research paper about coping skills

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Research Article

A count of coping strategies: A longitudinal study investigating an alternative method to understanding coping and adjustment

Roles Conceptualization, Formal analysis, Methodology, Project administration, Software, Validation, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Department of Psychology, Brock University, St. Catharines, Ontario, Canada

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing

• Taylor Heffer, 
• Teena Willoughby

• Published: October 5, 2017
• https://doi.org/10.1371/journal.pone.0186057
• Reader Comments

Researchers recently have suggested that coping flexibility (i.e., an individual’s ability to modify and change coping strategies depending on the context) may be an important way to investigate coping. The availability of numerous coping strategies may be an important precursor to coping flexibility, given that flexibility can only be obtained if an individual is able to access and use different coping strategies. Typically, studies examining the use of coping strategies compute means-based analyses, which assess not only what strategies are used but also how much they are used. Thus, there is limited ability to differentiate between individuals who use a lot of strategies infrequently, and individuals who use only one or two strategies a lot. One way to address this confound is to count the number of strategies that an individual uses without attention to how frequently they use them (i.e., a count-based approach). The present longitudinal study compares a count-based model and a means-based model of coping and adjustment among undergraduates ( N = 1132). An autoregressive cross-lagged path analysis revealed that for the count-based approach, using a greater number of positive coping strategies led to more positive adjustment and less suicide ideation over time than using a smaller number of positive coping strategies. Further, engagement in a greater number of negative coping strategies predicted more depressive symptoms and poorer emotion regulation over time. In comparison, the means-based model revealed identical results for negative coping strategies; however, engagement in more frequent positive coping strategies did not predict better positive adjustment over time. Thus, a count-based approach offers a novel way to examine how the number of coping strategies that individuals use can help promote adjustment among university students.

Citation: Heffer T, Willoughby T (2017) A count of coping strategies: A longitudinal study investigating an alternative method to understanding coping and adjustment. PLoS ONE 12(10): e0186057. https://doi.org/10.1371/journal.pone.0186057

Editor: Scott McDonald, Hunter Holmes McGuire VA Medical Center, UNITED STATES

Received: August 17, 2016; Accepted: September 25, 2017; Published: October 5, 2017

Copyright: © 2017 Heffer, Willoughby. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are available at: http://hdl.handle.net/10464/11163 .

Funding: This work was supported by Social Sciences and Humanities Research Council, Grant Number: 435-2014-1929 (TW). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

For many students, attending university can be stressful and challenging [ 1 , 2 ]. Students often are faced with many demands (e.g., moving away from home, struggling with financial constraints, etc.) often without the close social support of family and friends that they experienced when living at home [ 3 , 4 ]. Importantly, accumulation of these daily stressors can impact students’ adjustment [ 2 , 5 , 6 ]. Indeed, the rates of suicide ideation and depressive symptoms among university students are alarming. In a study of 16,760 American undergraduates, 36.1% reported feeling so depressed in the past year that it was difficult to function and 10.3% seriously considered suicide—yet many students may not seek out or be aware of appropriate resources that are available to them [ 7 , 8 ]. Thus, managing these challenges places a reliance on students’ own ability to cope. The current study seeks to investigate how the number of coping strategies that individuals use may be associated with adjustment over time.

The transactional theory of coping posits that coping is an evolving process that changes in response to context, in an effort to manage different internal and external demands [ 9 ]. Accordingly, the transactional theory of coping presumes that successful coping involves an ability to adjust and change coping strategies in a way that facilitates positive outcomes.

With this in mind, current models of coping have focused on the idea of coping flexibility- a way of studying coping that identifies an individual’s ability to modify their coping behavior according to the nature of each stressful situation (see [ 10 ]).

The availability of numerous coping strategies when stressed may be an important precursor to coping flexibility—in order to demonstrate flexibility among a variety of coping strategies, individuals must first possess a diverse range of coping strategies that they are able to use when stressed [ 11 ]. Studies investigating the use of coping strategies typically compute means-based analyses whereby they not only investigate what strategies are used, but also how much (i.e., a little, a medium amount, a lot) each is used—a composite score then is computed based on the average frequency of use across all the strategies [ 12 – 15 ]. As a result, this approach is unable to differentiate between individuals who use a lot of strategies infrequently and individuals who use only one or two strategies a lot. For example, an individual who uses three coping strategies “a little” (scored as a 2 on the Likert scale) would have an identical mean to someone who indicates using two strategies “not at all” (scored as a 1) and a third strategy “a lot” (scored as a 4); both means would be 2. In other words, when using a means-based analysis, distinct coping patterns can present with identical means, limiting the conclusions that can be made regarding the relationship between the number of coping strategies used and adjustment. One way to address this confound is to count the number of strategies that an individual uses when stressed without attention to how frequently they use them (i.e., a count-based approach).

Regardless of approach (count or mean), it also is important to note that some strategies may not be advantageous, regardless of how well an individual is able to use that specific strategy [ 16 ]. For instance, consider a person who copes with different situations by blaming themselves, self-medicating through alcohol use, and seeking support; this person would not be expected to have a more favourable outcome compared to if they had just used only one strategy such as seeking support, given that self-blame and alcohol use are unlikely to help. Thus, adaptive coping may require an ability to use coping strategies that are at least relatively positive in nature. The current study examines this hypothesis by separating coping strategies based on positive and negative coping. In doing so, differential associations between adjustment and the count of positive strategies versus the count of negative coping strategies used can be assessed. Of note, however, there may be some instances where certain coping strategies may not be considered to be truly negative or positive (e.g., distraction coping may not help an individual succeed on an exam). Thus, we acknowledge that these terms may be oversimplified.

Coping and negative adjustment

Despite the potential benefits of using multiple strategies to cope with stress, doing this may be difficult for individuals experiencing poor adjustment. Two indicators of poor adjustment that are examined in the current study are depressive symptoms and suicide ideation. Importantly, individuals with high levels of depressive symptoms demonstrate a more negative attribution style (i.e., a stable and internalized attitude that unpleasant circumstances will persist) compared to their non-depressed peers ([ 17 , 18 ]; see [ 19 ] for a review). Thus, believing that nothing can be done to alter an aversive situation may discourage an individual from seeking out new positive ways to cope with problems.

In line with this idea, concurrent studies using a means-based approach have found that using more frequent negative coping strategies (e.g., self-blame) are associated with higher depressive symptoms [ 20 ]. Further, in a longitudinal investigation, Lee and colleagues [ 21 ] found that more frequent engagement in avoidant coping was associated with more depressive symptoms over time, although they only tested one direction—from coping to depressive symptoms over time (see also [ 22 ]). Thus, interpretation of these findings generally is that negative coping leads to more depressive symptoms over time. However, a longitudinal study testing bidirectionality is necessary before conclusions about the direction of effects can be ascertained.

Suicide ideation also is associated with how well individuals are able to cope with stress [ 23 – 26 ]. For example, findings from concurrent studies indicate that individuals with higher levels of suicide ideation engage in more frequent (calculated by a means-based approach) maladaptive coping strategies [ 23 , 25 ] and tend to have more trouble problem solving in the face of stress [ 27 ], compared to individuals with lower levels of suicide ideation. Thus, individuals who engage in more suicide ideation may have more difficulty accessing multiple productive coping strategies when faced with stress. But it also may be that individuals who use more negative coping strategies in the face of stress have higher suicide ideation over time- a longitudinal study testing both directions of the effects is required in order to address these hypotheses.

Overall, while there is evidence of a means-based association between coping and negative adjustment, less is known about whether these results are transferable when looking solely at the number of strategies individuals have available to them. Interestingly, researchers often suggest that one way to help decrease negative adjustment (e.g., depressive symptoms and suicide ideation) may be to reduce the number of negative coping strategies that individuals use. Yet, a direct test of this hypothesis has not been conducted. Research examining a count-based approach is necessary before concluding that the number of strategies that individuals use is associated with adjustment. In addition, the current study will investigate the direction of effects of these relations over time. For example, it may be that individuals who engage in a greater number of negative coping strategies when stressed report more depressive symptoms and suicide ideation over time than their peers. On the other hand, individuals who report depressive symptoms and suicide ideation at Time 1 may engage in a greater number of negative coping strategies over time. In fact, both possibilities may be true—the effect may be bidirectional. Thus, an important goal of the present study is to investigate the direction of effects of these relations for both positive and negative coping.

Coping and positive adjustment

A second objective of the current study is to investigate the relationship between coping and positive adjustment. Coping often is investigated in terms of its ability to decrease negative outcomes. The current study, however, seeks to investigate whether coping can also play an important role in increasing positive outcomes. Indeed, having a higher number of positive coping strategies available in the face of stress may provide the individual with more resources to deal with stress. This may allow an individual to manage stress more effectively and be more confident in their ability to deal with problems. There is less research directly investigating coping and positive adjustment than coping and negative adjustment, and the research that has been done generally is concurrent rather than longitudinal.

As adjustment can be examined in a variety of ways, in the present study we will focus on three indicators: emotion regulation, self-esteem and academic achievement. All three are associated with coping [ 28 – 30 ] and represent particularly important indicators of adjustment among students. One indicator of positive adjustment that is associated with coping is emotion regulation. Individuals who are better able to regulate their emotions and engage in more positive affect may be more likely to seek out and use a number of positive coping strategies. According to the broaden-and-build theory, the experience of positive emotions (e.g., joy) broadens attention and thinking (i.e., heightens openness to new possibilities, big picture focus, etc.), in comparison to negative emotions, which tend to result in a narrowing of focus (i.e., fight or flight, etc., [ 31 ]). This broadening of attention is hypothesized to build personal resources, such as adaptive coping strategies [ 32 ]. In light of this, individuals who are better able to regulate emotions in a more positive manner may have a heightened ability to think more broadly, allowing for engagement in a variety of positive coping strategies, compared to those who have more narrow thinking. Alternatively, it may be that individuals who engage in a greater number of positive coping strategies may have a greater sense of control, and demonstrate a greater ability to adjust their coping responses and adapt to stress. As a result, these individuals may become more proficient in their ability to regulate their emotions. Fredrickson [ 33 ] posits that both interpretations warrant investigation (i.e., bidirectionality) by emphasizing that experience of positive emotion should help facilitate a broader source of coping, which could help improve later experiences of positive emotions.

Another way that coping has been implicated in promotion of positive adjustment is in its association to self–esteem [ 21 ]. For instance, individuals with high self-esteem are thought to have more effective and appropriate coping resources available to deal with stress (e.g., planning and problem solving [ 34 ]. With regards to the count of coping strategies used, it could be that individuals with high self-esteem may be more confident in their ability to cope with different stressors (and thus be more likely to engage in a variety of positive coping strategies). It also may be, however, that individuals who are able to use a greater number of positive coping strategies may develop a sense of control and feelings of confidence in their ability to handle different situations appropriately, thus leading to increased self-esteem.

In addition, academic achievement may be another important factor associated with coping. Academic achievement typically requires an ability to work well under pressure (e.g., writing exams, oral presentations) as well as an ability to collaborate on group projects. The ability to cope efficiently and employ more frequent positive orientated strategies when under stress/pressure has been found to be associated with better academic achievement, compared to those who rely on less effective coping strategies [ 35 , 36 ]. Further, Zeidner [ 37 ] emphasizes that success on exams is associated with a combined use of multiple strategies (i.e., increase study time, seek support from friends. While associations have been found between academic achievement and use of effective coping strategies, less is known about the longitudinal association between academic achievement and a count of the number of coping strategies used.

The current study seeks to investigate relationships between positive adjustment and a count of the number of strategies individuals use. A count-based analysis will help to clarify if having a number of positive coping strategies available when stressed will be associated with positive adjustment over time. It also is necessary to use a longitudinal design in order to assess bidirectionality. As an example, interpretations of concurrent studies surrounding academic achievement imply that having better coping strategies leads to better academic achievement; it also could be, however, that the ability to succeed in an academic setting may help build confidence and lead to a broadening of focus which could help increase the use of a variety of coping strategies. The same issues with interpretations can be applied to emotion regulation and self-esteem, thus further longitudinal examination is required.

Stress as a moderator

While a key goal of the present study is to investigate bidirectionality, it is quite possible that the associations among these variables may differ depending on the individuals’ level of stress. For instance, coping is generally considered in the context of stress; thus if an individual is not experiencing stress, we might not expect them to apply and use a number of coping strategies compared to individuals who are experiencing stress [ 38 , 39 ]. Indeed, it may be that individuals who have a lot of different stressors in their life may benefit more from using a variety of strategies, compared to individuals who have few stressors.

The current study

There are three main research questions associated with this longitudinal study. First, how is a count-based approach associated with adjustment over time, and are these effects bidirectional? Although research using a means-based approach has provided evidence for associations between coping and adjustment, little work has used a count-based approach or used this approach with a longitudinal design. We predict that using a greater number of positive coping strategies when stressed might be associated with better adjustment (i.e., less depressive symptoms, less suicide ideation, more self-esteem, better emotion regulation and higher academic achievement) over time than using a smaller number of positive coping strategies. We also expect that using a higher number of negative strategies will be associated with poorer adjustment (e.g., greater depressive symptoms, and higher suicide ideation) than using a smaller number of negative coping strategies. Given the lack of research, it is not clear whether using a greater number of negative coping strategies will be associated with poorer self esteem, emotion regulation and academic achievement over time. Further, the analyses examining bidirectionality in these associations over time are exploratory.

Second, the current study offers a comparison of a count-based approach and a means-based approach to studying coping and adjustment. Given that a counts-based model does not take into consideration how much individuals use each strategy and only examines the number of coping strategies individuals use, it also would be beneficial to compare this model to a means-based model that takes both of these factors into consideration. In doing so, differential associations between the two models can be compared in order to address the ways in which a count-based approach may be an alternative method to studying coping.

A third purpose of this study is to investigate whether stress is an important moderator of the association between coping (for both the count-based and the means-based methods) and adjustment. Additionally, all analyses controlled for sex and parental education given research suggesting that these variables are associated with coping and adjustment [ 40 – 42 ].

Participants

The current sample of 1,132 (70.5% female) first-year undergraduate students ( M age = 19.06, SD = .92) from a mid-sized Canadian university was drawn from a larger longitudinal study examining adjustment in university. In total, 87.5% of the participants were born in Canada. Consistent with the broader demographics for the region; the most common ethnic backgrounds endorsed other than Canadian were British (19%), Italian (16.8%), French (9.5%) and German (9%; [ 43 ]). Data on socioeconomic status indicated mean levels of parental education falling between “some college, university or apprenticeship program” and “completed a college/ apprenticeship/ technical diploma.”

Missing data occurred within each assessment time point because some students did not finish the entire questionnaire (average missing data = 1.8%) and because some students did not complete both waves of the data. Out of the original sample that completed the survey at Time 1, 73.1% completed Time 2 of the survey. The overall multivariate test for missingness was significant, Λ = .941, F (9, 1010) = 7.017, p < .001, η 2 = .059. Participants who were missing at the second time point were not significantly different from participants who were there at both time points, with two exceptions. Specifically, those who completed both waves of the study were more likely to be females and to have higher grades compared to those who only completed one wave of the study ( p s < .001). Missing values were imputed using the expectation–maximization algorithm (EM; iterations = 200) with all study measures included in the analysis, thus avoiding the biased parameter estimates that can occur with pairwise deletion, list-wise deletion or means substitution [ 44 ].

First-year university students were invited to participate in the survey examining factors related to stress and adjustment. The study was advertised by way of posters, emails, classroom announcements, website posting, and residence visits. Students could participate regardless of academic major, and were given monetary compensation or course credit for their participation. Only students who completed the first wave were invited (by email and/or phone) to participate again in the second wave. The Social Science Research Ethics Board approved the study (Ethics Approval Number: 09–118) and all participants provided informed written consent. Trained research assistants administered the survey. To ensure the safety of our participants a full debriefing was provided at the end of the survey and a list was given of both available mental health resources and researcher contact information. Participants also were given the opportunity during the survey to provide their contact information so that they could be contacted by a mental health professional if they were experiencing any distress.

Demographics.

Sex and parental education (one item per parent, scale ranged from 1 ( did not finish high school ) to 6 ( professional degree ), averaged for participants reporting on both parents; r = .40) were assessed at Time 1.

Coping was assessed using a shortened version of the Brief COPE (15 items) at Time 1 and then again one year later at Time 2 [ 45 ]. The Brief COPE includes positive and negative coping strategies. In order to differentiate between these positive and negative coping strategies, a principal components factor analysis with direct oblimin rotation was conducted using the data from Time 1. Four components emerged with eigenvalues > 1. Factor 2 was comprised of four negative coping items that hung together (i.e., self-blame, self-criticism, alcohol use, and giving up; eigenvalues = 2.73) with factor loadings ranging from 0.63 to 0.77. These items thus were included in the count of negative coping strategies. The three remaining factors reflected different subtypes of positive coping strategies such as religion (e.g., I pray or meditate), seeking support (e.g., I get emotional support from others), and reframing/humor (e.g., I look for something good in what is happening). Indeed, previous research has found that positive adjustment is associated with positive reframing and humor [ 46 ], seeking support [ 47 ] as well as religious coping strategies (see [ 48 ]). As the focus of this study was to investigate how many strategies individuals have access to using (regardless of the subtype of positive strategies), the items from the three remaining factors were grouped together in order to create the count of positive coping strategies (see S1 Table for more information on the factors).

When filling out the coping measure, participants were asked to indicate what they do when under a lot of stress on a scale ranging from 1 ( I usually don’t do this at all ) to 4 ( I usually do this a lot ). In order to create a count of how many strategies individuals use when stressed, the items were recoded such that that 0 represented not using the strategy (i.e., I usually don’t do this at all ), while 1 represented using the strategy to any degree (i.e., I usually do this a little bit , I usually do this a medium amount , I usually do this a lot ).

The count of negative coping strategies was created by counting the number of negative strategies individuals use when stressed (e.g., “I blame myself”, “I use alcohol and other drugs to make myself feel better,” etc.). An average of these strategies (based on the original items with the four-point scale) was also created and used in the means-based approach. Cronbach’s alpha was .68 at Time 1 and .72 at Time 2. The count of positive coping strategies was assessed by counting the number of positive strategies individuals use when stressed (e.g., “I get comfort and understanding from someone,” “I look for something good in what is happening” etc.). An average of these strategies (based on the original items with the four-point scale) was also created and used in the means-based approach. Cronbach’s alpha was .76 at Time 1 and .74 at Time 2. The Brief COPE has been shown to have good internal consistency and validity in previous research [ 45 ].

Depressive symptoms.

Participants completed The Center for Epidemiological Studies Depression Scale at Time 1 and Time 2 in order to assess their level of depressive symptoms (CES-D Scale; [ 49 ]; e.g., “I felt lonely” and “My sleep was restless”). Individuals indicated on a scale of 1 ( none of the time ) to 5 ( most of the time ) how often they experienced 20 symptoms associated with depression. Cronbach’s alpha in the present study was .91 at Time 1 and .92 at Time 2.

Suicide ideation.

Suicide ideation in the past year was assessed at Time 1 and Time 2 using a question from the Suicide Behaviors Questionnaire-Revised (SBQR; [ 50 ]; “How often have you thought about killing yourself in the past year?”). This item was rated using a 5-point scale that ranged from 1 ( never ) to 5 ( very often ). The SBQR has been shown to have good internal consistency and validity in previous research [ 50 ].

Self esteem.

Self-esteem was measured at Time 1 and Time 2 using the Rosenberg Self-Esteem Scale [ 51 ]. The measure included 10 items (e.g., “I take a positive attitude toward myself”) that were rated on a scale from 1 ( strongly disagree ) to 5 ( strongly agree ). Cronbach’s alpha was .904 at Time 1 and .916 at Time 2.

Academic achievement.

Academic achievement was measured at both Time 1 and Time 2 using students’ academic average for the corresponding year, recorded in percentages (e.g., 70%). Information was obtained from the University Registrar with the participants’ permission.

Emotion regulation.

Emotion regulation was assessed at both Time 1 and Time 2 using 6 items from the Difficulties in Emotion Regulation (DERS; [ 52 ]); e.g., ‘‘When I’m upset or stressed, I have difficulty concentrating”). The responses were based on a five-point Likert scale ranging from 1 ( almost never ) to 5 ( almost always ). The scale was recoded so that higher scores indicated better emotion regulation. Cronbach’s alphas at Time 1 and Time 2 were .73 and .74, respectively.

Stress was measured using The Daily Hassles Scale. Participants indicated how bothered they felt by 25 daily hassles. Hassles related to daily life stressors such as peer conflict, family, school and money (e.g., “Being lonely” and “Not having enough time”). Responses were rated on a scale from 1 ( almost never bothers me ) to 3 ( often bothers me ). Cronbach’s alpha for these 25 items was .84.

Preliminary analyses

The means and standard deviations of all study variables are outlined in Table 1 . All variables demonstrated acceptable levels of skewness and kurtosis with the exception of suicide ideation, which was transformed using the log-likelihood method to correct for non-normality. There was a significant main effect of sex on the number of positive coping strategies used, with females reporting using a greater number of positive coping strategies than males at both Time 1 and Time 2, p s < .004. Females also reported having more depressive symptoms than males at Time 1, p < .001, and higher academic achievement at Time 2, p = .006, than males. In contrast, males were significantly more likely to have better emotion regulation than females at both Time 1 and Time 2, ps < .001. At Time 2, males were more likely to engage in a greater number of negative coping strategies, p = .027, and also reported higher suicide ideation, p = .014, than females. There were no significant differences on parental education, p > .05.

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https://doi.org/10.1371/journal.pone.0186057.t001

Primary analyses

The primary statistical analyses were carried out using an auto-regressive cross-lagged path analysis in MPlus 7. Two models were run, a count-based model and a means-based model. The models were comprised of seven variables measured over 2 years: positive coping strategies, negative coping strategies, depressive symptoms, suicide ideation, academic achievement, emotion regulation, and self-esteem (see Figs 1 and 2 ). Across the two time periods, we included cross-lag paths among all seven key study variables, autoregressive paths (i.e., within each variable), and concurrent associations among all variables within each wave. Sex and parental education also were included as covariates, such that correlations were specified between each of the covariates and each variable at Time 1 and paths were estimated between the covariates and each variable at Time 2. Any significant path, therefore, accounted for covariates, previous scores on the outcome variables, correlations among variables within a wave, as well as any other predictors in the model (i.e., estimating the unique relation between study variables). Significant paths among the seven key study variables for both models (count-based and means-based) are depicted in Figs 1 and 2 (see S2 and S3 Tables for full results among key variables). Model fit was not relevant given that the models were saturated.

Numbers 1 and 2 indicate Time 1 and Time 2, respectively. Values indicate standardized beta weights (standard errors are in parenthesis). Pos = Positive, Neg = Negative.

https://doi.org/10.1371/journal.pone.0186057.g001

https://doi.org/10.1371/journal.pone.0186057.g002

The following results for the paths related to coping were consistent across both the count-based model and the means-based model (See Figs 1 and 2 as well as S2 and S3 Tables for specific path results as well as all results among adjustment indicators). There was a bidirectional association between the use of negative coping strategies and depressive symptoms, such that using more (as measured by a count and a mean) negative coping strategies at Time 1 was associated with higher depressive symptoms at Time 2, and depressive symptoms at Time 1 were positively associated with more engagement in negative coping strategies at Time 2. There also was a unidirectional association found between the use of negative coping and emotion regulation; specifically, using less negative coping strategies (as measured by a count and a mean) at Time 1 was associated with better emotion regulation at Time 2.

Critically, some results were not consistent among the two models. For the count-based model, using a greater number of positive coping strategies at Time 1 was associated with less suicide ideation, engagement in fewer negative coping strategies, higher self-esteem, as well as higher academic achievement one year later. There was also a bidirectional association between the number of positive coping strategies used and emotion regulation. Using a greater number of positive coping strategies at Time 1 was associated with better emotion regulation at Time 2, and better emotion regulation at Time 1 was associated with use of a greater number of positive coping strategies at Time 2.

For the means-based analysis, in addition to the overlapping findings among both models, there also was a unidirectional association found between positive coping and emotion regulation, such that better emotion regulation at Time 1 was associated with more positive coping (means-based) at Time 2. Further, there was a unidirectional association between academic achievement and negative coping. Specifically, higher academic achievement at Time 1 was associated with less negative coping (means-based) at Time 2.

We assessed whether stress was a significant moderator of the pattern of results in both the count-based and means-based models. Stress was categorized into two equal percentiles (50% each) encompassing higher versus lower daily stress. The Chi-Square Difference Test of Relative Fit was not significant for either the count model, χ 2 diff (42) = 45.516, p = .292, or the means-based model χ 2 diff (42) = 42.727, p = .439, indicating that the pattern of associations for both models was not different between people with lower stress compared to people with higher stress. We also assessed whether stress might be a significant moderator if we only included individuals who scored at the more extreme ends of stress (bottom 33% vs top 33%). Consistent with the previous result, the Chi-Square Difference Test of Relative Fit was not significant for either the count-based model, χ 2 diff (42) = 25.439, p = .980 or for the means-based model χ 2 diff (42) = 27.275, p = .961. Overall, these results reveal that stress does not appear to be a moderator of the pattern of results between coping and adjustment.

A large volume of research has been conducted on coping, stress, and adjustment [ 53 ]. In line with the transactional theory of coping, coping flexibility is an important way of studying coping that accounts for an individual’s ability to adjust and change coping styles in response to different internal and external demands [ 9 ]. Importantly, the availability of numerous coping strategies may be an important precursor to coping flexibility, given that flexibility may only be obtained if an individual is able to access and use different coping strategies [ 11 ]. Studies that have investigated the use of coping strategies, however, typically compute a means-based analysis—an approach that does not allow for differentiation between individuals who use a lot of strategies infrequently and individuals who use only one or two strategies a lot. In order to address this limitation, the current study created a count-based measure of coping, whereby the number of strategies that an individual uses was counted without attention to how frequently they use them.

The focus of the present study was to investigate the relationship between a count-based approach to coping and adjustment. Critically, using a greater number of positive coping strategies was associated with better adjustment (e.g., less suicide ideation, using a fewer number of negative coping strategies, higher self-esteem and better academic achievement) over time. Of note, this finding was not true for the means-based analysis. This is an important finding as it suggests that encouraging students to use a greater number of positive coping strategies can not only help to decrease negative adjustment, but also aid in promoting positive adjustment.

In terms of bidirectionality, there was a bidirectional relationship between using a greater number of negative coping strategies and more depressive symptoms. This finding is in line with the research suggesting that individuals with depression may have a more negative attribution style and thus may be more likely to use strategies such as giving up. Additionally, using these types of negative coping strategies predicted more depressive symptoms over time. In line with the broaden-and-build theory, a bidirectional association also was found between emotion regulation and the number of positive coping strategies used when stressed. Our results suggest that emotion regulation may be a distinct way to help broaden an individual’s positive coping resources when stressed, and in turn, individuals who use a greater amount of positive coping strategies when stressed may be better able to regulate their emotions in a more positive manner.

Another goal of the current study was to compare a means-based approach to a counts-based approach. Overall, it appears that the count-based approach offers similar findings to the means-based approach in terms of negative coping. The count-based approach, however, provided additional findings that suggest that using a greater number of positive coping strategies may be distinctly important for promoting positive adjustment as well as decreasing negative adjustment. Further research is needed to investigate why using a greater number of positive coping strategies may be adaptive. For instance, it could be that having more resources available or alternative ways to deal with stress allows individuals to deal with problems more effectively. It also is important for future research to identify the factors that lead some individuals to use more coping strategies than their peers (e.g., access to role models, higher executive functioning and planning skills, openness to experience, etc.). In addition, future research would benefit from identifying if there are differences between the number of strategies individuals think they might use in a situation (e.g., using hypothetical scenarios) compared to the number of strategies that they actually use when faced with stress. This would help identify whether individuals have certain strategies available but do not use them. Studies addressing these issues could help inform interventions aimed at teaching individuals how to use a variety of positive coping strategies as a way to promote adjustment.

The current study also found that stress was not a significant moderator of the relation between coping strategies and adjustment. This finding suggests that the using a greater number of positive coping strategies as well as using less negative coping strategies (lower average and a fewer number of negative strategies) may be beneficial for people with either high or low stress. Thus, even if an individual does not have a lot of stress in their life, it is still beneficial to have a greater number of positive coping strategies available to deal with problems effectively.

This study has important strengths, including a large sample, multiple indicators of adjustment, as well as being the first longitudinal study to offer a comparison between a means-based approach and a count-based approach to coping and adjustment. At the same time, the study has several limitations. First, generalizability is limited due to a predominantly Caucasian sample of university students. Second, the measure of stress comes from a self-report questionnaire of daily hassles. Thus, this measure is targeting more minor daily stressors, compared to major or severe stressors. It is worth noting, however, research findings emphasize the importance of cumulative daily stress/hassles in the role of negative adjustment [ 54 , 55 ]. Nonetheless, future research may benefit from investigating if the relationship between the number of coping strategies used and adjustment is more prominent among individuals facing major stressors. Another limitation is that coping was assessed via retrospective reports. It would be valuable for future research to assess these constructs in real time through techniques such as ecological moment sampling (e.g., daily diaries). Of note, the current study was unable to assess how coping may change depending on the situational context. Admittedly, it would be extremely difficult to evaluate and account for varying subjective stressors, as well as dispositional and environmental factors, in order to identify an objective measure of how coping may be adaptive in response to specific contexts [ 56 ]. Future research is needed to help disentangle how context may play a role in the relationship between a count of coping strategies used and adjustment.

In conclusion, the present study helps to elucidate the associations between adjustment and two methods of investigating coping over time. Understanding coping behaviours over time can help researchers and practitioners implement programs to improve coping efficiency and adjustment. Studies that investigate only a means-based approach are unable to differentiate between individuals who use one or two strategies a lot as opposed to those who use multiple strategies infrequently. Thus, a count-based method offers an innovative and practical way to implement interventions that could focus on teaching individuals to use a larger variety of coping strategies. Indeed, using a greater number of positive coping strategies is associated with less use of negative coping strategies, less suicide ideation, as well as higher self-esteem, emotion regulation, and academic achievement over time. Further, decreasing the ways in which individuals use negative coping strategies (average and count), can help to decrease depressive symptoms as well as increase emotion regulation over time. Given that university students report alarming rates of depressive symptoms and suicide ideation [ 8 ], there is a strong need for research investigating ways to decrease mental health problems as well as promote more positive adjustment.

Supporting information

S1 table. exploratory factor analysis..

https://doi.org/10.1371/journal.pone.0186057.s001

S2 Table. Autoregressive cross-lagged results for the count-based model.

https://doi.org/10.1371/journal.pone.0186057.s002

S3 Table. Autoregressive cross-lagged results for the means-based model.

https://doi.org/10.1371/journal.pone.0186057.s003

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• Research Article
• Open access
• Published: 06 April 2021

Health anxiety, perceived stress, and coping styles in the shadow of the COVID-19

• Szabolcs Garbóczy 1 , 2 ,
• Anita Szemán-Nagy 3 ,
• Mohamed S. Ahmad 4 ,
• Szilvia Harsányi 1 ,
• Dorottya Ocsenás 5 , 6 ,
• Viktor Rekenyi 4 ,
• Ala’a B. Al-Tammemi 1 , 7 &
• László Róbert Kolozsvári   ORCID: orcid.org/0000-0001-9426-0898 1 , 7  

BMC Psychology volume  9 , Article number:  53 ( 2021 ) Cite this article

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In the case of people who carry an increased number of anxiety traits and maladaptive coping strategies, psychosocial stressors may further increase the level of perceived stress they experience. In our research study, we aimed to examine the levels of perceived stress and health anxiety as well as coping styles among university students amid the COVID-19 pandemic.

A cross-sectional study was conducted using an online-based survey at the University of Debrecen during the official lockdown in Hungary when dormitories were closed, and teaching was conducted remotely. Our questionnaire solicited data using three assessment tools, namely, the Perceived Stress Scale (PSS), the Ways of Coping Questionnaire (WCQ), and the Short Health Anxiety Inventory (SHAI).

A total of 1320 students have participated in our study and 31 non-eligible responses were excluded. Among the remaining 1289 participants, 948 (73.5%) and 341 (26.5%) were Hungarian and international students, respectively. Female students predominated the overall sample with 920 participants (71.4%). In general, there was a statistically significant positive relationship between perceived stress and health anxiety. Health anxiety and perceived stress levels were significantly higher among international students compared to domestic ones. Regarding coping, wishful thinking was associated with higher levels of stress and anxiety among international students, while being a goal-oriented person acted the opposite way. Among the domestic students, cognitive restructuring as a coping strategy was associated with lower levels of stress and anxiety. Concerning health anxiety, female students (domestic and international) had significantly higher levels of health anxiety compared to males. Moreover, female students had significantly higher levels of perceived stress compared to males in the international group, however, there was no significant difference in perceived stress between males and females in the domestic group.

The elevated perceived stress levels during major life events can be further deepened by disengagement from home (being away/abroad from country or family) and by using inadequate coping strategies. By following and adhering to the international recommendations, adopting proper coping methods, and equipping oneself with the required coping and stress management skills, the associated high levels of perceived stress and anxiety could be mitigated.

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Introduction

On March 4, 2020, the first cases of coronavirus disease were declared in Hungary. One week later, the World Health Organization (WHO) declared COVID-19 as a global pandemic [ 1 ]. The Hungarian government ordered a ban on outdoor public events with more than 500 people and indoor events with more than 100 participants to reduce contact between people [ 2 ]. On March 27, the government imposed a nationwide lockdown for two weeks effective from March 28, to mitigate the spread of the pandemic. Except for food stores, drug stores, pharmacies, and petrol stations, all other shops and educational institutions remained closed. On April 16, a week-long extension was further announced [ 3 ].

The COVID-19 pandemic with its high morbidity and mortality has already afflicted the psychological and physical wellbeing of humans worldwide [ 4 , 5 , 6 , 7 , 8 , 9 ]. During major life events, people may have to deal with more stress. Stress can negatively affect the population’s well-being or function when they construe the situation as stressful and they cannot handle the environmental stimuli [ 10 ]. Various inter-related and inter-linked concepts are present in such situations including stress, anxiety, and coping. According to the literature, perceived stress can lead to higher levels of anxiety and lower levels of health-related quality of life [ 11 ]. Another study found significant and consistent associations between coping strategies and the dimensions of health anxiety [ 12 ].

Health anxiety is one of the most common types of anxiety and it describes how people think and behave toward their health and how they perceive any health-related concerns or threats. Health anxiety is increasingly conceptualized as existing on a spectrum [ 13 , 14 ], and as an adaptive signal that helps to develop survival-oriented behaviors. It also occurs in almost everyone’s life to a certain degree and can be rather deleterious when it is excessive [ 13 , 14 ]. Illness anxiety or hypochondriasis is on the high end of the spectrum and it affects someone’s life when it interferes with daily life by making people misinterpret the somatic sensations, leading them to think that they have an underlying condition [ 14 ].

