RELATIONSHIP BETWEEN LOCUS OF CONTROL

AND COPING STRATEGIES IN COMMUNITY

MENTAL HEALTH OUTPATIENTS

BY
MARGIE K. STEVENSON

A DISSERTATION PRESENTED TO THE GRADUATE CGUNE
Cr THE UNIVERSITY OF FLORIDA IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF DOCTOR OF PHILOSOPHv

UNIVERSITY OF FLORIDA
] 982

1

This dissertation is dedicated to my father, Leon Mayatte, who
taught me to value education and achievement and to my mother,
Lucille Mayatte, who taught me to value myself.

ACKNOWLEDGMENTS
I wish to express my appreciation to my doctoral committee
chairman, Dr. Ted Landsman, for his patient guidance and for setting
an example of the highest professional standards. Appreciation is
also extended to the members of my committee. Dr. David Suchman
deserves special thanks for his help in generating a research
topic and for his awareness of and responsiveness to my need for
emotional support throughout this work. Dr. Ruth Alexander has
provided an excellent role model of a professional woman who has
accomplished much in her field without sacrificing her femininity.
I am also indebted to Dr. James Algina, a very competent statis-
tician, for his technical assistance and for his efforts to commu-
nicate his expertise in a manner that was meaningful to me. My
deepest love and appreciation are extended to my wonderful husband
for his many personal sacrifices and his unfailing encouragement.
Without his understanding and support this dissertation would not
have been possible.

m

TABLE OF CONTENTS

Page

ACKNOWLEDGMENTS in

LIST OF TABLES vii

ABSTRACT vii i

CHAPTER I: INTRODUCTION 1

Rationale for the Study 5

Research Hypotheses 6

Definitions of Terms 6

CHAPTER II: REVIEW OF THE LITERATURE 10

Field Studies of Denial -Sensi tization

in Surgical Patients 12

Experimental Studies of Denial -Sensi ti zation

in Surgical Patients 13

Laboratory Studies Conceptualizing Coping

Along Denial-Sensitization Dimension 14

Summary of Research Conceptualizing Coping

as Denial-Sensitization 17

Atheoretical Studies of Coping with Naturally

Occurring Stressors 19

Evidence for the Adaptive Value of Strategies

Which Incorporate Denial 22

Strategies Which Combine Denial and Action-
Oriented Behaviors ■- '■

Studies Which Emphasize the Effectiveness of
Action-Oriented Strategies

Summary of Studies of Coping with Naturally
Occurring Events

22.

... 28

Determinants of Coping Behavior 29

iv

Sex Differences in Coping Strategy 31

Summary of Male-Female Differences in Coping 34

SES Differences in Coping Style 35

Locus of Control as a Mediator of Responses

to Stressful Events 37

Field Studies Relating Locus of Control to

Coping Strategies 38

Experimental Studies Relating Response to

Aversive Events to Locus of Control 43

Summary of Research Relating Locus of Control

to Coping Strategy 45

Research on Coping in Mental Health Clients 45

Null Hypotheses 50

CHAPTER III: METHOD 52

Subjects 52

Instruments 54

Procedure 64

Data Analysis 66

Statistical Analysis 74

CHAPTER IV: RESULTS 76

Direct Action Responses 78

Defensive Responses 80

Functional Somatic-Oriented Responses 80

Potentially Dysfunctional Somatic-Oriented Responses

--Type A 80

Potentially Dysfunctional Somatic-Oriented Responses

--Tyoe B °'

CHAPTER V: DISCUSSION 82

Exploratory Data 88

General izabil ity of Findings 92

Implications for Counseling 92

Limitations of the Study and Suggestions

for Future Research 94

Summary of Study 95

APPENDIX A: QUESTIONNAIRES 99

APPENDIX B: DEMOGRAPHIC DATA FORM 109

APPENDIX C: INFORMED CONSENT FORM I'll

REFERENCES 112

BIOGRAPHICAL SKETCH 119

VI

LIST OF TABLES

Table Page

1. Demographic Characteristics of Research Subjects 53

2. Pilot Study Varimax Rotated Factor Matrix 62

3. Varimax Rotated Factor Matrix 67

4. Subscales Used in Hypothesis Testing 70

5. Correlations Between Locus of Control and

Coping Responses 77

6. Relationship Between Control Variables and

Correlational Variables 79

7. Mean Scores on Locus of Control and Coping

Response Scales 85

VI i

Abstract of Dissertation Presented to the Graduate Council

of the University of Florida in Partial Fulfillment of the

Requirements for the Degree of Doctor of Philosophy

RELATIONSHIP BETWEEN LOCUS OF CONTROL

AND COPING STRATEGIES IN COMMUNITY

MENTAL HEALTH OUTPATIENTS

By
Margie K. Stevenson

December, 1982

Chairman: Theodore Landsman

Major Department: Counselor Education

A study of the relationship between locus of control and mecha-
nisms for coping with stressful events was conducted with 40 male and
60 female community mental health outpatient subjects. Responses to
stressful situations were measured by the Coping Response Inventory,
a 24-item rating scale developed by the researcher, based on coping
response categories designated by Richard Lazarus as direct action,
defensive and somatic-oriented. Locus of control was assessed by the
Adult Nowicki-Strickland Internal -External Control Scale. A partial
correlation analysis was conducted to determine the linear relation-
ship between locus of control and each of five coping response cate-
gories, while controlling for sex and socioeconomic status (SES). A
statistically significant relationship was found between locus of
control and choice of coping responses. As internal i ty increased,
choice of direct action and functional somatic-oriented responses

viii

increased and choice of one of two types of potentially dysfunctional
somatic-oriented responses decreased. Externality was found to relate
positively to choice of defensive and one of two types of potentially
dysfunctional somatic-oriented responses and negatively to choice of
direct action and functional somatic-oriented responses. The control
variables, sex and SES, contributed little to the relationship between
locus of control and coping strategies, although there was a tendency
for persons of higher SES to use more direct action responses and for
males to have higher SES than females. The rather low correlation co-
efficients, which ranged between .20 and .40, indicated that although
a person's belief concerning ability to influence outcomes is a factor
related to choice of responses to stressful events, it is not a major
factor. Other variables not included in the hypotheses of the study
which appeared to influence coping style were marital status, age and
the type of problem with which a person was coping. The results of
this study support Lazarus' theory that coping is a complex process
which includes some combination of responses which act directly upon
the stressor, responses which function to distort awareness of the
stressor and reduce threat and responses which alleviate the dysphoric
somatic accompaniments to coping with stressful events.

IX

CHAPTER I
INTRODUCTION

Since the definition of stress as a biological concept by Selye
(1956), social scientists from the disciplines of anthropology, psy-
chology, sociology and medicine have amassed an impressive body of
research data which established a relationship between adversive life
experiences and breakdown of physical and psychological functioning.
In addition to the part that they play in psychosomatic diseases,
stressful life events have been shown to be related to many somatic
disorders including heart disease, childhood leukemia and fractures;
as well as to the psychological disorders of acute schizophrenia,
neurosis, depression and suicide attempts (Andrews, Tennant, Hewson &
Vaillant, 1978; Dohrenwend & Dohrenwend , 1978). Yet, despite exposure
of all people to the stresses of living, which might include loss of a
loved one, changes in living or work situation, financial reversals,
injury, frustration or failure, only a relatively small percentage of
people succumb to physical or psychological impairment. It was this
knowledge that exposure to stressors alone was almost never sufficient
to explain onset of illness which has led to interest in identifying
those factors which mediate the impact of adversive experiences and
allow the individual to adapt to or cope with demanding circumstances
(Rabkin & Struening, 1976).

For the purposes of this paper Selye's definition of stress as
"the state manifested by a specific syndrome which consists of all the
nonspecifically-inauced changes within a biologic system" (1956, p. 54)

1

2

will be adopted. This definition views stress as a physiological re-
sponse of the system which is separate from those events which cause
it and is of interest here primarily as a motivator to relieve the
accompanying discomfort and reestablish the body's homeostasis.
The causal events or stimuli to which stress is a response are re-
ferred to as stressors or stressful situations and include any number
of nonspecific conditions which require change or adaptation. Al-
though stressors may be purely physical demands upon the body, psycho-
logical stressors are of special importance because of the frequency
with which individuals are faced with challenging emotional stimuli
in the course of their daily lives (Selye, 1976).

While certain events such as the death of a loved one or loss of
one's job are typically considered stressful by most people, there is
great diversity in the degree to which the same event is considered
stressful and in responses to such events. Individuals may respond
quite differently to the same event depending on whether it is per-
ceived as threatening, challenging, or of little significance to them.
Threat, therefore, is not an inherent property of a stimulus but
depends rather on the appraisal of its personal significance and of
one's potential for mastery (Lazarus, 1964). This appraisal, which is
influenced by many factors including characteristics of the stimulus,
the environment and the person, determines not only the manner in which
the event will be interpreted, but to a large degree, the choice of re-
sponse. If an event is perceived as a serious threat to self and one's
ability to reverse it is judged to be inadequate, the individual is
likely to respond quite differently from one who sees the event as a
challenge and feels that the capacity for mastery is high (Mechanic,

3

1962). This process of assessing the threat value of an event and
formulating a response to it is the essence of coping. Knowledge of
this process and its determinants is integral to the understanding of
behavior in the face of stressful circumstances.

Coping has been variously defined as "things that people do to
avoid being harmed by life strains" (Pearlin & Schooler, 1978, p. 2);
"efforts to deal with some new, and often problematic, situation or
encounter or to deal in some new way with an old problem" (Perlman,
1975, p. 213) and "behavior which has consequences relevant to the
situational demands" (Mechanic, 1962, p. 52). Lazarus and Launier
(1978) defined coping as "efforts ... to manage (i.e., master,
tolerate, reduce, minimize) environmental and internal demands, and
conflicts among them, which tax or exceed a person's resources"
(p. 311). The Lazarus and Launier conceptualization, which has been
adopted for this study, regards coping as the product of a cognitive
appraisal process whereby both the properties of the stimulus and the
individual's assessment of his/her potential for mastery enter into
defining a situation as stressful and formulating a response to it.
Lazarus (1977) defined three types of responses to situations ap-
praised as stressful. Direct action or instrumental responses are
attempts to influence or change the harmful nature of the stimulus,
defensive responses are attempts to deny or ameliorate the individual's
perception of the event and somatic-oriented responses are efforts
aimed at reducing the dysphoric somatic conditions which accompany the
body's physiological stress response. For the purposes of this study
somatic-oriented responses have been divided into those which are
functional and those which are potentially dysfunctional.

4

Data from field studies of naturally occurring stressors and from
experimental manipulations in laboratory settings have contributed
greatly to the understanding of the coping process and the many vari-
ables related to it. In recent years focus has shifted to assessment
and analysis of the mechanisms or dispositions which underlie coping,
especially those which determine the cognitive appraisal of threat
and the choice of coping strategy (Lazarus, 1974). One variable which
may be viewed as an organizing or guiding principle in this regard is
the individual's belief concerning the ability to control the course
of life and to intervene effectively in environmental events. This
belief or expectancy regarding the nature of the causal relationship
between one's own behavior and its consequences has been called locus
of control (Rotter, 1966). Individuals who believe that outcomes are
contingent upon their own actions are labelled internals and persons
who attribute what happens to them to luck, fate or powerful others
are referred to as externals. Internally controlled individuals, who
have a strong sense of personal efficacy, are more likely to initiate
attempts to alter negative circumstances than externally controlled
persons who are likely to respond in a manner consistent with their
belief that very little which they do directly results in an effect
(Wolk and Kurtz, 1975).

That locus of control can function as a moderator of the aver-
siveness of events has been shown in experimental studies with humans
as well as animals (Lefcourt, 1973). These studies provide evidence
that the illusion of control, even if not exercised, results in less
physiological arousal as a result of exposure to aversive stimuli
than when such control is lacking.

Rationale for the Study

The purpose of the present study is to identify coping strategies
being used by clients seeking counseling in a community mental health
facility and to relate those strategies to locus of control orien-
tation. It is hypothesized that effective coping strategies, greater
use of direct action and functional somatic-oriented responses, are
related to perception of life events as internally controlled and that
ineffective coping strategies, greater reliance on defensive and poten-
tially dysfunctional somatic-oriented responses, are related to per-
ception of life events as externally controlled. Confirmation of such
a relationship, although it would not establish causation, would provide
the clinician with information of value in developing therapeutic
interventions for persons who are having difficulty coping with current
circumstances.

The study of the coping process and its determinants is of par-
ticular relevance to the mental health clinician who provides services
to persons who often enter the mental health delivery system over-
whelmed by an event or series of events with which their usual coping
strategies are inadequate to deal (Perlman, 1975). The client's very
presence in the initial interview is evidence of a search for a new
approach to handling present circumstances. Since the seeking of pro-
fessional services is usually a rather late step in the process of
problem resolution after other attempts have failed (Overbeck, 1977),
the counseling interview offers a unique opportunity to study the
attempts which clients have made and continue to make in negotiating
the stressful situations with which they are actively engaged. In
addition to the knowledge to be gained from such an assessment in

6
furthering the understanding of the coping process, such an inquiry
could be very helpful to the clinician in planning effective treatment.

