Coping Styles Used by Chronic Health Disorder Sufferers

Coping Styles Used by Chronic Health Disorder Sufferers

Case study; BBC documentary called ‘The Truth about Depression’: (

In this essay the author will examine chronic illness with focus on depression and its symptoms as well as critically evaluate coping skills used by individuals with chronic depression.

According to better health (2015), a chronic illness is a long term illness, which can be stressful and may change the way a person lives or relates to others. For the purpose of this essay the author will investigate chronic depression (or Dysthymia). Despite mental health professionals’ massive efforts to educate the public, lack of knowledge and misconceptions around resulting in stigma and discrimination (Web MD, 2015). Coping Styles Used by Chronic Health Disorder Sufferers.

NHS (2015), state that the symptoms of chronic depression are sadness or depressed mood and being physically restless or rundown in a way that is noticeable by others. Fatigue or loss of energy and problems with concentration or making decisions, a loss of enjoyment in things that were once pleasurable, either weight gain or weight loss of more than five percent of weight within a month, insomnia or excessive sleep almost every day, feelings of hopelessness, worthlessness or excessive guilt and lastly, the most devastating symptom being the almost daily recurring thoughts of death or suicide. Coping Styles Used by Chronic Health Disorder Sufferers.

According to research carried out by Science Direct (2015), there are a range of different ways an individual can cope. These include; sourcing information on the illness, (which can help combat feelings of helplessness or lack of control), emotional support from others, (particularly family and close friends), setting short-term goals which can restore certainty, power and control and lastly, thinking about possible outcomes and discussing them with health professionals. The overall aim of these coping strategies would be to help the sufferer put into context and give some meaning to what is happening to them. However, not all individuals can achieve this and will find different ways of coping.


Whilst coping with depression, individuals need to work on many aspects, contending with sleeping problems, eating, activity, positive and negative emotions, thinking, and relationships. Above all, individuals need to cultivate hope. However, all of these aspects cannot be worked on at the same time. If an individual is severely depressed, their first priority should be their physical health as this can improve their emotional wellbeing by releasing endorphins. These can lift a sufferer’s mood and give them a sense of achievement. Sufferers may also benefit from exercising in groups in order to help build new relationships. However, this coping strategy may not be achievable by all individuals as the participation in such physical activity could be unrealistic due to other underlying health conditions (Everyday Health, 2015).

When reality is a nightmare for a sufferer of chronic depression, using sleep as a coping mechanism is simply like clocking out and taking a break from life.Coping Styles Used by Chronic Health Disorder Sufferers.  However, after sleeping, the reality will continue to make them unhappy. To add to this, a lack of sunlight due to excess sleeping will also lower the mood of the sufferer even further, because it causes an imbalance of certain brain chemicals (Thought Catalogue, 2015).

Some other coping skills to practice for sufferers of chronic depression could include; meditation and relaxation techniques. Deep breathing techniques, can activate a relaxation response and help reduce stress. Hobbies are also important in order to set aside time to allow relaxation and escape from the stresses of life, for example, gardening, art therapy, dancing or cooking. One must remember that these techniques may not be suitable for all suffers because of differing interests, or the severity of the depression as they may feel more apprehensive than others to venture out of their surroundings to attend these groups (NHS, 2015).

Psychologist World (2015), consider the attachment theory to be important when studying coping styles for chronic depression. Attachment is a biological need and is the basis of the power of therapy ranging from individual to group, hospitalization, and support groups. Ultimately, by the individual establishing or rebuilding secure attachments in friendships, family relationships, and intimate relationships they can start to recover.

Stressful life events contribute to the onset of chronic depression. An individual can minimize stress by learning to use coping skills to manage stress. Coping Styles Used by Chronic Health Disorder Sufferers. For example, by making sure there is clear communication with doctors, by maintaining emotional balance to cope with negative feelings and maintaining confidence and a positive self-image are essential in the process of remaining well. However, not all individuals can achieve this and find lowering stress levels harder to achieve than others (Help Guide, 2015).