According to the American Psychiatric Association—Diagnostic and Statistical Manual of Mental Disorders (fifth edition), Illness anxiety disorder is described as a preoccupation with acquiring or having a serious illness, and it reflects the high spectrum of health anxiety [ 15 ]. Somatic symptoms are not present or if they are, then only mild in intensity. The preoccupation is disproportionate or excessive if there is a high risk of developing a medical condition (e.g., family history) or the patient has another medical condition. Excessive health-related behaviors can be observed (e.g., checking body for signs of illness) and individuals can show maladaptive avoidance as well by avoiding hospitals and doctor appointments [ 15 ].

Health anxiety is indeed an important topic as both its increase and decrease can progress to problems [ 14 ]. Looking at health anxiety as a wide spectrum, it can be high or low [ 16 ]. While people with a higher degree of worry and checking behaviors may cause some burden on healthcare facilities by visiting them too many times (e.g., frequent unnecessary visits), other individuals may not seek medical help at healthcare units to avoid catching up infections for instance. A lower degree of health anxiety can lead to low compliance with imposed regulations made to control a pandemic [ 17 ].

The COVID-19 pandemic as a major event in almost everyone’s life has posed a great impact on the population’s perceived stress level. Several studies about the relation between coping and response to epidemics in recent and previous outbreaks found higher perceived stress levels among people [ 18 , 19 , 20 , 21 ]. Being a woman, low income, and living with other people all were associated with higher stress levels [ 18 ]. Protective factors like being emotionally more stable, having self-control, adaptive coping strategies, and internal locus of control were also addressed [ 19 , 20 ]. The findings indicated that the COVID-19 crisis is perceived as a stressful event. The perceived stress was higher amongst people than it was in situations with no emergency. Nervousness, stress, and loss of control of one’s life are the factors that are most connected to perceived stress levels which leads to the suggestion that unpredictability and uncontrollability take an important part in perceived stress during a crisis [ 19 , 20 ].

Moreover, certain coping styles (e.g., having a positive attitude) were associated with less psychological distress experiences but avoidance strategies were more likely to cause higher levels of stress [ 21 ]. According to Lazarus (1999), individuals differ in their perception of stress if the stress response is viewed as the interaction between the environment and humans [ 22 ]. An Individual can experience two kinds of evaluation processes, one to appraise the external stressors and personal stake, and the other one to appraise personal resources that can be used to cope with stressors [ 22 , 23 ]. If there is an imbalance between these two evaluation processes, then stress occurs, because the personal resources are not enough to cope with the stressor’s demands [ 23 ].

During stressful life events, it is important to pay attention to the increasing levels of health anxiety and to the kind of coping mechanisms that are potential factors to mitigate the effects of high anxiety. The transactional model of stress by Lazarus and Folkman (1987) provides an insight into these kinds of factors [ 24 ]. Lazarus and Folkman theorized two types of coping responses: emotion-focused coping, and problem-focused coping. Emotion-focused coping strategies (e.g., distancing, acceptance of responsibility, positive reappraisal) might be used when the source of stress is not embedded in the person’s control and these strategies aim to manage the individual’s emotional response to a threat. Also, emotion-focused coping strategies are directed at managing emotional distress [ 24 ]. On the other hand, problem-focused coping strategies (e.g., confrontive coping, seeking social support, planful problem-solving) help an individual to be able to endure and/or minimize the threat, targeting the causes of stress in practical ways [ 24 ]. It was also addressed that emotion-focused coping mechanisms were used more in situations appraised as requiring acceptance, whereas problem-focused forms of coping were used more in encounters assessed as changeable [ 24 ].

A recent study in Hunan province in China found that the most effective factor in coping with stress among medical staff was the knowledge of their family’s well-being [ 25 ]. Although there have been several studies about the mental health of hospital workers during the COVID-19 pandemic or other epidemics (e.g., SARS, MERS) [ 26 , 27 , 28 , 29 ], only a few studies from recent literature assessed the general population’s coping strategies. According to Gerhold (2020) [ 30 ], older people perceived a lower risk of COVID-19 than younger people. Also, women have expressed more worries about the disease than men did. Coping strategies were highly problem-focused and most of the participants reported that they listen to professionals’ advice and tried to remain calm [ 30 ]. In the same study, most responders perceived the COVID-19 pandemic as a global catastrophe that will severely affect a lot of people. On the other hand, they perceived the pandemic as a controllable risk that can be reduced. Dealing with macrosocial stressors takes faith in politics and in those people, who work with COVID-19 on the frontline.

Mental disorders are found prevalent among college students and their onset occurs mostly before entry to college [ 31 ]. The diagnosis and timely interventions at an early stage of illness are essential to improve psychosocial functioning and treatment outcomes [ 31 ]. According to research that was conducted at the University of Debrecen in Hungary a few years ago, the students were found to have high levels of stress and the rate of the participants with impacted mental health was alarming [ 32 ]. With an unprecedented stressful event like the COVID-19 crisis, changes to the mental health status of people, including students, are expected.

Aims of the study

In our present study, we aimed at assessing the levels of health anxiety, perceived stress, and coping styles among university students amidst the COVID-19 lockdown in Hungary, using three validated assessment tools for each domain.

Methods and materials

Study design and setting.

This study utilized a cross-sectional design, using online self-administered questionnaires that were created and designed in Google Forms® (A web-based survey tool). Data collection was carried out in the period April 30, 2020, and May 15, 2020, which represents one of the most stressful periods during the early stage of the COVID-19 pandemic in Hungary when the official curfew/lockdown was declared along with the closure of dormitories and shifting to online remote teaching. The first cases of COVID-19 were declared in Hungary on March 4, 2020. On April 30, 2020, there were 2775 confirmed cases, 312 deaths, and 581 recoveries. As of May 15, 2020, the number of confirmed cases, deaths, and recovered persons was 3417, 442, and 1287, respectively.

Our study was conducted at the University of Debrecen, which is one of the largest higher education institutions in Hungary. The University is located in the city of Debrecen, the second-largest city in Hungary. Debrecen city is considered the educational and cultural hub of Eastern Hungary. As of October 2019, around 28,593 students were enrolled in various study programs at the University of Debrecen, of whom, 6,297 were international students [ 33 ]. The university offers various degree courses in Hungarian and English languages.

Study participants and sampling

The target population of our study was students at the University of Debrecen. Students were approached through social media platforms (e.g., Facebook®) and the official student administration system at the University of Debrecen (Neptun). The invitation link to our survey was sent to students on the web-based platforms described earlier. By using the Neptun system, we theoretically assumed that our survey questionnaire has reached all students at the University. The students who were interested and willing to participate in the study could fill out our questionnaire anonymously during the determined study period; thus, employing a convenience sampling approach. All students at the University of Debrecen whose age was 18 years or older and who were in Hungary during the outbreak had the eligibility to participate in our study whether undergraduates or postgraduates.

Study instruments

In our present study, the survey has solicited information about the sociodemographic profile of participants including age (in years), gender (female vs male), study program (health-related vs non-health related), and whether the student stayed in Hungary or traveled abroad during the period of conducting our survey in the outbreak. Our survey has also adopted three international scales to collect data about health anxiety, coping styles, and perceived stress during the pandemic crisis. As the language of instruction for international students at the University of Debrecen is English, and English fluency is one of the criteria for international students’ admission at the University of Debrecen, the international students were asked to fill out the English version of the survey and the scales. On the other hand, the Hungarian students were asked to fill out the Hungarian version of the survey and the validated Hungarian scales. Also, we provided contact information for psychological support when needed. Students who felt that they needed some help and psychological counseling could use the contact information of our peer supporters. Four International students have used this opportunity and were referred to a higher level of care. The original scales and their validated Hungarian versions are described in the following sections.

Perceived Stress Scale (PSS)

The Perceived Stress Scale (PSS) measures the level of stress in the general population who have at least completed a junior high school [ 34 ]. In the PSS, the respondents had to report how often certain things occurred like nervousness; loss of control; feeling of upset; piling up difficulties that cannot be handled; or on the contrary how often the students felt they were able to handle situations; and were on top of things. For the International students, we used the 10-item PSS (English version). The statements’ responses were scored on a 5-point Likert scale (from 0 = never to 4 = very often) as per the scale’s guide. Also, in the 10-item PSS, four positive items were reversely scored (e.g. felt confident about someone’s ability to handle personal problems) [ 34 ]. The PSS has satisfactory psychometric properties with a Cronbach’s alpha of 0.78, and this English version was used for international students in our study.

For the Hungarian students, we used the Hungarian version of the PSS, which has 14 statements that cover the same aspects of stress described earlier. In this version of the PSS, the responses were evaluated on a 5-point Likert scale (0–4) to mark how typical a particular behavior was for a respondent in the last month [ 35 ]. The Hungarian version of the PSS was psychometrically validated in 2006. In the validation study, the Hungarian 14-item PSS has shown satisfactory internal consistency with a Cronbach’s alpha of 0.88 [ 35 ].

Ways of Coping Questionnaire (WCQ)

The second scale we used was the 26-Item Ways of Coping Questionnaire (WCQ) which was developed by Sørlie and Sexton [ 36 ]. For the international students, we used the validated English version of the 26-Item WCQ that distinguished five different factors, including Wishful thinking (hoped for a miracle, day-dreamed for a better time), Goal-oriented (tried to analyze the problem, concentrated on what to do), Seeking support (talked to someone, got professional help), Thinking it over (drew on past experiences, realized other solutions), and Avoidance (refused to think about it, minimized seriousness of it). The WCQ examined how often the respondents used certain coping mechanisms, eg: hoped for a miracle, fantasized, prepared for the worst, analyzed the problem, talked to someone, or on the opposite did not talk to anyone, drew conclusions from past things, came up with several solutions for a problem or contained their feelings. As per the 26-item WCQ, responses were scored on a 4-point Likert scale (from 0 = “does not apply and/or not used” to 3 = “used a great deal”). This scale has satisfactory psychometric properties with Cronbach's alpha for the factors ranged from 0.74 to 0.81[ 36 ].

For the Hungarian students, we used the Hungarian 16-Item WCQ, which was validated in 2008 [ 37 ]. In the Hungarian WCQ, four dimensions were identified, which were cognitive restructuring/adaptation (every cloud has a silver lining), Stress reduction (by eating; drinking; smoking), Problem analysis (I tried to analyze the problem), and Helplessness/Passive coping (I prayed; used drugs) [ 37 ]. The Cronbach’s alpha values for the Hungarian WCQ’s dimensions were in the range of 0.30–0.74 [ 37 ].

Short Health Anxiety Inventory (SHAI)

The third scale adopted was the 18-Items Short Health Anxiety Inventory (SHAI). Overall, the SHAI has two subscales. The first subscale comprised of 14 items that examined to what degree the respondents were worried about their health in the past six months; how often they noticed physical pain/ache or sensations; how worried they were about a serious illness; how much they felt at risk for a serious illness; how much attention was drawn to bodily sensations; what their environment said, how much they deal with their health. The second subscale of SHAI comprised of 4 items (negative consequences if the illness occurs) that enquired how the respondents would feel if they were diagnosed with a serious illness, whether they would be able to enjoy things; would they trust modern medicine to heal them; how many aspects of their life it would affect; how much they could preserve their dignity despite the illness [ 38 ]. One of four possible statements (scored from 0 to 3) must be chosen. Alberts et al. (2013) [ 39 ] found the mean SHAI value to be 12.41 (± 6.81) in a non-clinical sample. The original 18-item SHAI has Cronbach’s alpha values in the range of 0.74–0.96 [ 39 ]. For the Hungarian students, the Hungarian version of the SHAI was used. The Hungarian version of SHAI was validated in 2011 [ 40 ]. The scoring differs from the English version in that the four statements were scored from 1 to 4, but the statements themselves were the same. In the Hungarian validation study, it was found that the SHAI mean score in a non-clinical sample (university students) was 33.02 points (± 6.28) and the Cronbach's alpha of the test was 0.83 [ 40 ].

Data analyses

Data were extracted from Google Forms® as an Excel sheet for quality check and coding then we used SPSS® (v.25) and RStudio statistical software packages to analyze the data. Descriptive and summary statistics were presented as appropriate. To assess the difference between groups/categories of anxiety, stress, and coping styles, we used the non-parametric Kruskal–Wallis test, since the variables did not have a normal distribution and for post hoc tests, we used the Mann–Whitney test. Also, we used Spearman’s rank correlation to assess the relationship between health anxiety and perceived stress within the international group and the Hungarian group. Comparison between international and domestic groups and different genders in terms of health anxiety and perceived stress levels were also conducted using the Mann–Whitney test. Binary logistic regression analysis was also employed to examine the associations between different coping styles/ strategies (treated as independent variables) and both, health anxiety level and perceived stress level (treated as outcome variables) using median splits. A p-value less than 5% was implemented for statistical significance.

Ethical considerations

Ethical permission was obtained from the Hungarian Ethical Review Committee for Research in Psychology (Reference number: 2020-45). All methods were carried out following the institutional guidelines and conforming to the ethical standards of the declaration of Helsinki. All participants were informed about the study and written informed consent was obtained before completing the survey. There were no rewards/incentives for completing the survey.

Sociodemographic characteristics of respondents

A total of 1320 students have responded to our survey. Six responses were eliminated due to incompleteness and an additional 25 responses were also excluded as the students filled out the survey from abroad (International students who were outside Hungary during the period of conducting our study). After exclusion of the described non-eligible responses (a total of 31 responses), the remaining 1289 valid responses were included in our analysis. Out of 1289 participants (100%), 73.5% were Hungarian students and around 26.5% were international students. Overall, female students have predominated the sample (n = 920, 71.4%). The median age (Interquartile range) among Hungarian students was 22 years (5) and for the international students was 22 years (4). Out of the total sample, most of the Hungarian students were enrolled in non-health-related programs (n = 690, 53.5%), while most of the international students were enrolled in health-related programs (n = 213, 16.5%). Table 1 demonstrates the sociodemographic profile of participants (Hungarian vs International).

Perceived stress, anxiety, and coping styles

For greater clarity of statistical analysis and interpretation, we created preferences regarding coping mechanisms. That is, we made the categories based on which coping factor (in the international sample) or dimension (in the Hungarian sample) the given person reached the highest scores, so it can be said that it is the person's preferred coping strategy. The four coping strategies among international students were goal-oriented, thinking it over, wishful thinking, and avoidance, while among the Hungarian students were cognitive restructuring, problem analysis, stress reduction, and passive coping.

The 26-item WCQ [ 31 ] contains a seeking support subscale which is missing from the Hungarian 16-item WCQ [ 32 ]; therefore, the seeking support subscale was excluded from our analysis. Moreover, because the PSS contained a different number of items in English and Hungarian versions (10 items vs 14 items), we looked at the average score of the answers so that we could compare international and domestic students.

In the evaluation of SHAI, the scoring of the two questionnaires are different. For the sake of comparability between the two samples, the international points were corrected to the Hungarian, adding plus one to the value of each answer. This may be the reason why we obtained higher results compared to international standards.

Among the international students, the mean score (± standard deviation) of perceived stress among male students was 2.11(± 0.86) compared to female students 2.51 (± 0.78), while the mean score (± standard deviation) of health anxiety was 34.12 (± 7.88) and 36.31 (± 7.75) among males and females, respectively. Table 2 shows more details regarding the perceived stress scores and health anxiety scores stratified by coping strategies among international students.

In the Hungarian sample, the mean score (± standard deviation) of perceived stress among male students was 2.06 (± 0.84) compared to female students 2.18 (± 0.83), while the mean score (± standard deviation) of health anxiety was 33.40 (± 7.63) and 35.05 (± 7.39) among males and females, respectively. Table 3 shows more details regarding the perceived stress scores and health anxiety scores stratified by coping strategies among Hungarian students.

Concerning coping styles among international students, the statements with the highest-ranked responses were “wished the situation would go away or somehow be finished” and “Had fantasies or wishes about how things might turn out” and both fall into the wishful thinking coping. Among the Hungarian students, the statements with the highest-ranked responses were “I tried to analyze the problem to understand better” (falls into problem analysis coping) and “I thought every cloud has a silver lining, I tried to perceive things cheerfully” (falls into cognitive restructuring coping).

On the other hand, the statements with the least-ranked responses among the international students belonged to the Avoidance coping. Among the Hungarians, it was Passive coping “I tried to take sedatives or medications” and Stress reduction “I staked everything upon a single cast, I started to do something risky” to have the lowest-ranked responses. Table 4 shows a comparison of different coping strategies among international and Hungarian students.

To test the difference between coping strategies, we used the non-parametric Kruskal–Wallis test, since the variables did not have a normal distribution. For post hoc tests, we used Mann–Whitney tests with lowered significance levels ( p  = 0.0083). Among Hungarian students, there were significant differences between the groups in stress ( χ 2 (3) = 212.01; p < 0.001) and health anxiety ( χ 2 (3) = 80.32; p  < 0.001). In the post hoc tests, there were significant differences everywhere ( p  < 0.001) except between stress reduction and passive coping ( p  = 0.089) and between problem analysis and passive coping ( p  = 0.034). Considering the health anxiety, the results were very similar. There were significant differences between all groups ( p  < 0.001), except between stress reduction and passive coping ( p  = 0.347) and between problem analysis and passive coping ( p  = 0.205). See Figs.  1 and 2 for the Hungarian students.

Perceived stress differences between coping strategies among the Hungarian students

Health anxiety differences between coping strategies among the Hungarian students

Among the international students, the results were similar. According to the Kruskal–Wallis test, there were significant differences in stress ( χ 2 (3) = 73.26; p  < 0.001) and health anxiety ( χ 2 (3) = 42.60; p  < 0.001) between various coping strategies. The post hoc tests showed that there were differences between the perceived stress level and coping strategies everywhere ( p  < 0.005) except and between avoidance and thinking it over ( p  = 0.640). Concerning health anxiety, there were significant differences between wishful thinking and goal-oriented ( p  < 0.001), between wishful thinking and avoidance ( p  = 0.001), and between goal-oriented and avoidance ( p  = 0.285). There were no significant differences between wishful thinking and thinking it over ( p  = 0.069), between goal-oriented and thinking it over ( p  = 0.069), and between avoidance and thinking it over ( p  = 0.131). See Figs.  3 and 4 .

Perceived stress differences between coping strategies among the international students

Health anxiety differences between coping strategies among the international students

The relationship between coping strategies with health anxiety and perceived stress levels among the international students

We applied logistic regression analyses for the variables to see which of the coping strategies has a significant effect on SHAI and PSS results. In the first model (model a), with the health anxiety as an outcome dummy variable (with median split; median: 35), only two coping strategies had a statistically significant relationship with health anxiety level, including wishful thinking (as a risk factor) and goal-oriented (as a protective factor).

In the second model (model b), with the perceived stress as an outcome dummy variable (with median split; median: 2.40), three coping strategies were found to have a statistically significant association with the level of perceived stress, including wishful thinking (as a risk factor), while goal-oriented and thinking it over as protective factors. See Table 5 .

The relationship between coping strategies with health anxiety and perceived stress levels among domestic students

By employing logistic regression analysis, with the health anxiety as an outcome dummy variable (with median split; median: 33.5) (model a), three coping strategies had a statistically significant relationship with health anxiety level among domestic students, including stress reduction and problem analysis (as risk factors), while cognitive restructuring (as a protective factor).

Similarly, with the perceived stress as an outcome dummy variable (with median split; median: 2.1429) (model b), three coping strategies had a statistically significant relationship with perceived stress level, including stress reduction and problem analysis (as risk factors), while cognitive restructuring (as a protective factor). See Table 6 .

Comparisons between domestic and international students

We compared health anxiety and perceived stress levels of the Hungarian and international students’ groups using the Mann–Whitney test. In the case of health anxiety, the results showed that there were significant differences between the two groups ( W  = 149,431; p  = 0.038) and international students’ levels were higher. Also, there was a significant difference in the perceived stress level between the two groups ( W  = 141,024; p  < 0.001), and the international students have increased stress levels compared to the Hungarian ones.

Comparisons between genders within students’ groups (International vs Hungarian)

Firstly, we compared the international men’s and women’s health anxiety and stress levels using the Mann–Whitney test. The results showed that the international women’s health anxiety ( W  = 11,810; p  = 0.012) and perceived stress ( W  = 10,371; p  < 0.001) levels were both significantly higher than international men’s values. However, in the Hungarian sample, women’s health anxiety was significantly higher than men’s ( W  = 69,643; p  < 0.001), but there was no significant difference in perceived stress levels among between Hungarian women and men ( W  = 75,644.5; p  = 0.064).

Relationship between health anxiety and perceived stress

We correlated the general health anxiety and perceived stress using Spearman’s rank correlation. There was a significant moderate positive relationship between the two variables ( p  < 0.001; ρ  = 0.446). Within the Hungarian students, there was a significant correlation between health anxiety and perceived stress ( p  < 0.001; ρ  = 0.433), similarly among international students as well ( p  < 0.001; ρ  = 0.465).

In our study, we found that individuals who were characterized by a preference for certain coping strategies reported significantly higher perceived stress and/or health anxiety than those who used other coping methods. These correlations can be found in both the Hungarian and international students. In the light of our results, we can say that 48.4% of the international students used wishful thinking as their preferred coping method while around 43% of the Hungarian students used primarily cognitive restructuring to overcome their problems.

Regulation of emotion refers to “the processes whereby individuals monitor, evaluate, and modify their emotions in an effort to control which emotions they have, when they have them, and how they experience and express those emotions” [ 41 ]. There is an overlap between emotion-focused coping and emotion regulation strategies, but there are also differences. The overlap between the two concepts can be noticed in the fact that emotion-focused coping strategies have an emotional regulatory role, and emotion regulation strategies may “tax the individual’s resources” as the emotion-focused coping strategies do [ 23 , 42 ]. However, in emotion-focused coping strategies, non-emotional tools can also be used to achieve non-emotional goals, while emotion regulation strategies may be used for maintaining or reinforcing positive emotions [ 42 ].

Based on the cognitive-behavioral model of health anxiety, emotion-regulating strategies can regulate the physiological, cognitive, and behavioral consequences of a fear response to some degree, even when the person encounters the conditioned stimulus again [ 12 , 43 ]. In the long run, regular use of these dysfunctional emotion control strategies may manifest as functional impairment, which may be associated with anxiety disorders. A detailed study that examined health anxiety in the view of the cognitive-behavioral model found that, regardless of the effect of depression, there are significant and consistent correlations between certain dimensions of health anxiety and dysfunctional coping and emotional regulation strategies [ 12 ].

Similar to our current study, other studies have found that health anxiety was positively correlated with maladaptive emotion regulation and negatively with adaptive emotion regulation [ 44 ], and in the case of state anxiety that emotion-focused coping strategies proved to be less effective in reducing stress, while active coping leads to a sense of subjective well-being [ 17 , 27 , 45 , 46 , 47 ]

SHAI values were found to be high in other studies during the pandemic, and the SHAI results of the international students in our study were found to be even slightly higher compared to those studies [ 44 , 48 ]. Besides, anxiety values for women were found to be higher than for men in several studies [ 44 , 48 , 49 , 50 ]. This was similar to what we found among the international students but not among the Hungarian ones. We can speculate that the ability to contact someone, the closeness of family and beloved ones, familiarity with the living environment, and maybe less online search about the coronavirus news could be factors counting towards that finding among Hungarian students. Also, most international students were enrolled in health-related study programs and his might have affected how they perceived stress/anxiety and their preferred coping strategies as well. Literature found that students of medical disciplines could have obstacles in achieving a healthy coping strategy to deal with stress and anxiety despite their profound medical knowledge compared to non-health-related students [ 51 , 52 ]. Literature also stressed the immense need for training programs to help students of medical disciplines in adopting coping skills and stress-reducing strategies [ 51 ].

The findings of our study may be a starting point for the exploration of the linkage between perceived stress, health anxiety, and coping strategies when people are not in their domestic context. People who are away from their home and friends in a relatively alien environment may tend to use coping mechanisms other than the adequate ones, which in turn can lead to increased levels of perceived stress.

Furthermore, our results seem to support the knowledge that deep-rooted health anxiety is difficult to change because it is closely related to certain coping mechanisms. It was also addressed in the literature that personality traits may have a significant influence on the coping strategy used by a person [ 53 ], revealing sophisticated and challenging links to be considered especially during training programs on effective coping and management skills. On the other hand, perceived stress which has risen significantly above the average level in the current pandemic, can be most effectively targeted by the well-formulated recommendations and advice of major international health organizations if people successfully adhere to them (e.g. physical activity; proper and adequate sleep; healthy eating; avoiding alcohol; meditation; caring for others; relationships maintenance, and using credible information resources about the pandemic, etc.) [ 1 , 54 ]. Furthermore, there may be additional positive effects of these recommendations when published in different languages or languages that are spoken by a wide range of nationalities. Besides, cognitive behavioral therapy techniques, some of which are available online during the current pandemic crisis, can further reduce anxiety. Also, if someone does not feel safe or fear prevails, there are helplines to get in touch with professionals, and this applies to the University of Debrecen in Hungary, and to a certain extent internationally.

Naturally, our study had certain limitations that should be acknowledged and considered. The temporality of events could not be assessed as we employed a cross-sectional study design, that is, we did not have information on the previous conditions of the participants which means that it is possible that some of these conditions existed in the past, while others de facto occurred with COVID-19 crisis. The survey questionnaires were completed by those who felt interested and involved, i.e., a convenience sampling technique was used, this impairs the representativeness of the sample (in terms of sociodemographic variables) and the generalizability of our results. Also, the type of recruitment (including social media) as well as the online nature of the study, probably appealed more to people with an affinity with this kind of instrument. Besides, each questionnaire represented self-reported states; thus, over-reporting or under-reporting could be present. It is also important to note that international students were answering the survey questionnaire in a language that might not have been their mother language. Nevertheless, English fluency is a prerequisite to enroll in a study program at the University of Debrecen for international students. As the options for gender were only male/female in our survey questionnaire, we might have missed the views of students who do not identify themselves according to these gender categories. Also, no data on medical history/current medical status were collected. Lastly, we had to make minor changes to the used scales in the different languages for comparability.

The COVID-19 pandemic crisis has imposed a significant burden on the physical and psychological wellbeing of humans. Crises like the current pandemic can trigger unprecedented emotional and behavioral responses among individuals to adapt or cope with the situation. The elevated perceived stress levels during major life events can be further deepened by disengagement from home and by using inadequate coping strategies. By following and adhering to the international recommendations, adopting proper coping strategies, and equipping oneself with the required coping and stress management skills, the associated high levels of perceived stress and anxiety might be mitigated.

Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available due to compliance with institutional guidelines but they are available from the corresponding author (LRK) on a reasonable request.

Abbreviations

Centers for Disease Control and Prevention

Coronavirus Disease 2019

Perceived Stress Scale

Short Health Anxiety Inventory

Middle East Respiratory Syndrome

Severe Acute Respiratory Syndrome

Ways of Coping Questionnaire

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Acknowledgments

We would like to provide our extreme thanks and appreciation to all students who participated in our study. ABA is currently supported by the Tempus Public Foundation’s scholarship at the University of Debrecen.

This research project did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Szabolcs Garbóczy, Szilvia Harsányi, Ala’a B. Al-Tammemi & László Róbert Kolozsvári

Department of Psychiatry, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

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Department of Personality and Clinical Psychology, Institute of Psychology, University of Debrecen, Debrecen, Hungary

Anita Szemán-Nagy

Faculty of Medicine, University of Debrecen, Debrecen, Hungary

Mohamed S. Ahmad & Viktor Rekenyi

Department of Social and Work Psychology, Institute of Psychology, University of Debrecen, Debrecen, Hungary

Dorottya Ocsenás

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Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Móricz Zs. krt. 22, Debrecen, 4032, Hungary

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All authors SG, ASN, MSA, SH, DO, VR, ABA, and LRK have worked on the study design, text writing, revising, and editing of the manuscript. DO, SG, and VR have done data management and extraction, data analysis. Drafting and interpretation of the manuscript were made in close collaboration by all authors SG, ASN, MSA, SH, DO, VR, ABA, and LRK. All authors read and approved the final manuscript.

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Garbóczy, S., Szemán-Nagy, A., Ahmad, M.S. et al. Health anxiety, perceived stress, and coping styles in the shadow of the COVID-19. BMC Psychol 9 , 53 (2021). https://doi.org/10.1186/s40359-021-00560-3

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The Role of Coping Skills for Developing Resilience Among Children and Adolescents

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Children and adolescents experience rapid changes due to development and growth processes, thereby necessitating adaptation and flexibility. In addition, young people also often face environmental crises or traumas, human-made catastrophes, or individual (chronic illness) or family (parent divorce, death of a loved one) crises. In the past, to facilitate young people’s adaptation to change, major aims of parents, teachers, and therapists focused on protecting children and adolescents from harm and helping them grow up in a secure environment. Over time, modern life and the influence of the positive psychology orientation have led to a shift in those aims, which now focus more on helping young people feel happy, flourish, and use their own strengths. A key element in making this process of adaptation to change successful is resilience. This chapter deals with the effects of changes, crises, and traumas on children and adolescents, while focusing on the importance of resilience at the individual, family, and environmental levels. This approach directs adaptation to change efforts towards the present rather than towards the past, thereby meeting the important need of treating children and adolescents who have experienced crisis and trauma by imparting them with skills for better coping today in their major natural environments.

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The effects of changes, crises, and traumas on children and adolescents.

Ensuring the wellbeing of children and adolescents comprises a major goal for parents, educators, and mental health professionals. During childhood and adolescence, a wide range of cultural and environmental transformations occur as a result of young people’s rapid physiological growth, psychosocial development, and cognitive changes—encompassing increased family responsibilities, rising academic and social demands, separation and individuation from the family unit, and exploration of stressful new experiences with peers and novel adult activities (Steinberg, 2007 ). Taken together, these developments reinforce the emerging understanding of childhood and adolescence as a critical or sensitive period for the individual’s reorganization of regulatory systems, which is fraught with both opportunities and risks (Steinberg, 2013 ).

The rapid pace of these changes and fluctuations, alongside young people’s dependence on adults, renders them vulnerable and sensitive to environmental circumstances that may adversely affect their physical or emotional development (Levendosky, Leahy, Bogat, Davidson, & von Eye, 2006 ). This is especially manifested when, in addition to experiencing developmental changes, children and adolescence are exposed to traumatic experiences within the family (such as neglect, abuse, illness, divorce, death) or to environmental and community stressors and disasters (such as war, terrorist attack, or earthquake). Trauma symptoms have been reported in children as young as one year old (Bogat, DeJonghe, Levendosky, Davidson, & von Eye, 2006 ).

Cicchetti ( 2006 , 2013 ) claimed that children’s and adolescents’ limited life experiences—together with their vulnerability and sensitivity—preclude them from dealing effectively with stress, threats, and crises, which can affect their physical development as well as their personality and emotional development and may predispose them to behavioural, emotional, or cognitive disorders. Other researchers have noted that stressful life events may also impair family relationships, increase behaviour problems, and decrease social competence (Davies, Winter, & Cicchetti, 2006 ; Levendosky et al., 2006 ).

There is no doubt that change, crisis, and trauma render tremendous influence on young people’s psychosocial development; however, debates remain about how such experiences impact them. While some traumatic experiences seem to increase the mental health problems of children and adolescents, who demonstrate symptoms ranging from mild distress to severe dysfunction, it appears that other traumatic experiences, paradoxically, seem to affect them positively (Garbarino, 2002 ).

Two main trends have characterized research studying children’s and adolescents’ behaviour disorders under adverse conditions. The environmental approach conceptualizes changes and stress as the most important components influencing children’s disorders (Levendosky et al., 2006 ). According to this approach, change (of any kind) acts as a stimulus eliciting stress and anxiety, dependence, and regressive symptoms. It can jeopardize future growth and development, lead to disabling emotional disorders, and leave permanent psychological scars, which are then followed by behavioural and emotional changes and might disrupt the development of basic competencies, threatening the child’s ability to process and manage emotions effectively (Martinez-Torteya, Bogat, von Eye & Levendosky, 2009 ). The new or exacerbated symptoms might disappear after a short period of time, or they may develop further into post-traumatic stress disorder (PTSD; Garbarino, 2002 ). For years, research coinciding with the environmental approach has concentrated on the negative consequences of adversity, conceptualized primarily in terms of risks for psychopathology, dysfunction, breakdown, and other adverse impacts on individuals and families (Masten, 2018 ).

The second group of studies, in line with a resilience approach, has focused on normal development, asserting that children and adolescents generally respond ‘normally’ even to severe crises. These studies suggest that although children may evidence an increase in their frequency of behaviour problems, they often do not develop PTSD after exposure to trauma or stress, and after a time they return to their usual patterns of behaviour, relating to the event as a challenge (Ronen, Rahav, & Rosenbaum, 2003 ). Accordingly, while some individuals or families appear to be more vulnerable to adversity, there are others who seem to be better protected or to recover better after exposure to objectively similar traumas or family crises. Sometimes these ‘buffering’ effects may reflect children’s individual functioning at the positive end of a continuum (such as strong levels of emotional regulation or problem‐solving) along indices previously shown to exacerbate the risks posed by adversities such as poverty or family violence. In other cases, these young people may have access to ‘buffering’ environmental influences (like a supportive friend or mentor) that help protect them from the vulnerabilities typically studied in earlier models of stress and coping. According to this approach, resilience is the component that determines the difference between those individuals or families who continue on successfully and those who do not (Angelkovski, 2016 ).

Positive adjustment in general, and in high‐risk samples in particular, demonstrates the influences of personal traits, coping behaviour patterns, and specifically the ability to adapt to change. During recent decades, scholars have shifted their focus from studying trauma and risk to studying personal and environmental strengths and resources in the context of risk or adversity—including capabilities, processes, or outcomes denoted by desirable adaptation (Masten, 2007 , 2018 ). The present chapter upholds the view that stress is a challenge, which requires that children and adolescents be resourceful, cope, and adapt to the changing environment and their changing selves.

Resilience: Definitions and Ecological Levels

The concept of resilience emerged from the phenomenon of exposure to trauma, crisis, and change that necessitates coping with and living with adversity (Masten, 2007). The construct has several definitions; some highlighted responding to an event (Ungar, 2008 ) while others defined resilience as a trait characteristic of an individual or family (Luthar,  2006 ) or even of a community (Pike, Dawley, & Tomaney, 2010 ). Others have emphasized resilient processes, outcomes, or patterns ( a way of life ). Richardson ( 2002 ) reviewed three waves in scholars’ identification of resilient qualities. The first wave, from the early twentieth century, identified developmental assets and protective factors phenomenologically. The second wave, in the mid-twentieth century, described the process of disruption followed by reintegration in order to access resilient qualities. The third wave, exemplifying the postmodern and multidisciplinary view, identified resilience as the force that drives a person to grow through adversity and disruption.