One of the major purposes of therapy is to help clients learn to
recognize and understand the relationship between their behavior and
their difficulties and to accept responsibility for initiating changes
which will improve their condition (Baker, 1979). Therapeutic inter-
ventions for increasing awareness of personal responsibility and
potential for having an effect on one's life events are outlined by
Connolly (1980) and Stensrud and Stensrud (1981). If locus of control
orientation is related to choice of coping strategies the most ef-
fective intervention might be one which combines techniques for chang-
ing perception of control with exploration and implementation of more
effective coping responses.

Research Hypotheses
HA,A As internality increases choice of direct action and
functional somatic-oriented responses increases.

HA,D As internality increases choice of defensive and potentially
1 B

dysfunctional somatic-oriented responses decreases.

HA9fl As externality increases choice of direct action and

functional somatic-oriented responses decreases.

HA As externality increases choice of defensive and potentially
2B

dysfunctional somatic-oriented responses increases.
Definitions of Terms

Stress

Stress is "the state manifested by a specific syndrome which
consists of all the nonspecif ical ly-induced changes within a biologic
system" (Selye, 1956, p. 54).

Stressor

A stressor is a causal event or stimulus to which stress is a
response. Stressors may include any number of nonspecific conditions
which require change or adaptation and may be either physical or
psychological in nature. Physical stressors may include physical in-
jury, disease or exposure to noxious chemicals, extreme temperature or
aversive noise levels. Examples of psychological stressors include
loss of a loved one, changes in one's job or living situation, finan-
cial reversals, frustration or failure.
Coping

Coping is defined as ". . . efforts ... to manage (i.e., master,
tolerate, reduce, minimize) environmental and internal demands, and
conflicts among them, which tax or exceed a person's resources"
(Lazarus & Launier, 1978, p. 311). Coping efforts include direct
action responses, defensive responses, functional somatic-oriented
responses and potentially dysfunctional somatic-oriented responses.
Direct Action or Instrumental Responses

Direct action or instrumental responses are coping efforts which
are aimed directly at influencing or eliminating the harmful nature of
the stimulus. Direct action responses include preparation to meet
danger, attack against the harmful agent or evasion to avoid contact
when threatened by an agent which is overwhelmingly powerful or
dangerous. Direct action responses are most often related to positive
outcomes in managing stressful situations. Examples include seeking
information, analyzing the situation, exploring alternatives, con-
sulting with others and developing a plan of action. The terms direct
action and instrumental responses are used interchangeably.

Defensive Responses

Defensive responses are attempts to deny or ameliorate one's per-
ception of an event so that threat is reduced. Threat, however, is
reduced only in the mind of the individual as no action has been taken
to influence the stressor. Defensive strategies are considered costly
in that they distort reality and interfere with seeking adaptive alter-
natives. If evidence of the stressor increases, the defensive strat-
egy may become ineffective and the threat of harm may be reinstated.
Defensive responses include use of denial, projection, intellectu-
al ization or rationalization and may occur at conscious and unconscious
levels. Examples include ignoring the problem, deciding that it does
not really have an important effect, focusing on the concerns of others
and believing that things will take care of themselves.
Somatic-oriented Responses

Somatic-oriented responses are efforts directed toward reducing
the dysphoric somatic conditions which accompany the process of antici-
pating and responding to stressful events. Somatic accompaniments may
be experienced as increased anxiety, loss of appetite, sleeplessness,
impaired concentration or depressed mood state. Somatic-oriented
responses help to control those discomforts which interfere with adap-
tive responding without distorting or denying the significance of the
stressor. For the purposes of this study somatic-oriented responses
have been divided into functional and potentially dysfunctional re-
sponses.

Functional somatic-oriented responses. Functional somatic-
oriented responses are those which relieve somatic discomfort and
which have the potential for increasing present and future coping

9
capacity. Examples include engaging in physical exercise, gardening,
doing handwork or carpentry, reading or listening to music.

Potentially dysfunctional somatic-oriented responses. Potential-
ly dysfunctional somatic-oriented responses are those responses which
temporarily relieve somatic discomfort but which have the potential for
becoming additional sources of stress themselves. Examples include
drinking alcohol, smoking, taking tranquilizers or sleeping pills.
Locus of Control

Locus of control is a generalized expectancy which operates across
a large number of situations regarding the causal relationship be-
tween one's own behavior and its consequences. Internal locus of
control is the belief that outcomes or reinforcements are contingent
upon one's own actions, while external locus of control is the belief
that reinforcements are attributable to luck, fate or powerful others.

CHAPTER II
REVIEW OF THE LITERATURE

The study of the ways in which people cope with stressful life
situations has been of interest to researchers in a variety of disci-
plines for the past 25 to 30 years. Earliest investigations often
took the form of atheoretical field studies which observed how indi-
viduals coped with naturally occurring stressors such as being se-
verely burned (Hamburg, Hamburg & deGoza, 1953), stricken with polio-
melytis (Visotsky, Hamburg, Goss & Lebovits, 1961), undergoing major
surgery (Abram, 1965; Janis, 1958), losing a child through leukemia
(Chodoff, Friedman & Hamburg, 1964) or taking Ph.D. qualifying exami-
nations (Mechanic, 1962). From these early observations in the field
came the knowledge that the defense mechanisms played a major role in
the way individuals coped with stressful events. The tendency to use
denial and isolation of affect was found to be a typical component of
adaptive behavior in a variety of situations which represented threat
to life or to self-esteem. Janis (1958), in observing the coping be-
havior of patients anticipating major surgery, found that many showed
no apprehension prior to surgery but felt calm and invulnerable, appar-
ently denying or minimizing the possible dangers and threatening impli-
cations of their surgery. Along with those who typically employed de-
nial, Janis identified two other groups — those who were extremely appre-
hensive and who felt highly vulnerable to bodily damage and those who
were moderately fearful prior to surgery. The tendency to be either

10

11

extremely sensitive to the threatening aspects of a situation or to
deny them completely was found to relate to negative postsurgical
outcomes (Janis, 1958). Both styles appeared to prevent the individual
from developing strategies to cope with the surgery and the post-
surgical period. The group which had a moderate level of arousal con-
cerning surgery asked for and received realistic information about
what was going to happen to them and their convalescence was less
difficult. In addition, this group of individuals exhibited fewer
negative psychological reactions such as anger or resentfulness against
their caretakers. The identification of these three coping styles
spurred interest in the study of the polarities of denial and sensi-
tization.

Two instruments were developed which measured the dimension of
denial-sensitization. Byrne (1961) constructed the Repression-
Sensitization (RS) Scale from Minnesota Multiphasic Personality
Inventory (MMPI) items. The RS scale dichotomized individuals into
those who responded to threatening situations by avoiding or denying
the threat (repressors) and those who responded in similar circum-
stances by becoming alert to and seeking information about the threat-
ening nature of the situation (sensitizers). Goldstein (1959) devised
a sentence completion test which divided subjects into three coping
styles depending on the extent to which their responses reflected a
move toward or away from potentially threatening emotions. Those with
personalized, specific feeling-acknowledgments were defined as copers;
those with stereotyped denial or distancing of feelings, as avoiders
and those who emphasized neither style, as nonspecific defenders
(Andrew, 1970). Copers were similar to Byrne's sensitizers in being

12
hyperalert to the threatening aspects of the environment, while avoiders
were like repressors in denying those aspects (Lazarus, Averill S
Opton, 1974).

A number of studies using one or the other of these measures of
denial-sensitization have appeared in the literature. Several of these
studies were conducted with patients awaiting surgery and can be
divided into two types — field studies which observed the relationship
between coping strategy and postsurgical outcome and those which manip-
ulated the situation experimentally in an attempt to influence post-
surgical outcome.

Field Studies of
Denial-Sensitization in Surgical Patients

Studies of this group correlated coping strategy with a recovery
index which included number of days hospitalized postsurgical ly,
number of patient-requested medications and number of minor compli-
cations. The assumption was made that patients in each study were
homogeneous with regard to seriousness of condition and surgical pro-
cedure. In a study of male cancer patients considered by a physician
to be similar in relation to medical condition, MacCornack (1979) found
that copers did best on the recovery index, with nonspecific defenders
next and avoiders having the poorest outcomes. In a second study of
this type Cohen and Lazarus (1973) measured outcomes for 61 patients
(22 male, 39 female) admitted for elective surgery. They found that
copers showed slowest recovery, with more days hospitalized and greater
frequency of minor complications, while nonspecific defenders and
avoiders fared equally well. This study did not control for serious-
ness of surgery, therefore, the results were confounded by this over-
sight. A retrospective examination of the data showed that three of

13

the four most serious cases were in the coper group. This could

account for their poorer recovery rates.

Experimental Studies of
Denial-Sensitization in Surgical Patients

Three other studies of surgical patients which categorized sub-
jects along the denial-sensitization coping dimension included an
experimental manipulation. Andrew (1970) assessed outcomes for 40
males who had hernia surgery. Using Goldstein's test, patients were
divided into copers, avoiders and nonspecific defenders and were pro-
vided with audiotape information about the origin of hernia, the
dangers of delaying surgery; the surgical procedure and its conse-
quences. Of the three groups nonspecific defenders fared best, staying
fewest days in the hospital and requesting less medication than either
other group. There was no difference between copers and avoiders on
days of hospitalization; however, avoiders required more medication.
DeLong (1971) assessed the effect of providing audiotape information
prior to surgery, which was either consistent or inconsistent with the
patient's orientation toward threatening stimuli. For copers con-
sistent information was considered to be specific information about the
impending surgery and inconsistent information was general information
about the hospital. The reverse was considered consistent/inconsistent
for avoiders. As predicted, copers provided with specific informa-
tion did best on the recovery index and on a subjective measure of
recovery. Avoiders who had been given specific information made more
postoperative complaints. Regardless of the type of information given,
avoiders showed slower, more complicated recoveries. Ritter (1980)
also found that providing information consistent with coping style

14

resulted in decreased presurgical anxiety for 50 (37 male, 13 female)

patients scheduled for open-heart surgery, while no change in anxiety

was noted for those given inconsistent information.

Laboratory Studies Conceptualizing Coping
Along Denial-Sensitization Dimension

Laboratory studies have also used the tendency to approach or
to avoid threatening stimuli as a dimension along which to study the
effects of the experimental manipulation of stressors. Diskin, Gold-
stein and Grencik (1977) divided 135 law enforcement officers into
copers, avoiders and nonspecific defenders. After being further cate-
gorized into high or low anxiety groups according to scores on the
Trait-State Anxiety Scale, subjects were given one of three treatments
prior to exposure to a stressful film. The film depicted workshop
accidents in which workers were injured and which culminated in a scene
where a man died after being impaled through the abdomen by a board.
Subjects in two conditions were given specific information concerning
the disturbing events in the film, after being designated to either
relax alone for 10 minutes or to view a travelog about marine life.
The third group was immediately exposed to the film without any informa-
tion about its contents nor the opportunity to relax. Arousal (stress
reaction), as measured by skin conductance and subjective self-report,
was greatest in the condition where no information was provided prior
to the film. Highest reactivity was observed in subjects who were
categorized as high anxiety copers. These subjects were also rated
lowest on job performance by their supervisors, while low anxiety
avoiders and nonspecific defenders received the highest job ratings.

In a design which assessed the relationship between coping
style and exposure to failure, Carter (1974) divided 84 female

15
undergraduates into sensitizers, repressors and neutrals as measured
by the Byrne RS scale. Half of each group had a successful experience
with an anagram task and the other half experienced failure. Subjects
filled out five rating scales designed to elicit their responses to
the experience. Under conditions of failure, sensitizers reported
more anxiety and greater dissatisfaction with their performance than
either repressors or neutrals.

A study by Houston and Hodges (1970) observed the effect of either
threat of failure or electric shock on subjects categorized as deniers,
neutrals or sensitizers (accentuators) . Rather than the paper and
pencil instruments used by the investigators mentioned above, a be-
havioral measure of coping tendency was developed based on discrepancy
between subjective self-support and physiological measures of stress.
One hundred and eight male introductory psychology students were given
the digits backwards test from the Wechler Adult Intelligence Scale
and then were assigned to one of three conditions. Subjects in one
condition were told that they were doing well, subjects in a second
condition were told that they were doing poorly and subjects in the
third condition were told that they would be given an electric shock
to study its effect on blood pressure. All subjects were then given
the Affective Adjective Check List as a measure of subjective dis-
comfort. Heart rate was recorded prior to and after the threat manip-
ulation and used as an indicator of physiological arousal. Subjects
who exhibited physiological arousal which was relatively greater than
their reported subjective discomfort were designated deniers (tended
to deny their arousal). Subjects who reported relatively greater
subjective discomfort than they evidenced physiological arousal were

16
designated sensitizers or accentuators (accentuated their arousal).
Those individuals who showed a minimal discrepancy between the two
indicators were categorized as neutrals. Effectiveness of coping
style was measured by monitoring performance on a second adminis-
tration of the digits backwards test. The denial group performed best
under both the threat of shock condition and the failure condition,
with neutrals next and sensitizers doing worst in both of the condi-
tions. These researchers concluded that denial was an effective strat-
egy for these subjects when confronted with threat to ego (failure) or
threat of pain.