Finally hope is the foundation of recovery. What gives an individual hope might change from one time to another. Hope is likely to be intermingled with fear and doubt. One might be afraid to hope for fear of being disillusioned; thus hoping takes courage. Perhaps there’s no firmer ground for hope than the possibility that some good ultimately might come from the painful experience (Share Care, 2010-2015).

As well as needing to find ways to deal with the stress involved with chronic depression, from this essay the author has found that an individual will also need to understand their condition, know about the treatments and therapy’s on offer. Maintain trust and confidence in heath professionals, especially when recovery isn’t possible. Know how to control their symptoms by using individual coping skills and lastly maintain social relationships and avoid social isolation.

It was also found that obtaining and maintaining good coping skills takes practice. However utilizing these skills becomes easier over time. Most importantly, good coping skills make for good mental health wellness and a way forward from chronic depression.

In this essay the author has examined chronic illness focusing on chronic depression and its symptoms. It has also critically evaluated coping skills used by individuals with chronic depression. Coping Styles Used by Chronic Health Disorder Sufferers.


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Bifulco, A., & Moran, P. 1998.Wednesday’s Child: Research into women’s experience of neglect and abuse in childhood, and adult depression. London: Routledge.

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Williams, M. (1997).Cry of pain: Understanding suicide and self-harm. London: Penguin Books.

We examined which adaptive coping strategies, referring to the concept of ‘locus of disease control’, were of relevance for patients with chronic pain conditions, and how they were interconnected with patients’ life satisfaction and interpretation of disease.


In a multicenter cross-sectional anonymous survey with the AKU questionnaire, we enrolled 579 patients (mean age 54 ± 14 years) with various chronic pain conditions.


Disease as an adverse interruption of life was the prevalent interpretation of chronic pain conditions. As a consequence, patients relied on external powerful sources to control their disease (i.e., Trust in Medical HelpSearch for Information and Alternative Help), but also on internal powers and virtues (i.e., Conscious Way of LivingPositive Attitudes). In contrast, Trust in Divine Help as an external transcendent source and Reappraisal: Illness as Chance as an internal (cognitive) strategy were valued moderately. Regression analyses indicated that Positive Attitudes and higher age were significant predictors of patients’ life satisfaction, but none of the other adaptive coping strategies. While the adaptive coping strategies were not associated with negative interpretations of disease, the cognitive reappraisal attitude was of significant relevance for positive interpretations such as value and challenge.


The experience of illness may enhance intensity and depth of life, and thus one may explain the association between internal adaptive coping strategies (particularly Reappraisal) and positive interpretations of disease.Coping Styles Used by Chronic Health Disorder Sufferers.  To restore a sense of self-control over pain (and thus congruence with the situation), and the conviction that one is not necessarily disabled by disease, is a major task in patient care. In the context of health services research, apart from effective pain management, a comprehensive approach is needed which enhances the psycho-spiritual well-being of patients.


There are different ways to cope with pain, and there are different ways to regulate emotions associated with chronic diseases. Because most patients with chronic diseases are unable to ‘solve’ their persisting pain conditions by themselves (in terms of recovery or repair) and to find distance to negative emotions associated with pain, they have to find strategies to adapt to a long-lasting course of disease.Coping Styles Used by Chronic Health Disorder Sufferers.  Patients have to find ways to maintain physical, emotional and spiritual health despite of often long-lasting courses. Thus, patients’ coping with chronic pain is an ongoing process which includes appraisals of stress, cognitive, behavioural, and emotional coping responses, and subsequent reappraisals of stress.

One of the most frequently used concept on adaptation strategies of patients with chronic pain diseases differentiates active and passive coping [1,2]. Active coping (i.e., problem solving, including collecting information and refocusing on the problem, or regulation of emotion by focusing attention on the emotional response aroused by the stressor) is associated with less pain, less depression, less functional impairment, and higher general self-efficacy, while passive coping (i.e., avoidance and escape) is correlated with reports of greater depression, greater pain and flare-up activity, greater functional impairment, and lower general self-efficacy [1]. Although the importance of decreasing maladaptive and encouraging adaptive coping responses is emphasized by innovative treatment programs for chronic pain, one nevertheless has to ask which adaptive coping strategies were of relevance for the patients.

