drawn through the centroid: in this case the dark dotted line can be seen to depict opposing poles of

7 positive versus negative coping that is, it shows a clear polarity between positive strategies and avoidance behaviour. While not as clear cut, it might be that a second axis could represent different reactions or thought processes: stress as the behavioural and perceptual limitations involved in the stress response (e.g., felt that you were not on top of things) versus mindfulness (e.g., able to focus on what s happening) which represents an openness to the experience of the moment. Clearly this second axis is not as clearly defined as the coping poles and requires further investigation. In order to determine further the relationship among these variables, the data were submitted to a Pearson s Correlation (Table 1). Mindfulness was negatively related to scores on stress and avoidance coping which is congruent with their positions on the MDS map and with the previous work of Chiesa et al. (2011) and Weinstein et al. (2009) who found that people high on mindfulness used less experiential avoidance. Mindfulness was positively related to appraisal and both of these variables are indicative of thinking about the issue in the present. Interestingly, there was no relationship between perceiving demands as a challenge (e.g., take control of the situation) which has more behavioural components and use of resources (e.g., discuss it with my friends and colleagues) a social method to deal with the demand: it would seem that these factors albeit positive coping strategies are not necessarily in the same temporal space as mindfulness and appraisal (e.g., work out why it is a problem for me) which seems to be a thought process occurring in the present similar to what is said to occur with mindfulness. Table 1 Relationship among Variables Mindfulness Stress Appraisal Resources Avoidant Challenge Mindfulness 1.00 Stress -.60 *** 1.00 Appraisal.25 ** -.27 ** 1.00 Resources * 1.00 Avoidant -.35 ***.53 *** -.20 * Challenge ***.37 *** ** p<.01; *** p<.001

8 Although the current findings indicate that the proactive strategies are clustered together in the MDS and are positively correlated no elements of causality can be inferred from these data in terms of outcomes from the stressors experienced or indeed, the causal role of mindfulness in promoting positive coping or reducing avoidant coping. Clearly longitudinal studies are required to test the causality among these factors and across levels of mindfulness. It would also be of clinical interest to determine whether mindfulness can be construed as state and trait. Conclusion The current results provide some suggestion that mindfulness in a sample from the general population is related negatively to levels of perceived stress and levels of avoidant coping. Conversely, mindfulness is positively related to one s appraisal of the situation or demands upon one and these correlational findings are also reflected in a spatial representation using MDS. Despite the novel nature of these findings, causality can only be inferred from a longitudinal follow up of these participants which, if the current trends are supported, might have implications for prevention as well as stress management programs for both clinical and non-clinical populations. References Austin, J. (1999). Zen and the brain. London: The MIT Press. Baer, R. (2003). Mindfulness Training as a Clinical Intervention: A Conceptual and Empirical Review. Clinical Psychological Science and Practice, 10, Baker, J., & Berenbaum. (2007). Emotional approach and problem focused coping: A comparison of potentially adaptive strategies. Cognition and Emotion, 21, Beck, A. (1976). Cognitive Therapy and the Emotional Disorders. New York: International Universities Press. Bishop, S., Lau, M., Shapiro, S., Carlson, L., Anderson, N., Carmody, J., & Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and practice, 11,

9 Brown, K., & Ryan, R. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing coping strategies: a theoretically based approach. Journal of Personality and Social Psychology, 56, Chiesa, A., Calati, R., & Serretti, A. (2011). Does mindfulness training improve cognitive abilities? A systematic review of neuropsychological findings. Clinical Psychology Review, 31(3), Dekeyser, M., Raes, F., Leijssen, M., Leysen, S., & Dewulf, D. (2008). Mindfulness skills and interpersonal behaviour. Personality and Individual Differences, 44(5), Folkman, S., & Lazarus, R. (1980). An analysis of coping in a middle-aged community sample. Journal of Health and Social Behaviour, 21(3), Folkman, S., & Lazarus, R. S. (1985). If it changes it must be a process: Study of emotion and coping during three stages of a college examination. Journal of Personality and Social Psychology, 48(1), doi: / Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future.. Clinical Psychology: Science and Practice, 10, Kruskal, J. B., & Wish. M. (1977). Multidimensional Scaling. Sage Publications. Beverly Hills. CA. Langer, E. J., & Moldoveanu, M. (2000). The Construct of Mindfulness. Journal of Social Issues, 56(1), 1-9. doi: / Lazarus, R., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer. Lazarus, R., Folkman, S., Dunkel-Schetter, C., Delongis, A., & Gruen, R. J. (1986). Dynamics of a stressful encounter: Cognitive appraisal, coping, and encounter outcomes. Journal of Personality and Social Psychology, 50, Moore, K.A. (2003). The Deaking Coping Scale: Strategies for the management of demands.. Journal of Advanced Nursing, 21(2),

10 Piaget, J. (1961). The genetic approach to the psychology of thought. Journal of Educational Psychology, 52, Prati, G., Pietrantoni, L., & Cicognani, E. (2011). Coping strategies and collective efficacy as mediators between stress appraisal and quality of life among rescue workers. International Journal of Stress Management. doi: /a Roth, S., & Cohen, L. J. (1986). Approach, avoidance, and coping with stress. American Psychologist, 41(7), Ryan, B., & Brown, K. (2004). Perils and promise in defining and measuring mindfulness: Observations from experience. Clinical Psychology: Science and Practice, 11, Segal, Z., Williams, M., & Teasdale, J. (2002). Mindfulness-Based Cognitive Therapy for Depresion: A New Approach to Preventing Relapse. New York: Guildford Publications. Thompson, B. L., & Waltz, J. (2007). Everyday mindfulness and mindfulness meditation: Overlapping constructs or not? Personality and Individual Differences, 43(7),