Averill and Rosenn (1972) devised a different type of operational
definition of denial -sensitization for a study conducted with 80 male
undergraduates anticipating and receiving electric shock. Sensiti-
zation or vigilance was defined as choosing to listen for a warning
signal during anticipation of shock, while denial was defined as
choosing instead to listen to music. A second measure of the tendency
to avoid or approach threatening stimuli was the subject's response to
three avoidant and three vigilant types of statements indicating what
he was thinking about during each trial. Each subject was exposed to
three different levels of shock intensity. An avoidance response was
available in one condition if subjects listened for the warning signal,
while in another condition shock was delivered regardless of the coping
style the subject adopted. Although vigilance increased as a function
of shock intensity, especially among the avoidance group, a sizable
portion (30% in the avoidance condition and 50% in the nonavoidance
condition) chose a denial type of response even at the highest shock
intensity. These deniers who chose to listen to music were more

17
physiologically aroused based on heart rate and galvanic skin re-
sistance (GSR) than those who chose the vigilant strategy of listening
for the preshock signal. Subjects who listened for the tone (sensi-
tizers) showed least arousal in the condition where they could make a
response to avoid the shock (avoidance condition).

Another study which points to the tendency to adopt and per-
sistently maintain a denial coping style in dealing with threat was
reported by Niemela (1974). The GSR patterns of 15 male and 15 female
subjects anticipating and receiving shock were monitored. The majority
of the subjects showed anticipatory arousal prior to delivery of the
shock, evidence that they were sensitized to the impending aversive
event. However, six subjects showed no anticipation but exhibited a
very high arousal response to the delivery of the shock. When inter-
viewed later these subjects reported that they had denied the possi-
bility of receiving the shock during the waiting period. A question-
naire was also administered to assess everyday stress behavior. For
those who tended to use denial in the experimental situation, a pat-
tern emerged which was characterized by avoidance of disagreeable
events and failure to undertake preparation. This pattern was in con-
trast to that of subjects who were attuned to warnings and prepared
themselves prior to the occurrence of a stressful event.

Summary of Research
Conceptualizing Coping as Denial-Sensitization

The findings derived from these studies which conceptualized

coping with stressful situations along an approach-avoidance dimension

are admittedly inconsistent. These discrepancies may be due in some

cases to failure to control relevant variables, as in the Cohen and

18
Lazarus (1973) study of surgical patients where the groups were not
homogeneous with regard to seriousness of condition. However, despite
the lack of agreement on some points, some consistent information can
be extracted. These studies seem to confirm that there is a tendency
for individuals to cope with a stressful situation by either avoiding
or by being sensitized to and/or approaching its threatening aspects.
These two styles are apparent whether coping is assessed by question-
naire or through behavioral measures. Preferences for one style
rather than another within a given situation appear to be persistent
regardless of the consequences. Denial seems to be a viable mechanism
when threat is not extremely high, such as in performing a task in the
laboratory after being told that you are doing poorly, or awaiting
shock which is never delivered. Its effectiveness in controlling
arousal may not hold up when the threat actually materializes, as when
the shock is delivered, and may result in a more severe reaction at
that point than if a more vigilant strategy had been utilized (Niemela,
1974). The effectiveness with which police officers (Diskin et al . ,
1977) utilized denial both in dealing with laboratory conditions of
threat and in carrying out their duties, as evidenced by the high job
performance ratings given avoiders by their supervisors, is difficult
to explain. It is possible, however, that individuals who are self-
selected into an occupation which requires them to deal with high
threat situations on a daily basis may differ from the general popu-
lation on some variable relevant to denial -sensitization. Such a dif-
ference if it existed would make it difficult to interpret these indi-
viduals' performances in studies organized around the denial-sensiti-
zation dimension.

19
Another finding of these studies has been that providing informa-
tion regarding an impending threat reduces arousal when the stressor
is finally confronted, particularly if that information is of a nature
consistent with the individual's approach to dealing with threat
related information.

Atheoretical Studies of
Coping with Naturally Occurring Stressors

Additional evidence for the use of denial as a prominent coping
strategy has been derived from atheoretical field studies of the ways
in which individuals cope with naturally occurring stressful events.
However, in contrast to the conclusions drawn from some of the studies
cited above concerning the effectiveness of denial as a coping strategy,
these investigations seem to highlight the high costs involved in rely-
ing on an avoidant style of dealing with stressful situations.

Chodoff et al. (1964), in a study of parents whose children were
dying of leukemia or other malignant diseases, found that the use of
unusually strong denial defenses was related to a distressing reaction
to the child's death and to a difficult period of postmortem mourning.

Katz, Weiner, Gallagher and Hellman (1970) studied defensive
coping in 30 women awaiting breast biopsy for suspected malignancy.
They observed that although denial was extremely effective in relieving
anxiety, avoiding somatic symptoms and allowing the patient to function
adequately during the anticipatory period, those who relied on this
strategy also impaired their chances of survival by waiting longest to
consult their physician after discovering a lump in their breast.

Boyd, Yeager and McMillan (1973) followed a group of 27 male patients
who had major reconstructive surgery for occlusive disease. These patients
were observed from the period immediately prior to surgery through the

20
first postsurgical year. Based on the criterion of how soon he re-
turned to work or resumed a fulfilling life, the subject was assigned

to either a good or poor adjustment group. There were no differences
in seriousness of surgery nor in postsurgical complications for the
two groups. Based on indepth interviews and a battery of projective
and objective questionnaires, the poor adjusters relied on denial to
dim their awareness of or to avoid the impending threat. They perceived
their doctors as omnipotent figures and took a childlike, passive atti-
tude in their relationships with them. These patients blindly accepted
the information their doctors provided, seldom sought additional infor-
mation or clarification and avoided direct confrontation. When asked
about the worst thing that had ever happened to them and how they dealt
with it, they gave passive responses and evidenced reliance on magical
thinking.

Another study which points up the ineffectiveness of denial as a
primary strategy was reported by Teichman (1975). He used as his sub-
jects 20 Israeli families who had a father, son or husband missing in
action during the October 1973 Middle East war. Three coping styles
were observed: 1) resignation—a negation of all hope of seeing the
family member again, accompanied by engagement in bereavement behaviors;
2) extreme optimi sm--expression of extreme hope accompanied by seeking
and accumulating selective information which strengthened their con-
victions; and 3) search for objective information and initiation of
contact with persons in the same situation. Both resignation and ex-
treme optimism were considered defensive strategies because they in-
volved denial of reality and because both styles were related to ex-
treme crisis when the family member's death was confirmed.

21
Jam's (1965) observed that surgical patients who used denial
remained emotionally calm during the period when they were able to
deny the possibility of danger but reacted with intense fear or anger
when the inescapable signs of danger or suffering were actually en-
countered. He explained the mechanism by which denial interferes with
effective coping as follows:

The arousal of anticipatory fear prior to exposure to a
stressful life situation is one of the necessary condi-
tions for developing effective inner defenses that enable
the person to cope psychologically with stressful stimuli.
The effectiveness of the inner defenses which are erected
depends upon the degree to which the person can overcome
the powerful spontaneous tendency to deny the possibility
of being affected by an impending source of danger.
(Janis, 1965, p. 227)

He called the anticipatory working through or preparing for an impending
stressor the "work of worrying" which, like the work of mourning, en-
ables a person to cope more effectively in the long run with the stress-
ful experience.

Evidence for the adaptive value of anticipatory preparation moti-
vated by arousal prior to a stressful event of quite a different nature
was reported in a study of parachuters (Fenz, 1975). Skillful experi-
enced jumpers showed an inverted V-shaped pattern of arousal and avoid-
ance responses as measured by respiration, heart rate, GSR and re-
sponses to a word association test and a Thematic Apperception Test
(TAT) with pictures of varying relevance to parachuting. The peak of
arousal for these parachuters occurred in the presence of early, low
relevance cues and subsided to a normal level prior to the jump. This
pattern is judged to be adaptive in that good performance is highly
correlated with a low level of arousal at the time of the jump.

22

Evidence for the Adaptive Value of
Strategies Which Incorporate Denial

While undoubtedly denial of stimuli which alert one to the
threatening aspects of an impending stressful situation can inter-
fere with adaptive coping, the use of denial or other defensive strat-
egies can at times be functional for the individual. Such a posi-
tion is taken by Mechanic (1962), who did a longitudinal study of
students coping with Ph.D. qualifying examinations. He followed 20
doctoral level students for a 4 month period beginning 3 months be-
fore the examinations and ending approximately 1 month after they
were completed, when the results were announced. He found that those
students who studied most effectively were those who were able to
control their anxiety. They coped by actively seeking information
about the exams, organizing their time efficiently and studying with
good concentration until anxiety rose to a high enough level to inter-
fere with active coping. At this point they employed a variety of
intrapsychic and interpersonal defensive maneuvers such as avoidance
of anxiety provoking stimuli, magical thinking, humor and external-
ization of responsibility for the outcome of the examinations. These
defensive strategies helped to contain anxiety and insulate against
perceived threat, thus allowing continued coping. While recognizing
the dangers of excessive use of defensive strategies which might
lead one to restrict oneself to the point where useful coping alter-
natives are avoided, Mechanic adopted the position that "adequate
adaptation depends on some careful balance between coping and defen-
sive processes" (1962, p. 211).

23
Similar views were expressed by Coleman (1973) and Lazarus
(in press) both of whom recognized the complexity of coping and the
interdependence between defensive strategies such as denial and
action-oriented approaches. Coleman believed that the use of de-
fenses such as denial, rationalization and emotional isolation fa-
cilitated the capacity to deal with stressful situations by defending
against intense and disabling anxiety. Lazarus stressed that rather
than equate the use of denial with pathology, as has often been done
in the past, a more appropriate conclusion would be that mental health
requires some self-deception.

Strategies Which Combine
Denial and Action-Oriented Behaviors

That the use of a combined strategy which includes both denial
and reality-oriented behavior represents the way that individuals
cope with stressful circumstances has been confirmed in several
studies in addition to the one by Mechanic (1962) described above.
In an investigation of women undergoing mastectomy because of malig-
nant breast tumor, Penman (1980) divided 27 patients into those who
scored above and below the group mean on a coping adequacy rating
based on three dimensions of coping. While the best copers exhib-
ited a strategy which relied more on active engagement with issues
raised by their diagnosis and surgery than those who coped less ade-
quately, they also used a variety of responses which implied evasion
of the meaning of their illness, including denial and rationalization.
However, they used these strategies to a much lesser extent than they
used action-oriented reality responses and with less frequency than
poor copers did.

24

Sanders and Kardinal (1977) observed a similar pattern in an in-
depth study of four male and two female leukemia patients whose
disease was in clinical remission. In addition to reality-based strat-
egies which included information seeking, identification with other
patients and anticipatory grieving, these subjects used denial of
being sick during periods away from the hospital. This use of denial
was regarded as adaptive in that it countered the family's insistence
on keeping the patient in a sick role and permitted a return to a
more normal lifestyle during a time when he/she was feeling well.
However, the use of denial in this situation had the potential for
becoming problematic if it permitted patients to ignore signs of recur-
rence of their disease or interfered with reporting on schedule for
maintenance treatment.

Another situation in which the use of denial can be adaptive is
when a threatening event occurs suddenly, without warning or time for
preparation. In such a case preparation time may be bought through
a temporary period of self-deception which prevents the individual
from being overwhelmed (Hamburg & Adams, 1967). The operation of this
mechanism was observed by Hamburg et al . (1953) in their study of
severely burned patients and by Visotsky et al . (1961) with individu-
als stricken with pol iomelytis. In most patients this defensive re-
sponse was noted to gradually give way to a period of active coping
during which the seriousness and probable consequences of the circum-
stances were realistically faced.

Studies Which Emphasize the Effectiveness of
Action-Oriented Strategies

While coping approaches which combine reality-based action

responses with defensive ones have been shown to function well for

25
individuals in a variety of stressful situations, strategies which
rely predominately on the former have often been associated with the
most positive outcomes. An action-oriented or instrumental strategy
is rational, constructive and typically takes the form of problem-
solving and decision making (Coleman, 1973). The response may be one
which acts upon the stressor to eliminate it, one which acts upon the
individual to prepare against harm or to withdraw when threatened by
an agent which is overwhelmingly powerful and dangerous (Lazarus,
1977).

Evidence that individuals who cope effectively with a number of
different types of stressors most often adopt instrumental strategies
has been obtained in a number of field studies. Hamburg and Adams
(1967) followed a group of highly competent high school seniors
through their first year of college to observe how they coped with
leaving home and adjusting to college life. Two major approaches,
both of which fell under the rubric of instrumental coping, emerged.
These students actively sought information about the new situation,
the roles they would be required to assume and the difficulties they
might encounter. They also adopted a positive attitude toward their
new peers and obtained support as well as information from them.