In that vein, this chapter upholds that resilience occurs in the presence of significant adversity or threat. It infers the human capacity for adapting to adversity or overcoming the challenges posed by a threat or pressure while observably maintaining healthy successful functioning or ‘bouncing back’ after an initial distress response (Masten, 2007 , 2018 ). As part of the tendency to focus on positive virtues and strengths rather than on pathology and risk within the framework of positive psychology, the study of resilience emphasizes its adaptation and coping characteristics. Thus, the goal is not to look at the absence of pathology but rather to pinpoint behavioural and cognitive competencies and the mastery of appropriate developmental tasks that may explain the capacity for resilience (Cornum, Matthews, & Seligman, 2011 ; Kim-Cohen, Moffit, Caspi, & Taylor, 2004 ; Seligman, 2011 ). Masten ( 2018 ) emphasized the importance of both external adaptation to the environment and an internal sense of wellbeing as part of a comprehensive assessment of resilience. Moreover, resilience is better characterized as a dynamic process, because individuals can be resilient to specific environmental hazards or resilient at one time period but not another (Rutter, 2006 ). Through growth, children acquire new skills and resources that help them to ‘bounce back’ and develop an ability to succeed when faced with negative events later in life (Richardson, 2002 ). Evidently, whether one understands resilience as a developmental outcome, as a set of competencies, or as coping strategies, there is much overlap between these conceptualizations.

Moreover, although the definition of resilience has focused primarily on the individual and his or her outcomes to a traumatic or stressful event, coping also depends to a great extent on the developmental components and social determinants of health surrounding that individual (Luthar, 2006 , Luthar, Sawyer, & Brown, 2006 ). This is important because resilience is a coping process necessitating the interactions between the child or adolescent and his/her surroundings (Gilligan, 2004 ). Thus, resilience has been conceptualized as reflecting protective factors at the individual level (e.g., the capacity to navigate health-sustaining resources and seek out opportunities to experience feelings of wellbeing) and also protective conditions in the individual’s family, community, and culture that provide these health resources and experiences in culturally meaningful ways (Luthar et al., 2006 ). Therefore, resilience is influenced by the child’s environment, such that the interaction between individuals and their social ecologies may determine the degree of positive outcomes experienced. Rutter ( 2006 ) emphasized the need for environments such as schools to examine their balance of risk and protective factors in order to build support mechanisms and provide more protective situations.

Furthermore, cultural variation is hypothesized to exert an influence not only on specific children’s resilience but also on their local communities’ resilience. Pike et al. ( 2010 ) asserted that resilience has emerged as a notion seeking to capture the differential and uneven ability of geographical regions to react, respond, and cope with uncertain, volatile, and rapid change. Resilient communities adapt well in the face of adversity, trauma, tragedy, threats, or even significant sources of risk. Pike et al. ( 2010 ) emphasized that analysis of regional development and functioning has recently broadened from a mere focus on growth to a wider perspective on regions’ relative resilience in responding to the modern world’s ever-increasing diverse array of external shocks and transitions, including financial crises, dangerous climate change, terror campaigns, and extreme weather events.

Hence, overall, resilience depends not only on the individual child’s or adolescent’s developmental pathway and the family and immediate environment, but also on broader community resources. This constellation of characteristics may converge when high-risk, vulnerable children and adolescents grow up happy and successful despite being born and raised under disadvantaged circumstances. In this sense, resilience refers to better-than-expected developmental outcomes and to the ability for competence under stress (Ungar, 2008 ).

Basic Components Encompassing Resilience

As discourse on childhood and adolescence has expanded to focus on health instead of just on illness, Rutter ( 2006 ) underscored the need to relate to the correlations between risk and protective factors in explaining the processes underlying resilience. With regard to risk dimensions at the individual level, Seligman ( 2011 ) offered the ‘3 Ps’ of resilience—three perception distortion tendencies that can hinder recovery from adversity: personalization, pervasiveness, and permanence. Personalization is a cognitive distortion that makes people believe they are to blame for every problem, instead of looking at other, outside factors that may play a part in the adverse situation. People should take responsibility for a failure, but they should not see themselves as a failure. Pervasiveness  refers to the distorted belief that an adverse event will affect all areas of life instead of just one. People who have this mindset may find it hard to carry on with life because they feel there is no way out of their situation. Permanence  is the distorted belief that one’s feelings or situation will last forever. This may cause the person to feel overwhelmed. The truth is that time passes by, and life’s challenges go with it. Pain and pleasure are temporary. By recognizing these thoughts and beliefs as counterproductive, individuals can better understand their own tendencies to perceive situations, events, and themselves and can learn to foster resilience.

With regard to the vulnerability and protective factors explaining the processes underlying resilience, such dimensions characterize not only the individual child or adolescent but also the factors at play in the young people’s social and political context (Luthar, 2006 ; Luthar et al., 2006 ), spanning the family and community levels. The fact that some children and adolescents develop and function successfully even under dire circumstances accentuates the need for parents and professionals to become aware of the very different resources that may sustain young people’s wellbeing in various families and communities under stress, especially in schools.

Importantly, children and adolescents are capable of learning new skills that can increase their likelihood of adaptation to adversity (Luthar et al., 2006 ; Shannon, Beauchaine, Brenner, Neuhaus, & Gatzke‐Kopp, 2007 ). Studies have pinpointed coping resources (Folkman, 2008 ) and learned resourcefulness (Rosenbaum, 1990 , 2000 ) as crucial variables affecting the human response to stress. Among such skills, Ungar ( 2008 ) mentioned the importance of a sense of belonging, personal meaning, the experience of self-efficacy, life skills, vocational competencies, and the expression of one’s cultural and ethnic identification as aspects of healthy functioning associated with resilience (Ungar, Ghazinour, & Richter 2013 ).

The next sections of this chapter discuss some resilience-related skills mentioned in the literature. These include individual components such as self-control skills, self-efficacy, subjective wellbeing in general, and positive affect in particular, as well as familial and environmental components such as social support and interpersonal relationships.

The Role of the Individual in Developing Resilience

Self-control skills. Research has shown that self-control is of great importance to human psychological health and involves a crucial personal component for coping with stressful events—therefore a major element for becoming resilient (Ronen & Rosenbaum, 2010 ). The human desire to control is powerful, and the feeling of control is rewarding, while the loss of control is the main reason for the development of a large range of disorders. Hence, it is important to help children and adolescents feel that they can control situations (Gilbert, 2005 ).

Self-control may therefore be viewed as a coping mechanism, as skills and strategies, or as a protective factor in coping with life’s demands. Self-control comprises a goal-directed learned repertoire of behaviours that help people overcome stressful situations, pain, and disturbing emotions and be more resilient (Rosenbaum, 1990 , 2000 ). This repertoire of self-control skills enables people to act upon their aims, overcome difficulties, delay gratification, and cope with distress. Thus, it targets both internal as well as external disturbing situations. Self-control necessitates that people assess disruptions in their habitual way of thinking, believe that their actions can improve their coping, and expect themselves to be capable of creating the desired change.

A considerable body of research has previously shown that children and adolescents who were high in self-control behaviours—such as postponing gratification, planning the future, and using cognitions to guide actions—were less likely to behave aggressively (Blair, Denham, Kochanoff, & Whipple, 2004 ; Gyurak & Ayduk, 2008 ). Self-control skills are positively related to students’ academic competence and performance, independent of general intelligence, cognitive ability, and prior achievements (Liew, Chen, & Hughes, 2010 ; Valiente, Swanson, Lemery-Chalfant, & Berger, 2014 ).

Self-control skills increase coping both via a direct main effect and an indirect buffer effect. Directly, self-control increases one’s sense of value, self-efficacy, or self-evaluation while feeling support from others. The buffer effect refers to the decreased negative impact experienced as an outcome of stress and becoming more resilient (Ronen & Rosenbaum, 2010 ). Self-control can also have an effect on one’s subjective wellbeing by mediating the connection between stress and subjective wellbeing, thereby influencing a person’s primary or secondary appraisal of the distressing situation. Conceiving support as more available leads to better feelings about one’s ability to cope, to evaluate and resolve problems, and to decrease the potential threat (Orkibi & Ronen, 2015 , 2017 ).

Studies of Israeli adolescents have found significant links between high self-control skills and fewer negative emotions, as well as higher self-efficacy beliefs, positive emotions, and a higher positivity ratio and ability to be resilient while facing stress. For example, among children and adolescents, during the first and the second Gulf Wars in Israel, higher levels of self-control skills were connected to lower levels of fear and to fewer symptoms (Ronen et al., 2003 ; Ronen & Seeman, 2007 ). The existence of self-control skills was also found to enable the development of fewer symptoms while facing parents’ divorce or sickness (Hamama & Ronen-Shenhav, 2012 ; Ronen, Hamama, Rosenbaum, & Mishely-Yarlp, 2014 ).

Traditionally, self-control skills have been associated with reductions in maladaptive outcomes such as aggressive behaviour. Students with higher self-control skills reported a less hostile attribution bias (i.e., interpreting others’ intentions or behaviours as hostile and threatening) and less physically aggressive behaviour (Agbaria, Hamama, Orkibi, Gabriel-Fried, & Ronen, 2016 ). Further, self-control skills have been associated with increases in adaptive outcomes such as interpersonal and prosocial outcomes. Studies have demonstrated that when students showed high self-control skills, they reported higher perceived social support than their peers with low self-control skills (Orkibi & Ronen, 2015 ; Ronen, Abuelaish, Rosenbaum, Agbaria, & Hamama, 2013 ) as well as a higher rate of positive emotions and the subjective cognitive appraisal of being happy (Gilbert, 2005 ; Ronen et al., 2014 ). Some researchers view self-control as resulting from positive emotions because the latter create a good foundation for applying skills to achieve goals (Baumeister & Sparks, 2008 ; Baumeister, Vohs, DeWall, & Zhang, 2007 ; Tice, Baumeister, Shmueli, & Muraven, 2007 ). Considering that self-control skills have been highlighted as a crucial component in coping with crisis and in maintaining high levels of subjective wellbeing, it may be assumed that children and adolescents who possess a higher level of self-control skills will achieve higher levels of subjective wellbeing and develop better resilience.

Self-efficacy. Whereas self-control relates to behaviour, self-efficacy relates to beliefs about oneself. Self-efficacy comprises beliefs in one’s capabilities to organize and execute the courses of action required to achieve one’s goals (Bandura, 1997 ). Efficacy beliefs influence thought patterns, which can then enhance or undermine performance (Bandura, 1997 ). Such beliefs shape the plans and behaviours that people choose to pursue, how much effort they put forth in given endeavours, how long they will persevere in the face of obstacles and failures, their resilience to adversity, and whether their thought patterns are self-hindering or self-aiding. Thus, perceived self-efficacy may constitute a primary mediation agent in behavioural change.

Stronger perceived self-efficacy leads people to set higher personal goals and to commit themselves more firmly (Bandura, 1997 ). Inasmuch as challenging goals raise the level of motivation and performance attainments, the capacity to influence one’s own process of change actually comprises a component of control (Bandura, Caprara, Barbaranelli, & Pastorelli, 2001 ). Thus, once a person possesses the necessary self-control skills, it is crucial for the person to believe that s/he possesses those skills and that s/he is capable of executing the actions needed to achieve the desired change.

By predicting outcomes, people foster adaptive preparedness and exercise control that helps bring significance to their lives (Bandura et al., 2001 ). The way people think or believe in their own ability constitutes a most important feature in the process of change and may best be predicted by the combined influence of efficacy beliefs and the types of performance outcomes expected within given social systems (Bandura, 1997 ). The outcomes people anticipate depend largely on their judgement as to how well they will be able to perform and the anticipated consequences (Bandura, 1997 ). For example, Ronen, Hamama, and Rosenbaum ( 2013 ) found that children who wet the bed at night were able to overcome their bedwetting when they actively participated in predicting the process of change, such as their pace of decreasing weekly bedwetting frequency. Thus, predicting outcomes can become an important component involving children’s beliefs and the change process itself (Masten, 2007 ).

Self-efficacy has also been found to correlate with wellbeing. For instance, studies of Israeli adolescents revealed significant links between stronger self-efficacy beliefs and a higher positivity ratio —the positive ratio between positive emotions to negative emotions—which is an indication of a high level of wellbeing (Orkibi & Ronen, 2015 ; Ronen & Seeman, 2007 ). Self-efficacy was also shown to be important for improving family life and happiness (Waters, 2011 , 2015 ). Caprara, Steca, Gerbino, Paciello, and Vecchio ( 2006 ) reported that self-efficacy was a significant determinant of happiness.

Becoming active in change processes, believing in one’s ability to influence change, and predicting one’s own outcomes are all acquired skills (Rosenbaum, 1990 , 2000 ). These crucial components in the process of change are skills needing to be taught and practiced with clients (Masten, 2007 ; Ronen & Rosenbaum, 2010 ). Considering that self-efficacy beliefs have been pinpointed as a crucial component in overcoming difficulties and stress as well as in becoming happier and increasing wellbeing, it may be assumed that children and adolescents who possess a higher level of self-efficacy are more likely to develop better resilience.

Positive affect. Researchers have claimed that happiness is a protective or coping mechanism to help children and adolescents become resilient. Studies have presented good outcomes for happy people, who appear to be less aggressive and less anxious, to have better interpersonal relationships, and to be more inclined to be kind and charitable (Keyes, 2006 , 2013 ; Lyubomirsky, King, & Diener, 2005 ).

Within the framework of positive psychology, happiness has been studied as a positive personal resource, as a major life goal, and as a factor important for the optimal flourishing and functioning of people, groups, and institutions (Carr, 2004 ; Frederickson, 2009 ; Gable & Haidt, 2005 ). Keyes ( 2006 , 2013 ) suggested that happiness incorporates two abilities: achieving subjective wellbeing by expressing positive emotion, and achieving positive functioning towards oneself and one’s environment. Research showed that in order to become happier, people need to gain a sense of mastery, connectedness, and self-acceptance (Keyes, & Simos, 2012 ). Being happy does not mean that people do not experience stress, crises, or problems; rather, happiness encompasses a ‘secret weapon’ in trying to cope with such distress. For example, ‘happy’ people may understand that although distress exists, happy moments will return and one can work towards achieving more happiness (Diener, 2019 ; Keyes, 2006 ; Lyubomirsky et al., 2005 ; Ryff, 2014 ).

Many concepts relate to happiness: subjective wellbeing, satisfaction with life, flourishing, thriving, and more. The present chapter focuses on positive affect as an easier concept to explain, assess, and teach children and adolescents to be aware of and use.

Emotions have long been recognized as a major cause of human behaviour. Positive emotions increase positive human behaviour (Fredrickson, 2009 ). Positive emotions like enthusiasm, pride, and determination operate as independent bipolar constructs from negative emotions (e.g., fear, frustration, guilt), so that the existence of one does not necessarily point to a lack of the other (Bradburn, 1991 ; Watson, Clark, & Tellegen, 1988 ). Research has shown that the psychological impacts of unpleasant phenomena outweigh those of pleasant phenomena (Baumeister & Sparks, 2008 ) and that the impact of good events dissolves more rapidly than the impact of bad events, whereas a single bad event has greater impact than a comparable good event (Baumeister et al., 2007 ). Thus, it takes a larger quantity of positive emotional experiences to counteract the impact of adverse ones.

Positive affect and negative affect are often studied as part of a positive–negative rating scale (Watson et al., 1988 ). Positive emotions broaden momentary thought-action repertoires, resulting in a higher likelihood of pursuing a wider range of thoughts and actions, because one can see more possibilities (Fredrickson, 2009 ). While positive affect correlates with satisfaction from life as well as with high levels of self-confidence and a richer social life (Bood, Archer, & Norlander, 2004 ), negative affect correlates with reports of stress symptoms (Bood et al., 2004 ; Seligman, Steen, Park, & Peterson, 2005 ). Negative affect narrows momentary thought-action repertoires and causes humans to see fewer opportunities (Fredrickson, 2009 ; Magyar-Moe, 2009 ).

The experience of positive emotions is associated with better functioning and, in the long run, correlates with enhanced physical, intellectual, and social resources (Johnson, Waugh, & Fredrickson, 2010 ). It is therefore a crucial component for achieving resilience.

In several studies, we demonstrated the importance of positive affect for children’s and adolescents’ coping. Coping is regarded as an internal mechanism within the individual, which comprises a main way to manage diverse situations in life and to master environmental and internal conflicts, and thus to develop resilience (Folkman, 2008 ). Adolescents were shown to cope better with fear of wars and missile attacks when they maintained positive affect (Ronen & Seeman, 2007 ). Among Arab adolescents, lower rates of symptoms and of aggression emerged when they could express higher levels of positive affect (Ronen, Abuelaish et al., 2013 ), and when Israeli students expressed positive affect, they flourished, even while under exposure to risk (Orkibi & Ronen, 2015 ).

Thus, teaching children and adolescents to express positive affect, to overcome negative affect, and to look for activities and situations that increase their happiness may be major tools for helping them become more resilient, cope with difficulties, and be able to flourish.

The Role of the Family and Peers in Developing Resilience

The previous section presented self-control skills, self-efficacy, and positive affect as individual coping mechanisms for helping children and adolescents achieve resilience. However, children do not grow up alone; their family and society hold main roles in helping them develop those resilience skills. As Gilligan ( 2004 ) stated, while resilience may previously have been seen as residing in the person as a fixed trait, it is now more usefully considered as a variable quality that derives from a process of repeated interactions between a person and favourable features of the surrounding context in that person’s life. The degree of resilience displayed by a person in a certain context may therefore be said to be related to the extent to which that context has elements that nurture this resilience. It is therefore important to ask: How can families and communities increase resilience among children and adolescents? How can we train them to do so?

The desire to belong and to form attachments with family and friends is considered a fundamental human need. Multiple positive health and adjustment effects have been associated with a sense of belonging and with interpersonal attachments. It is also through supportive relationships that self-esteem and self-efficacy are promoted. Having social competence and having positive connections with peers, family, and prosocial adults are significantly related to children’s ability to adapt to life stressors (Masten, 2007 ).

Family-level protective factors include resources and supportive relationships, such as family coherence, stable caregiving, and parental relationships. Children whose mothers are available and supportive developed self‐regulation, self-efficacy, and self-esteem abilities. (Grolnick & Ryan, 1989 ). Strength-based parenting, parental warmth, support, positive expectations, and low derogation predict children’s behavioural and emotional adaptation under a wide variety of adverse circumstances (Kim‐Cohen et al., 2004). Parents who are aware of and use their children’s strengths enable them to enhance their self-efficacy beliefs, thus resulting in higher levels of wellbeing (Waters, 2011 , 2015 ). Effective parenting is associated with decreased externalizing behaviours and increased positive adaptation (Levendosky et al., 2006 ).

For children, the development of friendships and the ability to get along with peers individually and in groups is paramount. Friendships provide support systems that can foster emotional, social, and educational adjustment. Positive peer relationships have been shown to protect children during times of family crisis. Being part of at least one best friendship may also improve children’s adjustment. As children enter adolescence, these friendships may carry even more weight, as teens shift from being dependent on their immediate environment (the parents) to relating more to their peers. Society plays major roles in affecting adolescents’ self-identity, self-image, and self-evaluation (Steinberg, 2007 ).

Social support encompasses personal, social, and familial relationships (Sarason & Sarason, 1990 ). In the course of adolescence, relations with peers become a more central source of social support, and perceived support from parents either remains constant or decreases. Research has identified four kinds of social support: informative, instrumental, emotional, and companionship (House, 1981 ). The need for relatedness (the emotional and companionship aspects of support) refers to the need to feel significant, connected to, and cared for by important others rather than isolated or disconnected from others (Milyavskaya & Koestner, 2011 ). During recent decades, social support has been identified as one of the most crucial factors helping human beings cope, overcome difficulties, and enable a healthy lifestyle (Keyes, 2006 , 2013 ; Keyes & Semoes, Simoes 2012 ).

In all our studies, we have found that children and adolescents presented higher levels of wellbeing and a greater ability to flourish—even when exposed to terror, war, and aggression—when they had either family support or peer support (Orkibi & Ronen, 2015 ; Ronen et al., 2014 ). We can therefore conclude that children and adolescents can be resilient once they acquire the basic needed skills and live in a protective supportive environment of family and peers. Parents and communities can help enable children and adolescents to become resilient, which is important because professionals, on the one hand, can train children to enhance their social skills for obtaining support from others and, on the other hand, can train parents and families to increase children’s strengths, focus on those strengths, and help them express positive affect on the path towards greater resilience.

The Role of Schools in Developing Resilience

A major focus of research into resilience has investigated close figures in the child’s and adolescent’s extrafamilial environment as influencing young people’s coping ability. Beyond examining individual developmental pathways of vulnerable children and youth and their family resources as discussed previously, these studies have explored the health-enhancing capacities of the community and, especially, of the school system. Thus, protective factors at the community level may include peer relationships, non-family-member relationships, non-family-member social support, and religion, among others (Keyes, 2006 ; Gavriel-Fried & Ronen, 2016 ; Orkibi, Hamama, Gabriel-Fried, & Ronen, 2018 ).

There is broad agreement among educators, policymakers, and the public that schools are the child’s main life setting and has an important role to play in raising healthy children, by not only fostering their cognitive development but also their social and emotional development (Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011 ; Wehmeyer & Shogren, 2017 ). Considering the amount of time the average child spends at school during their lifetime, the influence of schools should never be underestimated (e.g., Howard & Walton, 2015 ). Schools provide environments for children with opportunities for positive peer interactions, significant relationships with adults other than their parents/caregivers, and promotion of social and emotional learning (Graham, Phelps, Maddisson, & Fitzgerald, 2011 ; Howard & Walton, 2015 ). Many schools have well-developed programs aimed at building resilience that are implemented across the board by teachers (Nolan, Taket, & Stagnitti, 2014 ). Educators can choose to enhance, or add to, these programs for the benefit of their students, employing various explicit or implicit strategies in doing so.

Students’ self-control skills are linked directly to their resiliency and wellbeing at school and may also be mediated through students’ perceived satisfaction of their basic psychological needs; hence, attaining basic needs at school is a key feature determining wellbeing (Ryan & Deci, 2000 ). Ryan and Deci ( 2000 ) posited that the satisfaction of students’ basic needs for autonomy, relatedness, and competence is crucial for students’ motivation, optimal development, effective functioning, and good health (Milyavskaya & Koestner, 2011 ). At school, subjective wellbeing consists of school satisfaction and the experience of more frequent positive emotions than negative emotions in school, as well as feeling confident, protected, a sense of trust, and autonomy—which enables students’ development of self-determination (Wehmeyer & Shogren, 2017 ).

In the United States, students who were higher on school satisfaction also scored significantly higher on measures of general life satisfaction, hope, and internal locus of control. Good teacher–student relationships and perceived peer social support are the basic components needed to achieve resiliency and wellbeing (Jiang, Huebner, & Siddall, 2013 ) as well as better in-school behaviour (Suldo, Bateman, & Gelley, 2014 ). School satisfaction was positively linked with positive emotions in school and negatively linked with negative emotions in school (e.g., Long, Huebner, Wedell, & Hills, 2012 ). Perceived goal mastery and teacher and peer support were significantly linked to school engagement and hope, whereas perceived autonomy was also linked to academic achievement in middle and high school students in the United States (Van Ryzin, 2011 ). In an extensive line of studies with Chinese adolescent students, wellbeing in school was generally significantly linked to perceived social support, scholastic competence, and social acceptance, and predicted students’ sense of school belonging and students’ wellbeing in school (Liu, Tian, Huebner, Zheng, & Li, 2015 ; Tian, Chen, & Huebner, 2014 ).

The field of positive psychology strives to understand the strengths within individuals, families, and even communities, and what they need to flourish. It is therefore natural to place emphasis on positive education to develop the art of ‘bouncing back’—the ability to spring back from negative events to live a high-quality life (Angelkovski, 2016 ). An important purpose of educational institutions is to equip students with the essential life skills required to become competent members of society after they complete their school years (White & Waters 2015 ). One of those vital capabilities is developing the capacity to be resilient. From an education perspective, children and adolescence should understand that things do not always go according to plan, and that remaining positive in these instances can help to ensure the best possible outcome (Angelkovski, 2016 ). In line with this view, we reasoned that because self-control skills are goal-directed skills that help people regulate their emotions, they will lead to greater self-determination in terms of helping students experience a greater sense of autonomy, volition, and self-endorsement of their behaviour in school as well as a sense of relatedness, belonging, and genuine connection with teachers and peers, and a sense of competence by enabling them to effectively interact with their school environment and maximize opportunities to express or develop their capabilities and strengths (Orkibi & Ronen, 2017 ).

Resilience-Promoting Projects

Many projects have developed over the last decade to impart resilience skills to children and adolescents. Their shared components entail interactive identification of protective factors, free play, behavioural methods, rehearsal, training in relaxation and self-control techniques, practice in generalizing the acquired skills, active parent involvement, and harnessing of teachers’ strengths (Alvord & Grados, 2005 ; Lavy, 2019 ).

In three large-scale national projects adopted by the Israeli government, our research and intervention team has targeted children and adolescents to impart self-control skills for decreasing behavioural disorders, increasing positive affect, and enhancing resilience. Each of the three projects started as a university-based controlled trial, implemented by university students to children and adolescents. As research outcomes supported these interventions’ efficacy, we started training teachers and educators in the field to apply these resilience-promoting projects as part of their regular school curricula while initially receiving supervision from us. Today, schools all over Israel now apply these projects independently.

The first project, initially called Be Strong (Ronen, 1994 ), offered children and adolescents a weekly course (adapted to age level) that focused on ‘how to become strong’. Participants first learned about strong people in the history of the world and in their country. They identified the characteristics and strengths that helped these people. Second, participants learned about human beings in general, while focusing on the links between thoughts, emotions, and behaviours in order to understand how people process experiences and function. In the third phase, participants observed and charted their own behaviours, trying to understand antecedents of those behaviours, the way they process information, and the links between their behaviours and their environment’s responses. They learned self-control skills and practiced them both at school and after school. In the last phase, each participant was asked to set a goal for change and to implement it using the material they had learned. The course was taught using the scientific method, where participants had to raise hypotheses about their own behaviours and find ways to observe and try to support those hypotheses.

Evaluation of the initial university-based program demonstrated that participating children and adolescents were able to change their behaviour, apply self-control skills, reduce behaviour problems such as disobedience or aggression, and improve prosocial goals such as increasing their social skills or number of friends. Higher self-control skills were found among those who participated in the program in comparison to classmates who were on the waiting list to begin the program.

This program was also adapted to small groups of high-risk aggressive young people, who studied their own aggressive patterns and thus learned to change their hostile thoughts and negative affect and to express more positive affect. This program targeting at-risk youth, called Empowering Children and Adolescents , is applied nationwide by the Israeli Ministry of Education. A controlled study assessing participating children/adolescents and their parents and teachers demonstrated substantial increases in self-control skills, prosocial behaviour, and school achievements alongside decreases in aggressive behaviour, showing significantly better outcomes compared to waitlisted students (Ronen & Rosenbaum, 2010 ).

Next, we were interested in learning if effective intervention requires explicit verbal training or if children and adolescents could boost their self-control skills and resilience by engaging consistently in structured activities that they enjoy, such as sports or music. In our Through Sports intervention, students who were assessed by their teachers as aggressive were offered the opportunity to join an extracurricular afterschool program involving six hours of sports each week, which integrated challenging and competitive athletic activities. The physical education teachers or coaches oversaw the program, and our only request was for them to give students feedback on their participation and to help students set goals each time for the next sports practice. Our controlled study of the program’s effectiveness demonstrated two different paths for reducing aggression among the student participants: One way was to reduce hostile thoughts and angry feelings, and the other way was to promote positive thinking and positive affect. Compared to peers who did not participate in the sports program, participants revealed significantly higher levels of self-control skills, positive affect, and happiness (Shachar, Ronen-Rosenbaum, Rosenbaum, Orkibi, & Hamama, 2016 ).

In another extracurricular program, Sulamot: Music for Social Change , we targeted the same goals via music. Together with the Israeli Philharmonic, we established children’s orchestras in boarding schools and institutions for children at risk, teaching all students to play an instrument and participate in the school’s orchestra. Empirical studies showed that even those children who were hyperactive, who were diagnosed with attention deficit disorders, who had been sexually or physically abused, or who had not successfully learned to read and write were able to learn musical notation, instrument playing, and skills of coordinating with peers in the orchestra. These studies (master’s theses and doctoral dissertations available only in Hebrew) demonstrated that playing music regularly in such high-status orchestras enabled children to reduce aggression, increase self-control and happiness, and become similar to children who were not assessed as high-risk.

The concept of resilience has been proposed as an answer to help young children and adolescents cope with exposure to change, crisis, and trauma—whether in low-risk or high-risk populations. Over recent years, it has become apparent that every human being faces difficulties in life, even young people in childhood and adolescence, and that trauma is not a direct outcome of an event but rather the way one deals with it. It is therefore necessary for all those involved in caring for, raising, and teaching young persons to work towards resilience as a developmental resource or set of natural coping skills for each individual child, in order to increase wellbeing and happiness and to better cope with the challenges, fluctuations, and adversities encountered in life.

Thus, the facilitation of children’s and adolescents’ resilience must be a shared undertaking by parents, extended family, schools, and the community—to impart them with those skills and to set up optimally protective environmental conditions. In addition to nurturing children and ensuring that their basic needs are met for food, sleep, and warmth, the adults in their lives should foster trust, confidence, the ability for healthy relationships, joyful and satisfying experiences, and self-acceptance. Children and adolescents who attain these crucial skills will be more resilient to deal with whatever they encounter in their lives.

Taking this approach one step further by describing resilience as a quality of the broader societal environment as much as of the individual and his/her closer circles, policymakers may do well to pay ‘careful attention… to the structural deficiencies in our society and to the social policies that families need in order to become stronger, more competent, and better functioning in adverse situations’ (Seccombe, 2002 , p. 385). This view of resilience that integrates multilevel factors related to individual dispositions, family resources, community opportunities, and social policy offers hope for improving resilience in significant ways, thereby ‘changing the odds’, especially for at-risk children, rather than expecting individual-level change alone to ‘beat the odds’ (p. 385).

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Ronen, T. (2021). The Role of Coping Skills for Developing Resilience Among Children and Adolescents. In: Kern, M.L., Wehmeyer, M.L. (eds) The Palgrave Handbook of Positive Education. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-64537-3_14

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Review article, examining academics’ strategies for coping with stress and emotions: a review of research.

• Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada

Existing research suggests that numerous aspects of the modern academic career are stressful and trigger emotional responses, with evidence further showing job-related stress and emotions to impact well-being and productivity of post-secondary faculty (i.e., university or college research and teaching staff). The current paper provides a comprehensive and descriptive review of the empirical research on coping and emotion regulation strategies among faculty members, identifies adaptive stress management and emotion regulation strategies for coping with emotional demands of the academic profession, synthesizes findings on the association between such strategies and faculty well-being, and provides directions for future research on this topic.

Introduction

Not unlike other professionals, post-secondary faculty (i.e., university or college research and teaching staff across ranks and tenure status) have consistently been found to report high levels of job-related stress ( Winefield et al., 2003 ). In the last few decades, higher education institutions worldwide have undergone fundamental changes. Major educational reforms, exponential expansion in student enrollment, escalating workloads, greater control by managers with respect to teaching quality and research productivity, and the movement towards commercialization have shifted the landscape of higher education into a competitive business ( Ogbonna and Harris, 2004 ; Biron et al., 2008 ; Rothmann and Barkhuizen, 2008 ; McAlpine and Akerlind, 2010 ). Subsequently, there is substantial pressure on academics to maintain high academic performance and productivity ( Catano et al., 2010 ; McAlpine and Akerlind, 2010 ).

Surveys carried out in the U.K. ( Tytherleigh et al., 2005 ; Kinman, 2014 ), Australia ( Winefield et al., 2003 ), and Canada ( Biron et al., 2008 ; Catano et al., 2010 ) suggest that these increased demands have contributed to high levels of job-related stress amongst academics. Most notably, a recent comparison of U.K. and Australian academics revealed that faculty suffered from higher levels of stress-related caseness (i.e., when some intervention is required) as compared with other university groups (e.g., post-secondary staff, support professonals; Kinman, 2014 ), with reported burnout by academics being comparable to that of school teachers and medical professionals for whom burnout levels are particularly high ( Watts and Robertson, 2012 ). Empirical evidence strongly supports the detrimental impact of stress on post-secondary faculty members’ physical (e.g., sleep problems, nausea, heart pounding) and psychological well-being (e.g., anxiety, depression, burnout, psychological distress)and professional competencies, as well as student attainment and institutional productivity ( Blix et al., 1994 ; Stevenson and Harper, 2006 ; Catano et al., 2010 ; Watts and Robertson, 2012 ; Barkhuizen et al., 2014 ; Kataoka et al., 2014 ; Shen et al., 2014 ; Salimzadeh et al., 2017 ).

A parallel line of research suggests that the academic profession elicits a wide variety of positive and negative emotions resulting from interactions with students, teaching and research-related activities, as well as organizational factors (e.g., Martin and Lueckenhausen, 2005 ; Postareff and Lindblom-Ylänne, 2011 ; Hagenauer and Volet, 2014a ). The emotion literature further underscores implications of emotions on our cognition, behavior, physical health, and psychological well-being (for meta-analytical summaries, see Houben et al., 2015 ; Lench et al., 2011 ). Importantly, these findings have been replicated in emergent research conducted with post-secondary faculty. For instance, a study of 175 Australian university teachers documented the impact of teaching-related emotions on instructional behavior: positive emotions concerning teaching was associated with student-focused teaching approaches and negative emotions instead linked to information transmission approaches ( Trigwell, 2012 ).

Similarly, a mixed-methods study of 18 U.S. faculty members showed that emotions predict faculty success in teaching and research as well as mediate the impact of perceived task value on teaching success and perceptions of academic control on research success ( Stupnisky et al., 2014 ). More precisely, faculty members who placed higher value on their teaching felt more enjoyment and pride in teaching and, in turn, experienced greater teaching success. As for research, the more faculty felt in control of their research, the more adaptive emotions they felt regarding research (e.g., enjoyment, pride) that, in turn, predicted greater research success. In the same vein, a study of 362 U.S. and Chinese college students found that students’ perceptions of university teachers’ positive emotions were significantly and positively correlated with students’ own positive emotions, behavioral and cognitive engagement, and critical thinking ( Zhang and Zhang, 2013 ).

As emotion and stress share overlapping dimensions, it is necessary to consider both their common and distinguishing features. Psychological stress is defined as “a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being” ( Lazarus and Folkman, 1984 , p. 19). While both stress and emotions are subject to appraisals of the personal significance of an emotional encounter, emotion is operationalized as a broader construct that encompasses negative experiences such as stress ( Lazarus, 1993 ). As such and as a subset of emotion, stress is more limited in scope and depth. While negative emotions are elicited when our goals are thwarted, perceived stress represents the belief that the challenges exceed one’s capabilities to cope with them ( Lazarus, 1993 ; Lazarus, 1998 ). In light of the above-mentioned common features, emotions and stress are reviewed together in the present paper.

