Meaning-focused coping – looking for the good things in dark times

I’ve been reading about ways to increase resilience and help people develop strengths to cope with pain, and came across this blog post on Positive Psychology News where Kathryn Britton reviews several papers by Susan Folkman and others who look at ways of coping.  I’ve posted before on the Lazarus and Folkman model of coping here and here.

Their original model described a path from Appraisal –> Coping –> Outcome –> Emotion, with two outcomes after a harmful or threatening event. The first outcome was simply to favorable resolution and positive emotion. The second outcome, led to an unfavorable resolution and distress, with a loop back to the appraisal process labeled negative emotion.  This model has been updated by Susan Folkman to include the impacts of positive emotion as people deal with unfavorable outcomes.  This is what can be called ‘meaning-focused coping’, which is defined in Britton’s post as

…appraisal-based coping in which the person draws on his or her beliefs (e.g., religious, spiritual, or beliefs about justice), values (e.g., ‘‘mattering’’), and existential goals (e.g., purpose in life or guiding principles) to motivate and sustain coping and well-being during a difficult time. Folkman, 2008

In other words, if people can draw on their values and beliefs to look for the positive or a meaning behind the difficult experience, they can persist with some degree of positivity even when things don’t look good.

Britton describes five processes that Folkman identified from research papers – and I want to explore how these might fit with people experiencing chronic pain.

Benefit finding, involves seeking the benefits that come out of misfortune, whether they be growth in wisdom, patience, and competence, greater appreciation for life, better sense of what really matters, or stronger social relationships.

We can ask people with chronic pain to reflect on the things they’ve gained by needing to take longer to do things, by becoming sensitive to stressors, by having to develop problem-solving skills, and for those who need to review their careers – on the way they can reflect on what really works for them in employment, what they enjoy and the strengths they can use.

Benefit reminding involves making an intentional effort to recall previously found benefits.

This is especially challenging during a flare-up, or when sleep or mood is disrupted – as clinicians we can remind people of the strong and resourceful way they have dealt with these challenges, and maybe writing down some of the new things they’ve learned from going through their experience of change.  Tough times are simply another period of change.

Adaptive goal processes involve reappraising goals in the light of changed circumstances, giving up goals that no longer work, and substituting new goals that are valuable to the individual.

Yesterday a participant in the pain management programme asked me whether it was OK to reconsider goals when they don’t apply any more.  I struggled for a moment to answer, and then I thought about the difference between outcome goals and actions – outcome goals depend on external factors like who else is running in a race if I want to be first, while actions are the things I am responsible for like going out to train for a race (heaven forbid I would ever do such a thing! This girl ain’t built for running).  When we set goals we’re really embodying our values – maybe we can find different ways to express our values through different actions, and in this way our goals may adapt so they fit with changing circumstances like being unable to sit as long as we’d like, or needing more sleep.

Reordering priorities is a value-based process where aspects of life move up or down the priority ladder. Sometimes priority reordering involves careful thought, but sometimes it just happens. Reordering priorities can be very stressful, but it can also lead to a renewed sense of purpose. Often it contributes to coping by narrowing focus to those factors that matter most, allowing people to let go of things that are no longer consequential.

This is a process that people with chronic pain (and other health situations) often struggle with – chronic pain challenges much of an individual’s beliefs about their strengths – and people with chronic pain often need to review whether they can persist with activities that other people expect from them.  This is part of the process of acceptance,  which seems to require learning that chronic pain is permanent.

Infusing ordinary events with positive meaning in order to experience positive emotion.

One exercise I’ve used often with people who are having a tough time is ‘pleasant events scheduling’.  There are times when people simply cannot think of something they enjoy, so we take the time to look at some feathers, a few pieces of paua, the clean lines of a classic motorbike, the taste of coffee, remembering the feel of fresh clean sheets on the bed.  Simple daily experiences and objects that we can appreciate. These small ordinary things make up our lives and, taken together with appreciation, fill life with positive emotions.

Britton summarises the findings from Folkman’s research by saying ‘Folkman’s message is that positive emotions play a strongly adaptive role in times that we think are dominated by negative emotions. Positive emotions lead people to make more positive appraisals of events, maintain energy for coping, and find meaning in stress and suffering.’

Head over to her blog for more reflections on positive psychology or go here to read the story of Peter who finds meaning in life despite advancing age, blindness and Parkinson’s disease.  While you’re there, take a look around some of the other posts in the Positive Psychology News site.  It’ll make your day.

Self management: Helping a person become their own healthcare expert

and how we can help

Health care in many places hasn’t moved an awful lot from a ‘patch ’em up and send ’em out’ mentality.  This is a great approach if you’re basically healthy, have acute appendicitis, and a quick recovery.  It’s not so good if you have chronic pain, are having to learn to live with it, and find your general coping is compromised.

Most of our health care training, however, is designed to follow the medical model (despite arguments that occupational therapists, for example, are trained in a biopsychosocial model – just watch what happens when a referral for therapy is received without a diagnosis!).  There is nothing fundamentally wrong with the medical model when it’s being used in the right place – it’s simply inadequate when the health problem can’t be ‘fixed’.  And the problem with our health care training is that it’s focused primarily on ‘diagnosing’ deficits, patching them up (or compensating for them) and hoping the person will get on with it. (more…)