Another study of coping techniques which used college students
as subjects was reported by Tanck and Robbins (1979). Using a
questionnaire they assessed the responses of 83 male and 50 female
undergraduates to the stressors of college life and found that the
three most frequently reported behaviors were: 1) try to analyze the
problem, 2) take direct action to deal with its source and 3) talk it
over with friends or family. Each of these responses represented an

26
instrumental strategy which attempted to deal directly with the
threatening event rather than escaping or avoiding it.

Further support for the adaptive value of instrumental coping
was provided by Deaton, Berg, Richlin and Litrownik (1977) who
studied the coping behavior of 111 naval officers and aviators who were
repatriated prisoners of war (POWs). A questionnaire of behaviors
engaged in during captivity was developed based on information ob-
tained from other POWs and subjects rated each activity according to
its effectiveness in dealing with solitary confinement. This group
reported a strong tendency to cope by devoting efforts toward control-
ling, changing or mastering the environment rather than by relying on
fantasy or other avoidant strategies. They rated activities related
to the captor-captive relationship as most useful in coping with the
situation. These included attempts to learn about their captors
through observation, to anticipate their captors' next move and to
develop contingencies to meet new situations as they arose. Repetitive
behaviors such as talking to oneself, pacing, watching insects, ritu-
alistic acts and withdrawal were judged to be least effective for
them. The fact that these men were military officers trained to re-
spond under conditions of war may have influenced their choice of
strategies or their reporting of them.

Coping in a similar circumstance was studied by Ford (1975) who
collected data on the 82-man surviving crew of the USS Pueblo,
an intelligence vessel captured and held for 11 months in North Korea.
Information concerning coping was derived from interview, question-
naire and subjects' reports concerning how they and other crew mem-
bers fared in captivity. This information was used as the basis for

27

designating crew members as successful or unsuccessful copers. Suc-
cessful coping consisted of the ability to defend against excessive
anxiety and depression, to contribute to group support and morale and
to provide realistic resistance to the captors' demands. Unsuccessful
coping was defined by the presence of psychiatric symptoms, behavior
detrimental to group morale and/or cooperation with captors as re-
ported by peers. The successful copers were found to be more flexible,
to make greater use of reality testing and to rely on a greater
number of mechanisms than the less successful copers.

Cowie (1976) observed the adjustment process of 27 cardiac
patients after a sudden, first heart attack. A major element of their
coping strategy, as determined from interviews with the patients and
their spouses, involved seeking information about heart disease from
medical personnel and other patients and using it to reconstruct their
past history so as to make sense out of their coronary. This process
which involved an instrumental strategy was found to be adaptive in
that it took the surprise element out of the event and made it easier
to understand and accept.

One final piece of evidence which pointed up the adaptiveness of
action-oriented coping was obtained in an investigation of relapsed
and nonrelapsed alcoholics conducted by Rosenberg (1980). Those who
continued to abstain from alcohol tended to deal with stressful
events in an active, assertive manner, while those who were drinking
again were found to respond to similar events with passivity and
compl iance.

28

Summary of Studies of
Coping with Naturally Occurring Events

From this large group of investigations of how people deal with
a variety of stressful circumstances a model of coping can be con-
structed. Effective coping seems to depend on the use of instrumental,
reality-based responses in anticipating and confronting stressful
events. To be capable of making such responses, anxiety must be kept
at a manageable level. Defensive strategies which allow the coper to
temporarily escape from the demands of the situation can be useful in
this regard. Healthy coping appears to be based on use of a variety
of responses rather than being limited to one or two and favors a
style which emphasizes instrumental responses over passive or avoidant
ones.

As has been shown, there is great diversity in the ways that
individuals respond to stressful situations. Some primarily utilize
instrumental strategies, others favor intrapsychic means of avoiding
or escaping the stressor and many combine these strategies, relying
on one or the other mechanism to varying degrees. An additional com-
ponent of coping which has been overlooked in most of these studies
was included by Lazarus (1977) in his multidimensional model of
coping. These strategies, which he called somatic-oriented behaviors,
are ways of reducing the affective, visceral or motor disturbances
which often accompany exposure to stressful events. They are similar
to defensive strategies in that they do not have an effect on the
stressor but rather operate on the person to alter subjective experi-
ence. While defensive strategies deny the existence of the event or
its significance for the individual, somatic-oriented strategies
operate to relieve the physiological distress associated with

29
responding to stressful events without denying or distorting the
situation. Somatic discomfort may be manifested as disturbances in
sleep pattern, appetite, concentration or mood state. Somatic-
oriented strategies allow the person a temporary respite from these
distressing accompaniments which interfere with adaptive functioning.
Such strategies can improve coping through alleviating somatic symp-
toms so that the individual is able to confront situations which
might otherwise be avoided or escaped from. Somatic-oriented re-
sponses can be divided into those which are functional in increasing
the individual's tolerance for or ability to deal with current or
future stressors and those which, although capable of temporarily
relieving the distressing accompaniments of the situation, also have
the potential for becoming additional sources of stress themselves.
Examples of functional somatic-oriented behaviors include engaging in
vigorous physical exercise, practicing relaxation techniques, listen-
ing to music or pursuing a hobby such as gardening, sewing or wood-
working. Potentially dysfunctional somatic-oriented behaviors include
drinking alcohol, smoking cigarettes, taking tranquilizers or taking
sleeping medications. While all of the latter group have the poten-
tial for becoming problems in and of themselves, Lazarus (1980) sug-
gested that judgment of them as dysfunctional should be reserved
until outcomes have been observed for the individuals using them.
Determinants of Coping Behavior
What are the factors which determine the way in which an indi-
vidual responds to a potentially threatening situation? Selye (1976)
writes, "in our life events, the stressor effects depend not so much
upon what we do or what happens to us but on the way we take it"

30
(p. 370). It is "how you take it" that ultimately determines whether
or not one adapts successfully to change. Whether an event will be
perceived as threatening depends to a large extent on the interpre-
tation made concerning its personal significance and the individual's
assessment of his/her ability to deal with it (Lazarus, 1964). This
means that the same stimulus can be regarded as threatening or benign
depending on the person's appraisal of it. In the past it was fre-
quently assumed that the severity of a stress reaction was directly
proportional to the intensity of the stressor (Katz et al . , 1970).
Yet, there is ample evidence that this is not the case and that it is
the individual's subjective judgement of the event rather than any
objective criterion which determines its threat value and influences
the response that one ultimately makes.

Anderson (1976) studied the responses of 93 male owners and
managers whose businesses were damaged by flooding after Hurricane
Agnes and found that there was a correlation between perceived se-
verity of loss (the stressor) as measured by questionnaire, interview
and coping response, but that there was no relationship between actual
loss based on objective financial data and coping style. Those who
perceived their losses as highest, not those who actually suffered the
greatest losses, had more defensive, emotional reactions to the situ-
ation and engaged in fewer instrumental behaviors directed toward
returning the business to its preflood level of performance.

Similar results were reported by Friedrich (1979) who investi-
gated predictors of coping behavior in mothers of handicapped children.
Severity of the handicap was not found to predict coping behavior nor
was it found to be positively related to reported stress. Katz et al.

31
(1970) found that women awaiting breast biopsy for suspected breast
cancer exhibited a variety of levels of affective distress and of
functioning although they were all anticipating the same possibly
life-threatening event.

Each of these studies which dealt with response to stressful
events as a function of perceived severity found that high perceived
threat was related to heavy reliance on defensive strategies. This is
consonant with Menninger's (1954) statement that minor stressors are
usually handled by relatively normal, healthy devices while those
experiences perceived as more severe "excite the ego to increasingly
energetic and expensive activity" (p. 412) in order to maintain a
tolerable level of tension.

In recent years researchers have attempted to identify those
factors which influence the individual's perception of an event's
threat and the tendency to respond either with a reality-based strate-
gy or an avoidant, defensive one. Two demographic variables, sex and
socioeconomic status (SES), have repeatedly been observed to operate
in this process.

Sex Differences in Coping Strategy

Although researchers have typically not focused on differences
in coping strategies utilized by males and females, many who have
analyzed their data separately for males and females have found that
these groups differ. In an investigation of the way that adults cope
with the role stressors of marriage, parenting, family economics and
work, Pearlin and Schooler (1978) interviewed a sample of 2,300 adults
representative of the population of Chicago. The criterion adopted
for effectiveness of a given mechanism was its ability to prevent the

32
experience of distress in the presence of life strains. Distress was
measured for each role area by an adjective checklist and strain was
assessed in a structured interview. Males were observed more often to
employ responses which inhibited stressful outcomes while females more
often used mechanisms which resulted in increased distress.

Calhoun (1980) also found a difference in the way that males and
females coped with marital role strains. A random sample of 434
married graduate students and nonstudent spouses completed a series of
questionnaires which identified major areas of marital role strains
and types of coping responses. Effectiveness of a style was deter-
mined, as in the Pearlin and Schooler (1978) study, by its association
with a reduction between strains and perceived stressfulness. Al-
though no differences were found in the effectiveness of strategies
used by males and females, females reported using more responses di-
rected toward trying to change the situation or its meaning, while
males tended to avoid the problem or to resign themselves to it.

Similar results were obtained in a study of persons coping with
marital dissolution (Brown, 1976). An assessment of coping strategy
was conducted based on two indepth interviews with 429 males and fe-
males who contacted a court marriage counseling service. The first
interview was done soon after their first contact with the service
and the second, 4 months later. Respondents were assigned to one of
11 coping styles based on their behavior during the 4 month interval
directed toward attaining goals stated at the first interview and on
the subject's perception of how he/she dealt with the divorce situ-
ation. Men were found to rely more on denial than women. The per-
centage of males classified in one of two avoidance-denial styles

33
was 33% whereas only 5% of females were characterized by these styles.
However, women were overrepresented in the three other styles which,
along with denial, were associated with increased distress over the
period covered by the study (13% of males as compared with 30% of
females). Instrumental styles, the most effective strategies in terms
of lowering distress, were utilized approximately equally by the two
groups although females employed them slightly more frequently than
males (52% of females compared to 46% of males). These findings along
with those reported by Calhoun (1980) in regard to use of denial are
inconsistent with those reported by Pearlin and Schooler (1978) who
found that males used more responses indicative of self-reliance and
controlled reflectiveness, while females made more responses to selec-
tively ignore or deny their problems.

In two studies which assessed coping in college students male-
female differences were also observed. Tanck and Robbins (1979) ad-
ministered a self-report itemized coping style questionnaire to 83
male and 50 female undergraduates. While both groups most frequently
chose instrumental responses as representative of the way they handled
stressful situations, males were more likely than females to use mari-
juana or seek sexual comfort, while females more often than males re-
ported that they became irritable and easily angered, spent hours
thinking about the problem, ate constantly or ceased functioning effec-
tively. Two of the responses reported more frequently by females than
by males were associated with measures of anxiety and depression.
Neither of the responses favored by males was associated with anxiety
or depression. Anxiety and depression were measured by responses to a
self-report questionnaire on which subjects were asked to indicate

34
their recent levels of tension and/or depression on a 4-point scale,
to estimate the duration of these feelings and to report what they
thought was the probable cause.

In another study which used college undergraduates as subjects,
Thelen and Varble (1970) compared 28 males and 37 females who came
for counseling at the campus mental health clinic with 61 male and
51 female introductory psychology students. Neither group had been in
personal counseling in the past two years. Coping and defense strate-
gies were measured by California Psychological Inventory (CPI) and
MMPI items designated by Haan (1964). The client group scored higher
than the psychology students on three of the seven defense scales
while the psychology students scored higher than the client group on
four of the seven coping scales. There were male-female differences
in both groups. On the coping scales males in the nonclient group but
not females scored higher than the client group on objectivity, while
females but not males scored higher on concentration. On the defense
scales client-group males scored higher on projection and doubt than
nonclient-group males but there were no differences between females of
the two groups on these scales. An unusual finding was that nonclient-
group males scored higher than client-group males and females on
denial .

Summary of Male-Female Differences in Coping

That there are differences in the strategies employed by males
and females seems to be the only truly consistent finding in this area.
Both males and females appear to rely more on instrumental strategies
than on defensive ones. When a defensive strategy is chosen, males
are probably more likely to use denial than females and females are

35
more likely than males to experience increased distress, anxiety and
depression, as a result of their choice of a defensive strategy.
Those who have noted greater use of instrumental styles by males than
by females have attributed these differences to socialization in a
culture which emphasizes active mastery of the environment more for
males than for females (Brown, 1976; Pearlin & Schooler, 1978). How-
ever, from the findings reported here it is unclear that males use more
instrumental strategies than females; rather the greatest differences
between the two groups appears to be in the choice of defensive re-
sponses.