Emotion regulation is defined as an everyday psychological process “by which individuals influence which emotions they have, when they have them, and how they experience and express these emotions” ( Gross, 1998b , p. 275). In contrast, coping refers to individuals’ efforts to manage stronger and more persistent negative emotions (i.e., stress) that involve “constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person” ( Lazarus and Folkman, 1984 , p. 141). Emotional labor, on the other hand, involves the “process of regulating both the internal and expressive components of emotions according to an organization’s display rules” ( Grandey, 2000 , p. 97). As such, whereas emotion regulation involves managing both positive and negative emotions on a daily basis, and coping pertains to sustained efforts to combat strong negative emotions in response to significant stressors, emotional labor pertains specifically to the emotions one is expected to convey to others in occupational settings regardless of what one is internally experiencing.

Empirical evidence indicates that the ability to effectively manage stress and emotions has important consequences for health and adaptive functioning (e.g., Folkman and Moskowitz, 2004 ; Gross, 2002 ; Gross and Levenson, 1997 ; John and Gross, 2004 ; for meta-analytical summaries, Skinner et al., 2003 ; Aldao et al., 2010 ; Webb et al., 2012 ). However, although existing research highlights the relevance of coping and emotion regulation for functional and dysfunctional outcomes within work contexts in general (e.g., Murphy, 1996 ; Lawrence et al., 2011 ), the nature and significance of post-secondary academics’ coping and emotion regulation strategies is underexplored. Furthermore, the existing literature on coping and emotion regulation in post-secondary faculty is scattered with no reviews of empirical findings on the topic having been carried out to date. Given the stressful and emotion-laden nature of the academic profession as well as the increasingly problematic nature of stress and the impact of emotions in post-secondary faculty, a comprehensive review of empirical findings is required.

As such, the present review addresses this research gap by providing a comprehensive and descriptive review of quantitative and qualitative research findings on coping and emotion-regulation strategies as reported by post-secondary faculty. It is anticipated that findings from this review will generate insight into academics’ coping and emotion management strategies as well as the consequences of these strategies for well-being and productivity. Furthermore, the findings should shed light on the design and implementation of optimal faculty interventions for post-secondary institutions to equip their academic teaching and research staff with adaptive psychological strategies and maintain their well-being levels ( Implications of Faculty Emotion Regulation and Emotional Labor section for examples of potential interventions). Prior to presenting the method of the review and the main findings, a brief overview of relevant constructs and their corresponding theoretical frameworks are presented.

Constructs Under Review: Coping and Emotion Regulation

Coping strategies. A variety of conceptualizations have been utilized to describe the structure of individuals’ psychological strategies for coping with negative emotions, with models typically distinguishing between problem- and emotion-focused coping ( Folkman and Lazarus, 1980 , Folkman and Lazarus, 1985 ), engagement (active, approach) versus disengagement (avoidance, passive) coping ( Roth and Cohen, 1986 ; Tobin et al., 1989 ), and primary (assimilative) versus secondary (accomodative) control coping ( Weisz et al., 1994 ; Weisz et al., 1984 ; for detailed reviews, see; Skinner et al., 2003 ; Skinner and Zimmer-Gembeck, 2016 ). Problem-focused coping (e.g., strategizing for the purpose of goal attainment) consists of efforts to solve the problem through modifying or eliminating the source of stress whereas emotion-focused coping (e.g., wishful thinking) seeks to regulate distressing emotions in the face of adversity so as to manage the psychological impact of stress. Similarly, engagement coping (e.g., support-seeking) entails active attempts to directly deal with the stressful situation or related feelings whereas disengagement coping (e.g., social withdrawal) refers to efforts to physically and cognitively distance oneself from the stressor and associated emotions.

Whereas perceiving a situation as a challenge may induce positive emotions such as eagerness or excitement, interpreting it instead as personally threatening generates negative emotions such as anxiety or fear ( Folkman, 2008 ). This concept of cognitive appraisals is consistently highlighted in the coping literature due to one’s interpretations regarding the significance and meaning of a stressful encounter mediating the impact of such events on subsequent emotions ( Lazarus and Folkman, 1984 ; Lazarus, 2000 ; Folkman, 2008 ). Importantly, cognitive appraisals are also assumed to determine the types of coping strategies individuals adopt to manage their emotions in stressful situations. Specifically, appraisals of a stressful encounter being controllable tend to trigger problem-solving responses such as planning and strategizing, whereas perceiving the situation as uncontrollable provokes accomodating or emotion-focused strategis such as acceptance or positive thinking ( Aldwin, 2007 ; Skinner and Zimmer-Gembeck, 2016 ).

However, it is also important to note that the assumed emotional consequences of a coping strategy may not in fact be the same as the actual effects of that strategy in response to a specific stressor. As postulated by Lazarus and Folkman (1987) , although coping could be mainly classified as problem-focused or emotion-focused, “in reality any coping thought or act can serve both or many other functions” (p. 152). Coping strategies are thus not universally adaptive or maladaptive for emotional well-being and can be judged as such only after considering the context and the social and personal resources available to the individual, as well as how they influence one’s actions ( Aldwin, 2007 ; Skinner and Zimmer-Gembeck, 2016 ). Nonetheless, research attempting to identify adaptive and maladaptive strategies has found problem-focused coping, engagement coping, as well as primary and secondary control coping to be typically adaptive in that they are consistently found to be linked with better emotional well-being and functioning. In contrast, disengagement and emotion-focused coping are shown to be associated with more maladaptive emotions and behavioral outcomes ( Compas et al., 2001 ).

Given the overlap between coping and emotion regulation frameworks, it is necessary to consider both their convergences and differences. Compared with emotion regulation, coping is a broader construct. Although both coping and emotion regulation are regulatory processes that include controlled and purposeful (i.e., goal-directed) efforts to improve emotional well-being that change over time (i.e., are temporal processes), coping focuses on much larger periods of time (e.g., coping with bereavement over months). However, whereas coping includes only controlled processes, emotion regulation reflects a continuum of processes from conscious, effortful, and controlled regulation of emotions to automatic regulation that takes place without conscious awareness. Accordingly, coping is commonly understood as a form of emotion regulation in which one engages in response to prolonged stress. More precisely, whereas coping primarily focuses on decreasing negative emotions in stressful encounters, emotion regulation targets both expression and experience of positive and negative emotions in stressful situations as well as non-stressful situations. Finally, although coping is performed by the person encountering stress, emotion regulation could be either intrinsic (individuals regulate their own emotions) or extrinsic in nature (emotions are regulated by others; Compas et al., 2014 ; Gross, 1998b , Gross, 2013 ; Gross and Thompson, 2007 ; Koole, 2009 ; Skinner and Zimmer-Gembeck, 2007 ).

Emotion regulation and emotional labor. Regulation of emotions has been studied under two distinct, yet overlapping, research traditions: emotion regulation and emotional labor. The two constructs are comparable in that both focus on modifying feelings and expressions through the use of different strategies ( Gross, 2013 ; Grandey, 2015 ). As mentioned above, emotion regulation encompasses a heterogeneous set of processes whereby people seek to influence the types of emotions they experience, when these emotions are experienced, and how they are expressed ( Gross et al., 2006 ). Emotional labor, on the other hand, represents a subtype of emotion regulation that takes place within a given work context where “display rules” prescribe specific emotions that may or may not be publicly expressed ( Ashforth and Humphrey, 1993 ; Grandey, 2000 ; Gross, 2013 ; Grandey and Gabriel, 2015 ).

Regarding existing proposed frameworks concerning emotion regulation, Gross’ process model ( Gross, 1998a ; Gross, 1998b ) is the most commonly used (for a meta-analysis, Webb et al., 2012 ) and is used in the present review as the organizing structure to synthesize empirical evidence on faculty coping and emotion regulation. The model differentiates between two major forms of emotion regulation in terms of their timing during the unfolding of an emotion: antecedent-focused (i.e., preventative) and response-focused (i.e., responsive). The former strategies are activated before our appraisals initiate emotion response tendencies, and encompass four main strategy types. Situation selection (e.g., confrontation and avoidance) involves choosing or avoiding people, activities, or places that will lead to a situation that can generate the desired emotions. Situation modification pertains to efforts to alter the emotion-inducing situation in order to change its emotional impact, and includes strategies such as direct situation modification, help/support-seeking, and conflict resolution. Attentional deployment (e.g., distraction, rumination, mindfulness) entails managing emotions without modifying the situation by choosing which aspects of a situation to attend to. Cognitive change (e.g., self-efficacy appraisal, challenge and threat appraisals, and positive reappraisal) involves re-evaluating a situation and altering one’s appraisals of it ( Gross, 1998a ; Gross, 1998b ; Gross and Thompson, 2007 ; Peña-Sarrionandia et al., 2015 ). In contrast, response-focused strategies (e.g., emotion sharing, verbal/physical aggression, substance use, and expressive suppression) are activated after emotional responses have been developed and attempt to influence experiential, behavioral, and physiological emotional response tendencies ( Gross, 1998a ; Gross, 1998b ; Gross and Thompson, 2007 ; Peña-Sarrionandia et al., 2015 ).

Existing empirical evidence further indicates that different forms of emotion regulation are associated with notably different affective, cognitive, and social outcomes (for meta-analytical reviews, Aldao et al., 2010 ; Webb et al., 2012 ). For instance, expressive suppression has been shown to maintain or intensify the internal experience of the negative emotion, and also lead to lower positive emotions, higher physiological arousal, feelings of inauthenticity, depressive symptoms, pessimism, as well as decreased memory and negative social consequences. Suppression is additionally linked to job dissatisfaction and quitting intentions within occupational settings. In contrast, reappraisal has generally been found to lead to more positive and fewer negative emotional experiences and expressions, having few social costs and either no impact or positive effects on subsequent memory processes ( Gross and Levenson, 1997 ; Richards and Gross, 2000 ; Côté and Morgan, 2002 ; Gross, 2002 ; Gross, 2015 ; Gross and John, 2003 ; Sutton, 2004 ; Peña-Sarrionandia et al., 2015 ). Overall, emotion regulation processes that target early stages of emotion generation are more effective than the strategies that target emotional responses ( Sutton, 2007 ).

Concerning the construct of emotional labor, different conceptualizations have been proposed. Seminal work by Hochschild (1983) categorized emotional labor into two major forms: surface-acting and deep-acting. Surface-acting entails displaying emotions that one does not actually feel by revising one’s external expression of an emotion without modifying actual internal feelings. In contrast, deep-acting refers to consciously modifying feelings so as to express the desired emotions. Both types of emotional labor are aimed at displaying required emotions with different motives. Specifically, surface-acting involves modifying emotional expressions, whereas deep-acting entails internalizing the desired emotion to appear authentic. Building on Hochschild (1983) classification, subsequent research by Ashforth and Humphrey (1993) added a third form of emotional labor: genuine or natural emotional labor that involves the expression of naturally felt emotions such that the employees do not have to deliberately manage their emotions.

Based on the conceptualizations presented, emotion regulation can thus be understood as encompassing a broader and more pervasive set of behaviors as compared to emotional labor. Also, despite the similarities in the strategies proposed in the two conceptual frameworks, they can be differentiated in that emotion regulation addresses an individuals’ general dispositional approach to dealing with emotions and focuses on internal processes and individual differences, whereas emotional labor reflects a more specific examination of emotion regulatory processes in the context of displaying expected emotions in employment settings ( Wang et al., 2019 ). The two traditions could also be differentiated in their concentration on positive and negative emotions. Specifically, emotion regulation research has largely focused on response-focused processes (i.e., suppression) to inhibit the expression of undesired negative emotional responses. In contrast, emotional labor researchers have mainly concentrated on amplifying the expression of desired positive emotions (i.e., surface-acting; Taxer and Frenzel, 2015 ).

Overall, research findings suggest that emotional inauthenticity (i.e., faking or hiding emotions) and surface-acting are associated with adverse individual and organizational outcomes in the form of impaired well-being, job attitudes, and performance outcomes. However, deep-acting has been shown to be desirable in that it is positively associated with organizational attachment, emotional performance, and customer satisfaction (for meta-analytic findings, see Hülsheger and Schewe, 2011 ; Kammeyer-Mueller et al., 2013 ). Further, existing research has yielded mixed results regarding the impact of emotional labor on specific well-being indicators such as job satisfaction, with some studies reporting positive effects (e.g., Zapf, 2002 ) and others demonstrating negative relations (e.g., Kinman et al., 2011 ). Given the significance of coping and emotion regulatory processes for job performance and productivity, in general, and psychological well-being in particular, existing research on the ways in which post-secondary faculty cope with stress and emotions as well as the ways in which academics are affected by the strategies they adopt needs to be synthesized to shed light on how to promote their performance and protect psychological health.

Existing empirical research on the strategies used by post-secondary faculty to manage work-related stress and emotions were located through a comprehensive search of English language, peer-reviewed empirical investigations via four electronic databases (Educational Research Information Center (ERIC), Psychological Information (PsycINFO), Web of Science, and Scopus). The search terms used included: 1) population: “college” or “university” + “faculty” or “professors” or “academics” or “instructor” or “research staff” or “teaching staff” or “lecturer” or “educator”, 2) stress and emotion: “stress”+ “emotion” or “affect” or “mood”, 3) emotion regulation and coping: “coping” or “stress management” or “coping behavior” + “emotion regulation” or “emotion management” or “emotion control”, and 4) emotional labor: “emotion labor” or “emotional labor” or “emotional dissonance” or “emotional authenticity.” Since coping and emotion regulation among faculty are relatively under-researched and no review to date has examined these topics in post-secondary faculty, we did not limit the search to a specific time span. Further, the current review excluded studies of medical academics (e.g., physicians, nurses) as well as faculty who were also social workers due to the unique demands and pressures associated with their non-academic, service-oriented work conditions ( Le Blanc et al., 2001 ; Watts and Robertson, 2012 ). In addition to the database searches, snowball searches of references of the retrieved studies were conducted. As per the inclusion and exclusion criteria specific to the aim of the present review, 25 empirical publications were included, with six drawing on two datasets ( Amatea and Fong-Beyette, 1987 ; Amatea and Fong, 1991 ; Gates, 2000a ; Gates, 2000b ; Hagenauer and Volet, 2014a , Hagenauer and Volet, 2014b ), in which the stress management and emotion regulation strategies in post-secondary faculty were examined. All studies reviewed are included in Supplementary Appendix SA and identified with an asterisk in the reference list.

Prevalence and Outcomes of Coping and Emotion Regulation Strategies

The present section synthesizes and critically examines published empirical findings ( n = 22) concerning the coping and emotion regulation strategies (i.e., behaviors, cognitions, and perceptions) in which academics engage when facing stress and emotional encounters, as informed by the process model of emotion regulation proposed by Gross (1998a) . The studies examining academics’ coping with stress reviewed for this paper ( n = 13; Supplementary Table S1 ) can be categorized into three main groups according to their foci: 1) those primarily assessing the specific coping strategies faculty members employ to deal with stress ( n = 5; Abouserie, 1996 ; Brown and Speth, 1988 ; Devonport et al., 2008 ; Kataoka et al., 2014 ; Perlberg and Keinan, 1986 ), 2) those that report findings on coping styles among academics combined with general university staff and other occupational groups ( n = 3; Amatea and Fong-Beyette, 1987 ; Amatea and Fong, 1991 ; Gillespie et al., 2001 ; Narayanan et al., 1999 ), and finally, 3) those that explore the association between academics’ coping strategies and well-being outcomes ( n = 6; Dunn et al., 2006 ; Kataoka et al., 2014 ; Lease, 1999 ; Mark and Smith, 2012 ; Ramsey et al., 2011 ; Tümkaya, 2007 ). The review identified five empirical publications ( Gates, 2000a ; Gates, 2000b ; Hagenauer and Volet, 2014a , Hagenauer and Volet, 2014b ; Regan et al., 2012 ; Supplementary Table S2 ) that examined academics’ strategies in dealing with emotions, with four of the studies referencing two datasets ( Gates, 2000a ; Gates, 2000b ; Hagenauer and Volet, 2014a , Hagenauer and Volet, 2014b ). As for emotional labor and its consequences, six studies were identified ( Berry and Cassidy, 2013 ; Constanti and Gibbs, 2004 ; Mahoney et al., 2011 ; Ogbonna and Harris, 2004 ; Pugliesi, 1999 ; Zhang and Zhu, 2008 ; Supplementary Table S2 ).

As stress is a subset of emotion ( Lazarus, 1993 ), the research findings on both coping and emotion regulation strategies are synthesized using process model of emotion regulation ( Gross, 1998a ; Gross, 1998b ) as the guiding framework. Based on the evidence presented in the studies reviewed, faculty members apply a variety of coping and emotional management strategies, either before or after emotional events. The findings from the present review further align with the evidence from the broader emotion management research in showing different strategy types to yield significantly different outcomes for academics’ psychological adjustment ( Skinner et al., 2003 ; Folkman and Moskowitz, 2004 ; Compas et al., 2014 ). For instance, academics’ perceived ability to handle job stress, and appraisals of personal resources, were shown to significantly and negatively correlate with the level of stress and strain experienced ( Amatea and Fong, 1991 ; Blix et al., 1994 ). The strategies identified in the present review align directly with the afore-mentioned guiding framework, namely the process model of emotion regulation proposed by Gross (1998a) and can be categorized into antecedent- or response-focused according to Gross’s categorization. Although the primary objective of the current review is to synthesize the findings on the strategies academics use, the outcomes associated with those strategies are also considered to help put the proposed implications in context.

Antecedent-focused strategies. The antecedent-focused strategies academics use to regulate their emotions in order to minimize the aversive nature of potential stressors (as opposed to modulating behavioral or physiological responses to a given stressor) can be further categorized into situation selection, situation modification, attention deployment, and cognitive change.

Selecting the situation. The studies reviewed suggest that faculty choose or avoid some people, activities and places to generate desired emotional impact. For instance, focus group interviews from a sample of 178 faculty and general staff from 15 Australian universities identified situation selection by establishing tight role boundaries by avoiding non-essential student and staff contact or saying no to unnecessary demands to handle stressful experiences ( Gillespie et al., 2001 ). The review findings further suggest that some academic work experiences, such as interactions with students, provoke negative emotions of anger, irritation, and disappointment. Additionally, being anxious, apprehensive, helpless, inadequate, and overwhelmed were reported with respect to online teaching experiences ( Regan et al., 2012 ; Hagenauer and Volet, 2014a ). As such, university teachers reported adopting strategies to make it less likely that their negative emotions would be provoked. The six U.S. university teachers in Regan et al. (2012) focus group interviews reported a number of strategies to regulate the negative emotions of feeling stressed, restricted, and devalued while teaching online, including adequate technology training and support from the educational institution, synchronous office hours, and face-to-face or telephone interactions with students. Additionally, interview findings from the 15 Australian university teachers indicated that faculty reported making attempts not to get involved in the emotional issues of their students ( Hagenauer and Volet, 2014b ). Also, adopting student-centered teaching approaches to maintain productive and positive interactions with students, to create positive energy and to help circumvent the occurrence of negative emotions were reported. Furthermore, the 337 Japanese university teachers in ( Kataoka et al., 2014) survey study reported using behavioral disengaement as an effective stress mangemnet technique ( Kataoka et al., 2014 ).

As for the consequences associated with situation selection, regulating emotions through strategies such as behavioral disengagement was linked to lower psychological adjustment in the form of severe depression, anxiety, social dysfunction, somatic symptoms and insomnia ( Kataoka et al., 2014 ). Additionally, escape-avoidance (i.e., ignoring or avoiding problem) was found to be associated with higher levels of anxiety and depression and lower job satisfaction ( Mark and Smith, 2012 ), predict greater strain ( Lease, 1999 ), and partially mediate the association between maladaptive perfectionism and psychological distress ( Dunn et al., 2006 ). Moreover, proactive coping, defined as anticipating potential stressors as challenges and generating the psychololgical resources necessary to prepare for future stressors ( Scwarzer and Taubert, 2002 ), was found to be correlated with better physical and psychological health ( Amatea and Fong, 1991 ; Kataoka et al., 2014 ).

Modifying the situation. Examples of situation modification were reported by 135 female U.S. faculty, researchers, and university administrators in Amatea and Fong-Beyette (1987) study who opted to manage stress primarily by adopting strategies such as planning and strategizing across different types of work-life conflict situations. Similar findings were observed by the participants in Gillespie et al. (2001) study who identified planning and prioritizing as key stress management techniques. More recently, the sample of 10 U.K. faculty interviewed by Devenport et al. (2008) also unanimously reported strategies such as prioritizing, proactive planning, and time-management to avoid potentially stressful encounters to be invaluable in managing and controlling stress. Whereas proactive coping, such as planning, reduces the need for reactive coping, faculty reported that some circumstances of organizational constraints such as lack of control necessitate reactive coping ( Devonport et al., 2008 ; Kataoka et al., 2014 ). This finding supports the observation that coping is primarily determined by environmental factors ( Lazarus and Folkman, 1984 ).

A survey of 150 U.S. faculty members further identified strategies such as identifying the cause of the problem or finding more about the situation, as the most frequently used stress management responses ( Brown and Speth, 1988 ). This finding is consistent with a U.S. study that qualitatively compared coping strategies across three occupations (i.e., clerical workers, sales associates, and university professors; Narayanan et al., 1999 ). The study found that, compared to other professions, academics were more likely to engage in situation modification strategies such as taking direct action or discussing the problem with their chair or head of the department. Additionally, a qualitative field study of nine tenured U.S. university teachers (using observations, field notes and interview data) found that faculty reported using language and labels, such as telling students that it is OK to become confused while learning, and communicating their personal expectations to students about how the students should behave ( Gates, 2000b ). This was aimed at influencing students’ behavior and thereby reducing the possibility of triggering negative emotions in teachers. Strategies such as learning to recognize and understand stress were also identified to be effective in coping with stress ( Gillespie et al., 2001 ).

The findings from this review are consistent with the broader coping research (e.g., Lazarus, 1993 ; Aldwin, 2007 ; Skinner and Zimmer-Gembeck, 2016 ) in showing problem-focused coping to be an effective stress response among post-secondary faculty. For instance, the studies reviewed reported utilization of problem-focused coping to be linked to better psychological adjustment in the form of lower levels of stress, depression, and psychological distress as well as better job satisfaction ( Brown and Speth, 1988 ; Dunn et al., 2006 ; Mark and Smith, 2012 ). Similarly, active coping was negatively associated with social dysfunction and severe depression, whereas instrumental support was negatively associated with depression ( Kataoka et al., 2014 ).

Attention deployment. Faculty also reported selectively attending to the stimuli to cope with their emotional experiences. For instance, a quantitative study of 100 Israeli faculty memebrs ( Perlberg and Keinan, 1986 ) identified intellectual stimulation such as reading journals, magazines, and attending conferences as one of the most effective ways of coping with stress in that it helps faculty divert attention from daily stressors. Likewise, the university teachers in the Kataoka et al. (2014) study reported employing self-distraction to be effective in managing stress (e.g., engaging in other work or leisure activities in order to think about stressors less; Carver 1997 ). The findings from this review are consistent with the health impairment risks of self-distraction in linking the use of this strategy to severe depression, anxiety, social dysfunction, somatic symptoms and insomnia among academics ( Kataoka et al., 2014 ).

Cognitive change . Consistent with the empirical findings that advocate cognitive-restructuring (i.e., reappraisal) due to its commonly observed beneficial impact on negative emotional experiences ( Lazarus, 2000 ; Folkman and Moskowitz, 2004 ), academics reported applying reappraisal of specific situations to make it less likely for negative emotions to be triggered. For instance, the faculty members in Brown and Speth (1988) study reported reappraisal as a key coping strategy. It also appears that cognitive techniques that involve positive reappraisal of work situations may reduce faculty members’ stress and negative emotions. For instance, examples of cognitive change were reported by participants in ( Gates, 2000a ; Gates, 2000b ) studies who opted to positively reappraise stimuli, for instance by remembering positive interactions, to down-regulate negative emotions. A quotation from a university teacher, who helped a student adopt an effective learning strategy after failing on an exam, is illustrative: “He (the student) graduated with honors. When he walked away, for me that was a tremendous reward because, according to him, I had an impact. And that’s what I try to focus on” ( Gates, 2000b , p. 483). The participating university teachers further indicated that they try to redefine disruptive students as young and impressionable, or to think of a student who is doing poorly as developing, in order to manage feelings of anger, anxiety, frustration, and disappointment ( Gates, 2000a ; Gates, 2000b ).

Similarly, the faculty members in Regan et al. (2012) study reported changing their view of the instructor as transmitter of information to facilitator of knowledge to avoid the negative emotion of feeling devalued in online learning environments. Furthermore, faculty reported using cognitive strategies such as rationalization or acceptance by adapting their expectations. For instance, acceptance was the most commonly reported stress management strategy (58%) among the 414 academics, including faculty and research assistants, surveyed in Abouserie (1996) study. Faculty also used rational arguments in the form of self-talk to down-regulate negative emotions such as feeling annoyed: “They are still in that kind of school-girl, school-boy mode, which is pretty normal at this … this stage” ( Hagenauer and Volet, 2014b , p. 271). Also, acceptance of the specific situation by lowering their self-expectations and work standards helped teachers to reduce disappointment, frustration and stress ( Gillespie et al., 2001 ; Hagenauer and Volet, 2014b ). The participants in Abouserie (1996) study also reported lowering their expectations to decrease strain by trying to think that “I am only human being,” though it was not reported as a frequent way of coping. Similar findings were observed by the participants in Gillespie et al. (2001) study who identified practicing stress management techniques such as lowering their standards and self-expectations by withdrawing from voluntary service activities (e.g., leaving committees) as key stress management techniques. Furthermore, the teachers interviewed by Hagnauer and Volet (2014a) reported sharing humor and jokes to facilitate good rapport with students and thereby a relaxed classroom atmosphere.

Evidence from the studies reviewed suggests that cognitive change can yield significantly different outcomes for academics’ well-being depending on how adaptively this strategy is used. For instance, studies of 102 U.S. teaching faculty and 283 Turkish faculty members found utilization of humor to be significantly and negatively associated with burnout ( Tümkaya, 2007 ; Ramsey et al., 2011 ). In contrast, wishful thinking and denial were shown to be maladaptive in predicting lower psychological adjustment in the form of anxiety, depression, somatic symptoms and job dissatisfaction ( Mark and Smith, 2012 ; Kataoka et al., 2014 ). However, contrary to their expectations, they did not find positve reappraisal to be significantly linked to well-being among acadeimics. This finding seems to run counter to the existing empirical findings showing that coping via positive restructuring is related to better psychological health.

Response-focused strategies. According to ( Gross, 1998a ; Gross, 1998b ) model of emotion regulation, academics can also apply a variety of strategies intended not to change their exposure or perceptions of a given stressors (antecedent-focused strategies) but rather to alter the experiential, physiological, and behavioral reactions following from their emotional responses to a stressor (response-focused strategies).

Social support. One such strategy targeted at experiential facets is sharing emotions. For instance, the participants in Hagenauer and Volet (2014b) study indicated that, being aware of the effectiveness of emotion sharing, they expressed their positive and negative emotions with family members and departmental colleagues. However, they believed there were not many opportunities to share and discuss negative emotions and their triggers due to the lonely nature of university teaching profession. Abouserie (1996) also identified using emotion expression strategies such as trying to bring their feeling into the open to deal with stress (e.g., sharing their feelings with friends and others).

The current review also highlights support seeking as an effective stress management strategy among faculty. For instance, the faculty members in Perlberg and Keinan (1986) study reported seeking social support (i.e., talking with a friend or telling jokes) as one of the most effective ways of coping with stress. Similarly, the faculty in Devenport et al. (2008) study unanimously reported managing stress via emotional support as well as professional counseling or psychological services. Abouserie (1996) also identified support seeking through talking with colleagues, involving oneself with friends, and talking about the problem with colleagues as effective coping responses. Their findings support the assertion by Rimé (2007) who contends that emotion sharing is beneficial to psychological well-being due to the social bonds it fosters as well as transference of affection and warmth.

Additionally, the study by Gillespie et al. (2001) reported that the participants relied on social support from family or friends, as well as attending scholarly conferences, as a means of coping with stress. It appears that while preparing manuscripts and presenting in conferences can be stressful, it enabes faculty to discuss work-related problems with collaborators and others. Interestingly, the effectiveness of social support has also been found to be linked to the level of stress faculty experience. For instance, in a survey of 131 tenure-track U.S. faculty members, Lease (1999) found perceptions of social and environmental support from colleagues, administrators, and departmental support staff to be beneficial for psychological adjustment when work-role stressors (i.e., role ambiguity and role insufficiency) were perceived as low in magnitude.

In contrast, the beneficial effect of social support was not evident when faculty perceived high levels of stress resulting from the demands placed on them by their academic roles (e.g., role ambiguity, role conflict, role overload; see Rizzo et al., 1970). This finding thus indicates that social support may not be sufficient to address the psychological challenges posed by lack of clarity over academic roles and responsibilities. Perceived social support was also found to be correlated with better physical and psychological health ( Amatea and Fong, 1991 ; Kataoka et al., 2014 ) as well as negatively associated with maladaptive perfectionism and psychological distress ( Dunn et al., 2006 ).

Physiological strategies. Other emotion management strategies used to reduce stress included modifying one’s physiological state through practices such as deep breathing or expressive gestures aimed at dissipating (vs. internalizing) the emotional experience (e.g., glaring at disruptive students; Gates, 2000a ; Gates, 2000b ). Taking deep breaths allowed teachers to monitor their feelings and assess the consequences of their emotions ( Gates, 2000a ). Faculty also reported taking regular breaks from their work, regularly exercising, and seeking alternative therapies for stress relief (e.g., yoga, massage relaxing; Abouserie 1996 ; Gillespie et al., 2001 ). Such physiologically-oriented strategies are generally found to be beneficial for reducing stress, improving psychological well-being and sleep quality, as well as relieving physical symptoms in other populations (e.g., government employees, school teachers, general university staff; Hartfiel et al., 2012 , Klatt et al., 2009 ; Lin et al., 2015 ).

Other maladaptive strategies. The findings from this review further reveal that to handle stressful experiences some faculty resort to alcohol, substance use and self-blame (e.g., Gillespie et al., 2001 ; Kataoka et al., 2014 ). Consistent with the findings in the broader well-being literature ( Aldwin and Revenson, 1987 ; Single et al., 2000 ; Teesson et al., 2000 ; Skinner and Zimmer-Gembeck, 2016 ), use of these strategies by post-secondary faculty was linked to lower psychological adjustment in the form of severe depression, anxiety, social dysfunction, somatic symptoms and insomnia ( Kataoka et al., 2014 ). Additionally, 19.1% of the 414 academics in Abouserie (1996) study reported that they often retreated to their office, or opted not to go to work at all (10.7%); behaviors implying social withdrawal and stress-related job absenteeism, respectively.

Prevalence and Consequences of Emotional Labor Strategies

As mentioned above, Grandey (2000) likened Gross (2006) antecedent and response-focused types of emotion regulation to ( Hochschild, 1983) concepts of deep and surface-acting, respectively. However, Grandey did assert that emotion regulation processes cannot be directly equated with emotional labor strategies because surface-acting encompasses not only suppression but also amplification and faking of emotions. Furthermore, although deep-acting requires cognitive appraisal, the ultimate goal is not to improve personal well-being but to facilitate their efforts to better convey feelings that appear genuine to others. As such, the findings on faculty emotional labor are presented separately in the section below.

The studies reviewed suggest that academics view emotional labor as an intrinsic aspect of their work. Indeed, emotional labor is so inextricably linked to academics’ profession that for some, it equals professionalism—and to a greater degree than in many other professions ( Berry and Cassidy, 2013 ). Gates (2000a) asserted that faculty emotional management was essential for job satisfaction and effective teaching, and ultimately, student attainment. There are times when faculty express their genuinely felt emotions as well as times when they regulate (i.e., hide, fake, or minimize) their emotions to conform to contextually mandated display rules. As such, whether an emotion is appropriate for a given situation is determined by the tacit display rules of post-secondary institution. Research findings further indicate that academics’ engagement in emotional labor partly derives from the aforementioned changes in higher education organizations and the subsequent ever-intensifying expectations associated with those changes ( Gates, 2000a ; Ogbonna and Harris, 2004 ; Biron et al., 2008 ; McAlpine and Akerlind, 2010 ). Indeed, marketization of higher education has led some scholars to conceptualize students as customers ( Constanti and Gibbs, 2004 ), with academics being increasingly required to perform emotional labor to satisfy their job requirements and support student needs ( Ogbonna and Harris, 2004 ). For example, the following comment from one U.K. university teacher vividly describes the experience of conveying expected positive emotions to students despite internally feeling strong negative emotions: “Sometimes I feel like shouting at them (students) but I know what this will do to my teaching evaluations. I just stand there and pretend to be laughing even though I am fuming inside” ( Ogbonna and Harris, 2004 , p. 1197).

The studies reviewed further reveal that post-secondary faculty are particularly concerned with negative emotions and seek to down-regulate or suppress them (e.g., anger) to stay within the emotional boundaries of their profession. In contrast, faculty are more likely to openly express positive emotions such as enjoyment, humor, and happiness, as long as the display does not include intense emotional reactions ( Gates, 2000a ; Gates, 2000b ; Hagenauer and Volet, 2014b ). For instance, a national sample of 598 U.S. college and university faculty members ( Mahoney et al., 2011 ) consistently reported emotional suppression as a surface-acting emotional labor strategy. Similarly, a later mixed-methods study of 61 U.S. university teachers ( Berry and Cassidy, 2013 ) exploring use of emotional display, suppression, and faking strategies of emotional labor found that suppression was the most frequently used emotional labor strategy, followed by faking. Faculty also reported engaging in suppression of negative emotions, for example, masking or hiding negative emotions such as anger and disappointment during interactions with students, and instead expressing positive emotions (e.g., enthusiasm) or specific negative emotions (e.g., disappointment) that conveyed a belief in students’ potential ( Gates, 2000a ; Gates, 2000b ). Likewise, all participants in Hagenauer and Volet (2014b) study believed that negative emotions needed to be controlled in the classroom, either suppressed or expressed in a norm-accordant manner, in order to appear professional. They also reported suppressing negative emotions resulting from out of classroom issues such as high workload. These findings echo those of studies of school teachers ( Sutton, 2004 ; Aultman et al., 2009 ; Sutton et al., 2009 ).

