When I talk to people who have long-term pain, they are often offended when I ask them how they are ‘coping’ as if it’s some negative thing to talk about. Of course they’re coping aren’t they? After all they’re getting up, getting out to care for their families, going to work, maintaining their homes – so of course they’re coping.
Well, they have a point – coping is defined as ‘any behaviour that can be observed in response to threat, regardless of its success’ according to Tunks and Bellissimo (1988). I’ve written before about Lazarus and Folkman who define it as ‘effortful behaviour engaged in response to a stressor’ (1984). The authors of this article, (VanDamme, Crombez & Eccleston, 2008) argue that coping can only really be defined in terms of its effect on the ability to ‘make sense of unwanted experience, and how they avoid, adapt, or alter the perceived causes of those experiences’ – and in doing so, integrate the experience into their life goals and life context. Ahhh, food for my soul!
This paper introduces the concept of coping in a motivation context, and identifies that most coping strategies have both a passive and an active element – taking medication, for example, allows the pain to reduce and is commonly seen as a passive strategy, and yet it allows the individual to continue to pursue active goals within his or her life.
I’ve argued before that most of our literature on coping is drawn from people who are not coping, that is, who are looking for treatment. So the conclusions about ‘what works’ and ‘what doesn’t’ is drawn from quite a skewed sample. I’ve wondered for a long time whether the divisions between ‘active’ and ‘passive’ or ‘avoidant’ versus ‘approach’ or ‘problem-focuses’ versus ’emotion-focused’ are all that helpful when it comes to a pervasive, chronic problem that is not going away even if you try really, really hard.
I don’t have time to go through this whole article this morning – will have a good look at it later today – but from what I’ve read so far, coping is placed as a concept that exists within what a person identifies as valuable. Van Damme, Crombez and Eccleston state ‘patients cope with chronic pain for a reason: to pursue a meaningful and valued life.’ Yes exactly!
And from this I wonder whether some of our efforts in helping people might be better placed to focus on what people actually want to do in their lives, rather than just on pain reduction. After all, even if people get grumpy and irritated and frustrated that their pain is there – their pain is still there. What counts is whether they’re doing things that they value. Which is more satisfying – searching for a cure or living an active and value-filled life?
Van Damme, S., Crombez G., Eccleston, C., (2008) Coping with pain: A motivational perspective, Pain, doi:10.1016/j.pain.2008.07.022
S DAMME, G CROMBEZ, C ECCLESTON (2008). Coping with pain: A motivational perspective Pain DOI: 10.1016/j.pain.2008.07.022