SES Differences in Coping Style
In addition to sex the other demographic variable which has been
associated with coping style in a number of studies is SES. SES is
the individual's status in the social system and is generally assessed
with reference to education and occupation, which usually determine
income and access to material goods and services. The relationship
between SES and coping style has been consistent, with membership in
higher SES groups positively correlated with effective coping. It has
often been asserted that members of lower socioeconomic strata experi-
ence more stressful life events and have fewer personal and material
resources with which to cope. Their families are more likely to be
disrupted by separation, divorce or premature death, thus depriving
them of a major source of support in handling stressful life events
(Dohrenwend & Dohrenwend, 1967). Because of their lower level of edu-
cation, verbal skills which facilitate manipulation of environmental
circumstances may be less well-developed than in middle class persons.
Evidence that lower SES members are highly vulnerable to breakdown in

36
coping mechanisms has been provided by two epidemiological studies of
the relationship between stressful events and depressive symptomology.
Brown, Bhrolchain and Harris (1975) in a study of a random sample of
200 women living in London and 114 female outpatients being treated
for depression found that working class women with young children
were the most likely to experience failure in their coping strategy as
evidenced by the presence of clinical depression. This increased vul-
nerability was correlated with a high level of ongoing stressful life
events and lack of psychological support from a close interpersonal
relationship.

A similar finding was reported by Warheit (1979) in a two-stage
study of 517 persons subsampled from 1,645 statistical probability
sample of adults living in the southeastern United States. Stressful
life events, coping resources (personal, familial, social and cultural)
and depressive symptomology were assessed from data obtained from two
interviews conducted 3 years apart, utilizing a 317-question inter-
view schedule. Highest depression scores were found in those who ex-
perienced high rates of stressful events involving loss and that were
either from the lower SES strata or did not have friends nearby to
help. Low SES was found to correlate positively with both high loss
and fewer personal and social resources with which to cope.

Several other investigations have noted SES differences in re-
lation to coping effectiveness. Parent (1976) studied stress and
coping in 113 male and female adults living in a southern city and
found that people from lower SES groups differed from those from higher
SES groups in their greater use of indirect strategies. Penman (1980),
who followed mastectomy patients for 4 months after their surgery,

37
found that those who made the best adjustment were those who relied
predominately on instrumental responses in dealing with the issues
raised by their diagnosis and surgery. Although she found no differ-
ences between these women and those who used avoidant, passive or
fatalistic styles on 12 of 14 demographic and health variables, there
were positive relationships between adaptive coping and education and
income. Finally, Brown (1976) found that positive psychological out-
come during a 4 month period of marital dissolution was positively
correlated with education, one measure of social class, but not with
family income.

Although sex and SES are important variables which often influ-
ence the way a potentially stressful situation is appraised and re-
sponded to, an even greater influence may be exerted by the individu-
al's judgment of the ability to master the situation.

Locus of Control
as a Mediator of Responses to Stressful Events

Many who have studied variations in individual responses to
similar stressful situations have been aware of the importance of
belief about one's potential for influencing the environment as a
determinant of whether an event will be perceived as benign or threat-
ening and whether a strategy to change the situation or to attempt
to deny or avoid it will be chosen. The person's belief about self in
this regard has been mentioned as an important characteristic in inter-
preting and responding to stimuli by Dohrenwend and Dohrenwend (1978),
Lazarus (1977), Lefcourt (1973), Pearlin and Schooler (1978) and Rab-
kin and Struening (1976).

The belief concerning personal efficacy has been called locus of
control by Rotter (1966) who developed the Internal -External Locus of

38
Control Scale (I-E Scale), an instrument to measure it. The construct
of locus of control is based on social learning theory and is consid-
ered to be a generalized expectancy which operates across a large
number of situations regarding the nature of the causal relationship
between one's behavior and its consequences (Lefcourt, 1966).'' When out-
come or reinforcement is believed by the individual to be contingent
upon personal actions, the person is designated an internal (I) and
when reinforcement is attributed to luck, chance, fate or powerful
others, the individual is designated an external (E). 'Locus of control
may be considered a key determinant of the coping process in that it
represents an underlying personality trait which influences perception
of personal power vis-a-vis a situation and expectation concerning out-
come. Persons who feel powerless to direct their own experiences are
unlikely to initiate responses to take direct action to control a
stressful event. They are more likely to respond in a manner con-
sistent with their belief that little which they do will have an effect
(Wolk & Kurtz, 1975). On the other hand, internally controlled per-
sons are more apt to be alert to those aspects of the environment which
provide information relevant to their future behavior and to take steps
to improve environmental conditions (Rotter, 1966).

Field Studies Relating Locus of Control to Coping Strategies
A number of researchers have studied the relationship of locus of
control to choice of coping strategy. Anderson (1977), in his study
of male business owners'/managers' responses to flood damage (cited
previously), tested the hypothesis that locus of control led to differ-
ences in perception of a stressful situation and affected performance.
Subjects were given Rotter's I-E Scale and scores were correlated with

39
subjective perception of stressful ness and coping strategy. Perception
of stressfulness was measured by the Subjective Stress Scale-Form B, a
list of 14 adjectives from which the subject chooses the one which
most adequately describes his/her strongest feeling about a situation.
Assessment of coping was based on data obtained in a structured inter-
view. Coping responses were assigned to one of two categories, prob-
lem solving behaviors or emotional reactions. Externals perceived
greater stress and employed fewer task-oriented problem solving behav-
iors and more defensive behaviors than internals. Task-oriented re-
sponses were positively correlated with high levels of organizational
performance in returning the business to preflood operational status.
Anderson concluded that locus of control influenced performance pri-
marily through choice of task versus emotional -oriented coping
behavior.

Wolk and Kurtz (1975) in a study of 92 older adults between the
ages of 60 and 85 assessed the relationship between locus of control
and three separate measures of adjustment; a scale based on develop-
mental tasks of the later years, an instrument which measured social,
psychological and physiological involvement and the Life Satisfaction
Index. On all three measures internals manifested higher levels of
adjustment.

In a study which defined effective coping as continued good physi-
cal health despite high levels of stressful life events over a period
of two years, Barber (1979) conducted an indepth interview with two
groups of employees of a California school district. All had experi-
enced crisis levels of stressors as defined by the Holmes and Rahe
Social Readjustment Rating Scale (Holmes & Rahe, 1967), but the two
groups differed in relation to physical well-being as assessed by a

40
health questionnaire. Subjects were also given the I-E Scale, along
with several other personality instruments. Healthier subjects were
more internal and accepted more responsibility for what happened in
their lives.

Dinardo (1972) in a study of adjustment to spinal cord injury
found differences in 53 hospitalized males as a function of their
scores on the I-E Scale. Internals were less likely than externals to
be depressed, a factor shown to favor good adjustment to spinal cord
injury.

In her study of adjustment to divorce (cited above) Brown (1976)
correlated coping style with locus of control for the female subjects
of her sample and found that internals most often utilized instrumental
styles, while the more external subjects were most often categorized
as paralyzed victims because of their failure to make any behavioral
attempt to change their situation.

Tanck and Robbins (1979) in their questionnaire assessment of
coping in male and female college students also observed differences
in strategy for externals and internals. Internal females were more
likely to take direct action and to meditate, while their external
counterparts were more prone to seek sexual comfort or to use alcohol as
a way of dealing with the stressors of college life. External males re-
ported daydreaming, fantasizing or seeking professional help as repre-
sentative of the ways in which they behaved in stressful situations.

In a study of the ways in which people coped with depression,
Rippere (1976) administered an antidepressive behavior checklist to 40
male and 40 female subjects who comprised five groups. Subjects were
depressed outpatients, depressed inpatients, nondepressed outpatients,

41
clinical psychology graduate students and general practice medical
patients. Subjects checked the number of behaviors they used when
they felt depressed and evaluated each one in regard to its helpful-
ness. A version of the I-E Scale modified for use with British re-
spondents was used to divide the subjects into internals and externals.
No differences were found as a function of group, sex or locus of con-
trol. However, there was a significant interaction between sex and
locus of control with internal males and external females reporting
fewer antidepressive activities and finding fewer of these activities
helpful than external males and internal females. No attempt was made
to explain the unusual finding that internality in males was related to
use of fewer antidepressive behaviors while internality was associated
with use of a greater number of antidepressive behaviors in females.

Although Pearlin and Schooler's (1978) study of responses to four
different types of role strains in the general population (cited pre-
viously) did not use the I-E Scale, mastery, which was defined as the
extent to which one regards one's life circumstances as being under
one's own control versus fatalistically ruled, was measured by an in-
strument developed by the researchers. Mastery was found to relate
positively to effective coping and to achieved status, expecially edu-
cation and income.

Horn (1975) investigated the adjustment of 15 high and 15 low-
level functioning women to past negative experiences. Level of func-
tioning was measured by the Personal Orientation Inventory and by fac-
tors of the Edwards Personal Preference Scale.

While the two groups did not differ in exposure to stressful
negative experiences such as divorce, death, sickness, accident,

42
hostility and violence, their retrospective perceptions of the experi-
ences and their personal adjustment in relation to them differed
remarkably. High-level functioning women were found to be more inner
directed, to have relied more often on self-help rather than profes-
sional help in coping with the negative events and were more likely to
have accepted and integrated the experiences into their personality
than low-level functioning women. Although locus of control was not a
variable in this study, the inner directedness of the high-level func-
tioning group is similar to the construct of internality.

Two other studies which correlated locus of control with coping
mechanisms found no significant relationship between the two variables.
Chamberlain (1980) studied the responses of 55 oil company executives
and 20 spouses concerning stressful events which they experienced over
a two week period. Using a questionnaire he obtained information about
the source of stress, its perceived magnitude and how it was dealt with.
Coping strategy was measured by the Byrne R-S Scale, an instrument
which conceptualizes coping along a continuum of vigilance/avoidance
in regard to the threatening aspects of a situation. Subjects also
were administered the I-E Scale. Locus of control was not found to be
a significant factor in determining perceived magnitude of stress nor
in choice of coping response. Ritter (1980) also failed to find a
relationship between locus of control and coping style for 37 male and
13 female patients awaiting open-heart surgery. Patients were inter-
viewed before and after receiving preoperative information on the day
before their surgery. As in the Chamberlain study, coping was assessed
on the vigilance/avoidance continuum and locus of control was measured
by the I-E Scale.

43

Experimental Studies Relating Response to
Aversive Events to Locus of Control

Several studies conducted in the laboratory have investigated
the relationship between locus of control and coping with stressful
situations. Two such studies conducted at a Canadian university ob-
served differences between internals and externals to experimental
manipulations which attempted to deceive and embarrass subjects. Lef-
court, Gronnerud and McDonald (1973) exposed 65 male subjects, who had
been solicited for participation in a test of verbal facility, to a
list of words which was intended to arouse suspicion that the experi-
menter had been dishonest in his description of the task and intended
to embarrass them. After the first 13 words which were nonsexual in
nature, every third, then every second and eventually every word was
a sexual double entendre. Tape recordings of response times and ver-
bal answers were made and subjects were also videotaped through a one-
way mirror so that their nonverbal behavior in response to their dis-
covery of the experimenter's duplicity could be observed. The de-
pendent variable was the number of humor responses made by the subject
as he became aware of the true nature of the experiment. Responding
with humor was considered by the researchers indicative of lack of
apprehension and as an adaptive response to the situation. Internals as
measured by the I-E Scale exhibited more smiles and laughter than
externals who tended to respond to the situation with gravity.

In a second "double cross" experiment conducted to obtain evidence
for the reliability of the results just cited, Sardoni (cited in Lef-
court, 1976) showed subjects mug shots of a series of individuals
identified as criminals and asked them to identify the type of offense

44
committed by each. During the experiment, without the knowledge of
the subject, a picture was taken of him and presented as the tenth
criminal. After the presentation of the subject's photograph, three
pictures of well-known political figures were shown. The purpose of
the experiment was to observe the responses of internal and external
subjects to evidence that they had been tricked. Internals more often
responded with humor than externals, while externals more often re-
sponded with annoyance and self-consciousness. Whether these manipu-
lations actually represented threatening situations is questionable,
however, consistent differences were observed between externals and
internals across the two situation.

Another experimental study which observed differences between
internals and externals in a stressful situation was reported by Gal
(1976). Two hundred male students were divided into Is and Es based
on the I-E Scale and exposed to one of three threat condi tions—shock-
contingent, shock-noncontingent or no shock. In the shock-contingent
condition, delivery of the aversive stimulus was contingent upon the
subject's performance on a task, in the noncontingent condition shock
was unavoidable and in the no shock condition, shock was not mentioned.
According to GSR, skin conductance and heart rate, as well as subjec-
tive report, internals were found to be more tense performing under
the shock-contingent condition than under the noncontingent condition.
The reverse was true for externals. These findings were contrary to
the hypotheses of the study which predicted that each group would be
more comfortable performing under conditions congruent with their
generalized expectancy concerning control of events.

45

Summary of Research
Relating Locus of Control to Coping Strategy

Although these research findings do not present a totally con-
sistent picture of the relationship between locus of control, appraisal
of threat and choice of coping strategy, they do support the hy-
pothesis that locus of control is an important variable in this regard.
Most of the studies cited reported that internals perceived a situ-
ation as less stressful, exhibited lower levels of arousal and em-
ployed coping strategies which relied predominately on instrumental,
problem solving techniques. Externals, on the other hand, were shown
to perceive a situation as more stressful, to exhibit higher levels
of physiological arousal and to use more defensive coping strategies.
Internality has also been shown to correlate with the absence of
physical symptoms in the presence of high levels of stressful life
events, good adjustment to spinal cord injury, positive adjustment in
the later years and more effective coping in a variety of naturally
occurring and experimentally contrived circumstances representing
threat.