A recent meta-analysis found that among older adults with persistent pain, the most frequently reported coping strategies were Task Persistence (maintaining activity, for example despite fluctuations of pain intensity), Pacing (activity avoidance), and Coping Self-Statements (a form of conditioning to put a stop for example to thoughts that lead to anxiety etc. and to replace them with rational thoughts); the least frequently used strategies were Asking for Assistance and Relaxation [3]. Findings from that study suggest useful coping strategies clinicians could explore with individual patients [3]. Coping Styles Used by Chronic Health Disorder Sufferers.

Our own study results suggest that most patients with chronic diseases use adaptive coping strategies which can be differentiated according to the utilization of external resources of health control (i.e., Trust in Medical HelpSearch for Information and Alternative Help; Trust in Divine Help) and internal sources (i.e., Conscious Way of LivingPositive AttitudesReappraisal: Illness as Chance) [4,5]. Particular the cognitive reappraisal strategy was of outstanding relevance. It deals with patients’ interpretation of disease as an opportunity, a hint to change life, and reflect upon what is essential in life. Because of this reflection, patients may alter their goals, change aspects of life or behaviour, and may see their situation as a chance for personal growth (transformation). However, the subjective meaning of illness is influenced by intrapersonal, disease-related and environmental factors [6]. These interpretations of illness may have an influence on preferences in decision-making and choice of coping strategies.

In this report, we intended to analyze which adaptive coping strategies referring to the concept of ‘locus of health control’ (in terms of external or internal resources), were of relevance for patients with chronic pain conditions, and how these strategies were associated with patients’ life satisfaction and interpretation of illness. Our hypothesis was that particularly the adaptive coping strategies referring on the internal resources are associated with life satisfaction, while positive interpretations of illness (such as challenge or value) are related to reappraisal processes.

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For this multicenter cross-sectional survey, patients were recruited from the acute pain outpatient clinic of the Communal Hospital in Herdecke, from the Department of Internal and Integrative Medicine at the Essen-Mitte Clinics, from the Orthopaedic Clinic in Bad Bocklet and from the orthopaedic Baumrain Clinic in Bad Berleburg. Their institutional heads gave approval to run this anonymous survey. All enrolled individuals were informed of the purpose of the study, were assured of confidentiality, and consented to participate. The questionnaires were anonymous (and asked neither for names, addresses or clinical details – with the exception of a diagnosis), and the pooled data could not be tracked back to individual patients.

To minimize the bias of a ‘convenience sample’, different medical centres in West-Germany were chosen, and patients were recruited consecutively as they attended the respective clinics. To obtain a more naturalistic sample, we had neither inclusion nor exclusion criteria (with the exception of the diagnosis chronic pain disease and consent to participate). Coping Styles Used by Chronic Health Disorder Sufferers.We did not measure pain intensity scores, and thus we categorized the patients according to the recruiting source which indicated differences with respect to the need for acute interventions (which is given in the out-patient clinic offering predominantly acute pain relieving interventions, as contrasted to rehabilitation clinics which offer predominantly orthopaedic interventions and medication, and the internal and integrative medicine clinic offering mind-body programs, naturopathy and medication).

The demographic data of 579 (out of 607) patients which provided enough data for statistical analyses were depicted in table ​table1.1. The underlying pain diseases were heterogeneous: 15% had spine-associated pain syndromes (low back pain etc.), 12% fibromyalgia, 8% polyarthritis/-arthrosis, 4% migraine/headache, 4% chronic inflammatory bowel diseases, 4% cancer (accompanied by pain), 8% amputations accompanied by pain, 4% pain associated with psycho-physical exhaustion, and 40.5% various other or unclear pain diagnoses (i.e., “pain syndrome”, “general pain”, etc.) categorized as “others”. In most cases, the chronic pain conditions were not associated with work injuries or post surgical conditions. However, one recruiting centre added exclusively patients with phantom pain after limb amputations.