Interestingly, although studies show academics to consistently report engaging in suppression of emotions, the reported reasons for this behavior vary considerably. While some academics do so for moral reasons, such as caring for their students ( Hagenauer and Volet, 2014b ) or fostering students’ social and emotional development ( Gates, 2000a ), for others emotion suppression is motivated by the belief that students are customers who need to be satisfied ( Constanti and Gibbs, 2004 ). In a qualitative study of 54 U.K. university lecturers, Ogbonna and Harris (2004) found that the participants performed surface-acting emotional labor more commonly than deep-acting, with interactions with students or one’s superiors being particularly likely to elicit surface-acting behavior. The authors further observed the most commonly reported form of deep-acting by faculty to involve the active and conscious attempt to arouse a given emotion. By contrast, Zhang and Zhu (2008) in a survey of 164 Chinese university lecturers found that, of the three dimensions of emotional labor, participants engaged the most in deep-acting and the least in surface-acting. The authors assert that this finding could be due to a prominent Chinese mentality of thinking through emotions and viewing teachers as parents who care for and nurture their students by trying to display appropriate emotions. The findings from the present review suggest that academics consistently engage in emotional labor aimed at 1) constructing an optimal learning environment, 2) nurturing positive student–teacher relationships, 3) serving as role models for their students, or 4) satisfying students and benefitting their post-secondary institutional expectations ( Gates, 2000a ; Gates, 2000b ; Constanti and Gibbs, 2004 ; Hagenauer and Volet, 2014b ).

Studies have further examined the empirical links between emotional labor and well-being as well as employment outcomes in academics ( Pugliesi, 1999 ; Ogbonna and Harris, 2004 ; Mahoney et al., 2011 ; Berry and Cassidy, 2013 ) including personal well-being outcomes such as work stress, psychological distress, and burnout as well as job-related outcomes such as job satisfaction, affective commitment, and career advancement. As for personal well-being consequences, research on post-secondary faculty has found faking of emotions to lead to greater job stress and psychological distress ( Ogbonna and Harris, 2004 ). Additionally, the requirement to suppress job-related stress and negative emotions has been linked to the experience of frustration ( Constanti and Gibbs, 2004 ). Similarly, a study of 2,069 U.S. academics (i.e., faculty and general university staff; Pugliesi, 1999 ) found self-focused emotional labor (e.g., deep-acting) to be less detrimental for job stress and psychological distress than other-focused forms of emotional labor (e.g., attempting to help coworkers feel better about themselves).

Similarly, Mahoney et al. (2011) found genuine expression of negative emotions, faking positive emotions, and suppressing negative emotions to predict greater emotional exhaustion, whereas genuine expression of positive emotions, faking negative emotions, and suppressing positive emotions predicted lower emotional exhaustion. Likewise, Zhang and Zhu (2008) compared the effects of deep-acting and surface-acting strategies in a sample of 164 Chinese university teachers and found that deep-acting predicted lower burnout, whereas surface-acting predicted greater burnout. These findings are aligned with studies of school teachers showing comparable links between emotional labor and burnout (e.g., Näring et al., 2006 ; Lorente Prieto et al., 2008 ) and underscore the potential consequences of emotional labor for personal well-being in faculty.

Additionally, research indicates that emotional labor may correspond with job satisfaction in faculty members, with the relations varying depending on the context and type of labor involved. For instance, Berry and Cassidy (2013) found that although university lecturers reported high levels of emotional labor, they nevertheless felt satisfied with their jobs. A possible explanation for this contradictory finding is that the sample of university lecturers reported that they felt they had some job autonomy. As feelings of job autonomy and control tend to predict better job satisfaction (e.g., Thompson and Prottas, 2006 ), it is possible that this aspect of faculty members’ occupational environment may have mitigated the otherwise negative effects of high emotional labor levels. In contrast, Pugliesi (1999) found that performing self-focused and other-focused emotional labor negatively predicted job satisfaction. Similarly, Mahoney et al. (2011) found genuine expression of negative emotions to predict lower job satisfaction, with genuine expression of positive emotions instead contributing to greater job satisfaction and affective commitment. These authors also found that faking positive emotions and suppressing negative emotions were negatively linked to job satisfaction, whereas faking negative emotions was positively related to job satisfaction.

Additionally, greater emotional labor was reported to benefit faculty with respect to organizational rewards such as career progression ( Ogbonna and Harris, 2004 ). A quotation from a university teacher is illustrative: “It’s about image—creating a brand of “me.” In my place careers are built on teaching portfolios. If you can create an image of yourself as a brilliant teacher—you’ve got it made. I have no problem with faking concern about students if it gets me another increment (point)” ( Ogbonna and Harris, 2004 , p. 1197). Although career growth has generally been linked to higher levels of job satisfaction and commitment (e.g., Maia et al., 2016 ), the sample of U.K. lecturers assessed by Ogbonna and Harris (2004) found high levels of emotional labor due to occupational expectations to correspond with low levels of job satisfaction. Ogbonna and Harris (2004) further found academics to report engaging in emotional labor to contribute to feeling a lack of collegiality and teamwork due to diminished social interaction and a corresponding lack of emotional support from colleagues. These findings are, in general, consistent with studies of school teachers that link higher levels of emotional labor to greater burnout, job dissatisfaction, and health problems (e.g., Kinman et al., 2011 ; Wrobel, 2013 ).

Summary of Review Findings

Post-secondary academic employment poses various stressors for faculty members who are expected to ensure high quality teaching, research, and service in an evolving occupational context. However, despite the emotion laden nature of academic work, there is remarkably little research on the emotional experiences of post-secondary faculty with respect to coping, emotion regulation, and emotional labor processes. Given the significance of these topics for well-being and academic performance, efforts to improve workplace quality in post-secondary institutions should not only emphasize academics’ teaching, research, and service behaviors, but also how they deal with their emotions. As such, the topics of coping, emotion regulation, and emotional labor merit a more prominent niche in studies of academics. To address this research gap, the present paper reviewed the fragmented empirical literature pertaining to the strategies used by post-secondary faculty to cope with stress and regulate their emotions as organized according to the process model of emotion regulation ( Gross, 1998a ; Gross, 1998b ) and emotional labor theories ( Hochschild, 1983 ; Ashforth and Humphrey, 1993 ; Grandey, 2000 ).

There is growing evidence that the academic work has been intensified as a result of the substantial changes to the context of higher education (e.g., Biron et al., 2008 ; McAlpine and Akerlind, 2010 ). Consequently, in order to adequately meet the multiplicity of organizational and occupational demands, faculty are required to show or exaggerate some emotions as well as minimize or suppress the expression of other emotions ( Ogbonna and Harris, 2004 ). Findings from these few studies suggest that academics regularly attempt to not only control their emotions in stressful educational settings, but also to display appropriate emotional responses even if the response is inauthentic. In other words, although published research has consistently established the link between greater emotional inauthenticity (i.e., surface-acting) and lower employee well-being, post-secondary faculty nonetheless regularly perform this type of emotional labor as part of their emotion-related job expectations and their potential benefits for student development and learning.

The findings of the present review, albeit from a limited empirical basis, reveal that post-secondary faculty adopt a variety of coping and emotion regulation strategies. This scant evidence further indicates that the coping and regulatory strategies academics employ have implications for their well-being as well as performance. More specifically, cognitive reappraisal, problem-solving, and social support were found to be adaptive in helping academics reduce stress and maintain their well-being. Conversely, study findings revealed emotion suppression to be prevalent yet have mixed effects among post-secondary faculty, with suppression showing both benefits (e.g., achieving teaching and learning goals, fostering positive interactions with students; Constanti and Gibbs, 2004 ; Gates, 2000b ; Hagenauer and Volet, 2014b ) as well as negative effects for academics (e.g., maintaining and intensifying negative emotions; Hagenauer and Volet, 2014b ). As an illustration, the university teachers interviewed in Hagenauer and Volet (2014b) study indicated that they “boil underneath” if they tried to completely conceal their emotions. Similarly, maladaptive coping responses such as escape, social isolation, and submission were found to be detrimental for psychological and behavioral outcomes in post-secondary faculty ( Brown and Speth, 1988 ; Lease, 1999 ; Dunn et al., 2006 ; Mark and Smith, 2012 ; Kataoka et al., 2014 ).

Additionally, the evidence from limited studies shows emotional labor in post-secondary faculty to have potentially negative consequences for their psychological and occupational well-being. Specifically, when engaging in surface-acting emotional labor, the disparity between truly experienced emotions and external expressions corresponds with higher psychological strain. Further, faculty who reported performing more emotional labor experienced higher levels of job stress, were at a greater risk of developing burnout, and were less satisfied with their work ( Pugliesi, 1999 ; Constanti and Gibbs, 2004 ; Ogbonna and Harris, 2004 ; Mahoney et al., 2011 ). Nevertheless, post-secondary faculty do report viewing emotional labor as an intrinsic element of their academic work ( Berry and Cassidy, 2013 ), suggesting positive links between emotional labor and job satisfaction. Additionally, some evidence suggests that emotional labor may not be entirely detrimental for faculty as it can be perceived by students and others as conveying professionalism and objectivity in the classroom, potentially resulting in career benefits (e.g., better teaching evaluations; Ogbonna and Harris, 2004 ). Furthermore, evidence of job satisfaction despite high levels of emotional labor ( Berry and Cassidy, 2013 ) suggests that fulfilling the emotional demands of faculty position does not necessarily come at the expense of job satisfaction. In conclusion, given the pivotal role of academics in knowledge creation and instruction (e.g., Atkins et al., 2002 ), impaired well-being and performance among faculty has clear implications for quality of academic work, student development, and institutional efficacy ( Lease, 1999 ; Gillespie et al., 2001 ).

Implications of Faculty Emotion Regulation and Emotional Labor

In sum, the findings presented underscore the importance of continued research on the varied types of coping strategies, emotion regulation behaviors, and emotional labor approaches used by faculty in response to academic challenges given clear links to both personal well-being and employment outcomes. Moreover, these findings suggest that post-secondary administrators and support personnel (e.g., department heads, faculty workshop coordinators) are well-advised to raise faculty awareness of the implications of their emotion regulation strategies, and highlight the need for further investigation into avenues for enhancing faculty coping and regulatory skills. Indeed, promoting adaptive emotion regulation is necessary for successful job performance and can help academics deal more effectively with stress and emotions, and thus directly decrease the level of job stress and indirectly protect their well-being and productivity. By implication, stress reduction and health protection in post-secondary faculty could be achieved not only by decreasing work demands, but also by developing their personal resources such as coping and emotion regulation skills ( Gates, 2000b ; Zhang and Zhu, 2008 ; Regan et al., 2012 ; Kataoka et al., 2014 ). University administrators aiming to equip faculty with effective regulatory skills and promote well-being are encouraged to develop related orientation content for new faculty, developing counselling and mental health support for faculty in general, as well as improving training for administrators to better identify and respond to mental health concerns in faculty.

Additionally, university administrators, policy makers, and faculty development programs are ideally positioned to understand the emotional aspects of their primary institutional resources’ work ( Gmelch et al., 1984 ). These stakeholders are thus especially encouraged to take active steps in developing and implementing interventions to raise academics’ awareness regarding coping and emotion regulation strategies and their associated consequences, to promote coping and emotion regulation skills, and to foster academics’ use of effective strategies for improving faculty well-being and performance. Despite the lack of research on academics, research evidence from other occupational groups (e.g., teachers) raises the possibility that training post-secondary faculty to develop more adaptive coping and emotion management skills might result in favorable outcomes that will, by extension, benefit the academic institutions ( Kotsou et al., 2011 ). For example, empirical evidence across occupational settings consistently demonstrates the efficacy of cognitive reappraisal stress management interventions such as cognitive behavioral therapy (CBT; for meta-analytical summaries, see Kim, 2007 ; Richardson and Rothstein, 2008 ; Van der Klink et al., 2001 ). Additionally, mindfulness-based stress reduction (MBSR) programs show a range of cognitive (e.g., enhanced working memory and attention), psychological (i.e., improvements in emotion regulation skills and self-efficacy, decrease in stress, anxiety, emotional exhaustion, and depression as well as increase in positive emotions) and physiological benefits (i.e., improved immune function) among K-12 students and teachers (e.g., Napoli et al., 2005 ; Poulin et al., 2008 ; Roeser et al., 2012 ), university students ( Freeman et al., 2015 ; Ford et al., 2018 ), other occupational groups (e.g., Janssen et al., 2018 ), as well as general population (e.g., Davidson et al., 2003 ; Hölzel et al., 2011 ).

As such, post-secondary administrators are recommended to consider integrating CBT and MBSR interventions into faculty development programs to facilitate adaptive emotion regulation, well-being, and performance in faculty members. Increased health and well-being among post-secondary faculty should, in turn, lead to greater occupational engagement and satisfaction as well as lower levels of faculty burnout and attrition. Increased faculty well-being should also support the formation of positive relationships with students that, in turn, promote students’ sense of belonging, engagement, learning, and achievement. Nonetheless, given research findings showing mindfulness training to be inappropriate for chronically stressed individuals due to negative effects of chronic stress on sustained attention and complex thought processes (e.g., Sapolsky, 1994 ; Arnsten, 1998 ), it is possible that CBT or MBSR may be ineffective for the chronically stressed faculty they are intended to serve. Hence, it is incumbent on administrators to also focus on long-term improvements to academic work environments to make them less emotionally demanding by reducing workloads (e.g., excessive teaching responsibilities faced by non-tenure-track faculty; Baldwin and Wawrzynski, 2011 ), facilitating balance between academic responsibilities (e.g., teaching releases to offset research or administrative demands; Stupnisky et al., 2015 ), clarifying role expectations (e.g., tenure expectations), as well as providing effective physical and mental health resources (e.g., gym memberships, vacation time) and stress management workshops ( Gillespie et al., 2001 ).

With respect to the present findings concerning emotional labor strategies, this review further suggests that higher education institutions are well-advised to encourage deep-acting strategies and discourage surface-acting as part of existing professional development initiatives aimed at improving teaching effectiveness. Moreover, given that social support was consistently found to protect faculty against job stress, institutional efforts to promote faculty collegiality (e.g., regular social events, departmental lecture series) as well as develop collaborative work spaces, team teaching initiatives, and faculty mentorship programs should contribute to greater connectedness, enhanced well-being, and improved teaching and research productivity.

Empirical evidence demonstrates the beneficial effects of such initiatives. For instance, studies of faculty members have shown implementation of mentorship programs to result in favorable outcomes such as higher retention rates, improvement in self-perceived abilities, and higher academic success rates as measured by number of peer-reviewed publications, leadership and professional activities, honors, and awards ( Zeind et al., 2005 ; Ries et al., 2012 ; Jackevicius et al., 2014 ). Additionally, existing studies highlight the potential benefits of team teaching initiatives for faculty members, including deepened pedagogical knowledge, improvements in teaching skills and effectiveness, higher motivation to teach, overcoming feelings of isolation by creating a sense of community, and enhanced conflict management skills ( Robinson and Schaible, 1995 ; Cohen and DeLoise, 2002 ; Kluth and Straut, 2003 ; Lester and Evans, 2008 ). Furthermore, social activities have been shown to foster integration and social cohesion in faculty members ( Lindholm, 2003 ) and particularly among pre-tenure faculty ( Fleming et al., 2016 ).

Limitations and Future Directions

The methodologies of the studies reveiwed had multiple limitations, many of which were recognized by authors of the respective studies. Firstly, 12 of the 22 studies employed only quantitative analyses and thus failed to capture the full complexity of academics’ lived experiences concerning their challenges and emotion regulation otherwise afforded by qualitative protocols ( Creswell and Creswell, 2017 ). Second, the few studies that investigated emotion regulation among faculty focused largely on negative emotions such as anger, burnout, and stress, thus neglecting the potential benefits of upregulation of positive emotions on well-being and performance ( Fredrickson, 2000 ; Fredrickson, 2001 ; Folkman, 2008 ; Fredrickson, 2013 ; Quoidbach et al., 2015 ). Third, the majority of the studies focused on how academics regulate their teaching-related emotions, thereby neglecting various other domains of academic work such as research, service, or administration. Considering recent empirical evidence regarding the domain specificity of emotional experiences in post-secondary faculty (e.g., teaching vs. research; Stupnisky et al., 2014 ), future studies are encouraged to explore the strategies academics employ to regulate their emotions in domains other than teaching.

Fourth, a majority of the studies reviewed drew on populations from single organizations thus raising concerns of generalizability to academics at large. Hence, future studies are encouraged to draw on larger numbers of academics from varied institution types (e.g., colleges, trade schools, universities; teaching vs. research intensive schools) to better ascertain the external validity of the study findings. Relatedly, although the studies reviewed were conducted across several countries (e.g., U.K., U.S., Canada, Australia, Japan), there are to date insufficient studies conducted within a given cultural context or geographical setting to allow for generalizations as to how cultural or geographic differences may moderate the prevalence and effects of emotion regulation and coping in faculty. Fifth, all but two studies ( Constanti and Gibbs, 2004 ; Gates, 2000a ; Gates, 2000b ) employed exclusively self-report measures that are susceptible to response biases warranting that future research also investigate academics’ coping and emotion regulation strategies using more objective assessments such as observations, experience sampling, and physiological markers ( Spector, 2006 ; Paulhus and Vazire, 2007 ; Pekrun and Bühner, 2014 ).

Finally, given that multiple studies reported data from aggregate samples that included both faculty and non-faculty participants (e.g., researchers, administrators, see Amatea and Fong-Beyette, 1987 ; Gillespie et al., 2001 ), it was not possible in these studies to more closely examine factors that pertain specifically to post-secondary faculty (e.g., thesis supervision, tenure pressures). Accordingly, further research on stress management and emotion regulation in post-secondary faculty specifically, as well as further differentiation between disparate types of faculty employment (e.g., non-tenure-track vs. tenure-track employment; Hall, 2019 ), are needed to better examine the role of coping, emotion regulation, and emotional labor among faculty in the context of modern academic employment.

Author Contributions

Conceptualization, RS; methodology, RS; writing—original draft preparation, RS; writing—review and editing, NCH, RS, and AS; supervision, AS; funding acquisition. RS.

This research was funded by Fonds de Recherche duQuébec-Sociétéet Culture (fund number: 192306).

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/feduc.2021.660676/full#supplementary-material

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Keywords: post-secondary faculty, stress, coping, emotions, emotion regulation

Citation: Salimzadeh R, Hall NC and Saroyan A (2021) Examining Academics’ Strategies for Coping With Stress and Emotions: A Review of Research. Front. Educ. 6:660676. doi: 10.3389/feduc.2021.660676

Received: 29 January 2021; Accepted: 23 August 2021; Published: 20 September 2021.

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*Correspondence: Raheleh Salimzadeh, [email protected]

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Article contents

Work, stress, coping, and stress management.

• Sharon Glazer Sharon Glazer University of Baltimore
•  and  Cong Liu Cong Liu Hofstra University
• https://doi.org/10.1093/acrefore/9780190236557.013.30
• Published online: 26 April 2017

Work stress refers to the process of job stressors, or stimuli in the workplace, leading to strains, or negative responses or reactions. Organizational development refers to a process in which problems or opportunities in the work environment are identified, plans are made to remediate or capitalize on the stimuli, action is taken, and subsequently the results of the plans and actions are evaluated. When organizational development strategies are used to assess work stress in the workplace, the actions employed are various stress management interventions. Two key factors tying work stress and organizational development are the role of the person and the role of the environment. In order to cope with work-related stressors and manage strains, organizations must be able to identify and differentiate between factors in the environment that are potential sources of stressors and how individuals perceive those factors. Primary stress management interventions focus on preventing stressors from even presenting, such as by clearly articulating workers’ roles and providing necessary resources for employees to perform their job. Secondary stress management interventions focus on a person’s appraisal of job stressors as a threat or challenge, and the person’s ability to cope with the stressors (presuming sufficient internal resources, such as a sense of meaningfulness in life, or external resources, such as social support from a supervisor). When coping is not successful, strains may develop. Tertiary stress management interventions attempt to remediate strains, by addressing the consequence itself (e.g., diabetes management) and/or the source of the strain (e.g., reducing workload). The person and/or the organization may be the targets of the intervention. The ultimate goal of stress management interventions is to minimize problems in the work environment, intensify aspects of the work environment that create a sense of a quality work context, enable people to cope with stressors that might arise, and provide tools for employees and organizations to manage strains that might develop despite all best efforts to create a healthy workplace.

• stress management
• organization development
• organizational interventions
• stress theories and frameworks

Introduction

Work stress is a generic term that refers to work-related stimuli (aka job stressors) that may lead to physical, behavioral, or psychological consequences (i.e., strains) that affect both the health and well-being of the employee and the organization. Not all stressors lead to strains, but all strains are a result of stressors, actual or perceived. Common terms often used interchangeably with work stress are occupational stress, job stress, and work-related stress. Terms used interchangeably with job stressors include work stressors, and as the specificity of the type of stressor might include psychosocial stressor (referring to the psychological experience of work demands that have a social component, e.g., conflict between two people; Hauke, Flintrop, Brun, & Rugulies, 2011 ), hindrance stressor (i.e., a stressor that prevents goal attainment; Cavanaugh, Boswell, Roehling, & Boudreau, 2000 ), and challenge stressor (i.e., a stressor that is difficult, but attainable and possibly rewarding to attain; Cavanaugh et al., 2000 ).

Stress in the workplace continues to be a highly pervasive problem, having both direct negative effects on individuals experiencing it and companies paying for it, and indirect costs vis à vis lost productivity (Dopkeen & DuBois, 2014 ). For example, U.K. public civil servants’ work-related stress rose from 10.8% in 2006 to 22.4% in 2013 and about one-third of the workforce has taken more than 20 days of leave due to stress-related ill-health, while well over 50% are present at work when ill (French, 2015 ). These findings are consistent with a report by the International Labor Organization (ILO, 2012 ), whereby 50% to 60% of all workdays are lost due to absence attributed to factors associated with work stress.

The prevalence of work-related stress is not diminishing despite improvements in technology and employment rates. The sources of stress, such as workload, seem to exacerbate with improvements in technology (Coovert & Thompson, 2003 ). Moreover, accessibility through mobile technology and virtual computer terminals is linking people to their work more than ever before (ILO, 2012 ; Tarafdar, Tu, Ragu-Nathan, & Ragu-Nathan, 2007 ). Evidence of this kind of mobility and flexibility is further reinforced in a June 2007 survey of 4,025 email users (over 13 years of age); AOL reported that four in ten survey respondents reported planning their vacations around email accessibility and 83% checked their emails at least once a day while away (McMahon, 2007 ). Ironically, despite these mounting work-related stressors and clear financial and performance outcomes, some individuals are reporting they are less “stressed,” but only because “stress has become the new normal” (Jayson, 2012 , para. 4).

This new normal is likely the source of psychological and physiological illness. Siegrist ( 2010 ) contends that conditions in the workplace, particularly psychosocial stressors that are perceived as unfavorable relationships with others and self, and an increasingly sedentary lifestyle (reinforced with desk jobs) are increasingly contributing to cardiovascular disease. These factors together justify a need to continue on the path of helping individuals recognize and cope with deleterious stressors in the work environment and, equally important, to find ways to help organizations prevent harmful stressors over which they have control, as well as implement policies or mechanisms to help employees deal with these stressors and subsequent strains. Along with a greater focus on mitigating environmental constraints are interventions that can be used to prevent anxiety, poor attitudes toward the workplace conditions and arrangements, and subsequent cardiovascular illness, absenteeism, and poor job performance (Siegrist, 2010 ).

Even the ILO has presented guidance on how the workplace can help prevent harmful job stressors (aka hindrance stressors) or at least help workers cope with them. Consistent with the view that well-being is not the absence of stressors or strains and with the view that positive psychology offers a lens for proactively preventing stressors, the ILO promotes increasing preventative risk assessments, interventions to prevent and control stressors, transparent organizational communication, worker involvement in decision-making, networks and mechanisms for workplace social support, awareness of how working and living conditions interact, safety, health, and well-being in the organization (ILO, n.d. ). The field of industrial and organizational (IO) psychology supports the ILO’s recommendations.

IO psychology views work stress as the process of a person’s interaction with multiple aspects of the work environment, job design, and work conditions in the organization. Interventions to manage work stress, therefore, focus on the psychosocial factors of the person and his or her relationships with others and the socio-technical factors related to the work environment and work processes. Viewing work stress from the lens of the person and the environment stems from Kurt Lewin’s ( 1936 ) work that stipulates a person’s state of mental health and behaviors are a function of the person within a specific environment or situation. Aspects of the work environment that affect individuals’ mental states and behaviors include organizational hierarchy, organizational climate (including processes, policies, practices, and reward structures), resources to support a person’s ability to fulfill job duties, and management structure (including leadership). Job design refers to each contributor’s tasks and responsibilities for fulfilling goals associated with the work role. Finally, working conditions refers not only to the physical environment, but also the interpersonal relationships with other contributors.

Each of the conditions that are identified in the work environment may be perceived as potentially harmful or a threat to the person or as an opportunity. When a stressor is perceived as a threat to attaining desired goals or outcomes, the stressor may be labeled as a hindrance stressor (e.g., LePine, Podsakoff, & Lepine, 2005 ). When the stressor is perceived as an opportunity to attain a desired goal or end state, it may be labeled as a challenge stressor. According to LePine and colleagues’ ( 2005 ), both challenge (e.g., time urgency, workload) and hindrance (e.g., hassles, role ambiguity, role conflict) stressors could lead to strains (as measured by “anxiety, depersonalization, depression, emotional exhaustion, frustration, health complaints, hostility, illness, physical symptoms, and tension” [p. 767]). However, challenge stressors positively relate with motivation and performance, whereas hindrance stressors negatively relate with motivation and performance. Moreover, motivation and strains partially mediate the relationship between hindrance and challenge stressors with performance.

Figure 1. Organizational development frameworks to guide identification of work stress and interventions.

In order to (1) minimize any potential negative effects from stressors, (2) increase coping skills to deal with stressors, or (3) manage strains, organizational practitioners or consultants will devise organizational interventions geared toward prevention, coping, and/or stress management. Ultimately, toxic factors in the work environment can have deleterious effects on a person’s physical and psychological well-being, as well as on an organization’s total health. It behooves management to take stock of the organization’s health, which includes the health and well-being of its employees, if the organization wishes to thrive and be profitable. According to Page and Vella-Brodrick’s ( 2009 ) model of employee well-being, employee well-being results from subjective well-being (i.e., life satisfaction and general positive or negative affect), workplace well-being (composed of job satisfaction and work-specific positive or negative affect), and psychological well-being (e.g., self-acceptance, positive social relations, mastery, purpose in life). Job stressors that become unbearable are likely to negatively affect workplace well-being and thus overall employee well-being. Because work stress is a major organizational pain point and organizations often employ organizational consultants to help identify and remediate pain points, the focus here is on organizational development (OD) frameworks; several work stress frameworks are presented that together signal areas where organizations might focus efforts for change in employee behaviors, attitudes, and performance, as well as the organization’s performance and climate. Work stress, interventions, and several OD and stress frameworks are depicted in Figure 1 .

The goals are: (1) to conceptually define and clarify terms associated with stress and stress management, particularly focusing on organizational factors that contribute to stress and stress management, and (2) to present research that informs current knowledge and practices on workplace stress management strategies. Stressors and strains will be defined, leading OD and work stress frameworks that are used to organize and help organizations make sense of the work environment and the organization’s responsibility in stress management will be explored, and stress management will be explained as an overarching thematic label; an area of study and practice that focuses on prevention (primary) interventions, coping (secondary) interventions, and managing strains (tertiary) interventions; as well as the label typically used to denote tertiary interventions. Suggestions for future research and implications toward becoming a healthy organization are presented.

Defining Stressors and Strains

Work-related stressors or job stressors can lead to different kinds of strains individuals and organizations might experience. Various types of stress management interventions, guided by OD and work stress frameworks, may be employed to prevent or cope with job stressors and manage strains that develop(ed).

A job stressor is a stimulus external to an employee and a result of an employee’s work conditions. Example job stressors include organizational constraints, workplace mistreatments (such as abusive supervision, workplace ostracism, incivility, bullying), role stressors, workload, work-family conflicts, errors or mistakes, examinations and evaluations, and lack of structure (Jex & Beehr, 1991 ; Liu, Spector, & Shi, 2007 ; Narayanan, Menon, & Spector, 1999 ). Although stressors may be categorized as hindrances and challenges, there is not yet sufficient information to be able to propose which stress management interventions would better serve to reduce those hindrance stressors or to reduce strain-producing challenge stressors while reinforcing engagement-producing challenge stressors.

Organizational Constraints

Organizational constraints may be hindrance stressors as they prevent employees from translating their motivation and ability into high-level job performance (Peters & O’Connor, 1980 ). Peters and O’Connor ( 1988 ) defined 11 categories of organizational constraints: (1) job-related information, (2) budgetary support, (3) required support, (4) materials and supplies, (5) required services and help from others, (6) task preparation, (7) time availability, (8) the work environment, (9) scheduling of activities, (10) transportation, and (11) job-relevant authority. The inhibiting effect of organizational constraints may be due to the lack of, inadequacy of, or poor quality of these categories.

Workplace Mistreatment

Workplace mistreatment presents a cluster of interpersonal variables, such as interpersonal conflict, bullying, incivility, and workplace ostracism (Hershcovis, 2011 ; Tepper & Henle, 2011 ). Typical workplace mistreatment behaviors include gossiping, rude comments, showing favoritism, yelling, lying, and ignoring other people at work (Tepper & Henle, 2011 ). These variables relate to employees’ psychological well-being, physical well-being, work attitudes (e.g., job satisfaction and organizational commitment), and turnover intention (e.g., Hershcovis, 2011 ; Spector & Jex, 1998 ). Some researchers differentiated the source of mistreatment, such as mistreatment from one’s supervisor versus mistreatment from one’s coworker (e.g., Bruk-Lee & Spector, 2006 ; Frone, 2000 ; Liu, Liu, Spector, & Shi, 2011 ).

Role Stressors

Role stressors are demands, constraints, or opportunities a person perceives to be associated, and thus expected, with his or her work role(s) across various situations. Three commonly studied role stressors are role ambiguity, role conflict, and role overload (Glazer & Beehr, 2005 ; Kahn, Wolfe, Quinn, Snoek, & Rosenthal, 1964 ). Role ambiguity in the workplace occurs when an employee lacks clarity regarding what performance-related behaviors are expected of him or her. Role conflict refers to situations wherein an employee receives incompatible role requests from the same or different supervisors or the employee is asked to engage in work that impedes his or her performance in other work or nonwork roles or clashes with his or her values. Role overload refers to excessive demands and insufficient time (quantitative) or knowledge (qualitative) to complete the work. The construct is often used interchangeably with workload, though role overload focuses more on perceived expectations from others about one’s workload. These role stressors significantly relate to low job satisfaction, low organizational commitment, low job performance, high tension or anxiety, and high turnover intention (Abramis, 1994 ; Glazer & Beehr, 2005 ; Jackson & Schuler, 1985 ).

Excessive workload is one of the most salient stressors at work (e.g., Liu et al., 2007 ). There are two types of workload: quantitative and qualitative workload (LaRocco, Tetrick, & Meder, 1989 ; Parasuraman & Purohit, 2000 ). Quantitative workload refers to the excessive amount of work one has. In a summary of a Chartered Institute of Personnel & Development Report from 2006 , Dewe and Kompier ( 2008 ) noted that quantitative workload was one of the top three stressors workers experienced at work. Qualitative workload refers to the difficulty of work. Workload also differs by the type of the load. There are mental workload and physical workload (Dwyer & Ganster, 1991 ). Excessive physical workload may result in physical discomfort or illness. Excessive mental workload will cause psychological distress such as anxiety or frustration (Bowling & Kirkendall, 2012 ). Another factor affecting quantitative workload is interruptions (during the workday). Lin, Kain, and Fritz ( 2013 ) found that interruptions delay completion of job tasks, thus adding to the perception of workload.

Work-Family Conflict

Work-family conflict is a form of inter-role conflict in which demands from one’s work domain and one’s family domain are incompatible to some extent (Greenhaus & Beutell, 1985 ). Work can interfere with family (WIF) and/or family can interfere with work (FIW) due to time-related commitments to participating in one domain or another, incompatible behavioral expectations, or when strains in one domain carry over to the other (Greenhaus & Beutell, 1985 ). Work-family conflict significantly relates to work-related outcomes (e.g., job satisfaction, organizational commitment, turnover intention, burnout, absenteeism, job performance, job strains, career satisfaction, and organizational citizenship behaviors), family-related outcomes (e.g., marital satisfaction, family satisfaction, family-related performance, family-related strains), and domain-unspecific outcomes (e.g., life satisfaction, psychological strain, somatic or physical symptoms, depression, substance use or abuse, and anxiety; Amstad, Meier, Fasel, Elfering, & Semmer, 2011 ).

Individuals and organizations can experience work-related strains. Sometimes organizations will experience strains through the employee’s negative attitudes or strains, such as that a worker’s absence might yield lower production rates, which would roll up into an organizational metric of organizational performance. In the industrial and organizational (IO) psychology literature, organizational strains are mostly observed as macro-level indicators, such as health insurance costs, accident-free days, and pervasive problems with company morale. In contrast, individual strains, usually referred to as job strains, are internal to an employee. They are responses to work conditions and relate to health and well-being of employees. In other words, “job strains are adverse reactions employees have to job stressors” (Spector, Chen, & O’Connell, 2000 , p. 211). Job strains tend to fall into three categories: behavioral, physical, and psychological (Jex & Beehr, 1991 ).

Behavioral strains consist of actions that employees take in response to job stressors. Examples of behavioral strains include employees drinking alcohol in the workplace or intentionally calling in sick when they are not ill (Spector et al., 2000 ). Physical strains consist of health symptoms that are physiological in nature that employees contract in response to job stressors. Headaches and ulcers are examples of physical strains. Lastly, psychological strains are emotional reactions and attitudes that employees have in response to job stressors. Examples of psychological strains are job dissatisfaction, anxiety, and frustration (Spector et al., 2000 ). Interestingly, research studies that utilize self-report measures find that most job strains experienced by employees tend to be psychological strains (Spector et al., 2000 ).

Leading Frameworks

Organizations that are keen on identifying organizational pain points and remedying them through organizational campaigns or initiatives often discover the pain points are rooted in work-related stressors and strains and the initiatives have to focus on reducing workers’ stress and increasing a company’s profitability. Through organizational climate surveys, for example, companies discover that aspects of the organization’s environment, including its policies, practices, reward structures, procedures, and processes, as well as employees at all levels of the company, are contributing to the individual and organizational stress. Recent studies have even begun to examine team climates for eustress and distress assessed in terms of team members’ homogenous psychological experience of vigor, efficacy, dedication, and cynicism (e.g., Kożusznik, Rodriguez, & Peiro, 2015 ).

Each of the frameworks presented advances different aspects that need to be identified in order to understand the source and potential remedy for stressors and strains. In some models, the focus is on resources, in others on the interaction of the person and environment, and in still others on the role of the person in the workplace. Few frameworks directly examine the role of the organization, but the organization could use these frameworks to plan interventions that would minimize stressors, cope with existing stressors, and prevent and/or manage strains. One of the leading frameworks in work stress research that is used to guide organizational interventions is the person and environment (P-E) fit (French & Caplan, 1972 ). Its precursor is the University of Michigan Institute for Social Research’s (ISR) role stress model (Kahn, Wolfe, Quinn, Snoek, & Rosenthal, 1964 ) and Lewin’s Field Theory. Several other theories have since evolved from the P-E fit framework, including Karasek and Theorell’s ( 1990 ), Karasek ( 1979 ) Job Demands-Control Model (JD-C), the transactional framework (Lazarus & Folkman, 1984 ), Conservation of Resources (COR) theory (Hobfoll, 1989 ), and Siegrist’s ( 1996 ) Effort-Reward Imbalance (ERI) Model.