Research on Coping in Mental Health Clients

Although a great deal of research has been done in the area of
coping, very little is known about the process as it operates in those
who seek professional help in dealing with stressful life events. The
few studies which have focused on counseling clients have either been
limited in scope and have overlooked the complexity of the process or
have utilized very small samples. Five studies were included in the
literature; two of these were conducted with student samples and three
used as subjects adults seeking counseling services in community facil-
ities.

46
Coelho, Silber and Hamburg (1962) assessed coping in three
groups of college freshmen by means of a projective test, the Student
TAT, which was developed for this purpose. Subjects included 30 male
and female freshmen selected from three groups: 10 highly competent
students chosen for their social, academic and interpersonal adjust-
ment, 10 students from an English class at a state university and 10
students who were hospitalized in a psychiatric ward because of emo-
tional difficulties experienced during their freshman year. Subjects
were shown a set of slides which represented college situations which
tended to be new and problematic for entering freshmen and were in-
structed to describe the situation which led up to the scene, what was
happening at the present time, the thoughts and feelings of the charac-
ters and what the outcome would be. A coping index was developed
based on the number and type of activities attributed to the hero and
the favorableness of outcome. Although no significant differences were
found between the two normal groups, there were differences between
normals and patients with greatest differences between the patient
group and the highly competent student group. Patients showed lower
problem solving competence, found fewer solutions to the potentially
stressful situations and projected favorable outcomes in only one-half
of the situations. The normal groups coped through active effort and
were optimistic about outcomes compared with the student patients who
coped passively and with pessimism.

Another study which included a client group was reported by Thelen
and Varble (1970) (cited above), who compared coping styles for 28 male
and 37 female college students who came for treatment at the university
ntal health clinic and 61 male and 51 female introductory psychology

me

47
students. Items from the CPI and MMPI as designated by Haan (1964)
were used as measures of coping and defense. Differences between the
treatment group and the nontreatment group were found on the coping
scales and on the defense scales. The nontreatment group scored
higher on three of the four coping scales for which differences were
observed and the treatment group scored higher on three of the four
defense scales where differences were found.

Both of these studies were conducted with student populations.
The former included only 10 patients and did not analyze the data
separately for males and females. The latter included a larger sample
and conducted separate analyses by sex. However, neither study con-
trolled for SES nor locus of control, two variables consistently shown
to be relevant to the coping process.

Three studies have appeared in the literature which focused on
adults who sought mental health services at community facilities.
Overbeck (1977) did an exploratory investigation of stressful ante-
cedents to application for help at a community clinic and obtained
information about the responses clients made to these events. Only
three adult outpatients were interviewed along with 16 parents of
children being treated in the children's unit and one adolescent
client. This small sample was all female except for one father. The
Social Readjustment Rating Scale (Holmes & Rahe, 1967) was adminis-
tered to assess stressful life events and an indepth interview was
conducted to obtain information about a number of client variables in-
cluding response to stressful events. Coping strategies were divided
into four broad categories: cognitive, affective, behavioral and
somatic. No data were presented, however the following statement was

made with regard to coping:

Most subjects expressed inability to cope effectively
with their circumstances: several clearly found their
style of coping inadequate; e.g., 'doing something'
(behavior coping) did not help--there was a need to
know (cognitive coping) what the trouble was; or 'I
knew what was wrong but I couldn't decide how I felt
about it' (affective coping); or 'everytime he did
that, I would end up in bed (somatic coping) and that
didn't help things'. Subjects tended to repeat
compulsively their coping styles even when they were
highly ineffective. (Overbeck, 1977, p. 218)

Rippere (1976) (cited previously) also conducted a study of coping
mechanisms which included a small group of outpatients. Data on how
individuals dealt with depression were collected by means of a check-
list of antidepressive behaviors. Clients drawn from depressed out-
patients, depressed inpatients, nondepressed inpatients, clinical
psychology graduate students and general practice medical patients
formed five groups of 16 each. Data were analyzed separately for males
and females and for internals and externals. The only results pre-
sented concerned the number of antidepressive activities engaged in
and the number of these found by the individual to be helpful. De-
pressed outpatients were not found to differ from the other groups on
either of these variables. However, a significant interaction was
found between locus of control and sex. Internal males and external
females reported fewer responses and found less of them helpful than
internal females and external males. Whether depression is actually
a stressor which must be coped with is a debatable issue in itself.
It has been suggested that depression represents a response to
failure to cope effectively with stressful events, yet many individuals
find the concomitants of depression dysphoric and initiate behaviors
directed toward alleviating them.

49
A final study of this type was done by Brown (1976) (also cited
previously). The coping behavior of 198 male and 270 female appli-
cants to a court marriage counseling service was assessed by two in-
depth interviews conducted soon after the first contact with the agency
and again 4 months later. Responses to the stressor of marital dis-
solution and behaviors engaged in aimed at the attainment of goals
stated during the first interview were assigned to one of 11 coping
style categories. Results were analyzed separately for males and
females. Locus of control was assessed for females and correlated
with coping strategy but was not measured for the male subjects.
Internal females were found to experience greater reduction of dis-
tress between the two interviews, while externals more often em-
ployed strategies which were associated with continued distress.
Education and income were tested for their effect on coping for
females but not for males. Coping styles differed significantly
according to years of education but not according to family income.
Education was positively related to effective coping with instru-
mental copers having a significantly higher mean level of education
than those who used defensive or passive styles. Although this study
did take into account sex, SES and locus of control as they related
to the coping process, the primary focus was on how females coped
with marital dissolution and for that reason data were not presented
for males on SES or locus of control. A major shortcoming of this
study was that although data were collected at two stages with clients
who applied for counseling, no attempt was made to account for the
effect of the counseling process on type of coping strategy used or
on change in level of distress. It is likely that some clients never

50
returned for a second appointment while others may have participated
in counseling for the entire 4 month period covered by the study.

As can be seen, more research is needed with adult clinical
outpatients to fully understand how the coping process operates
within this group. An adequate study must include a large represen-
tative sample and control for the relevant variables of sex, SES and
locus of control. Additionally, such an investigation should use a
measure of coping strategies which reflects the complexity of the
coping process. The present study was designed to meet these cri-
teria. The focus was on identifying the relationship between locus
of control and coping strategies in male and female community mental
health outpatients. Assessment of coping was conducted by means of
an inventory developed by the researcher, based on the theoretical
position of Lazarus (1977). Coping response categories included
direct action, defensive, functional somatic-oriented and potentially
dysfunctional somatic-oriented strategies. The following hypotheses
were tested:

Null Hypotheses
HO There is no positive linear relationship between inter-

nality and choice of direct action and functional somatic-
oriented responses.

HO There is no negative linear relationship between inter-
1 B

nality and choice of defensive and potentially dysfunc-
tional somatic-oriented responses.

HO There is no negative linear relationship between exter-

L A

nality and choice of direct action and functional somatic-
oriented responses.

51

H0OD There is no positive linear relationship between exter-

2B

nality and choice of defensive and potentially dysfunc-
tional somatic-oriented responses.

CHAPTER III
METHOD

Subjects

Individuals who requested counseling services through the Out-
patient Department of the Palm Beach County Comprehensive Community
Mental Health Center, who were nonpsychotic and who had not received
counseling during the preceding six months, served as subjects. Data
collection was initiated December 1, 1981, and continued through June
15, 1982, when 100 questionnaires had been completed.

The demographic characteristics of the research subjects are shown
in Table 1. There were no statistically significant differences in
sex, race and education between these subjects and the population which
is served by the Center's Outpatient Department, based on data avail-
able for the previous year beginning August 1, 1980, and ending July 31,
1981. However, a significantly larger proportion of the research sub-
jects were younger than 30 years of age. There were also some differ-
ences between the research subjects and the outpatient population on
marital status. A significantly greater proportion of the research sub-
jects had never married and a lesser proportion were presently married.
There were no differences between the sample and the Center's out-
patient population in the proportion of separated/divorced and widowed
subjects.

These subjects are similar to client populations served by many
community mental health outpatient clinics in urban areas throughout
the country with the exception of those which serve high percentages

of minority group members.

52

53

Table 1

Demographic Characteristics
of Research Subjects

Group

Group

Sex

Male

Female
Aqe

< 30

30-49

50-65
> 65
Race

White

Black

Hispanic
Marital status

Single

Married

Divorced

Widowed

40
60

51
37
08

04

92

06
02

37
32
28
03

Years of education

< 12 20

12-15 66

> 16 14
Social class

I 02

II 05

III 25

IV 52

V 16

Type of problem

Relationship 26

Depression 16

Anxiety 04

Combination of above 45

Other 09
Referral source

Self 45

Family/friend 33

Agency 16

Physician 06

54
Instruments
Adult Nowicki-Strickland Internal-External Control Scale

The Adult Nowicki-Strickland Internal-External Control Scale
(ANS-IE) (See Appendix A) was used as a measure of locus of control,
an individual's tendency to perceive reinforcement as being under
one's own control as opposed to attributing control to chance, fate
or powerful others. The ANS-IE was developed in response to the need
for a scale to overcome the problems attributed to the Rotter Locus
of Control Scale (Nowicki, 1979). The Rotter scale has shown a con-
sistent relationship to social desirability responses and to denial of
psychopathology. Rotter items have also been criticized for con-
founding personal, social, political and ideological causation.
Additionally, the difficult reading level of the scale has made it
inappropriate for a large segment of the population.

The ANS-IE was constructed on the basis of Rotter's definition of
the internal -external control of reinforcement dimension and contains
items which describe reinforcement situations across the interpersonal
and motivational areas of affiliation, achievement and dependency
(Nowicki & Strickland, 1973). The scale is a paper and pencil measure
consisting of 40 questions which are answered "Yes" or "No" by placing
a mark in the appropriate blank next to each item. Items are written
at the fifth grade reading level. Scores range from 0 through 40
with higher scores reflecting greater externality.

The scale has been administered to a variety of groups including
male and female college students, community subjects, racial and
ethnic groups and subjects with physical and emotional disorders.

55
Norms are available for each of these groups (Nowicki , 1979). The
psychometric characteristics of the ANS-IE are reported below.

Item statistics. Item-total score correlations for a college
sample (in = 154) and a sample of community adults (n = 33) ranged
from .01 to .60 (Nowicki, 1979).

Internal consistency. Nowicki and Duke (1974) reported split-half
reliabilities ranging from .74 to .86 based on a series of studies.
Because the items are not arranged in order according to difficulty,
the split-half reliabilities represent an underestimate of the true
internal consistency reliability.

Test-retest reliability. Test-retest reliability for college
students over a six weeks period was reported to be .83 (Nowicki &
Duke, 1974) and .65 for a seven week period (Chandler, 1976).

Discriminative validity. ANS-IE scores were not found to be re-
lated to social desirability as measured by the Marlowe-Crowne Social
Desirability Scale for two samples of college students (n = 48, r =
.10; n = 68, r = .06). The relationship of ANS-IE scores to intelli-
gence, as measured by scores on the Scholastic Aptitude Test, was also
investigated and found not to be significant (n = 48, _r = .11).

Construct validity. The ANS-IE and the Rotter Locus of Control
Scale were administered to two college samples and one community adult
sample (r = .68, df = 47, £ < .01 ; r = .48, df = 37, £<.01; r = .44,
df = 33, £<.05). These results are consistent with the contention
that the two measures are assessing the same construct but not in an
identical manner. The ANS-IE was also found to relate significantly
to Levinson's Internal ity (r = -.24, n = 1 1 95, £< .01 ) ; Powerful Others
(r = .24, n = 1196, £< .01 ) and Chance (r = .40, n - 1195, £ < .01) scales.

56

Additional evidence for the validity of the ANS-IE as a measure
of locus of control was provided by the following findings which were
predicted by social learning theory upon which the locus of control
construct is based. Internal ity, as measured by the ANS-IE, was
found by Mink (cited in Nowicki, 1979) to correlate positively with
higher family income, educational and occupational levels. Blacks
tended to be more external than whites even when middle class black
college students were compared with middle class white students.
These findings are consistent with the expectation that individuals who
are restricted by social and environmental barriers and who are sub-
jected to limited access to goods and services would develop an exter-
nally-oriented outlook on life (Joe, 1971). In the area of psycho-
pathology, social learning theory predicts and most investigators,
whether they have used the Rotter scale, the ANS-IE or other measures
of control orientation, have found that externality is related to
psychological maladjustment (Brannigan, Rosenberg & Loprete, 1977;
Duke & Mullens, 1973; Joe, 1971). Significant differences on the
ANS-IE were observed between hospitalized schizophrenics (mean = 16.30),
hospitalized nonschizophrenics (mean - 11.95) and staff workers (mean
= 9.20) (Nowicki & Duke, 1974). High externality scores were also cor-
related with high Neuroticism scores on the Eysenck scale (males, r =
.36, £ < .10; females,r = .40, £<.05) (Nowicki , 1979).
Coping Response Inventory

The Coping Response Inventory (CRI) (See Appendix A), a self-
report of coping behaviors developed by the researcher, was used as
a measure of behaviors engaged in as a response to events or situa-
tions which subjects defined as stressful. The CRI is a pencil and

57
paper measure consisting of 24 items which are rated on a 7-point
Likert-type scale. The scale was developed based upon Lazarus' (1977)
formulation of the coping process and includes categories of responses
which he defined as direct action, defensive and somatic-oriented. The
somatic-oriented category was divided by the researcher into two cate-
gories which have been designated as functional somatic-oriented and
potentially dysfunctional somatic-oriented.