Table 1

Demographic data of patients with chronic pain conditions

All patients
Gender (%)
women 77
men 23

Age (years) 54.3 ± 14.4

Family status (%)
married 48
living with partner 10
divorced 14
living alone 15
widowed 14

Educational level (%)
secondary (Hauptschule) 48
junior high school (Realschule) 23
high school (Gymnasium) 15
other 13

Religious denomination (%)
christian 83
others 4
none 13

Underlying pain conditions (%)
spine-associated pain syndromes 15
fibromyalgia 12
polyarthritis/-arthrosis 8
migraine/headache 4
chronic inflammatory bowel diseases 4
cancer (accompanied by pain) 4
amputations (accompanied by pain) 8
pain associated with psycho-physical exhaustion 4
other pain syndromes or diseases 41

Duration of disease (months) 96 ± 116

Life Satisfaction (% Score) 67 ± 18

Escape from Illness (% Score) 52 ± 27
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Adaptive coping strategies in response to chronic pain conditions were measured with the AKU questionnaire (AKU is an acronym of the German translation of “Adaptive Coping with Disease”), which was designed to identify adaptive coping styles, such as to create favourable conditions, search for information, medical support, religious support, social support, initiative spirit, and positive (re)interpretation of disease [4,5,7]. The underlying concept of the instrument refers to internal and external loci of disease/health control based on the work of Rotter [8,9] and Levenson [10]. The questionnaire was re-validated recently in a sample of 6,963 individuals, and we were able to approve the 6 factorial structure of the 28-item instrument which had a good internal consistency (Cronbach’s alpha = 0.867; difficulty index 0.67) [5], i.e.:

▪ Trust in Divine Help in response to disease addresses non-organized intrinsic religiosity as an external transcendent resource to cope (i.e., trust in a higher power which carries through; strong belief that God will help; faith is a strong hold, even in hard times; pray to become healthy again; live in accordance with religious convictions). Coping Styles Used by Chronic Health Disorder Sufferers.

▪ Trust in Medial Help addresses patients’ reliance on an external medical source of health control (i.e., trust in the therapeutic potentials of modern medicine, take prescribed medicaments, follow advises of medicals, full confidence in doctors and therapists).

▪ Search for Information and Alternative Help refers to external sources providing additional information or alternative help (i.e., thoroughly informed about disease; get thorough information how to become healthy again; find people which can help; search for alternative ways of healing).

▪ Conscious Way of Living addresses cognitive and behavioural strategies in terms of internal powers and virtues (i.e., healthy diet; physical fitness; living consciously; keep away harmful influences; change life to get well).

▪ Positive Attitudes refers to internal cognitive and behavioural strategies (i.e., realization of shelved dreams and wishes; resolving cumbering situations of the past; take life in own hands; doing all that what pleases; positive thinking; avoiding thinking at illness).

▪ Reappraisal: Illness as Chance addresses a reappraisal attitude referring to cognitive processes of life reflection (i.e., reflect on what is essential in life; illness has meaning; illness as a chance for development; appreciation of life because of illness).

The items of the AKU were scored on a 5-point scale from disagreement to agreement (0 – does not apply at all; 1 – does not truly apply; 2 – don’t know; 3 – applies quite a bit; 4 – applies very much). The sum scores were referred to a 100% level (transformed scale score). Scores > 50% indicate high agreement or utilization of coping strategy, while scores < 50% indicate low usage of respective strategy.

The questionnaire holds 3 independent items, which did not contribute to the primary AKU item pool. They made up an independent scale termed Escape from illness (i.e., fear what illness will bring; would like to run away from illness; when I wake up, I don’t know how to face the day”, which addresses a passive (avoidance-escape) coping style [4,5,7], while the AKU questionnaire differentiates active adaptive coping styles. It was confirmed recently that Escape correlated strongly with depression, with disease appraisals such as ‘weakness/failure’ and ‘punishment’, and negatively with life satisfaction [11]. The items were scored on a 5-point scale from disagreement to agreement.