Field Theory

The premise of Kahn et al.’s ( 1964 ) role stress theory is Lewin’s ( 1997 ) Field Theory. Lewin purported that behavior and mental events are a dynamic function of the whole person, including a person’s beliefs, values, abilities, needs, thoughts, and feelings, within a given situation (field or environment), as well as the way a person represents his or her understanding of the field and behaves in that space. Lewin explains that work-related strains are a result of individuals’ subjective perceptions of objective factors, such as work roles, relationships with others in the workplace, as well as personality indicators, and can be used to predict people’s reactions, including illness. Thus, to make changes to an organizational system, it is necessary to understand a field and try to move that field from the current state to the desired state. Making this move necessitates identifying mechanisms influencing individuals.

Role Stress Theory

Role stress theory mostly isolates the perspective a person has about his or her work-related responsibilities and expectations to determine how those perceptions relate with a person’s work-related strains. However, those relationships have been met with somewhat varied results, which Glazer and Beehr ( 2005 ) concluded might be a function of differences in culture, an environmental factor often neglected in research. Kahn et al.’s ( 1964 ) role stress theory, coupled with Lewin’s ( 1936 ) Field Theory, serves as the foundation for the P-E fit theory. Lewin ( 1936 ) wrote, “Every psychological event depends upon the state of the person and at the same time on the environment” (p. 12). Researchers of IO psychology have narrowed the environment to the organization or work team. This narrowed view of the organizational environment is evident in French and Caplan’s ( 1972 ) P-E fit framework.

Person-Environment Fit Theory

The P-E fit framework focuses on the extent to which there is congruence between the person and a given environment, such as the organization (Caplan, 1987 ; Edwards, 2008 ). For example, does the person have the necessary skills and abilities to fulfill an organization’s demands, or does the environment support a person’s desire for autonomy (i.e., do the values align?) or fulfill a person’s needs (i.e., a person’s needs are rewarded). Theoretically and empirically, the greater the person-organization fit, the greater a person’s job satisfaction and organizational commitment, the less a person’s turnover intention and work-related stress (see meta-analyses by Assouline & Meir, 1987 ; Kristof-Brown, Zimmerman, & Johnson, 2005 ; Verquer, Beehr, & Wagner, 2003 ).

Job Demands-Control/Support (JD-C/S) and Job Demands-Resources (JD-R) Model

Focusing more closely on concrete aspects of work demands and the extent to which a person perceives he or she has control or decision latitude over those demands, Karasek ( 1979 ) developed the JD-C model. Karasek and Theorell ( 1990 ) posited that high job demands under conditions of little decision latitude or control yield high strains, which have varied implications on the health of an organization (e.g., in terms of high turnover, employee ill-health, poor organizational performance). This theory was modified slightly to address not only control, but also other resources that could protect a person from unruly job demands, including support (aka JD-C/S, Johnson & Hall, 1988 ; and JD-R, Bakker, van Veldhoven, & Xanthopoulou, 2010 ). Whether focusing on control or resources, both they and job demands are said to reflect workplace characteristics, while control and resources also represent coping strategies or tools (Siegrist, 2010 ).

Despite the glut of research testing the JD-C and JD-R, results are somewhat mixed. Testing the interaction between job demands and control, Beehr, Glaser, Canali, and Wallwey ( 2001 ) did not find empirical support for the JD-C theory. However, Dawson, O’Brien, and Beehr ( 2016 ) found that high control and high support buffered against the independent deleterious effects of interpersonal conflict, role conflict, and organizational politics (demands that were categorized as hindrance stressors) on anxiety, as well as the effects of interpersonal conflict and organizational politics on physiological symptoms, but control and support did not moderate the effects between challenge stressors and strains. Coupled with Bakker, Demerouti, and Sanz-Vergel’s ( 2014 ) note that excessive job demands are a source of strain, but increased job resources are a source of engagement, Dawson et al.’s results suggest that when an organization identifies that demands are hindrances, it can create strategies for primary (preventative) stress management interventions and attempt to remove or reduce such work demands. If the demands are challenging, though manageable, but latitude to control the challenging stressors and support are insufficient, the organization could modify practices and train employees on adopting better strategies for meeting or coping (secondary stress management intervention) with the demands. Finally, if the organization can neither afford to modify the demands or the level of control and support, it will be necessary for the organization to develop stress management (tertiary) interventions to deal with the inevitable strains.

Conservation of Resources Theory

The idea that job resources reinforce engagement in work has been propagated in Hobfoll’s ( 1989 ) Conservation of Resources (COR) theory. COR theory also draws on the foundational premise that people’s mental health is a function of the person and the environment, forwarding that how people interpret their environment (including the societal context) affects their stress levels. Hobfoll focuses on resources such as objects, personal characteristics, conditions, or energies as particularly instrumental to minimizing strains. He asserts that people do whatever they can to protect their valued resources. Thus, strains develop when resources are threatened to be taken away, actually taken away, or when additional resources are not attainable after investing in the possibility of gaining more resources (Hobfoll, 2001 ). By extension, organizations can invest in activities that would minimize resource loss and create opportunities for resource gains and thus have direct implications for devising primary and secondary stress management interventions.

Transactional Framework

Lazarus and Folkman ( 1984 ) developed the widely studied transactional framework of stress. This framework holds as a key component the cognitive appraisal process. When individuals perceive factors in the work environment as a threat (i.e., primary appraisal), they will scan the available resources (external or internal to himself or herself) to cope with the stressors (i.e., secondary appraisal). If the coping resources provide minimal relief, strains develop. Until recently, little attention has been given to the cognitive appraisal associated with different work stressors (Dewe & Kompier, 2008 ; Liu & Li, 2017 ). In a study of Polish and Spanish social care service providers, stressors appraised as a threat related positively to burnout and less engagement, but stressors perceived as challenges yielded greater engagement and less burnout (Kożusznik, Rodriguez, & Peiro, 2012 ). Similarly, Dawson et al. ( 2016 ) found that even with support and control resources, hindrance demands were more strain-producing than challenge demands, suggesting that appraisal of the stressor is important. In fact, “many people respond well to challenging work” (Beehr et al., 2001 , p. 126). Kożusznik et al. ( 2012 ) recommend training employees to change the way they view work demands in order to increase engagement, considering that part of the problem may be about how the person appraises his or her environment and, thus, copes with the stressors.

Effort-Reward Imbalance

Siegrist’s ( 1996 ) Model of Effort-Reward Imbalance (ERI) focuses on the notion of social reciprocity, such that a person fulfills required work tasks in exchange for desired rewards (Siegrist, 2010 ). ERI sheds light on how an imbalance in a person’s expectations of an organization’s rewards (e.g., pay, bonus, sense of advancement and development, job security) in exchange for a person’s efforts, that is a break in one’s work contract, leads to negative responses, including long-term ill-health (Siegrist, 2010 ; Siegrist et al., 2014 ). In fact, prolonged perception of a work contract imbalance leads to adverse health, including immunological problems and inflammation, which contribute to cardiovascular disease (Siegrist, 2010 ). The model resembles the relational and interactional psychological contract theory in that it describes an employee’s perception of the terms of the relationship between the person and the workplace, including expectations of performance, job security, training and development opportunities, career progression, salary, and bonuses (Thomas, Au, & Ravlin, 2003 ). The psychological contract, like the ERI model, focuses on social exchange. Furthermore, the psychological contract, like stress theories, are influenced by cultural factors that shape how people interpret their environments (Glazer, 2008 ; Thomas et al., 2003 ). Violations of the psychological contract will negatively affect a person’s attitudes toward the workplace and subsequent health and well-being (Siegrist, 2010 ). To remediate strain, Siegrist ( 2010 ) focuses on both the person and the environment, recognizing that the organization is particularly responsible for changing unfavorable work conditions and the person is responsible for modifying his or her reactions to such conditions.

Stress Management Interventions: Primary, Secondary, and Tertiary

Remediation of work stress and organizational development interventions are about realigning the employee’s experiences in the workplace with factors in the environment, as well as closing the gap between the current environment and the desired environment. Work stress develops when an employee perceives the work demands to exceed the person’s resources to cope and thus threatens employee well-being (Dewe & Kompier, 2008 ). Likewise, an organization’s need to change arises when forces in the environment are creating a need to change in order to survive (see Figure 1 ). Lewin’s ( 1951 ) Force Field Analysis, the foundations of which are in Field Theory, is one of the first organizational development intervention tools presented in the social science literature. The concept behind Force Field Analysis is that in order to survive, organizations must adapt to environmental forces driving a need for organizational change and remove restraining forces that create obstacles to organizational change. In order to do this, management needs to delineate the current field in which the organization is functioning, understand the driving forces for change, identify and dampen or eliminate the restraining forces against change. Several models for analyses may be applied, but most approaches are variations of organizational climate surveys.

Through organizational surveys, workers provide management with a snapshot view of how they perceive aspects of their work environment. Thus, the view of the health of an organization is a function of several factors, chief among them employees’ views (i.e., the climate) about the workplace (Lewin, 1951 ). Indeed, French and Kahn ( 1962 ) posited that well-being depends on the extent to which properties of the person and properties of the environment align in terms of what a person requires and the resources available in a given environment. Therefore, only when properties of the person and properties of the environment are sufficiently understood can plans for change be developed and implemented targeting the environment (e.g., change reporting structures to relieve, and thus prevent future, communication stressors) and/or the person (e.g., providing more autonomy, vacation days, training on new technology). In short, climate survey findings can guide consultants about the emphasis for organizational interventions: before a problem arises aka stress prevention, e.g., carefully crafting job roles), when a problem is present, but steps are taken to mitigate their consequences (aka coping, e.g., providing social support groups), and/or once strains develop (aka. stress management, e.g., healthcare management policies).

For each of the primary (prevention), secondary (coping), and tertiary (stress management) techniques the target for intervention can be the entire workforce, a subset of the workforce, or a specific person. Interventions that target the entire workforce may be considered organizational interventions, as they have direct implications on the health of all individuals and consequently the health of the organization. Several interventions categorized as primary and secondary interventions may also be implemented after strains have developed and after it has been discerned that a person or the organization did not do enough to mitigate stressors or strains (see Figure 1 ). The designation of many of the interventions as belonging to one category or another may be viewed as merely a suggestion.

Primary Interventions (Preventative Stress Management)

Before individuals begin to perceive work-related stressors, organizations engage in stress prevention strategies, such as providing people with resources (e.g., computers, printers, desk space, information about the job role, organizational reporting structures) to do their jobs. However, sometimes the institutional structures and resources are insufficient or ambiguous. Scholars and practitioners have identified several preventative stress management strategies that may be implemented.

Planning and Time Management

When employees feel quantitatively overloaded, sometimes the remedy is improving the employees’ abilities to plan and manage their time (Quick, Quick, Nelson, & Hurrell, 2003 ). Planning is a future-oriented activity that focuses on conceptual and comprehensive work goals. Time management is a behavior that focuses on organizing, prioritizing, and scheduling work activities to achieve short-term goals. Given the purpose of time management, it is considered a primary intervention, as engaging in time management helps to prevent work tasks from mounting and becoming unmanageable, which would subsequently lead to adverse outcomes. Time management comprises three fundamental components: (1) establishing goals, (2) identifying and prioritizing tasks to fulfill the goals, and (3) scheduling and monitoring progress toward goal achievement (Peeters & Rutte, 2005 ). Workers who employ time management have less role ambiguity (Macan, Shahani, Dipboye, & Philips, 1990 ), psychological stress or strain (Adams & Jex, 1999 ; Jex & Elaqua, 1999 ; Macan et al., 1990 ), and greater job satisfaction (Macan, 1994 ). However, Macan ( 1994 ) did not find a relationship between time management and performance. Still, Claessens, van Eerde, Rutte, and Roe ( 2004 ) found that perceived control of time partially mediated the relationships between planning behavior (an indicator of time management), job autonomy, and workload on one hand, and job strains, job satisfaction, and job performance on the other hand. Moreover, Peeters and Rutte ( 2005 ) observed that teachers with high work demands and low autonomy experienced more burnout when they had poor time management skills.

Person-Organization Fit

Just as it is important for organizations to find the right person for the job and organization, so is it the responsibility of a person to choose to work at the right organization—an organization that fulfills the person’s needs and upholds the values important to the individual, as much as the person fulfills the organization’s needs and adapts to its values. When people fit their employing organizations they are setting themselves up for experiencing less strain-producing stressors (Kristof-Brown et al., 2005 ). In a meta-analysis of 62 person-job fit studies and 110 person-organization fit studies, Kristof-Brown et al. ( 2005 ) found that person-job fit had a negative correlation with indicators of job strain. In fact, a primary intervention of career counseling can help to reduce stress levels (Firth-Cozens, 2003 ).

Job Redesign

The Job Demands-Control/Support (JD-C/S), Job Demands-Resources (JD-R), and transactional models all suggest that factors in the work context require modifications in order to reduce potential ill-health and poor organizational performance. Drawing on Hackman and Oldham’s ( 1980 ) Job Characteristics Model, it is possible to assess with the Job Diagnostics Survey (JDS) the current state of work characteristics related to skill variety, task identity, task significance, autonomy, and feedback. Modifying those aspects would help create a sense of meaningfulness, sense of responsibility, and feeling of knowing how one is performing, which subsequently affects a person’s well-being as identified in assessments of motivation, satisfaction, improved performance, and reduced withdrawal intentions and behaviors. Extending this argument to the stress models, it can be deduced that reducing uncertainty or perceived unfairness that may be associated with a person’s perception of these work characteristics, as well as making changes to physical characteristics of the environment (e.g., lighting, seating, desk, air quality), nature of work (e.g., job responsibilities, roles, decision-making latitude), and organizational arrangements (e.g., reporting structure and feedback mechanisms), can help mitigate against numerous ill-health consequences and reduced organizational performance. In fact, Fried et al. ( 2013 ) showed that healthy patients of a medical clinic whose jobs were excessively low (i.e., monotonous) or excessively high (i.e., overstimulating) on job enrichment (as measured by the JDS) had greater abdominal obesity than those whose jobs were optimally enriched. By taking stock of employees’ perceptions of the current work situation, managers might think about ways to enhance employees’ coping toolkit, such as training on how to deal with difficult clients or creating stimulating opportunities when jobs have low levels of enrichment.

Participatory Action Research Interventions

Participatory action research (PAR) is an intervention wherein, through group discussions, employees help to identify and define problems in organizational structure, processes, policies, practices, and reward structures, as well as help to design, implement, and evaluate success of solutions. PAR is in itself an intervention, but its goal is to design interventions to eliminate or reduce work-related factors that are impeding performance and causing people to be unwell. An example of a successful primary intervention, utilizing principles of PAR and driven by the JD-C and JD-C/S stress frameworks is Health Circles (HCs; Aust & Ducki, 2004 ).

HCs, developed in Germany in the 1980s, were popular practices in industries, such as metal, steel, and chemical, and service. Similar to other problem-solving practices, such as quality circles, HCs were based on the assumptions that employees are the experts of their jobs. For this reason, to promote employee well-being, management and administrators solicited suggestions and ideas from the employees to improve occupational health, thereby increasing employees’ job control. HCs also promoted communication between managers and employees, which had a potential to increase social support. With more control and support, employees would experience less strains and better occupational well-being.

Employing the three-steps of (1) problem analysis (i.e., diagnosis or discovery through data generated from organizational records of absenteeism length, frequency, rate, and reason and employee survey), (2) HC meetings (6 to 10 meetings held over several months to brainstorm ideas to improve occupational safety and health concerns identified in the discovery phase), and (3) HC evaluation (to determine if desired changes were accomplished and if employees’ reports of stressors and strains changed after the course of 15 months), improvements were to be expected (Aust & Ducki, 2004 ). Aust and Ducki ( 2004 ) reviewed 11 studies presenting 81 health circles in 30 different organizations. Overall study participants had high satisfaction with the HCs practices. Most companies acted upon employees’ suggestions (e.g., improving driver’s seat and cab, reducing ticket sale during drive, team restructuring and job rotation to facilitate communication, hiring more employees during summer time, and supervisor training program to improve leadership and communication skills) to improve work conditions. Thus, HCs represent a successful theory-grounded intervention to routinely improve employees’ occupational health.

Physical Setting

The physical environment or physical workspace has an enormous impact on individuals’ well-being, attitudes, and interactions with others, as well as on the implications on innovation and well-being (Oksanen & Ståhle, 2013 ; Vischer, 2007 ). In a study of 74 new product development teams (total of 437 study respondents) in Western Europe, Chong, van Eerde, Rutte, and Chai ( 2012 ) found that when teams were faced with challenge time pressures, meaning the teams had a strong interest and desire in tackling complex, but engaging tasks, when they were working proximally close with one another, team communication improved. Chong et al. assert that their finding aligns with prior studies that have shown that physical proximity promotes increased awareness of other team members, greater tendency to initiate conversations, and greater team identification. However, they also found that when faced with hindrance time pressures, physical proximity related to low levels of team communication, but when hindrance time pressure was low, team proximity had an increasingly greater positive relationship with team communication.

In addition to considering the type of work demand teams must address, other physical workspace considerations include whether people need to work collaboratively and synchronously or independently and remotely (or a combination thereof). Consideration needs to be given to how company contributors would satisfy client needs through various modes of communication, such as email vs. telephone, and whether individuals who work by a window might need shading to block bright sunlight from glaring on their computer screens. Finally, people who have to use the telephone for extensive periods of time would benefit from earphones to prevent neck strains. Most physical stressors are rather simple to rectify. However, companies are often not aware of a problem until after a problem arises, such as when a person’s back is strained from trying to move heavy equipment. Companies then implement strategies to remediate the environmental stressor. With the help of human factors, and organizational and office design consultants, many of the physical barriers to optimal performance can be prevented (Rousseau & Aubé, 2010 ). In a study of 215 French-speaking Canadian healthcare employees, Rousseau and Aubé ( 2010 ) found that although supervisor instrumental support positively related with affective commitment to the organization, the relationship was even stronger for those who reported satisfaction with the ambient environment (i.e., temperature, lighting, sound, ventilation, and cleanliness).

Secondary Interventions (Coping)

Secondary interventions, also referred to as coping, focus on resources people can use to mitigate the risk of work-related illness or workplace injury. Resources may include properties related to social resources, behaviors, and cognitive structures. Each of these resource domains may be employed to cope with stressors. Monat and Lazarus ( 1991 ) summarize the definition of coping as “an individual’s efforts to master demands (or conditions of harm, threat, or challenge) that are appraised (or perceived) as exceeding or taxing his or her resources” (p. 5). To master demands requires use of the aforementioned resources. Secondary interventions help employees become aware of the psychological, physical, and behavioral responses that may occur from the stressors presented in their working environment. Secondary interventions help a person detect and attend to stressors and identify resources for and ways of mitigating job strains. Often, coping strategies are learned skills that have a cognitive foundation and serve important functions in improving people’s management of stressors (Lazarus & Folkman, 1991 ). Coping is effortful, but with practice it becomes easier to employ. This idea is the foundation for understanding the role of resilience in coping with stressors. However, “not all adaptive processes are coping. Coping is a subset of adaptational activities that involves effort and does not include everything that we do in relating to the environment” (Lazarus & Folkman, 1991 , p. 198). Furthermore, sometimes to cope with a stressor, a person may call upon social support sources to help with tangible materials or emotional comfort. People call upon support resources because they help to restructure how a person approaches or thinks about the stressor.

Most secondary interventions are aimed at helping the individual, though companies, as a policy, might require all employees to partake in training aimed at increasing employees’ awareness of and skills aimed at handling difficult situations vis à vis company channels (e.g., reporting on sexual harassment or discrimination). Furthermore, organizations might institute mentoring programs or work groups to address various work-related matters. These programs employ awareness-raising activities, stress-education, or skills training (cf., Bhagat, Segovis, & Nelson, 2012 ), which include development of skills in problem-solving, understanding emotion-focused coping, identifying and using social support, and enhancing capacity for resilience. The aim of these programs, therefore, is to help employees proactively review their perceptions of psychological, physical, and behavioral job-related strains, thereby extending their resilience, enabling them to form a personal plan to control stressors and practice coping skills (Cooper, Dewe, & O’Driscoll, 2011 ).

Often these stress management programs are instituted after an organization has observed excessive absenteeism and work-related performance problems and, therefore, are sometimes categorized as a tertiary stress management intervention or even a primary (prevention) intervention. However, the skills developed for coping with stressors also place the programs in secondary stress management interventions. Example programs that are categorized as tertiary or primary stress management interventions may also be secondary stress management interventions (see Figure 1 ), and these include lifestyle advice and planning, stress inoculation training, simple relaxation techniques, meditation, basic trainings in time management, anger management, problem-solving skills, and cognitive-behavioral therapy. Corporate wellness programs also fall under this category. In other words, some programs could be categorized as primary, secondary, or tertiary interventions depending upon when the employee (or organization) identifies the need to implement the program. For example, time management practices could be implemented as a means of preventing some stressors, as a way to cope with mounting stressors, or as a strategy to mitigate symptoms of excessive of stressors. Furthermore, these programs can be administered at the individual level or group level. As related to secondary interventions, these programs provide participants with opportunities to develop and practice skills to cognitively reappraise the stressor(s); to modify their perspectives about stressors; to take time out to breathe, stretch, meditate, relax, and/or exercise in an attempt to support better decision-making; to articulate concerns and call upon support resources; and to know how to say “no” to onslaughts of requests to complete tasks. Participants also learn how to proactively identify coping resources and solve problems.

According to Cooper, Dewe, and O’Driscoll ( 2001 ), secondary interventions are successful in helping employees modify or strengthen their ability to cope with the experience of stressors with the goal of mitigating the potential harm the job stressors may create. Secondary interventions focus on individuals’ transactions with the work environment and emphasize the fit between a person and his or her environment. However, researchers have pointed out that the underlying assumption of secondary interventions is that the responsibility for coping with the stressors of the environment lies within individuals (Quillian-Wolever & Wolever, 2003 ). If companies cannot prevent the stressors in the first place, then they are, in part, responsible for helping individuals develop coping strategies and informing employees about programs that would help them better cope with job stressors so that they are able to fulfill work assignments.

Stress management interventions that help people learn to cope with stressors focus mainly on the goals of enabling problem-resolution or expressing one’s emotions in a healthy manner. These goals are referred to as problem-focused coping and emotion-focused coping (Folkman & Lazarus, 1980 ; Pearlin & Schooler, 1978 ), and the person experiencing the stressors as potential threat is the agent for change and the recipient of the benefits of successful coping (Hobfoll, 1998 ). In addition to problem-focused and emotion-focused coping approaches, social support and resilience may be coping resources. There are many other sources for coping than there is room to present here (see e.g., Cartwright & Cooper, 2005 ); however, the current literature has primarily focused on these resources.

Problem-Focused Coping

Problem-focused or direct coping helps employees remove or reduce stressors in order to reduce their strain experiences (Bhagat et al., 2012 ). In problem-focused coping employees are responsible for working out a strategic plan in order to remove job stressors, such as setting up a set of goals and engaging in behaviors to meet these goals. Problem-focused coping is viewed as an adaptive response, though it can also be maladaptive if it creates more problems down the road, such as procrastinating getting work done or feigning illness to take time off from work. Adaptive problem-focused coping negatively relates to long-term job strains (Higgins & Endler, 1995 ). Discussion on problem-solving coping is framed from an adaptive perspective.

Problem-focused coping is featured as an extension of control, because engaging in problem-focused coping strategies requires a series of acts to keep job stressors under control (Bhagat et al., 2012 ). In the stress literature, there are generally two ways to categorize control: internal versus external locus of control, and primary versus secondary control. Locus of control refers to the extent to which people believe they have control over their own life (Rotter, 1966 ). People high in internal locus of control believe that they can control their own fate whereas people high in external locus of control believe that outside factors determine their life experience (Rotter, 1966 ). Generally, those with an external locus of control are less inclined to engage in problem-focused coping (Strentz & Auerbach, 1988 ). Primary control is the belief that people can directly influence their environment (Alloy & Abramson, 1979 ), and thus they are more likely to engage in problem-focused coping. However, when it is not feasible to exercise primary control, people search for secondary control, with which people try to adapt themselves into the objective environment (Rothbaum, Weisz, & Snyder, 1982 ).

Emotion-Focused Coping

Emotion-focused coping, sometimes referred to as palliative coping, helps employees reduce strains without the removal of job stressors. It involves cognitive or emotional efforts, such as talking about the stressor or distracting oneself from the stressor, in order to lessen emotional distress resulting from job stressors (Bhagat et al., 2012 ). Emotion-focused coping aims to reappraise and modify the perceptions of a situation or seek emotional support from friends or family. These methods do not include efforts to change the work situation or to remove the job stressors (Lazarus & Folkman, 1991 ). People tend to adopt emotion-focused coping strategies when they believe that little or nothing can be done to remove the threatening, harmful, and challenging stressors (Bhagat et al., 2012 ), such as when they are the only individuals to have the skills to get a project done or they are given increased responsibilities because of the unexpected departure of a colleague. Emotion-focused coping strategies include (1) reappraisal of the stressful situation, (2) talking to friends and receiving reassurance from them, (3) focusing on one’s strength rather than weakness, (4) optimistic comparison—comparing one’s situation to others’ or one’s past situation, (5) selective ignoring—paying less attention to the unpleasant aspects of one’s job and being more focused on the positive aspects of the job, (6) restrictive expectations—restricting one’s expectations on job satisfaction but paying more attention to monetary rewards, (7) avoidance coping—not thinking about the problem, leaving the situation, distracting oneself, or using alcohol or drugs (e.g., Billings & Moos, 1981 ).

Some emotion-focused coping strategies are maladaptive. For example, avoidance coping may lead to increased level of job strains in the long run (e.g., Parasuraman & Cleek, 1984 ). Furthermore, a person’s ability to cope with the imbalance of performing work to meet organizational expectations can take a toll on the person’s health, leading to physiological consequences such as cardiovascular disease, sleep disorders, gastrointestinal disorders, and diabetes (Fried et al., 2013 ; Siegrist, 2010 ; Toker, Shirom, Melamed, & Armon, 2012 ; Willert, Thulstrup, Hertz, & Bonde, 2010 ).

Comparing Coping Strategies across Cultures

Most coping research is conducted in individualistic, Western cultures wherein emotional control is emphasized and both problem-solving focused coping and primary control are preferred (Bhagat et al., 2010 ). However, in collectivistic cultures, emotion-focused coping and use of secondary control may be preferred and may not necessarily carry a negative evaluation (Bhagat et al., 2010 ). For example, African Americans are more likely to use emotion-focused coping than non–African Americans (Knight, Silverstein, McCallum, & Fox, 2000 ), and among women who experienced sexual harassment, Anglo American women were less likely to employ emotion focused coping (i.e., avoidance coping) than Turkish women and Hispanic American women, while Hispanic women used more denial than the other two groups (Wasti & Cortina, 2002 ).

Thus, whereas problem-focused coping is venerated in Western societies, emotion-focused coping may be more effective in reducing strains in collectivistic cultures, such as China, Japan, and India (Bhagat et al., 2010 ; Narayanan, Menon, & Spector, 1999 ; Selmer, 2002 ). Indeed, Swedish participants reported more problem-focused coping than did Chinese participants (Xiao, Ottosson, & Carlsson, 2013 ), American college students engaged in more problem-focused coping behaviors than did their Japanese counterparts (Ogawa, 2009 ), and Indian (vs. Canadian) students reported more emotion-focused coping, such as seeking social support and positive reappraisal (Sinha, Willson, & Watson, 2000 ). Moreover, Glazer, Stetz, and Izso ( 2004 ) found that internal locus of control was more predominant in individualistic cultures (United Kingdom and United States), whereas external locus of control was more predominant in communal cultures (Italy and Hungary). Also, internal locus of control was associated with less job stress, but more so for nurses in the United Kingdom and United States than Italy and Hungary. Taken together, adoption of coping strategies and their effectiveness differ significantly across cultures. The extent to which a coping strategy is perceived favorably and thus selected or not selected is not only a function of culture, but also a person’s sociocultural beliefs toward the coping strategy (Morimoto, Shimada, & Ozaki, 2013 ).

Social Support

Social support refers to the aid an entity gives to a person. The source of the support can be a single person, such as a supervisor, coworker, subordinate, family member, friend, or stranger, or an organization as represented by upper-level management representing organizational practices. The type of support can be instrumental or emotional. Instrumental support, including informational support, refers to that which is tangible, such as data to help someone make a decision or colleagues’ sick days so one does not lose vital pay while recovering from illness. Emotional support, including esteem support, refers to the psychological boost given to a person who needs to express emotions and feel empathy from others or to have his or her perspective validated. Beehr and Glazer ( 2001 ) present an overview of the role of social support on the stressor-strain relationship and arguments regarding the role of culture in shaping the utility of different sources and types of support.

Meaningfulness and Resilience

Meaningfulness reflects the extent to which people believe their lives are significant, purposeful, goal-directed, and fulfilling (Glazer, Kożusznik, Meyers, & Ganai, 2014 ). When faced with stressors, people who have a strong sense of meaning in life will also try to make sense of the stressors. Maintaining a positive outlook on life stressors helps to manage emotions, which is helpful in reducing strains, particularly when some stressors cannot be problem-solved (Lazarus & Folkman, 1991 ). Lazarus and Folkman ( 1991 ) emphasize that being able to reframe threatening situations can be just as important in an adaptation as efforts to control the stressors. Having a sense of meaningfulness motivates people to behave in ways that help them overcome stressors. Thus, meaningfulness is often used in the same breath as resilience, because people who are resilient are often protecting that which is meaningful.

Resilience is a personality state that can be fortified and enhanced through varied experiences. People who perceive their lives are meaningful are more likely to find ways to face adversity and are therefore more prone to intensifying their resiliency. When people demonstrate resilience to cope with noxious stressors, their ability to be resilient against other stressors strengthens because through the experience, they develop more competencies (Glazer et al., 2014 ). Thus, fitting with Hobfoll’s ( 1989 , 2001 ) COR theory, meaningfulness and resilience are psychological resources people attempt to conserve and protect, and employ when necessary for making sense of or coping with stressors.

Tertiary Interventions (Stress Management)

Stress management refers to interventions employed to treat and repair harmful repercussions of stressors that were not coped with sufficiently. As Lazarus and Folkman ( 1991 ) noted, not all stressors “are amenable to mastery” (p. 205). Stressors that are unmanageable and lead to strains require interventions to reverse or slow down those effects. Workplace interventions might focus on the person, the organization, or both. Unfortunately, instead of looking at the whole system to include the person and the workplace, most companies focus on the person. Such a focus should not be a surprise given the results of van der Klink, Blonk, Schene, and van Dijk’s ( 2001 ) meta-analysis of 48 experimental studies conducted between 1977 and 1996 . They found that of four types of tertiary interventions, the effect size for cognitive-behavioral interventions and multimodal programs (e.g., the combination of assertive training and time management) was moderate and the effect size for relaxation techniques was small in reducing psychological complaints, but not turnover intention related to work stress. However, the effects of (the five studies that used) organization-focused interventions were not significant. Similarly, Richardson and Rothstein’s ( 2008 ) meta-analytic study, including 36 experimental studies with 55 interventions, showed a larger effect size for cognitive-behavioral interventions than relaxation, organizational, multimodal, or alternative. However, like with van der Klink et al. ( 2001 ), Richardson and Rothstein ( 2008 ) cautioned that there were few organizational intervention studies included and the impact of interventions were determined on the basis of psychological outcomes and not physiological or organizational outcomes. Van der Klink et al. ( 2001 ) further expressed concern that organizational interventions target the workplace and that changes in the individual may take longer to observe than individual interventions aimed directly at the individual.

The long-term benefits of individual focused interventions are not yet clear either. Per Giga, Cooper, and Faragher ( 2003 ), the benefits of person-directed stress management programs will be short-lived if organizational factors to reduce stressors are not addressed too. Indeed, LaMontagne, Keegel, Louie, Ostry, and Landsbergis ( 2007 ), in their meta-analysis of 90 studies on stress management interventions published between 1990 and 2005 , revealed that in relation to interventions targeting organizations only, and interventions targeting individuals only, interventions targeting both organizations and individuals (i.e. the systems approach) had the most favorable positive effects on both the organizations and the individuals. Furthermore, the organization-level interventions were effective at both the individual and organization levels, but the individual-level interventions were effective only at the individual level.

Individual-Focused Stress Management

Individual-focused interventions concentrate on improving conditions for the individual, though counseling programs emphasize that the worker is in charge of reducing “stress,” whereas role-focused interventions emphasize activities that organizations can guide to actually reduce unnecessary noxious environmental factors.

Individual-Focused Stress Management: Employee Assistance Programs

When stress become sufficiently problematic (which is individually gauged or attended to by supportive others) in a worker’s life, employees may utilize the short-term counseling services or referral services Employee Assistance Programs (EAPs) provide. People who utilize the counseling services may engage in cognitive behavioral therapy aimed at changing the way people think about the stressors (e.g., as challenge opportunity over threat) and manage strains. Example topics that may be covered in these therapy sessions include time management and goal setting (prioritization), career planning and development, cognitive restructuring and mindfulness, relaxation, and anger management. In a study of healthcare workers and teachers who participated in a 2-day to 2.5-day comprehensive stress management training program (including 26 topics on identifying, coping with, and managing stressors and strains), Siu, Cooper, and Phillips ( 2013 ) found psychological and physical improvements were self-reported among the healthcare workers (for which there was no control group). However, comparing an intervention group of teachers to a control group of teachers, the extent of change was not as visible, though teachers in the intervention group engaged in more mastery recovery experiences (i.e., they purposefully chose to engage in challenging activities after work).

Individual-Focused Stress Management: Mindfulness

A popular therapy today is to train people to be more mindful, which involves helping people live in the present, reduce negative judgement of current and past experiences, and practicing patience (Birnie, Speca, & Carlson, 2010 ). Mindfulness programs usually include training on relaxation exercises, gentle yoga, and awareness of the body’s senses. In one study offered through the continuing education program at a Canadian university, 104 study participants took part in an 8-week, 90 minute per group (15–20 participants per) session mindfulness program (Birnie et al., 2010 ). In addition to body scanning, they also listened to lectures on incorporating mindfulness into one’s daily life and received a take-home booklet and compact discs that guided participants through the exercises studied in person. Two weeks after completing the program, participants’ mindfulness attendance and general positive moods increased, while physical, psychological, and behavioral strains decreased. In another study on a sample of U.K. government employees, study participants receiving three sessions of 2.5 to 3 hours each training on mindfulness, with the first two sessions occurring in consecutive weeks and the third occurring about three months later, Flaxman and Bond ( 2010 ) found that compared to the control group, the intervention group showed a decrease in distress levels from Time 1 (baseline) to Time 2 (three months after first two training sessions) and Time 1 to Time 3 (after final training session). Moreover, of the mindfulness intervention study participants who were clinically distressed, 69% experienced clinical improvement in their psychological health.