Direct action responses are efforts which are aimed directly at
influencing or eliminating the harmful nature of the stressor. De-
fensive responses are attempts to deny or ameliorate one's perception
of a threatening situation so that threat is reduced. Threat, however,
is reduced only in the mind of the individual as no action is taken to
influence the stressor. Somatic-oriented responses are efforts to
reduce the dysphoric somatic conditions which accompany the process of
anticipating and responding to stressful events. Somatic-oriented
responses are directed toward alleviating somatic manifestations such
as anxiety, loss of appetite, sleeplessness, impaired concentration
or depressed mood state. Functional somatic-oriented responses are
those which relieve somatic dysphoria and increase one's capacity for
coping. Potentially dysfunctional somatic-oriented responses are those
which relieve somatic discomfort but which have the potential for be-
coming additional sources of stress themselves.

Eight items which were judged by the researcher to be behavioral
examples of these coping response categories were drawn, with per-
mission of the authors, from a coping response questionnaire developed
by Tanck and Robbins (1979). For example, "Try analyzing the problem"
and "Talk the problem over with friends or family" were selected as

58
responses which represented direct action strategies. "Daydream or
fantasize" was chosen as an example of a defensive strategy and "En-
gage in vigorous exercise" was selected as an example of a functional
somatic-oriented response. "Take tranqui 1 izing medicines" and "Drink
alcohol" were chosen to represent potentially dysfunctional somatic-
oriented responses.

Listed below are the items as they appeared on the Tanck and
Robbins scale:

Try analyzing the problem.

Talk the problem over with friends or family.

Daydream or fantasize.

Engage in vigorous exercise.

Watch TV or go to a movie.

Eat constantly.

Drink alcohol .

Take tranquil izing medicines.

Two of these items were modified to avoid negative connotations.
The word "fantasize" was dropped from the item "Daydream or fantasize"
and the phrase "think about more pleasant things" was substituted. The
word "constantly" was omitted from the item "Eat constantly" and the
item was rewritten as "Eat more."

An additional 16 items were written by the researcher with the
assistance of a member of the University of Florida Student Mental
Health clinical staff. Each item represented an attempt to opera-
tionally define the four categories of responses specified by Lazarus
(1977). These items are listed below:

Find out everything I can about the situation.

Read about how others have solved similar problems.

59

Consider all the alternatives.

Try to make a decision.

Focus on the concerns of others instead of my problem.

Decide that the problem doesn't really affect me.

Believe that things will take care of themselves.

Ignore the problem.

Try to relax or rest.

Read or listen to music.

Garden or work in the yard.

Take a hot bath or shower.

Do some work with my hands (sew, paint, do carpentry).

Sleep a lot.

Smoke more.

Take sleeping medicines.

These 16 items were combined with the eight items from the Tanck
and Robbins scale to form the CRI.

A pilot study of the CRI was conducted to establish the relia-
bility and validity of the instrument. The questionnaire was adminis-
tered to outpatient clients of the Palm Beach County Comprehensive
Community Mental Health Center (_n = 50) and to nonclient community
subjects (n - 102). The psychometric properties of the CRI, which are
based upon this pilot study are presented below.

Test-retest reliability. Test-retest reliability coefficients
for the four subscales for nonclient adults (n = 34) over a 6-week
period were direct action, .90; defensive, .70; functional somatic-
oriented, .80; and potentially dysfunctional somatic-oriented, .80.
Coefficients for a group of community mental health clients [n = 33)

60
during ongoing therapy for a 6-8 week period were direct action, .65;
defensive, .70; functional somatic-oriented, .60; and potentially
dysfunctional somatic-oriented, .75. These lower correlations are
consistent with the expectation that coping behavior is affected by
the therapy process.

These reliability coefficients are based on responses to the CRI
in the format of a 4-point scale with categories of "Never," Some-
times," "Usually" and "Always." Evidence that some subjects consid-
ered the four categories inadequate to describe their behavior was
suggested by check marks placed on the lines which divided two cate-
gories and by responses such as "Almost Never" or "Almost Always"
written on the questionnaire. In response to this feedback and in
an effort to increase reliability the scale was changed from a 4 to a
7-point scale before being administered to the dissertation research
subjects. "Rating scales, like test scores, tend to increase in re-
liability as the number of ratable categories and items increases"
(Sax, 1974, p. 482).

Content validity. A list of the items grouped together according
to category was sent to two groups working in the field of stress re-
search, Dr. Richard Lazarus, Director of the Stress and Coping Project,
University of California, Berkeley and Drs. Tanck and Robbins of George
Washington University. Their comments as to the appropriateness of
the items were requested. Feedback was elicited from these two
research groups because they were engaged in research which was closely
related to the topic of the present research. Dr. Lazarus was the
author of the theory of coping upon which the present study is based
and Drs. Tanck and Robbins (1979) published a 22-item coping response

61

questionnaire which they used in a study of asserti veness , locus of

control and coping behaviors in college students. Eight items from

the Tanck and Robbins questionnaire were included in the CRI.

Dr. Lazarus offered the following comments:

I am glad you sent me your coping materials. You are
obviously thinking along lines similar in many ways
to those of my own research group. My only important
criticism has to do with the prior judgment that some
modes of somatic-oriented coping are inherently dys-
functional, or for that matter, functional. This
indeed could be the case, but I think the decision
depends on the outcomes, and perhaps on the pattern-
ing of coping employed by individuals. (Lazarus,
1980, p. 1)

In response to this feedback, the category dysfunctional somatic-
oriented responses was modified by adding the word "potentially."

Dr. Robbins responded to the request sent to the Tanck and
Robbins research team. He wrote:

In general, your items seem to fit within the cate-
gories you are using .... I have no problems
with categories 1 , 3 & 4. The items seem O.K.
Category 2 concerns me somewhat because it deals
at least in part with unconscious processes as
described by Lazarus (projection, e.g.,) and
yet the items tend to be conscious decisions ....
I like the idea of a coping inventory and I suggest
a factor analysis of your items might be useful
to see if they cluster along lines indicated by
Lazarus. (Robbins, 1980, p. 1 )

Construct validity. In response to Dr. Robbins' suggestion a
principal-component factor analysis with varimax rotation was con-
ducted on the responses of 143 pilot study subjects. This analysis
verified the existence of the four coping response categories. Four
factors with eigenvalues greater than 1 accounted for 75% of the
total variance. Table 2 summarizes the results of the varimax rotated
factor matrix.

62

Table 2

Pilot Study
Varimax Rotated Factor Matrix

Item Item Loading

Direct action factor

Talk the problem over with a friend .33

or family member.

Try analyzing the problem. .71

Find out everything I can about the situation. .77

Consider all the alternatives. .70

Try to make a decision. -75

Defensive factor

Sleep a lot. -40

Believe that things will take care of themselves. .33

Ignore the problem. -53

Get away from the problem by watching T.V. .36

Eat more. -33

Daydream or think about more pleasant things. .67

Functional somatic-oriented factor

Exercise--take a walk, jog, swim, dance. .33

Garden or work in the yard. -77
Do some work with my hands (sew, paint,

do carpentry, etc.). -57

Potentially dysfunctional somatic-oriented factor

Take tranquil izing medicines. -94

Take sleeping medicines. -71

Note: Table includes factors with eigenvalues greater than 1

63

As can be seen, items from the direct action and defensive cate-
gories clustered together as expected, providing strong evidence for
the existence of these two response categories. Limited validity
was provided for the two somatic-oriented categories. Only two of the
six items defined by the researcher as potentially dysfunctional
somatic-oriented responses clustered together. A third item from
this category, "Drink Alcohol" correlated .25 with this factor. The
items "Sleep a Lot" and "Eat More" clustered with items defining the
defensive category. In the functional somatic-oriented category only
three of six items correlated .33 or greater with each other. A fifth
factor with an eigenvalue of .92 contained the remaining three items
from this category. A second factor analysis which combined the pilot
study data with the dissertation research data was conducted and the
results of this second analysis were used in selecting the items for
testing the hypotheses of the study. Results of this analysis are
presented in the Data Analysis section.
Demographic Data Form

A demographic data form (See Appendix B) was used to obtain infor-
mation concerning client age, sex, race, marital status, education,
occupation, presenting problem and referral source. This information
was used to provide a description of the demographic characteristics
of the sample and in the assignment of SES scores. Determination of
SES was based on the Hollingshead Two Factor Index of Social Position
(Hollingshead, 1957). Occupation and education are the two factors
which are used by the Index in determining SES. Occupation is pre-
sumed to reflect the skills that individuals possess as they perform
the many maintenance functions of society. Education is believed to

64
reflect both knowledge and cultural taste. The occupational scale is
divided into seven groups. Higher executives, proprietors of large
concerns and major professionals are given a score of 1, proprietors
of medium- si zed businesses and lesser professionals are assigned a
score of 2, etc., and unskilled employees are assigned a score of 7.
Each category contains a detailed list of occupational titles so that
assignment of an occupational score can be determined objectively. The
educational scale is also divided into seven groups. Persons who have
completed a recognized professional course leading to a graduate
degree are given a score of 1, those who have completed a standard
college or university program leading to a college degree are given a
score of 2, etc., and those who have completed less than seven years
of schooling are given a score of 7. The factors of occupation and
education are combined to form an Index of Social Position score by
multiplying each scale score by a designated factor weight and summing
the two resulting scores.

Procedure

During the data collection period which began December 1, 1981,
and ended June 15, 1982, all individuals who requested outpatient
counseling at the Palm Beach County Community Mental Health Center
were screened during the initial intake interview to determine if they
met the criteria for inclusion in the research. To be eligible a
client must be judged by the interviewer to be nonpsychotic and must
not have been in counseling during the preceding six months.

Determination of the client's mental status was made from be-
havioral observation based on the Mental Status Schedule (Spitzer,
Fleiss, Endicott & Cohen, 1967). Specifically the client must: 1) be

65
oriented as to time, place and person; 2) not display bizarre appear-
ance or behavior (engage in rituals, talk to self, posture, grimace);
3) not show overt signs of agitation (i.e. inability to sit, pacing,
accelerated speech); 4) not show evidence of disorganized thought
processes (i.e. aimless or excessively detailed speech, juxtaposition
of ideas with no logical relationship, rapid changes of topic so that
ideas are incomplete, irrelevant and/or incoherent); 5) not present
evidence of delusions or hallucinations; 6) not be emotionally with-
drawn to the extent of showing visible signs of retarded speech and
movement, lack of awareness of surroundings, absence of emotional
responsivity.

The purpose of requiring that a client not have had counseling
during the prior six months was to obtain subjects who were actively
coping with a stressful situation for which they had not received
professional help.

At the end of the initial interview, each of the five outpatient
therapists, including the researcher, asked new clients who met the
inclusion criteria to read the consent form (See Appendix C). Those
who agreed to participate by signing the consent form and returning
it to the therapist were given a packet which included in the follow-
ing order: the demographic information form, the CRI and the ANS-IE.
Subjects were instructed to complete the questionnaires in the re-
ception room after leaving the therapist's office and to deposit them
in a box provided in the reception area. The instructions were
repeated on the demographic information form, the first page of the
packet.

66

A statement included on the demographic data form reminded sub-
jects that the questionnaires did not contain their names and would be
seen only by the researcher. This statement and the collection of the
completed forms in a box in the reception area were intended to assure
the subjects of anonymity, thus increasing the probability of obtaining
unbiased responses.

Five subjects who were eligible to participate declined to do so.
Another seven subjects who agreed to participate did not return the
questionnaires. Five more subjects were dropped from the analysis due
to failure to respond to all of the questions. One hundred subjects'
responses were included in the analysis.

Data Analysis
Scoring

Coping response inventory (CRI). A principal -component factor
analysis with varimax rotation was done combining the data from the
pilot study factor analysis (n - 143) with the responses of the re-
search subjects [n = 100). Seven factors were extracted which ac-
counted for 59% of the total variance. The results are summarized in
Table 3.

Of the seven factors extracted, five defined the response cate-
gories of the study. Factor 1 represented direct action responses,
Factor 2 represented functional somatic-oriented responses, Factor 3
represented avoidance responses and Factor 4 represented defensive
responses of the type described by Lazarus. Factors 5 and 6 repre-
sented two forms of potentially dysfunctional somatic-oriented re-
sponses. Factor 5 represented the use of medications as a response

67
Table 3
Varimax Rotated Factor Matrix

Factor Item Item Loading

Direct action factor

Talk the problem over with a friend or

family member. .51

Try analyzing the problem. .73

Find out everything I can about the situation. .79

Consider all the alternatives. -75

Try to make a decision. .74

Functional somatic-oriented factor

Read or listen to music. .35

Exercise--take a walk, jog, swim, dance. .64

Garden or work in the yard. .73

Read about how others have solved similar problems. .34a
Do some work with my hands (sew, paint,

do carpentry, etc.). -65

Avoidance factor

3 Take a hot bath or shower. -62

Get away from the problem by watching T.V.
Eat more.

