Rick Allen, PhD   
California Licensed Psychologist

California Psychologist January 2003 Volume XXXVI Number 1

Coping With Traumatic Stress
Rick Allen, PhD

When psychologists respond to disasters and traumatic events, they need to tailor their interventions to both the individual and the situation. When working in an active disaster site, such as Ground Zero, interventions need to prevent workers from becoming overwhelmed. These interventions bolster individuals against stress and help them function. They include emotional support, educational interventions, normalizing, and interventions that enhance coping modalities employed by the workers. Interventions that focus on coping are matched to the client’s coping behavior.

The literature suggests that coping with traumatic events can be viewed as a process. This process is characterized by the utilization of different coping modalities at different times. (Aldwin, 1997) This article focuses on a model that posits three types of coping: avoidant coping; instrumental coping; and psychological coping. A number of researchers have discussed similar coping categories, but have not presented a model for selecting interventions based upon the client’s current coping. (Carver et al. 1989, Freedy et al., 1992).

Avoidant coping is characterized by actions that help individuals avoid being overwhelmed by traumatic stressors, memories and other reminders. Avoidant coping includes a wide range of activities such as denial, dissociative reactions, drinking, going to a movie, stress reduction and sleeping. These actions help remove the individual from awareness of the traumatic stressors to which they have been or are continuing to be exposed.

Instrumental coping is characterized by actions that help individuals remedy the effects of a traumatic event, or to carry on life activities. These may include seeking outside assistance from relief organizations, cleaning up debris from a disaster, providing rescue or recovery services, or returning to work and acquiring resources.

Psychological coping, to which we frequently focus our interventions, is based on helping individuals gain control over symptoms, understand how their world has changed, understand their own reactions to events, mourn, and psychologically reconstitute after a traumatic event.

All three modalities serve some important functions. They help the individual maintain a sense of control through avoiding overwhelming feelings or memories, regain a sense of control through restoring their home or environment, and restore psychological functioning to the pre-exposure level of functioning.

In assessing coping modalities, it is important to keep in mind what research in this area suggests about the function of coping and how it serves the individual. Information or interventions need to be congruent with the type of coping modality. A study on surgery patients found that two primary coping modes employed by those about to undergo surgery. These coping modes were referred to as blunters and monitors. Blunters do not want any information about the procedure and what is going to occur. Providing this group of patients with information distresses them. Monitors, in contrast, want information and become less distressed when informed about the procedure. (Miller and Mangan, 1983).

Another coping principle has to do with perceived control and coping. In situations where the individual has no control, an emotionally focused coping mechanism may be more effective in reducing their stress. If there is a sense of control, even to a limited degree, then an active or instrumental coping mechanism may be more effective in reducing stress. Soloman found that combat soldiers who had some control over their situation had fewer stress symptoms regardless of their level of combat exposure. (Soloman, 1989). Soldiers who experienced higher levels of combat exposure and had some ability to control the situation had less severe stress reactions than soldiers with less intense combat exposure who felt they had little or no control over their situation. If there are elements in the situation that can be controlled, helping the individual focus on instrumental coping can be more effective at reducing distress. If the individual cannot exert control, then an emotional (psychological) coping strategy may be more effective in reducing their stress. There are also times when an avoidant coping approach may help prevent the individual from being overwhelmed. (Bettleheim 1943; Frankl, 1963).

The research literature suggests that individual coping varies over time, and meets different needs after a traumatic event. Likewise, interventions counter to individual’s coping modes are distressing. Given these two factors, interventions should be used that address the coping mode being use. These interventions can assist individuals to improve their coping in two ways. First, they can help the client become aware of how they are coping with their stress, and how their coping mode (i.e., avoidant, instrumental or psychological) serves a function. The client can be educated about how different coping modes serve different purposes. and that moving between them can aid in recovery from the traumatic event. For example, when working with recovery workers, you might mention that at some point in time it is useful to find a place to express feelings and to come to grips with what they have experienced. You could explain that psychological coping will be a phase in their recovery and how they might go about it, although you would not be providing psychological interventions at that time.

The second type of intervention is assisting the individual to choose a healthier form of coping within the modality they are employing. For example, an individual who goes home and drinks until numb is employing an avoidant coping strategy. You could help them replace this with a more healthful avoidant coping, such as going to a movie, eating out with friends, or getting a massage. Helping the client to develop an understanding of how they use coping to reduce the effects of traumatic stress, and to make more conscious and healthful choices, can aid them in attaining a sense of control over their own psychological reactions.

This model integrates discrete evidence that has been viewed separately in the past. Matching interventions to a client’s current coping mode is less likely to cause distress, more likely to be congruent with current needs, and offers them a model how to manage posttraumatic stress. This approach is also useful in psychotherapy by selecting appropriate and timely interventions based upon clients’ current coping, and by exploring material that triggers a shift in their coping modes.

Rick Allen, PhD is the CPA Northern California Disaster Coordinator, and serves on the CPA Board of Directors as Monterey Bay Psychological Association Representative. He was a disaster mental health team leader at Ground Zero in New York last fall, and has managed and provided psychological services at numerous disasters and human initiated traumatic incidents. Dr. Allen has engaged in research on trauma and coping, developed a child trauma scale, written articles, and edited the Handbook of Post Disaster Interventions. He consults with organizations on workplace trauma mitigation, and provides workshops on treating trauma and organizing services after a traumatic event. Dr. Allen can be reached at rallenphd@aol.com. References are available upon request from CPA Central Office.