Individual-Focused Stress Management: Biofeedback/Imagery/Meditation/Deep Breathing

Biofeedback uses electronic equipment to inform users about how their body is responding to tension. With guidance from a therapist, individuals then learn to change their physiological responses so that their pulse normalizes and muscles relax (Norris, Fahrion, & Oikawa, 2007 ). The therapist’s guidance might include reminders for imagery, meditation, body scan relaxation, and deep breathing. Saunders, Driskell, Johnston, and Salas’s ( 1996 ) meta-analysis of 37 studies found that imagery helped reduce state and performance anxiety. Once people have been trained to relax, reminder triggers may be sent through smartphone push notifications (Villani et al., 2013 ).

Smartphone technology can also be used to support weight loss programs, smoking cessation programs, and medication or disease (e.g., diabetes) management compliance (Heron & Smyth, 2010 ; Kannampallil, Waicekauskas, Morrow, Kopren, & Fu, 2013 ). For example, smartphones could remind a person to take medications or test blood sugar levels or send messages about healthy behaviors and positive affirmations.

Individual-Focused Stress Management: Sleep/Rest/Respite

Workers today sleep less per night than adults did nearly 30 years ago (Luckhaupt, Tak, & Calvert, 2010 ; National Sleep Foundation, 2005 , 2013 ). In order to combat problems, such as increased anxiety and cardiovascular artery disease, associated with sleep deprivation and insufficient rest, it is imperative that people disconnect from their work at least one day per week or preferably for several weeks so that they are able to restore psychological health (Etzion, Eden, & Lapidot, 1998 ; Ragsdale, Beehr, Grebner, & Han, 2011 ). When college students engaged in relaxation-type activities, such as reading or watching television, over the weekend, they experienced less emotional exhaustion and greater general well-being than students who engaged in resources-consuming activities, such as house cleaning (Ragsdale et al., 2011 ). Additional research and future directions for research are reviewed and identified in the work of Sonnentag ( 2012 ). For example, she asks whether lack of ability to detach from work is problematic for people who find their work meaningful. In other words, are negative health consequences only among those who do not take pleasure in their work? Sonnetag also asks how teleworkers detach from their work when engaging in work from the home. Ironically, one of the ways that companies are trying to help with the challenges of high workload or increased need to be available to colleagues, clients, or vendors around the globe is by offering flexible work arrangements, whereby employees who can work from home are given the opportunity to do so. Companies that require global interactions 24-hours per day often employ this strategy, but is the solution also a source of strain (Glazer, Kożusznik, & Shargo, 2012 )?

Individual-Focused Stress Management: Role Analysis

Role analysis or role clarification aims to redefine, expressly identify, and align employees’ roles and responsibilities with their work goals. Through role negotiation, involved parties begin to develop a new formal or informal contract about expectations and define resources needed to fulfill those expectations. Glazer has used this approach in organizational consulting and, with one memorable client engagement, found that not only were the individuals whose roles required deeper re-evaluation happier at work (six months later), but so were their subordinates. Subordinates who once characterized the two partners as hostile and akin to a couple going through a bad divorce, later referred to them as a blissful pair. Schaubroeck, Ganster, Sime, and Ditman ( 1993 ) also found in a three-wave study over a two-year period that university employees’ reports of role clarity and greater satisfaction with their supervisor increased after a role clarification exercise of top managers’ roles and subordinates’ roles. However, the intervention did not have any impact on reported physical symptoms, absenteeism, or psychological well-being. Role analysis is categorized under individual-focused stress management intervention because it is usually implemented after individuals or teams begin to demonstrate poor performance and because the intervention typically focuses on a few individuals rather than an entire organization or group. In other words, the intervention treats the person’s symptoms by redefining the role so as to eliminate the stimulant causing the problem.

Organization-Focused Stress Management

At the organizational level, companies that face major declines in productivity and profitability or increased costs related to healthcare and disability might be motivated to reassess organizational factors that might be impinging on employees’ health and well-being. After all, without healthy workers, it is not possible to have a healthy organization. Companies may choose to implement practices and policies that are expected to help not only the employees, but also the organization with reduced costs associated with employee ill-health, such as medical insurance, disability payments, and unused office space. Example practices and policies that may be implemented include flexible work arrangements to ensure that employees are not on the streets in the middle of the night for work that can be done from anywhere (such as the home), diversity programs to reduce stress-induced animosity and prejudice toward others, providing only healthy food choices in cafeterias, mandating that all employees have physicals in order to receive reduced prices for insurance, company-wide closures or mandatory paid time off, and changes in organizational visioning.

Organization-Focused Stress Management: Organizational-Level Occupational Health Interventions

As with job design interventions that are implemented to remediate work characteristics that were a source of unnecessary or excessive stressors, so are organizational-level occupational health (OLOH) interventions. As with many of the interventions, its placement as a primary or tertiary stress management intervention may seem arbitrary, but when considering the goal and target of change, it is clear that the intervention is implemented in response to some ailing organizational issues that need to be reversed or stopped, and because it brings in the entire organization’s workforce to address the problems, it has been placed in this category. There are several more case studies than empirical studies on the topic of whole system organizational change efforts (see example case studies presented by the United Kingdom’s Health and Safety Executive). It is possible that lack of published empirical work is not so much due to lack of attempting to gather and evaluate the data for publication, but rather because the OLOH interventions themselves never made it to the intervention stage, the interventions failed (Biron, Gatrell, & Cooper, 2010 ), or the level of evaluation was not rigorous enough to get into empirical peer-review journals. Fortunately, case studies provide some indication of the opportunities and problems associated with OLOH interventions.

One case study regarding Cardiff and Value University Health Board revealed that through focus group meetings with members of a steering group (including high-level managers and supported by top management) and facilitated by a neutral, non-judgemental organizational health consultant, ideas for change were posted on newsprint, discussed, and areas in the organization needing change were identified. The intervention for giving voice to people who initially had little already had a positive effect on the organization, as absence decreased by 2.09% and 6.9% merely 12 and 18 months, respectively, after the intervention. Translated in financial terms, the 6.9% change was equivalent to a quarterly savings of £80,000 (Health & Safety Executive, n.d. ). Thus, focusing on the context of change and how people will be involved in the change process probably helped the organization realize improvements (Biron et al., 2010 ). In a recent and rare empirical study, employing both qualitative and quantitative data collection methods, Sørensen and Holman ( 2014 ) utilized PAR in order to plan and implement an OLOH intervention over the course of 14 months. Their study aimed to examine the effectiveness of the PAR process in reducing workers’ work-related and social or interpersonal-related stressors that derive from the workplace and improving psychological, behavioral, and physiological well-being across six Danish organizations. Based on group dialogue, 30 proposals for change were proposed, all of which could be categorized as either interventions to focus on relational factors (e.g., management feedback improvement, engagement) or work processes (e.g., reduced interruptions, workload, reinforcing creativity). Of the interventions that were implemented, results showed improvements on manager relationship quality and reduced burnout, but no changes with respect to work processes (i.e., workload and work pace) perhaps because the employees already had sufficient task control and variety. These findings support Dewe and Kompier’s ( 2008 ) position that occupational health can be reinforced through organizational policies that reinforce quality jobs and work experiences.

Organization-Focused Stress Management: Flexible Work Arrangements

Dewe and Kompier ( 2008 ), citing the work of Isles ( 2005 ), noted that concern over losing one’s job is a reason for why 40% of survey respondents indicated they work more hours than formally required. In an attempt to create balance and perceived fairness in one’s compensation for putting in extra work hours, employees will sometimes be legitimately or illegitimately absent. As companies become increasingly global, many people with desk jobs are finding themselves communicating with colleagues who are halfway around the globe and at all hours of the day or night (Glazer et al., 2012 ). To help minimize the strains associated with these stressors, companies might devise flexible work arrangements (FWA), though the type of FWA needs to be tailored to the cultural environment (Masuda et al., 2012 ). FWAs give employees some leverage to decide what would be the optimal work arrangement for them (e.g., part-time, flexible work hours, compressed work week, telecommuting). In other words, FWA provides employees with the choice of when to work, where to work (on-site or off-site), and how many hours to work in a day, week, or pay period (Kossek, Thompson, & Lautsch, 2015 ). However, not all employees of an organization have equal access to or equitable use of FWAs; workers in low-wage, hourly jobs are often beholden to being physically present during specific hours (Swanberg McKechnie, Ojha, & James, 2011 ). In a study of over 1,300 full-time hourly retail employees in the United States, Swanberg et al. ( 2011 ) showed that employees who have control over their work schedules and over their work hours were satisfied with their work schedules, perceived support from the supervisor, and work engagement.

Unfortunately, not all FWAs yield successful results for the individual or the organization. Being able to work from home or part-time can have problems too, as a person finds himself or herself working more hours from home than required. Sometimes telecommuting creates work-family conflict too as a person struggles to balance work and family obligations while working from home. Other drawbacks include reduced face-to-face contact between work colleagues and stakeholders, challenges shaping one’s career growth due to limited contact, perceived inequity if some have more flexibility than others, and ambiguity about work role processes for interacting with employees utilizing the FWA (Kossek et al., 2015 ). Organizations that institute FWAs must carefully weigh the benefits and drawbacks the flexibility may have on the employees using it or the employees affected by others using it, as well as the implications on the organization, including the vendors who are serving and clients served by the organization.

Organization-Focused Stress Management: Diversity Programs

Employees in the workplace might experience strain due to feelings of discrimination or prejudice. Organizational climates that do not promote diversity (in terms of age, religion, physical abilities, ethnicity, nationality, sex, and other characteristics) are breeding grounds for undesirable attitudes toward the workplace, lower performance, and greater turnover intention (Bergman, Palmieri, Drasgow, & Ormerod, 2012 ; Velez, Moradi, & Brewster, 2013 ). Management is thus advised to implement programs that reinforce the value and importance of diversity, as well as manage diversity to reduce conflict and feelings of prejudice. In fact, managers who attended a leadership training program reported higher multicultural competence in dealing with stressful situations (Chrobot-Mason & Leslie, 2012 ), and managers who persevered through challenges were more dedicated to coping with difficult diversity issues (Cilliers, 2011 ). Thus, diversity programs can help to reduce strains by directly reducing stressors associated with conflict linked to diversity in the workplace and by building managers’ resilience.

Organization-Focused Stress Management: Healthcare Management Policies

Over the past few years, organizations have adopted insurance plans that implement wellness programs for the sake of managing the increasing cost of healthcare that is believed to be a result of individuals’ not managing their own health, with regular check-ups and treatment. The wellness programs require all insured employees to visit a primary care provider, complete a health risk assessment, and engage in disease management activities as specified by a physician (e.g., see frequently asked questions regarding the State of Maryland’s Wellness Program). Companies believe that requiring compliance will reduce health problems, although there is no proof that such programs save money or that people would comply. One study that does, however, boast success, was a 12-week workplace health promotion program aimed at reducing Houston airport workers’ weight (Ebunlomo, Hare-Everline, Weber, & Rich, 2015 ). The program, which included 235 volunteer participants, was deemed a success, as there was a total weight loss of 345 pounds (or 1.5 lbs per person). Given such results in Houston, it is clear why some people are also skeptical over the likely success of wellness programs, particularly as there is no clear method for evaluating their efficacy (Sinnott & Vatz, 2015 ).

Moreover, for some, such a program is too paternalistic and intrusive, as well as punishes anyone who chooses not to actively participate in disease management programs (Sinnott & Vatz, 2015 ). The programs put the onus of change on the person, though it is a response to the high costs of ill-health. The programs neglect to consider the role of the organization in reducing the barriers to healthy lifestyle, such as cloaking exempt employment as simply needing to get the work done, when it usually means working significantly more hours than a standard workweek. In fact, workplace health promotion programs did not reduce presenteeism (i.e., people going to work while unwell thereby reducing their job performance) among those who suffered from physical pain (Cancelliere, Cassidy, Ammendolia, & Côte, 2011 ). However, supervisor education, worksite exercise, lifestyle intervention through email, midday respite from repetitive work, a global stress management program, changes in lighting, and telephone interventions helped to reduce presenteeism. Thus, emphasis needs to be placed on psychosocial aspects of the organization’s structure, including managers and overall organizational climate for on-site presence, that reinforces such behavior (Cancelliere et al., 2011 ). Moreover, wellness programs are only as good as the interventions to reduce work-related stressors and improve organizational resources to enable workers to improve their overall psychological and physical health.

Concluding Remarks

Future research.

One of the areas requiring more theoretical and practical attention is that of the utility of stress frameworks to guide organizational development change interventions. Although it has been proposed that the foundation for work stress management interventions is in organizational development, and even though scholars and practitioners of organization development were also founders of research programs that focused on employee health and well-being or work stress, there are few studies or other theoretical works that link the two bodies of literature.

A second area that requires additional attention is the efficacy of stress management interventions across cultures. In examining secondary stress management interventions (i.e., coping), some cross-cultural differences in findings were described; however, there is still a dearth of literature from different countries on the utility of different prevention, coping, and stress management strategies.

A third area that has been blossoming since the start of the 21st century is the topic of hindrance and challenge stressors and the implications of both on workers’ well-being and performance. More research is needed on this topic in several areas. First, there is little consistency by which researchers label a stressor as a hindrance or a challenge. Researchers sometimes take liberties with labels, but it is not the researchers who should label a stressor but the study participants themselves who should indicate if a stressor is a source of strain. Rodríguez, Kozusznik, and Peiró ( 2013 ) developed a measure in which respondents indicate whether a stressor is a challenge or a hindrance. Just as some people may perceive demands to be challenges that they savor and that result in a psychological state of eustress (Nelson & Simmons, 2003 ), others find them to be constraints that impede goal fulfillment and thus might experience distress. Likewise, some people might perceive ambiguity as a challenge that can be overcome and others as a constraint over which he or she has little control and few or no resources with which to cope. More research on validating the measurement of challenge vs. hindrance stressors, as well as eustress vs. distress, and savoring vs. coping, is warranted. Second, at what point are challenge stressors harmful? Just because people experiencing challenge stressors continue to perform well, it does not necessarily mean that they are healthy people. A great deal of stressors are intellectually stimulating, but excessive stimulation can also take a toll on one’s physiological well-being, as evident by the droves of professionals experiencing different kinds of diseases not experienced as much a few decades ago, such as obesity (Fried et al., 2013 ). Third, which stress management interventions would better serve to reduce hindrance stressors or to reduce strain that may result from challenge stressors while reinforcing engagement-producing challenge stressors?

A fourth area that requires additional attention is that of the flexible work arrangements (FWAs). One of the reasons companies have been willing to permit employees to work from home is not so much out of concern for the employee, but out of the company’s need for the focal person to be able to communicate with a colleague working from a geographic region when it is night or early morning for the focal person. Glazer, Kożusznik, and Shargo ( 2012 ) presented several areas for future research on this topic, noting that by participating on global virtual teams, workers face additional stressors, even while given flexibility of workplace and work time. As noted earlier, more research needs to be done on the extent to which people who take advantage of FWAs are advantaged in terms of detachment from work. Can people working from home detach? Are those who find their work invigorating also likely to experience ill-health by not detaching from work?

A fifth area worthy of further research attention is workplace wellness programing. According to Page and Vella-Brodrick ( 2009 ), “subjective and psychological well-being [are] key criteria for employee mental health” (p. 442), whereby mental health focuses on wellness, rather than the absence of illness. They assert that by fostering employee mental health, organizations are supporting performance and retention. Employee well-being can be supported by ensuring that jobs are interesting and meaningful, goals are achievable, employees have control over their work, and skills are used to support organizational and individual goals (Dewe & Kompier, 2008 ). However, just as mental health is not the absence of illness, work stress is not indicative of an absence of psychological well-being. Given the perspective that employee well-being is a state of mind (Page & Vella-Brodrick, 2009 ), we suggest that employee well-being can be negatively affected by noxious job stressors that cannot be remediated, but when job stressors are preventable, employee well-being can serve to protect an employee who faces job stressors. Thus, wellness programs ought to focus on providing positive experiences by enhancing and promoting health, as well as building individual resources. These programs are termed “green cape” interventions (Pawelski, 2016 ). For example, with the growing interests in positive psychology, researchers and practitioners have suggested employing several positive psychology interventions, such as expressing gratitude, savoring experiences, and identifying one’s strengths (Tetrick & Winslow, 2015 ). Another stream of positive psychology is psychological capital, which includes four malleable functions of self-efficacy, optimism, hope, and resilience (Luthans, Youssef, & Avolio, 2007 ). Workplace interventions should include both “red cape” interventions (i.e., interventions to reduce negative experiences) and “green cape” interventions (i.e., workplace wellness programs; Polly, 2014 ).

A Healthy Organization’s Pledge

A healthy workplace requires healthy workers. Period. Among all organizations’ missions should be the focus on a healthy workforce. To maintain a healthy workforce, the company must routinely examine its own contributions in terms of how it structures itself; reinforces communications among employees, vendors, and clients; how it rewards and cares for its people (e.g., ensuring they get sufficient rest and can detach from work); and the extent to which people at the upper levels are truly connected with the people at the lower levels. As a matter of practice, management must recognize when employees are overworked, unwell, and poorly engaged. Management must also take stock of when it is doing well and right by its contributors’ and maintain and reinforce the good practices, norms, and procedures. People in the workplace make the rules; people in the workplace can change the rules. How management sees its employees and values their contribution will have a huge role in how a company takes stock of its own pain points. Providing employees with tools to manage their own reactions to work-related stressors and consequent strains is fine, but wouldn’t it be grand if organizations took better notice about what they could do to mitigate the strain-producing stressors in the first place and take ownership over how employees are treated?

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A Qualitative Study of How Adolescents’ Use of Coping Strategies and Support Varies in Line With Their Experiences of Adversity

Emily stapley.

1 Evidence Based Practice Unit (EBPU), Anna Freud National Centre for Children and Families and University College London (UCL), 4-8 Rodney Street, N1 9JH London, England

Sarah Stock

Jessica deighton, ola demkowicz.

2 Manchester Institute of Education, The University of Manchester, Manchester, England

Associated Data

Access to data is restricted to the HeadStart Learning Team to comply with the study’s ethical approval. Materials (e.g., interview schedules) are available upon request to the corresponding author.

Not applicable.

Adolescence is associated with a rise in the incidence of mental health issues. Thus, the factors, processes, and contexts that protect and promote positive mental health in adolescence are of key interest to policymakers.

Our aim was twofold: First, to explore the coping strategies and sources of support that adolescents identify as protective (or not) in the face of difficulty over a three-year period; second, to examine how and why this may vary in line with the levels of adversity that they report experiencing in life.

Participants were attending schools in England implementing a mental health prevention programme called HeadStart. 93 semi-structured interviews were conducted with 31 adolescents (age 11–12 at the outset of the study; 58% female) once per year over three years. The interviews were analysed using thematic analysis.

Six coping strategy themes (e.g., ‘Disengaging from problems’) and five support themes (e.g., ‘Parents as a source of comfort and advice’) were derived from the interviews. The types, quality, and consistency of reported coping strategies and support varied in line with whether adolescents were experiencing higher or lower levels of adversity in life over time, and according to the resources that they had available within their physical and social contexts.

Conclusions

Our findings underscore the importance for mental health prevention programmes of bolstering both individual-level coping strategies and the resources available within adolescents’ environments to help them to manage adversity.

Adolescence is a period of major life change, characterised by physical transformations, psychological and cognitive development, and changes to peer and family relationships (Blakemore, 2012 ). Adolescence is also associated with a rise in the incidence of mental health issues, with the latest statistics in the UK indicating that among 11- to 16-year-olds, 17.6% had a diagnosable mental disorder in 2020, as compared to 14.4% of 5- to 10-year-olds (Vizard et al., 2020 ). It has been calculated that the cost of ‘late intervention’ to combat the problems that young people experience, such as mental disorders, is nearly £17 billion (Chowdry & Fitzsimons, 2016 ). Therefore, developing effective early intervention programmes, and ascertaining the factors, processes, and contexts that protect and promote adolescent wellbeing and positive mental health, is of key interest for policymakers seeking to prevent the onset of mental health issues in adolescence.

Researchers have distinguished between protective factors, which are associated with positive outcomes in the face of risk and adversity, and promotive factors, which are associated with positive outcomes generally (Masten & Barnes, 2018 ). The study of such factors features prominently in research seeking to explain why some individuals show resilience in the face of trauma, adversity, and risk, whereas others show poorer outcomes (e.g., Luthar, 2015 ; Masten & Barnes, 2018 ). Resilience can be broadly defined as the complex and dynamic process of adaptation to adversity (Luthar, Cicchetti, & Becker, 2000 ; Masten, 2014 ; Ungar, 2012 ), though we note that there are various subtleties and variations in how resilience can be understood (for an overview, see Southwick, Bonanno, Masten, Panter-Brick, & Yehuda, 2014 ).

Recent theory and research in this area has increasingly focused upon the embedded nature of resilience, whereby adaptation is facilitated through interactions between the individual and aspects of their ecological environment. For example, Ungar ( 2008 ) has defined resilience as a process whereby individuals navigate towards the resources to sustain their wellbeing that are available to them within their physical and social contexts. Thus, rather than putting the onus solely on the individual’s ability to cope, this definition underscores the role of both the individual and their environment in promoting wellbeing (Ungar, Brown, Liebenberg, Cheung, & Levine, 2008 ). Similarly, Masten ( 2021 ), advocating for a systemic perspective on resilience, has argued that the degree to which young people are able to respond adaptively in the face of disaster depends on the resilience of the interconnected systems around them, including family, school, community, and policy. Such definitions are underpinned by Bronfenbrenner’s ( 1979 ) ecological systems theory, which emphasises the role in child development of the child’s interaction with the interrelated, nested systems around them (Ungar, Ghazinour, & Richter, 2013 ).

Following early pioneers in the study of resilience (e.g., Garmezy, 1974 , 1985 ), researchers have tended to distinguish between three broad categories of protective factors: individual factors, such as effective coping skills or high self-esteem; family factors, such as a positive caregiver-child relationship or family climate; and environmental or community factors, such as prosocial peers or a positive school environment (e.g., Eriksson, Cater, Andershed, & Andershed, 2010 ; Fritz, de Graaff, Caisley, van Harmelen, & Wilkinson, 2018 ; Olsson, Bond, Burns, Vella-Brodrick, & Sawyer, 2003 ). Thus, the concepts of coping and social support have prominence within the study of protective factors. Coping can be defined as the “constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person” (Lazarus & Folkman, 1984 , p.141), and social support as the resources that the individual’s social network provides to help them to handle difficulties (Cohen, 2004 ).

Research investigating protective factors has often been quantitative in design. For instance, numerous studies have examined what factors protect young people in the face of adversity (e.g., Askeland et al., 2020 ; Eriksson et al., 2010 ), which factors reduce the likelihood of young people developing mental health issues (e.g., Fritz et al., 2018 ; Fritz, Stochl, Goodyer, van Harmelen, & Wilkinson, 2020 ), which factors predict resilience following trauma (e.g., Lai, Lewis, Livings, La Greca, & Esnard, 2017 ; Masten, 2021 ), and in what ways the impact of protective factors varies by the level of adversity experienced (e.g., Bowen, Lee, & Weller, 2007 ; Kassis, Artz, Scambor, Scambor, & Moldenhauer, 2013 ). However, quantitative research in this area has been criticised for its lack of attention to how, why, and when particular factors, or combinations of factors, may be more or less protective for young people from their own perspectives and in their own words (Eriksson et al., 2010 ; Ungar, 2003 ). Qualitative research designs are well suited for answering such questions, including offering greater nuance in understanding the complex protective processes that are ecologically embedded within each individual’s world.

Previous qualitative studies have explored young people’s identification of the protective factors and processes that contribute to resilience in the context of academic attainment (e.g., Chee, 2019 ; Morales, 2008 ), economic disadvantage (Smokowski & Reynolds, 1999 ), and specific mental health difficulties (e.g., Everall, Altrows, & Paulson, 2006 ; Las Hayas et al., 2016 ), as well as young people’s ways of coping with adversity or stress in daily life (e.g., Stapley, Demkowicz, Eisenstadt, Wolpert, & Deighton, 2020a ; Ungar et al., 2008 ). For example, through interviews with 13 young adults in Canada who overcame suicidality in adolescence, Everall et al. ( 2006 ) identified four domains of resilience: (a) social processes - having consistent, supportive relationships with others (such as family members, peers, teachers, and professionals); (b) emotional processes - being aware of and able to express feelings; (c) cognitive processes - gaining new perspectives and having a sense of control; and (d) taking action with purpose and specific goals in mind. In another Canadian study, Ungar et al. ( 2008 ) identified seven experiences that 19 adolescents described as enhancing their mental health, which they each had varying access to within their environments: material resources; supportive relationships; a desirable sense of self; a sense of power and control; cultural traditions; a meaningful role within the community; and feeling part of something bigger.

By illuminating protective factors and processes, and exploring how and why they may vary by context, resources, or the level of adversity experienced, qualitative research findings can inform the development of interventions seeking to bolster young people’s resilience and prevent the onset of mental health issues (Eriksson et al., 2010 ; Luthar, 2015 ). For instance, Ungar, Hadfield, and Ikeda ( 2018 ) interviewed 85 adolescents in Canada, who had different levels of exposure to risk and varying access to resilience-promoting resources (e.g., a supportive adult), about their experiences of service use. They found that adolescents at higher risk and with low resilience voiced a preference for professional support with more relaxed boundaries, such as contact outside of official therapy time, implying that this type of therapeutic relationship may be a protective factor for these adolescents (Ungar et al., 2018 ). On the other hand, adolescents with high resilience and at low risk described less need for professional support in general due to the social capital that they already had in their lives, implying that the social support networks that these adolescents already have access to may be protective enough without additional therapeutic support (Ungar et al., 2018 ).

Given the rising rates of mental health issues among adolescents in the UK (Vizard et al., 2020 ), recent UK government policy has moved towards schools being key sites from which to deliver interventions to promote wellbeing and prevent the onset of mental health issues (Department of Health and Social Care & Department for Education, 2018 ). The significant proportion of time that young people spend in school means that schools can reach a much wider range of young people than clinical services and can overcome barriers associated with attending clinical services, such as travel, timing, and cost issues (Masia-Warner, Nangle, & Hansen, 2006 ). As studies of resilience are inevitably contextually situated because what is experienced as protective in one context may not be available or seen as adaptive in another (Ungar, 2008 ), there is a need for qualitative research specifically in a UK context to explore the factors and processes that young people find to be protective in the face of difficulties in life, including how, why, and in what circumstances these may vary. Such findings can then be used to inform the development of effective school-based prevention and early intervention programmes to meet a range of needs.

Consequently, in the current study, we sought to build on existing understanding in this area by taking a qualitative approach to inquiry and exploring the factors, processes, and contexts (with a focus on the concepts of coping and social support) that are deemed protective from adolescents’ own perspectives and in their own words, within the setting of a school-based mental health prevention programme in the UK. Specifically, our study sought to address the following aims using qualitative methods: (1) To explore the coping strategies and sources of support that adolescents identify as protective (or not) in the face of difficult situations and feelings over a three-year period; (2) To examine how and why this may vary in line with the levels of adversity that they report experiencing in life.

Research Design

We used an interpretive, qualitative research design to explore, through semi-structured interviews, young people’s lived experiences of and perspectives on problems and difficulties in daily life, coping strategies, and accessing or receiving support both from formal sources, including professionals, and informal sources, including family and friends. Our analysis primarily draws on Braun and Clarke’s ( 2006 , 2021 ) guidance for conducting thematic analysis and is underpinned by a critical realist epistemological perspective. This takes the view that while there is a real world that exists independently of our perceptions and constructions of it, our understanding of it is a construction from our own point of view (Maxwell, 2010 ). This means that we see our analysis of the data as being an interpretation of participants’ reality, which we have constructed from our own perspectives, contexts, and views of the world. We are experienced researchers in the child and adolescent mental health research field, currently working in the context of evaluating interventions seeking to enhance young people’s resilience, mental health, and wellbeing, to learn about what helps to manage and prevent mental health difficulties.

Setting for the Study

HeadStart is a six-year, school-based, mental health prevention programme, which launched in 2016 in six local authorities in England. The aim of HeadStart is to promote resilience, wellbeing, and positive mental health through the delivery of a range of preventive and early intervention approaches seeking to boost young people’s coping strategies and environmental resources (Evidence Based Practice Unit, 2018 , 2019 ). A five-year qualitative longitudinal study is being conducted to explore young people’s experiences of HeadStart and, in doing so, examine the role and place of HeadStart more broadly within young people’s perspectives on coping and receiving support. Young people were invited to take part in the study by school staff or HeadStart staff if they had already received support from HeadStart by the first timepoint of the study or if they were identified as likely to receive it in future. To date, 82 interviews with the same cohort of young people have been conducted at Time 1 (2017 or 2018), 78 at Time 2 (2018 or 2019), and 55 at Time 3 (2019). Data collection in 2020 (Times 3 and 4) was paused due to Covid-19 restrictions.

Ethical Considerations

Ethical approval for this study was granted by the University College London (UCL) Research Ethics Committee (ID number 7963/002). As all participants were under the age of 16, written informed consent was sought from the young people’s parents/carers and written assent to take part and for the publication of their anonymised data was sought from the young people at the outset of the study. It was made clear in study information sheets that participation was voluntary, and that participants could withdraw at any time without consequence. Participants received a £10 voucher after each interview as a thank you for taking part. To protect participant confidentiality, interview transcripts were anonymised (e.g., with names of people and places removed).

Participants

A subsample of 31 participants from the wider qualitative longitudinal study sample was selected for inclusion in the present study. The subsample represented nine secondary schools across four of the HeadStart areas. Demographic information about the subsample can be seen in Table  1 . All 31 participants had taken part in Time 1, 2 and 3 interviews, yielding a total subset of 93 interviews. 25 participants from the wider study sample were excluded from the subsample as they were missing interviews at Time 2 or 3. Given our study’s focus on adversity, 14 participants were excluded because they did not discuss coping strategies and support in the context of experiencing any mental health difficulties, family strain, or bullying, nor did they not report receiving any targeted support from HeadStart at Time 1. Targeted (indicated or selective) support is offered to select students, including those with mild or subclinical symptoms of a mental disorder or those with experience of particular risk factors, such as parental mental health issues (Campbell, 2004 ; Werner-Seidler, Perry, Calear, Newby, & Christensen, 2017 ). 12 participants from one HeadStart area were excluded because they were up to two years younger (age 9–10 years) than the majority of the young people (age 11–12 years) at Time 1, thus they did not align with our study’s focus on adolescence.

Self-Reported Demographic Information about the Subsample (N = 31)

a Exact age data were missing for two participants at Time 2 and one participant at Time 3

Data Collection

The interviews were conducted by four members of the research team (including the first and last authors). The interviews took place in a private room at participants’ schools. Where possible, the same researcher interviewed each participant at all three timepoints. All interviews were audio recorded and transcribed verbatim. The interviews in our subsample ranged in length from 20.47 to 60.05 min at Time 1 ( M  = 40.3, SD  = 9.86), 21.39 to 68.43 min at Time 2 ( M  = 38.05, SD  = 12.95), and 22.55 to 63.23 min at Time 3 ( M  = 41.83, SD  = 11.16).

The interview schedule developed by the research team was semi-structured, which meant that while there were core questions asked by the researcher in each interview, the conversation around these key areas was led by participants’ responses. Core interview questions asked about participants’ experiences of and perspectives on coping with problems and difficult situations or feelings in life, including strategies that they drew on and social and professional support that they accessed (and their opinions on this). At Times 2 and 3, the interview schedule also asked about any changes over time in relation to topics raised previously. For example, ‘You mentioned when I met with you last year that you were having arguments with your friends, how are your friendships this year?’.

Reflexivity

Reflexivity is a means for the researcher to critically engage with their role in the research process, including remaining self-aware and cognizant of their own influence on the research and in turn how the research may be affecting them (Probst, 2015 ). The research team designed an interview reflection tool to facilitate interviewers in debriefing following each interview. Reflections were audio-recorded and discussed further with the research team lead (the first author) when the interviewer deemed this to be helpful. The intention was to provide a space for interviewers to offload their immediate thoughts and feelings following each interview, and to encourage them to develop their interview skills through reflecting on their technique in each interview.

We reflect that our approach to data collection and analysis is inevitably influenced by our own understanding and experiences of the research area. For instance, our approach to asking young people about their experiences of coping and support was influenced by our theoretical grounding as researchers within systemic theories of resilience. Thus, in each interview, we specifically explored young people’s experiences within the context of key systems, including family, peers, and school. We also recognise that our approach to data collection and analysis is influenced and limited by our own understanding and experiences of the world, including sociodemographic differences between ourselves and the young people, such as in terms of age, ethnicity, and gender identity. For example, the age gap between ourselves and participants, in conjunction with the interviews taking place on school premises, could have reinforced hierarchical structures inherent in schools (Ozer, Newlan, Douglas, & Hubbard, 2013 ), and thus inhibited participants from speaking openly in their interviews about their experiences and opinions. Therefore, we endeavoured at each interview to establish a secure, non-hierarchical space for the young people to speak to us in, emphasising confidentiality (unless any safeguarding issues arose), young people’s right to withdraw at any time, and that there were no right or wrong answers. Our interview schedules were also developed in conjunction with young people to ensure that the questions were meaningful to and understood by our target audience.

Data Analysis

To address our study aims, our analysis sought to answer two research questions sequentially: (1) What helps adolescents to manage difficult situations and feelings over a three-year period? (2) How does ‘what helps’ vary depending on the level of adversity that adolescents report experiencing in their lives over time?

To answer the first research question, a hybrid deductive/inductive thematic analysis was conducted by the first and second authors using NVivo (version 12) to identify the coping strategies and sources of support that participants reported drawing on at Times 1, 2, and 3. An existing thematic framework of young people’s coping behaviour was used to facilitate this, which was derived through an earlier inductive thematic analysis, guided by Braun and Clarke’s ( 2006 ) methodology, of all 82 interviews conducted at Time 1 with the young people taking part in the wider qualitative longitudinal study (see Stapley et al., 2020a ). The framework consisted of the following main themes: Activities and strategies; Disengaging from problems; Standing up for yourself; Acceptance of problems; Social support; HeadStart support; Other professional support; Hiding feelings or problems (Stapley et al., 2020a ).