To measure how the patients interpret their disease, we used the ‘Interpretation of Illness Questionnaire’ (IIQ) [12] which refers to the work of the Canadian psychiatrist Lipowski [13].Coping Styles Used by Chronic Health Disorder Sufferers.  The 8-item instrument has satisfactory internal consistency (Cronbach’s alpha = 0.730) and involves guilt-associated negative interpretations (i.e., punishment, weakness), fatalistic negative interpretations (i.e., adverse interruption of life/loss, threat/enemy), strategy-associated interpretations (i.e., relieving break from the demands of life, call for help), and positive interpretations of disease (i.e., challenge, value) [12]. The items were scored on a 5-point scale from disagreement to agreement (0 – does not apply at all; 1 – does not truly apply; 2 – don’t know; 3 – applies quite a bit; 4 – applies very much), and are referred to a 100% level (4 “regularly” = 100%).

Life satisfaction was measured with the Brief Multidimensional Life Satisfaction Scale (BMLSS) [14]. The eight items of the BMLSS refer to intrinsic dimensions (Myself, Overall Life), social dimensions (Friendships, Family life), external dimension (Work, Where I live), and the perspective dimension (Financial Situation, Future Prospects). All items were scored on a 7-point scale from dissatisfaction to satisfaction (0 – Terrible; 1 – Unhappy; 2 – Mostly dissatisfied; 3 – Mixed (about equally satisfied and dissatisfied); 4 – Mostly satisfied; 5 – Pleased; 6 – Delighted). The Life Satisfaction sum score was referred to a 100% level (transformed scale score). Scores > 50% indicate high life satisfaction, while scores < 50% indicate low satisfaction.

Statistical analysis

Analyses of variance (ANOVA), correlation and stepwise regression analyses were performed with SPSS for Windows 17.0. We judged p < 0.01 as significant. With respect to the correlation analyses, r > .5 is regarded as a strong correlation, r between .3 and .5 as a moderate correlation, while r between .2 and .3 is regarded as a weak correlation, and r < .2 as no or negligible correlation.

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Demographic characteristics of patients

We analyzed data of 579 patients (mean age 54 ± 14 years) with chronic pain conditions (mean duration of disease: 96 ± 116 months). As shown in Table ​Table1,1, most patients were living with a partner, had a lower educational level, and a Christian denomination. We had a predominance of female patients (77%), which is in line with findings of Munce and Steward [15], who reported that women had higher rates of chronic pain conditions and depression than men. However, Escape from illness, as a passive avoidance-escape strategy, was not a major issue to the patients (Table ​(Table1);1); instead, Life Satisfaction scores were moderately expressed, indicating that the patients were mostly satisfied. Coping Styles Used by Chronic Health Disorder Sufferers.


Adaptive coping in patients with chronic pain conditions

The patients with chronic pain conditions analyzed herein relied on both external powerful sources to control their disease (i.e., Trust in Medical HelpSearch for Information and Alternative Help) and on internal powers and virtues (i.e., Conscious and Healthy Way of LivingPositive Attitudes), while the transcendent external locus of disease control (i.e., Trust in Divine Help), and also Reappraisal: Illness as Chance were valued moderately (Table ​(Table2).2). With respect to age, underlying pain conditions and burden of pain (as an indirect measure we investigated which clinic was seen for treatment, i.e., the acute pain outpatient clinic offers predominantly acute pharmaceutical interventions, while the rehabilitation clinics offers predominantly orthopaedic interventions and medication, as contrasted by mind-body programs, naturopathy and medication in the internal and integrative medicine clinic) we found several significant differences which are depicted in Table ​Table2.2. The utilization of the respective adaptive coping strategies did not significantly differ with respect to gender (Table ​(Table2),2), while the educational level had a small impact on Trust in Medical Help, which was the highest in patients with low educational level (F = 3.2; p = 0.022). Age had a significant (p < .0001) impact on Trust in Divine Help (F = 10.4), Trust in Medical Help (F = 5.2) and Conscious Way of Living (F = 4.8). Duration of disease had no significant impact on the adaptive coping strategies (F < 2.0; n.s.); however, Conscious Way of Living showed in trend some degree of variance (F = 2.3; p = .053). Coping Styles Used by Chronic Health Disorder Sufferers.