We used this existing framework to guide our coding of the interviews in the present study, but also renamed and restructured themes, and created new themes, as necessary to best reflect the Time 1, 2, and 3 interview data. The coding process involved collating relevant transcript extracts under each theme. For instance, a new subtheme of ‘Support from boyfriends or girlfriends’ was developed from coding participants’ Time 2 and 3 interviews and included within a new main theme of ‘Support from close and trustworthy friends’. ‘Hiding feelings or problems’ ceased to be a main theme in the present study, as it became apparent when exploring the data across all three timepoints that this was typically spoken about in relation to particular groups of people, principally parents, friends, and school staff. Thus, in our study, participants’ references to finding it difficult to talk to or hiding problems or feelings from others have been captured as relevant when describing their experiences and perceptions of support from these groups.

To answer the second research question, an inductive thematic analysis was conducted, again by the first and second authors using NVivo (version 12), guided by the six steps outlined by Braun and Clarke ( 2006 , 2021 ): becoming familiarised with the data; systematically coding the data or applying descriptive labels to transcript extracts; collating similar codes (labels) to generate initial themes; developing and reviewing themes; refining and giving names and definitions to themes; and the report. The interviews were re-coded in NVivo to develop new themes, which this time delineated the difficult situations and feelings that participants reported experiencing at Times 1, 2, and 3.

Braun and Clarke ( 2021 ) take a reflexive approach to thematic analysis, which can be distinguished from codebook or coding reliability approaches to thematic analysis. We view our analysis as primarily reflexive, but at times reflecting elements more akin to a codebook approach. Our use of an existing thematic framework, for example, when answering our first research question perhaps more closely reflects a codebook approach, whereby the themes were developed using the Time 1 dataset and then used to guide our analysis of the Time 2 and 3 datasets, with refinements made as necessary in light of new data. By contrast, the analysis process for our second research question took an entirely open and bottom-up approach to both coding and theme development, which aligns more closely with a reflexive approach.

The first and second authors worked together throughout the analysis for both research questions to code the data and develop themes, using a collaborative approach to facilitate rich, in-depth engagement with the data (Braun & Clarke, 2019 ), and to ensure that our interpretations remained grounded within the data. However, we did not seek to assess interrater reliability during our analysis, thus our analysis was not aligned with a coding reliability approach to thematic analysis. This is because, in line with Braun and Clarke’s ( 2021 ) reflexive approach, we view researcher subjectivity as a “resource for knowledge production which inevitably sculpts the knowledge produced, rather than a must-be-contained threat to credibility” (p. 334–335), thus interrater reliability is not seen as a marker for quality of analysis.

Braun and Clarke ( 2021 ) also distinguish between themes defined as patterns of shared meaning organised by a central concept, which is a core part of their reflexive approach, and themes defined as summaries of participant responses in relation to particular topics within the data, which is more aligned with a codebook approach. Researchers taking a reflexive approach to thematic analysis need to justify their use of the latter (Braun & Clarke, 2021 ). Due to the large volume of data that we were working with and our aim of drawing relatively broad, concrete comparisons between groups of participants, we reflect that some of our themes align more closely with what Braun and Clarke ( 2021 ) describe as ‘shared-topic’ themes (e.g., ‘Varying trajectories of HeadStart and other professional support’), rather than ‘shared-meaning’ themes (e.g., ‘Disengaging from difficulties’).

As the final step in our analysis, by examining the transcript content coded to each theme delineating the difficult situations and feelings that each participant reported experiencing at each timepoint, participants were then divided into three groups by the first and second authors, each representing a different level of adversity. The three groups were: Group A - participants who reported that their levels of difficulty in life had improved or were manageable by Time 3; Group B - participants who reported experiencing some ongoing difficulties and some areas of improvement by Time 3; Group C – participants who reported that their levels of difficulty had deteriorated or were hard to manage by Time 3. The authors initially separately allocated each participant to one of the three groups and then checked each other’s allocations, with discussion of any instances of disagreement until agreement was reached.

Table  2 ; Fig.  1 show the difficult situations and feelings reported by participants in each of the three groups at any timepoint.

Frequencies (N) and Proportions (%) of Participants in each Group who Reported Experiencing Particular Difficult Situations and Feelings at any Timepoint

Frequencies ( N ) of participants in each group who reported experiencing particular difficult situations and feelings at any timepoint

As can be seen in Table  2 ; Fig.  1 , comparatively high proportions of participants across the three groups reported experiencing feelings of sadness and anxiety, as well as experiences of being bullied at any timepoint. However, Group C contained the highest proportions of participants who reported experiencing difficulties with anger, self-harm, arguments with parents and/or siblings, parental abuse, parental mental health issues (such as depression), getting into trouble at school, and arguments with peers. By contrast, the highest proportion of participants who reported lacking in confidence and self-esteem could be seen in Group A. Groups B and C contained the highest proportions of participants who reported experiencing some form of family or parental stress (such as animosity between parents or family financial difficulties) at any timepoint.

Table  3 ; Fig.  2 present the coping strategies and sources of support (organised in terms of individual-, family-, and environment-level protective factors and processes) that participants across the three groups reported drawing on at two or more timepoints to manage difficulties in life. Reports at two or more timepoints was considered a proxy for participants’ consistency in usage of specific coping strategies and sources of support over time. Previous quantitative longitudinal research has identified stability in adolescents’ reports of using particular coping strategies over at least a two-year period (Valiente, Eisenberg, Fabes, Spinrad, & Sulik, 2015 ).

Frequencies (N) and Proportions (%) of Participants in each Group who Reported Drawing on Particular Coping Strategies and Sources of Support at Two or More Timepoints

a Current or historic targeted support received from HeadStart or other professionals (e.g., child and adolescent mental health services; CAMHS) is shown as reported at any timepoint by participants

Frequencies ( N ) of participants in each group who reported drawing on particular coping strategies and sources of support at two or more timepoints. (Note. Current or historic targeted support received from HeadStart or other professionals (e.g., CAMHS is shown as reported at any timepoint by participants)

Individual-level Factors and Processes

Engaging in activities.

Participants described engaging in different activities (e.g., playing video games, drawing, and playing football) to take their mind off their problems, have fun, or relax: “When I’m thinking about the worries and when I’m, like, drawing, it’s, like, makes me a lot, like, do you know, thinking about the worries, it makes them go somewhere else” (Group A, Time 2). The prevalence of this theme, in terms of references at two or more timepoints, was higher in Groups B (73%) and C (75%) than Group A (50%).

However, participants in Groups B and C also reported that engaging in activities did not always help. Reasons for this included that some problems (such as a grandparent dying) can make you feel so sad that engaging in an activity does not help, some activities (e.g., boxing) can make you feel angrier instead of calmer, and some activities (e.g., eating comfort food) are not necessarily good for you: “I realised me doing boxing has made me more angry and then, then when people are annoying me, then I know that I have the power to do something” (Group C, Time 3).

Using Techniques

Participants described using different techniques or specific strategies (e.g., deep breathing techniques, stress balls, and counting to 10), sometimes suggested by a professional, to try to regulate their emotions: “ When I was clicking my fingers I always… I just, when I got nervous or I got angry or something like that, I feel like that calmed me down” (Group C, Time 3). The prevalence of this theme, in terms of references at two or more timepoints, was higher in Groups B (55%) and C (67%) than Group A ( N  = 13%).

Yet, participants in Groups B and C also reported limitations in the efficacy of strategies, such as forgetting to take deep breaths to manage their anger in the heat of the moment. Participants in Groups B (18%) and C (33%) also mentioned engaging in self-harm as a coping strategy at various points in their lives. However, self-harm was only identified as a current coping strategy by the third timepoint by participants in Group C: “[My sister] just tells me I’m an idiot, (chuckles) and I need to stop doing it” (Group C, Time 3).

Disengaging from Difficulties

Almost all participants across the three groups described instances at two or more timepoints when they had dealt with problems by deliberately disengaging from them, such as through distracting themselves, forgetting problems, choosing to put problems out of their mind, or ignoring the existence of problems and individuals who were upsetting them (e.g., bullies): “I just try my best to not listen to them and just ignore them” (Group A, Time 2).

Positive Thinking

Participants described engaging in positive thinking in the face of difficulty, including trying to see the positive side of difficult situations, thinking positive thoughts to cheer themselves up, and persevering and not giving up: “Make something happy out of it or just think about generally something that makes you happy and then like… sort of like post the angry feelings out with the happy feelings” (Group B, Time 1). The prevalence of this theme, in terms of references at two or more timepoints, was highest in Group A (75%), as compared to Groups B (45%) and C (33%).

Accepting Difficulties

Participants described how over time they had become used to difficult situations or had simply accepted the existence of particular aspects of life that they found hard, which could eventually make such situations less stressful and easier to handle: “I was really shy, and like, I was scared to talk to other people, I kind of got used to it and, like, I’m not as shy anymore” (Group A, Time 3). This theme also included participants’ references to waiting for problems or difficult feelings to pass or ‘blow over’. The prevalence of this theme, in terms of references at two or more timepoints, was higher in Groups A (50%) and B (27%) than Group C ( N  = 8%).

Self-defence

Participants described situations (principally arguments with friends, family members, or teachers) at two or more timepoints that in their view required them to challenge unwanted behaviour from others or defend themselves (verbally or physically): “I ain’t just going to stand there and have everyone call me a wimp when they hit me, and I don’t hit them back. I’m just going to stand there and hit them back” (Group B, Time 1). The prevalence of this theme was higher in Groups B (64%) and C (58%) than Group A (38%).

Family-level Factors and Processes

Parents as a source of comfort and advice.

Participants in Group A often referred to both of their parents (63%) as being a supportive presence in their lives: “The first people I would go to are my parents if there was a problem. Which is really good, and they would give me their honest opinion” (Group A, Time 2). This included feeling able to and wanting to talk to their parents about their problems, with reference to their parents making them feel better, giving them advice, or helping them to see another perspective or reach a solution. Similarly, 45% of participants in Group B described both of their parents, at two or more timepoints, as being a source of support, comfort, and advice in difficult situations. A higher proportion of participants in Group C identified one of their parents (58%), usually their mother, as being a supportive presence in their lives, as opposed to both parents (17%). This parent was described as being a source of advice and comfort.

Parents at Arms-length

Only a minority (25%) of Group A participants perceived one parent as being a more prominent source of support than the other at two or more timepoints. Both of these participants self-identified as female and described feeling more able to talk to their mothers about problems than their fathers, who they felt may not understand their problems to the same degree that their mothers would: “If it’s to do with girls or problems at school, I probably wouldn’t necessarily speak to [my dad] about it but sometimes, I do” (Group A, Time 2). Similarly, participants in Group B (36%) who described one parent as being a more prominent source of support than the other indicated that they had a closer relationship with one parent (usually their mother). By contrast, the other parent for participants in Group C was often seen as being a source of difficulty in their lives or as less available to talk to (such as because they were busy or they did not live with them), and so was considered to be a less suitable source of support for these reasons.

Participants in Group B also described instances of not always feeling able to, not always wanting to, or hesitating to talk to their parents about their problems. For instance, if they thought that they might worry or upset their parents, if their parents were not available to talk to, if they thought that a problem was not major enough to warrant talking to their parents about, or if, in general, they preferred trying to resolve problems on their own first. Similarly, participants in Group C described finding it hard to speak to their parents about some issues, such as feeling sad or having low self-esteem, because, for example, they felt that their parents did not understand what they were going through.

My mum is always like, ‘Toughen up’. I literally can’t and like I don’t know what to say to my mum when she says to me, ‘Toughen up’, when she’s like, ‘You need to stop crying, you need to grow up’, and I don’t know if I can. (Group C, Time 3)

Other Family Members as a Supportive Presence

Participants also described drawing on support from other members of their families. The prevalence of this theme, in terms of references at two or more timepoints, was higher in Group B (73%) than Groups A (38%) and C (33%). There were participants in all three groups who saw their siblings (and also, in a small number of cases, their cousins) as ‘having their back’ and as being someone to talk to about problems and seek advice from because, for example, they had had similar experiences to each other: “If there’s any problems with me, like, s- I, I could talk to [my sister]. And like, she’ll listen. Like, I’ll, I can trust her […] she won’t, like, tell my mum if I don’t want her to” (Group B, Time 2). In terms of support from extended family, participants across the three groups most often referred to their grandmother as a source of support, describing them as another person to talk to about problems and seek advice from, in the absence of or in addition to parental support. Participants in Groups B and C also described their pets as being a source of comfort and as cheering them up when they were feeling sad, worried, or angry.

Environment-level Factors and Processes

Support from close and trustworthy friends.

Similar proportions of participants across Groups A (75%), B (73%), and C (67%) described at two or more timepoints how their friends (including, for a minority, boyfriends or girlfriends) were a source of support in times of difficulty. Friends were referred to as cheering you up, standing up for you in arguments or against bullies, and being someone to talk to and receive relatable advice from, for example for problems that your parents would not understand. However, while trust in family members was more implicit, there were participants across all three groups who mentioned having specific or close friends whom they trusted more than others to keep their problems confidential: “I have one friend […] she’s like really… we talk about everything. When I told, when I say something to her, it then doesn’t come out anyone’s mouth” (Group B, Time 3).

School Staff as a Double-edged Sword

Higher proportions of participants in Groups B (55%) and C (58%), as compared to Group A (38%), reported drawing on or being given support, when needed, from school staff (teachers and/or pastoral care staff) at two or more timepoints. Participants in Group A primarily described school staff as mediating in situations of bullying or arguments with peers, and felt that particular school staff members were supportive or were there for them to talk to if they needed to. However, Group A participants also reported that generally they felt more comfortable seeking support from family and friends, although they would consider talking to a school staff member if a problem was really serious: “If we’re talking about like school, no, not really, because um I just feel like that’s, that’s not what I do, that’s not how I deal with things. Like, I, I, I’d rather go to my friends or my mum” (Group A, Time 3).

Participants in Group B similarly described school staff as intervening in difficult situations with peers, and also described seeking support from specific school staff members if they were upset or if they wanted someone to talk to. However, Group B participants also mentioned times when school staff had not always been able to provide effective support. For instance, school staff were not always available to talk to about problems, they did not always listen or take action, or they could not always be trusted to keep problems confidential. Talking to a teacher about issues with peers could also result in you being labelled as a ‘snitch’, which was not helpful: “If I do tell on the people who do it, they w- they will A, start calling me a snitch, and B, start making fun of [me] even more” (Group B, Time 1).

Participants in Group C described having arguments with and feeling blamed by teachers, but also described instances when they had been given support by particular members of school staff, including seeing them as someone to speak to about difficult family situations, bullying, or managing anger. However, Group C participants also described times when they had struggled to trust school staff, including having an awareness that there may be consequences of speaking to school staff (such as an investigation happening), worries about teachers forming an opinion of you, and experiences of or anticipation of not feeling understood by school staff: “I find it a bit difficult to tell teachers because I know that their policy is obviously they can’t tell pupils, but they can tell like people if it’s a major problem like anyone [is] in danger” (Group C, Time 3).

Varying Trajectories of HeadStart and Other Professional Support

Group C contained the highest proportion of participants who reported receiving targeted support from HeadStart at any timepoint (75%), followed by Group A (63%) and Group B (45%). On the other hand, Group B contained the highest proportion of participants who reported receiving current or historic support from other professionals (outside of HeadStart) at any timepoint (73%), followed by Group C (58%) and Group A ( N  = 0).

At Time 1, four participants in Group A reported meeting with a peer mentor (an older student at school). They described the positive impact of this type of HeadStart support, including learning coping strategies, having someone relatable to talk to, and boosting their confidence. At Time 2, none of these participants reported still being in receipt of peer mentoring. Three had been offered additional HeadStart support (such as involvement in co-producing their area’s programme). However, one had decided not to take part as none of her friends had signed up this year, another’s support had stopped because of school staff strikes, and the other participant’s support had never begun. One participant in Group A mentioned receiving HeadStart support for the first time at Time 2 (counselling). At Time 3, no participants in Group A reported receiving any HeadStart support: “I just stopped it because I didn’t think I’d need it anymore” (Group A, Time 3).

At Time 1, four participants in Group B reported receiving HeadStart support, including one-to-one (peer mentoring or counselling) and small group-based support (psychoeducational sessions or co-production meetings). They described receiving useful advice about coping with being bullied and handling difficult feelings (such as anger and anxiety), enjoying being involved in HeadStart, and finding it helpful to have someone to speak to about their worries.

They give some really good ad- advice, like when we was learning about worrying and stress, there was like some stuff that we can do to like help deal with that, and then things that we do, like, that are maybe bad and like how we can stop that like happening, and like a better way to cope with it. (Group B, Time 1)

At Times 2 and 3, only one participant in Group B was still receiving HeadStart support. This participant reported feeling more confident and less anxious as a result, but also felt that some of their group sessions had been disrupted by other students misbehaving. Two participants in Group B did not feel at Times 2 and 3 that they needed support from HeadStart anymore, as they were feeling better. However, two other participants (one of whom also described receiving ongoing support from a professional at CAMHS to manage her anxiety across Times 1, 2, and 3, and the other of whom mentioned seeing a school counsellor at Time 2) stated that they would like to receive support from HeadStart again at Time 2. One of these participants still felt the same at Time 3, whereas the other felt that they did not need any support from HeadStart by Time 3.

Two participants did not report receiving support from HeadStart at any timepoint, but did mention taking medication to manage attention deficit hyperactivity disorder (ADHD) across Times 1, 2, and 3. Five participants also described historic contact with social services, counselling, and/or therapy to manage such issues as school-related stress or difficult family situations. Four of these participants identified aspects of this support that had been unhelpful, such as finding it boring, finding it hard to talk about difficult feelings or situations, or having their trust betrayed. Only one of these participants stated that his therapy had had a positive impact on his levels of worry and stress at the time. However, he also said that he would not necessarily want to receive therapy again.

Nobody wants to be the person who’s, like, gone to therapy three years in a row. And um ‘cause I don’t want to miss school as well because last time I had to go to therapy I, I, I missed a lot of school. (Group B, Time 2)

At Time 1, five participants in Group C reported receiving one-to-one (peer mentoring) or small group-based HeadStart support (psychoeducational sessions or co-production meetings). Participants described getting things off their chests through talking to others about their problems, and learning how to manage their worries and anger. One of these participants also reported receiving ongoing small group and one-to-one support from HeadStart support workers across Times 2 and 3. However, the other four participants reported no longer receiving HeadStart support at Time 2 because it had ended or because they had not found it helpful.

Of the latter four participants, one participant did not report receiving any HeadStart support at Time 3 either. Another reported receiving HeadStart support again at Time 3 in the form of co-production meetings, as well as having contact with social care and a school counsellor, which he described as limited in its utility. The remaining two participants described receiving support from statutory CAMHS, social care, and/or a counsellor instead of HeadStart at Time 2. Both felt that this support was more helpful. By Time 3, one of these participants was still receiving ongoing counselling, and the other had stopped receiving support from statutory CAMHS, but had been referred to another form of small group-based HeadStart support at school.

Why do you think the CAMHS course has been more helpful than [HeadStart]? They explained it more in detail and like, I don’t know. Talking to like other people with ADHD and stuff and I found than better than. ‘Cause like not really much people has ADHD in this school. (Group C, Time 2)

Two participants in Group C reported receiving HeadStart support for the first time at Time 2 (counselling). For one of these participants, this support had continued at Time 3, although with a new counsellor, as her previous counsellor at Time 2 had not managed to help her. For the other participant, this support (which had also included therapeutic work with her parents) had ended by Time 3. However, both of these participants also mentioned receiving support from statutory CAMHS in relation to feelings of anxiety, depression, and self-harm at Time 3.

[My previous counsellor] couldn’t cope with the situation. It was too hard for her to deal with because, she, she, she was too young […] like, she couldn’t help, she didn’t know what to do with it. Um, and that’s why we had to go with a different person. (Group C, Time 2)

Two participants in Group C reported receiving HeadStart support (e.g., online counselling) for the first time at Time 3. One of these participants also mentioned receiving professional support at Time 1 for ADHD. The other participant mentioned historic contact with social care at Time 2 and current support from social care at Time 3. This participant described having recently been referred to a youth worker by her social worker for additional emotional support, which she felt had been helpful.

Our sample consisted of adolescents who were attending schools in England implementing a mental health prevention programme, HeadStart. Within our sample, we identified three groups of participants: those who reported that their levels of difficulty in life had improved or were manageable by the third year of the study (Group A); those who reported experiencing some ongoing difficulties and some areas of improvement (Group B); and those who reported that their levels of difficulty had deteriorated or were hard to manage (Group C). Young people who reported experiencing higher and/or persistent levels of difficulty in life over time, as compared to their counterparts, more often described using such coping strategies as self-defence and self-harm, referred to limitations in the efficacy of particular activities and strategies, voiced reasons why they were reluctant or unable to seek support from their parents, perceived limitations in support from school staff, and reported more mixed experiences of support from professionals, in terms of the timing of support and their perceptions of its efficacy. This aligns with findings from a previous qualitative study conducted to examine change over the first two years of HeadStart in young people’s experiences of difficulties and support, drawing on the wider qualitative longitudinal study sample of 78 participants (Stapley, Eisenstadt, Demkowicz, Stock, & Deighton, 2020b ). This study found that young people who described having more difficult experiences in general over the two-year period were more likely to report having sources of support characterised by uncertainty or ambiguity (Stapley et al., 2020b ).

The findings of the current study also reflect previous quantitative findings, which have similarly identified variation in the incidence and impact of protective factors according to the level of adversity that young people are experiencing (e.g., Fergusson, Lynskey, & Horwood, 1996 ; Kassis et al., 2013 ). However, our qualitative findings also add to this previous quantitative research by showing when, how, and why particular factors and processes may be more or less protective from the perspective of young people who are experiencing varying levels of adversity. For instance, in previous research, friendships have been found to mitigate against the negative effects of bullying (Kendrick, Jutengren, & Stattin, 2012 ), and family adversity (Criss, Pettit, Bates, Dodge, & Lapp, 2002 ). Yet, while comparatively high proportions of participants across all three groups in our study referred to their friends as a source of support in times of difficulty, the proportion of participants who also described having arguments with their friends was highest in Group C. This could suggest that the quality of support may influence the level of protection that it can offer. Indeed, high quality friendships, defined in terms of perceptions of supportiveness, have been found to predict lower levels of future victimisation by bullies (Kendrick et al., 2012 ).

Quality may also be relevant when considering the limitations in the efficacy of particular coping strategies that participants in Groups B and C reported, as well as the use of self-harm as a coping strategy in a minority of cases. The coping strategy of positive thinking, on the other hand, employed by a majority of participants in Group A, has been identified in previous research as being an individual-level protective factor implicated in promoting young people’s resilience (Masten & Barnes, 2018 ), and as an adaptive coping strategy (Losoya, Eisenberg, & Fabes, 1998 ; Zimmer-Gembeck & Skinner, 2011 ). Yet, disengagement or withdrawal from problems has been found in previous studies to be associated with poorer mental health outcomes (e.g., (Seiffge-Krenke, 2004 ; Seiffge-Krenke & Klessinger, 2000 ). By contrast, our findings indicate that this is a strategy that the majority of young people engage in, regardless of their levels of difficulty in life (see also Stapley et al., 2020a ). Perhaps this alternatively reflects previous findings from the emotion regulation literature that the use of distraction can enhance adolescents’ levels of positive affect and reduce their levels of negative affect, which may be a solution in the short-term (Wante, Van Beveren, Theuwis, & Braet, 2018 ).

While parental support was drawn on by young people in all three groups in our study, the majority of participants in Group C cited one parent, rather than both, as a source of support, with the non-supportive parent described as less available to talk to because for example, they were busy, they did not live together, or they were a source of difficulty in their lives. By contrast, the majority of participants in Group A referred to both of their parents as being a supportive presence in their lives. Previous qualitative studies have similarly highlighted the importance, from young people’s perspectives, of familial support in protecting against adversity or promoting recovery from mental health issues (e.g., Las Hayas et al., 2016 ; Smokowski & Reynolds, 1999 ). Indeed, close caregiver-child relationships have frequently been identified as a key family-level protective factor for young people in the face of adversity (Masten, 2021 ). The higher levels of familial stress reported by young people in Groups B and C, as compared to Group A, may explain the differences in the levels of familial support that they reported. For example, previous research has identified a negative association between interparental conflict and parental emotional support provision for young people (Riggio, 2004 ).

In terms of support from HeadStart, 61% of participants reported receiving some form of targeted HeadStart support by the end of the three-year period of our study: three-quarters of participants in Group C, just under half of Group B, and just under two-thirds of Group A. In Groups A and B, the majority of participants reported receiving support from HeadStart at Time 1 only. By contrast, in Group C, participants described a range of interactions with HeadStart, with some participants only reporting receiving support at one timepoint and others reporting receiving multiple forms of support across or at different timepoints. Our findings suggest that more long-term, regular, or sustained preventive intervention may be needed for young people who are experiencing higher levels of difficulty in life (see also Stapley et al., 2020b ), such as those within Groups B and C, with perhaps more ‘light touch’ engagement for those experiencing less difficulty over time, such as those within Group A. The latter reflects Ungar et al.’s ( 2018 ) finding that adolescents with high resilience and low risk describe less need for professional support in general, potentially due to the social support that they already have.

School staff nominations are often a starting point for the identification of students for targeted interventions (Campbell, 2004 ). However, research has shown that teachers have less accuracy in identifying young people with emotional problems, compared to behavioural problems (e.g., Cunningham & Suldo, 2014 ; Splett et al., 2020 ), and with moderate or subclinical levels of symptoms, compared to severe (Splett et al., 2019 ). This could offer a potential explanation for why just under 50% of participants in Group B, for example, reported ever receiving HeadStart support, and why, for participants in Group C, the timing of their interactions with HeadStart varied. Thus, instating a regular wellbeing and mental health symptom check-in (such as using standardised self-report outcome measures) with young people each school year, and at the end of support interventions, could help to ensure that young people are offered additional support as and when it is needed (Humphrey & Wigelsworth, 2016 ; Stapley et al., 2020b ).

On the other hand, it is possible that some participants were offered support and chose not to engage with it. Indeed, participants in Groups B and C identified both positive elements and limitations of the HeadStart and professional support that they had received, and described ways in which school staff could be supportive, but also voiced concerns about trusting school staff, or instances of not feeling listened to or understood by school staff. Previous qualitative studies of young people’s help-seeking behaviour have similarly identified young people’s perceptions of issues around school staff trustworthiness and availability as barriers to help-seeking (Helms, 2003 ; Lindsey & Kalafat, 1998 ). Such concerns could thus present a barrier to young people’s engagement with preventive interventions led by trained school staff or implemented within a school setting. Therefore, reviews of evaluations of existing programmes have highlighted the important role that a programme component focusing on promoting a supportive school environment or ethos can have in maximising engagement with and the effectiveness of school-based prevention and early intervention programmes (Weare & Nind, 2011 ).

Training in coping and problem-solving skills is often a key component in psychological interventions (Horwitz, Opperman, Burnside, Ghaziuddin, & King, 2016 ). Some of the coping strategies that participants described appear to align with treatment components across a range of evidence-based prevention and treatment approaches; for instance, positive thinking echoes aspects of cognitive restructuring activities within cognitive behavioural therapy (CBT) approaches (Clark, 2013 ). Yet, interventions that primarily aim to effect change at the level of the individual may have more limited efficacy for those who are experiencing high levels of contextual stress. Indeed, higher levels of family dysfunction have been found to predict poorer mental health treatment outcomes for adolescents (Phillips et al., 2000 ). This could explain why participants in Group C, approximately 90% of whom reported experiencing various sources of familial stress, were experiencing difficulties with their mental health and relationships by Time 3, despite 75% of them reporting receipt of HeadStart support by that point. Thus, following a review of resilience research, Luthar ( 2015 ) concluded that to maximise the potential for success, resilience-enhancing interventions should focus on invoking change in both the child and in their wider environment. For instance, the UK-based Thrive Framework is a needs-based approach to mental health and wellbeing support, which “provides a set of principles for creating coherent and resource-efficient communities of mental health and wellbeing support for children, young people and families” (Wolpert et al., 2019 , p.2).

In a review of school-based mental health services, Rones and Hoagwood ( 2000 ) found that effectiveness was associated with multi-component programmes that targeted the ecology of the child, such as through involving parents (e.g., in parenting skill development sessions) and teachers (e.g., in classroom management techniques training). Similarly, in a systematic review, Weare and Nind ( 2011 ) found that the involvement of parents was cited in multiple reviews as a key ingredient in school-based preventive interventions. However, only one participant in our study mentioned receiving a HeadStart intervention that involved therapeutic work with their parents. Thus, particularly for young people who are experiencing higher levels of adversity in life (e.g., familial strain), our findings suggest that mental health prevention programmes like HeadStart could benefit from placing emphasis on implementing interventions that seek to effect change and boost the resources available within young people’s wider contexts, as well as within young people themselves. This reflects theories of resilience that emphasise the role of the individual’s connections and relationships with external systems in promoting resilience, as well as their own capacity to cope (e.g., Masten & Barnes, 2018 ; Ungar et al., 2008 ).

Strengths and Limitations

Our study illuminates the different coping strategies and sources of support that adolescents experiencing varying levels of adversity in life view as protective (or less so) in relation to handling difficult situations and feelings over a three-year period – and why. A limitation of our study relates to the transferability of our findings. Most notably, our sample consisted of adolescents who were identified and invited to take part by school staff or HeadStart staff, based on current or potential future engagement in some aspect of HeadStart. Thus, our findings may overlook wider experiences, including those experiencing adversity without the school’s awareness, whose experiences of coping and social support may well be different. Similarly, there may be individuals who declined to take part, and we do not know how their experiences relate to those reported here.

Furthermore, our sample includes only those who chose to take part in all three interviews over the three-year period of the study. We do not know whether additional themes would be identified from interviews with adolescents who were unable to take part in all three interviews, such as if they had moved to a different school and were uncontactable by the research team. It is possible that the latter may be those who are experiencing particularly high levels of adversity. In terms of demographic information, we note that the majority of our sample identified themselves as being from a White ethnic background. Future research would benefit from an emphasis on sociodemographic representativeness in sampling, including direct exploration of how ethnicity may play a role in the protective factors and processes identified by adolescents in the UK. We note too that our findings are by nature specific to England, but may nevertheless offer value to researchers in other countries when considered in conjunction with research specific to their locality.

The findings solely reflect participants’ reports of experiences of difficulties in life, coping, and engagement with support that they remembered to or chose to share in their interviews. While every effort was made to help participants to feel comfortable and secure in the interview situation, including building rapport during each interview and ensuring where possible that the same researcher interviewed the same participant across all three timepoints, some participants may have felt less comfortable about sharing their experiences with a stranger, or sharing experiences that might have led to them feeling upset or embarrassed in their interviews (Docherty & Sandelowski, 1999 ). Lack of reference in an interview is not an objective indication that a participant definitely did not draw on a particular coping strategy or support source. For this reason, we did not seek to explore change over time in the minutiae of young people’s usage of particular coping strategies and support. Participants were also not explicitly asked about change over time in relation to each individual coping strategy and source of support mentioned in each interview.

The interview questions focused on participants’ experiences of coping and seeking or receiving support over each year of the study. Thus, it is important to note that while a broad range of protective factors have been identified in resilience research, including for example ‘skilled parenting’ and ‘connections with well-functioning communities’ (Masten & Barnes, 2018 ), our study focused specifically on the types of coping strategies and sources of support that young people report as being protective in the face of difficulty, as this was the focus of the interviews. In addition, there were a minority of problems (e.g., physical health issues) and sources of support (e.g., support from adults outside of the family and school) that were referenced so infrequently and by such a small number of participants that they were not included in our final list of themes.

Participants were grouped in our analysis based on their subjective experiences of the levels of difficulty in their lives that they were experiencing by the third timepoint of the study. We are unable to report objectively on the levels of mental health difficulties that would meet clinical thresholds within our sample. However, we reflect on the possible circularity of grouping participants in this way, in that individuals with higher levels of mental health concerns may be more likely to perceive situations as stressful or notice stressful aspects of their environment, or individuals experiencing more stressful situations or situated within a more stressful environment may be more likely to experience higher levels of mental health concerns.

Our findings add to previous research by showing that the types, quality, and consistency of reported coping strategies and support, as described by adolescents in a UK context, varies in line with whether adolescents report experiencing higher or lower levels of adversity in life over time, and according to the resources that they have available within their physical and social environments. Future research in this area could qualitatively explore the additional factors and processes, both internal and external to the individual, beyond coping strategies and sources of support, that adolescents in this context describe as protective, and examine how these may also vary in line with the level of adversity experienced. Future research could also seek to further disentangle the differences between the presence and quality of different support sources and coping strategies as protective factors. Understanding the specific support and coping processes that are perceived to be most helpful by adolescents could indicate important areas for intervention.

Our findings suggest that more long-term, regular, or sustained early intervention may be needed for young people experiencing higher levels of difficulty in life. School staff and practitioners implementing regular reviews with young people regarding their support needs and preferences could help to ensure that young people receive timely support that is best suited to their needs. This aligns with a needs-based approach to providing support for young people’s mental health and wellbeing. Finally, for maximum effectiveness with young people who are experiencing high levels of contextual adversity, preventive interventions could benefit from being multi-component, such as incorporating family, school, and individual elements to boost the resources available within young people’s wider contexts, as well as within young people themselves.

Acknowledgements

We are indebted to the young people who generously shared their experiences with us.

With thanks to other members of the HeadStart Learning Team (Mia Eisenstadt, Rosa Town, Alisha O’Neill, and Parise Carmichael-Murphy) for their vital role in the collection, management, and analysis of data used to inform our research publications.

With thanks also to our colleagues in the National Institute for Health Research (NIHR) Children and Families Policy Research Unit (Ruth Gilbert, Kevin Herbert, Tanya Lereya, and Sarah Cattan) for their helpful feedback on earlier drafts of this paper.

Author Contributions

ES conceived of the study, led on in its design, coordination, and data collection and analysis, and drafted the manuscript; SS participated in the study design and data analysis, and contributed to the drafting of the manuscript; JD led on the acquisition of funding, participated in the study design and coordination, and contributed to the drafting of the manuscript; OD participated in data collection and analysis, and contributed to the drafting of the manuscript. All authors read and approved the final manuscript.

HeadStart is a six-year, £67.4 m National Lottery funded programme set up by The National Lottery Community Fund, the largest funder of community activity in the UK. The interview data analysed in this study were collected as part of the Learning Team’s national evaluation of HeadStart, funded by The National Lottery Community Fund. The views expressed are those of the author(s) and not necessarily those of The National Lottery Community Fund.

This study was funded by the National Institute for Health Research (NIHR) Policy Research Programme. ES was also partly supported by the NIHR ARC North Thames. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Availability of Data and Material

Code availability, declarations.

The authors have no relevant financial or non-financial interests to disclose.

As all participants were under the age of 16, written informed consent was sought from the young people’s parents/carers and written assent was sought from the young people themselves for them to take part and for the publication of their anonymised data.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval for this study was granted by the University College London (UCL) Research Ethics Committee (ID number 7963/002).

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