Defensive factor

61
.58

Daydream or think about more pleasant things. .70

Focus on the concerns of others instead of my problem. .63
Decide that the problem doesn't really affect me. .73
Believe that things will take care of themselves. .63b
Ignore the problem. -42

Read about how others have solved similar problems. .36

Table 3 - continued

Factor Item Item Loading

Potentially dysfunctional somatic-oriented type A factor

5 Take tranquil izing medicines. .84

Take sleeping medicines. .85

Potentially dysfunctional somatic-oriented type B factor

6 Believe that things will take care of themselves. .41
Drink more alcohol. .65

Smoke more. .68

Other somatic-oriented responses

7 Try to relax or rest. .70

Read or listen to music. .59

Sleep a lot. .41

Exercise--walk, jog, swim, dance. .34

Note: Includes factors with eigenvalues greater than 1.
dItem loaded approximately equally on two factors and was dropped.
bItem correlated signigicantly with two factors and was assigned to
defensive factor.

69
to stress and Factor 6 represented drinking alcohol and smoking.
Factor 7 represented somatic-oriented responses which did not fit the
researcher's definitions of either functional or dysfunctional. Be-
cause Factors 3 and 7 did not fit into the categories defined by
Lazarus, they were not used in testing the hypotheses of the study.

Factors 1, 2, 4, 5 and 6 were used in forming the subscales.
Items which loaded .30 or greater on each of these factors were com-
bined to form five subscales. The item "Read about how others solved
similar problems" was dropped because it loaded approximately equally
on both Factors 2 and 4. "Believe that things will take care of them-
selves," which also loaded significantly on two factors (.63 on Factor
4, .41 on Factor 6), was retained as a Factor 4 item. Table 4 summa-
rizes the five subscales used in the hypothesis testing.

Subscale scores were derived by summing item scores for each
subject. Item scores ranged from 0-6 with 0 points scored for a
response of "Never" and 6 points for a response of "Always". Sub-
scales had the following range of scores: 1) 0-30; 2) 0-24; 3) 0-24;
4) 0-12; 5) 0-12.

Adult Nowicki-Strickland internal-external control scale (ANS-IE).
The ANS-IE is scored in the direction of externality such that higher
scores represent greater external control orientation. Scores were
not dichotomized into groups of externals and internals, rather the
continuum of scores was used to prevent the loss of data. Listed
below are the 40 items which make up the ANS-IE. One point was scored
for a "Yes" response on the items which are preceded by a (Y) and one
point was scored for a "No" response on the items which are preceded
by a (N). Zero points were scored for other responses.

70

Table 4

Subscales Used in Hypothesis Testing

lumber Item

Direct action responses

Talk the problem over with a friend or family member.

Try analyzing the problem.

Find out everything I can about the situation.

Consider all the alternatives.

Try to make a decision.

Defensive responses

Focus on the concerns of others instead of my problem.
Decide that the problem doesn't really affect me.
Believe that things will take care of themselves.
Ignore the problem.

Functional somatic-oriented responses

Read or listen to music.

Exercise--take a walk, jog, swim, dance.

Garden or work in the yard.

Do some work with my hands (sew, paint, do carpentry, etc.)

4 Potentially dysfunctional somatic-oriented type A responses

Take tranquil i zing medicines,
Take sleeping medicines.

5 Potentially dysfunctional somatic-oriented type B responses

Drink more alcohol
Smoke more.

71
(Y) Do you believe that most problems will solve themselves if you

just don't fool with them?
(N) Do you believe that you can stop yourself from catching a cold?
(Y) Are some people just born lucky?
(N) Most of the time did you feel that getting good grades meant a

great deal to you?
(Y) Are you often blamed for things that just aren't your fault?
(N) Do you believe that if somebody studies hard enough he or she

can pass any subject?
(Y) Do you feel that most of the time it doesn't pay to try hard

because things never turn out right anyway?
(Y) Do you feel that if things start out well in the morning that it's

going to be a good day no matter what you do?
(N) Do you feel that most of the time parents listen to what their

children have to say?
(Y) Do you believe that wishing can make good things happen?
(Y) When you get punished does it usually seem it's for no good

reason at all ?
(Y) Most of the time do you find it hard to change a friend's (mind)

opinion?
(N) Do you think that cheering more than luck helps a team to win?
(Y) Did you feel that it was nearly impossible to change your parent's

mind about anything?
(N) Do you believe that parents should allow children to make most of

their own decisions?
(Y) Do you feel that when you do something wrong there's very little

you can do to make it right?

72

(Y) Do you believe that most people are just born good at sports?
(Y) Are most of the other people your age stronger than you are?
(Y) Do you feel that one of the best ways to handle most problems is

just not to think about them?
(N) Do you feel that you have a lot of choice in deciding whom your

friends are?
(Y) If you find a four leaf clover, do you believe that it might

bring you good luck?
(N) Did you often feel that whether or not you did your homework had

much to do with what kind of grades you got?
(Y) Do you feel that when a person is angry at you, there's little

you can do to stop him or her?
(Y) Have you ever had a good luck charm?
(N) Do you believe that whether or not people like you depends on

how you act?
(N) Did your parents usually help you if you asked them to?
(Y) Have you felt that when people were angry with you it was

usually for no reason at all?
(N) Most of the time, do you feel that you can change what might

happen tomorrow by what you do today?
(Y) Do you believe that when bad things are going to happen they just

are going to happen no matter what you try do do to stop them?
(N) Do you think that people can get their own way if they just keep

trying?
(Y) Most of the time do you find it useless to try to get your own

way at home?

73
(N) Do you feel that when good things happen they happen because of

hard work?
(Y) Do you feel that when somebody wants to be your enemy there's

little you can do to change matters?
(N) Do you feel that it's easy to get friends to do what you want

them to do?
(Y) Do you usually feel that you have little to say about what you get

to eat at home?
(Y) Do you feel that when someone doesn't like you there's little you

can do about it?
(Y) Did you usually feel that it was almost useless to try in school

because most other children were just plain smarter than you were?
(N) Are you the kind of person who believes that planning ahead makes

things turn out better?
(Y) Most of the time, do you feel that you have little to say about

what your family decides to do?
(N) Do you think it's better to be smart than to be lucky?

Socioeconomic status (SES). Information from the demographic
information form relating to years of education and occupation was
used to compute an Index of Social Position according to the Hoi lings-
head Two Factor Index of Social Position. Each subject was assigned an
occupational scale score between 1 and 7 based on the listing of occu-
pational titles provided by the Hollingshead Index and an educational
scale score between 1 and 7 also based on criteria specified by the
Hollingshead Index. In accordance with Holl ingshead 's formula the
two factors, occupation and education, were combined to form the Index
of Social Position by multiplying each scale score by the following

74
factor weights: occupation, 7; education, 4, and summing the resulting
weighted scores. The range of scores is from 11 to 77 with lower
scores representing higher SES. The Index of Social Position scores
can be arranged on a continuum or divided into social class groups.
For the data analysis the continuum of scores was used.
Statistical Analysis

A partial correlation analysis was done using the Statistical
Package for the Social Sciences (SPSS) subprogram Partial Corr (Nie,
Hull, Jenkins, Steinbrenner & Bent, 1970). Partial correlation pro-
vides a single measure of association describing the relationship be-
tween two variables, while statistically adjusting for the effects of
one or more control variables. The linear effect of the control vari-
ables is removed from both independent and dependent variables, cre-
ating adjusted independent and dependent variables which are uncor-
rected with all control variables which have been entered.

Locus of control was defined as the independent variable. Five
dependent variables were defined--direct action, defensive, functional
somatic-oriented, potentially dysfunctional somatic-oriented Type A
(medication) and Type B (drinking alcohol and smoking) responses. Sex
and SES, two variables shown to relate consistently to coping behavior,
were defined as control variables. Three partial -correlation coef-
ficients (two first-order and one second-order partial) were computed
to determine the relationship between locus of control and each cate-
gory of coping behavior after variance contributed by sex and SES had
been removed. For example, to determine the relationship between
locus of control and direct action responses the following partials
were computed:

75

First-order partial. Locus of control was correlated with direct
action responses while controlling for sex.

First-order partial. Locus of control was correlated with direct
action responses while controlling for SES.

Second-order partial. Locus of control was correlated with direct
action responses while controlling for sex and SES simultaneously.
Because the hypotheses were directional, one-tailed tests of sta-
tistical significance were computed for all partials.

CHAPTER IV
RESULTS

The data indicate that there is a statistically significant but
small relationship between locus of control and the strategies for
coping with stressful events reported by community mental health
outpatient clients. A partial correlation analysis was conducted
to assess the relationship between locus of control and coping strat-
egies, while controlling for sex and SES. A significant positive
linear relationship was found between internal locus of control and
choice of direct action and functional somatic-oriented responses.
A significant negative linear relationship was found between internal
locus of control and defensive responses and one of two types of
potentially dysfunctional somatic-oriented responses, the use of
medication as a response to stress. No significant relationship was
found between internal ity and a second type of potentially dysfunc-
tional somatic-oriented response, drinking alcohol and smoking.

A significant negative linear relationship was found between
external locus of control and choice of direct action and functional
somatic-oriented responses. A significant positive relationship was
found between externality and choice of defensive responses. Only
one of two types of potentially dysfunctional somatic-oriented re-
sponses, the use of medications as a response to stressful events,
showed a positive significant relationship to externality. Table 5
summarizes the results of the partial correlation analysis.

76

77

Table 5

Correlations Between Locus of Control
and Coping Responses

Direct action Defensive

Functional
somatic

Dysfunctional

somatic
A B

Simple correlations

-.32**

.17* -.22** .40**

.16

Correlations controlling for sex

-.34**

.19* -.21* .39**

.17*

Correlations controlling for SES

-.31**

.19* -.20* .40**

.15

Correlations controlling for sex and SES

33*

.20*

,20*

.40*

16

*r^ < . 05

**£ < . 01

78

The first row of coefficients represents zero order partial s or
the simple relationships between locus of control and each of the
coping response patterns. The second and third rows show the first
order partial s, which relate locus of control to coping responses
while controlling first for sex and then for SES. The last row of
coefficients is second order partials, which represent the relation-
ships between the independent and dependent variables while control-
ling for sex and SES simultaneously. As can be seen, the control
variables contributed very little variance to the relationship be-
tween the independent variable and the dependent variables. There-
fore, the relationship between locus of control and the five coping
response styles exists virtually independently of sex or SES.

Table 6 presents the relationships between the control variables,
sex and SES, between sex and the correlation variables and between SES
and the correlational variables. There was a statistically signifi-
cant relationship between SES and direct action strategies (r = -.19,
df = 98, £ -.03) with subjects of higher social class reporting more
of these responses than subjects of lower social classes. Sex was
also found to relate significantly to SES (r = .22, df = 98, £ = .02)
with males having higher SES scores than females.
Direct Action Responses

Subjects with low scores on the ANS-IE (high internal ity) chose
more direct action responses than those with high scores (high exter-
nality) (r = -.33). Internal subjects, more often than their external
counterparts, reported talking a problem over with a friend or family
member, trying to analyze the problem, finding out everything they
could about the situation, considering all the alternatives and trying

79

Table 6

Relationship Between Control Variables
and Correlational Variables

Sex

SES

Locus of control

.10

.15

Direct action responses

.15

-.19*

Defensive responses

-.13

-.07

Functional somatic-oriented
responses

-.07 -.14

Dysfunctional somatic-oriented
responses

Type A .06 .00

Type B -.11 -09

Sex 1-00 .22*

SES -22* 1.00

80
to make a decision, as responses to events which caused them to feel
tense or upset. Both internals and externals reported using these
types of responses more frequently than other coping strategies.
Direct action responses accounted for 16.7% of total variance, the
highest percentage of variance contributed by a factor of the CRI .
Defensive Responses

High scores on the ANS-IE (high externality) were significantly
related to the choice of behaviors which had the effect of denying the
stressor or its personal significance or ameliorating the subject's
perception of it (r = .20). Externals, more frequently than internals,
reported focusing on the concerns of others instead of their problem
(projection), deciding that the problem did not really affect them
(rationalization), believing that things would take care of themselves
(rationalization) and ignoring the problem (denial).
Functional Somatic-Oriented Responses

Internals, more than externals, reported using the following re-
sponses which have the effect of relieving the dysphoric somatic ac-
companiments of stressful events while increasing future capacity for
coping (r = -.20): "Read or listen to music," "Excercise--take a
walk, jog, swim, dance," "Garden or work in the yard" and "Do some
work with my hands (sew, paint, do carpentry, etc.)."

Potentially Dysfunctional Somatic-Oriented Responses--Type A

High scores on the ANS-IE (externality) were related to use of
sleeping pills and tranquilizers (r = .40) as methods of relieving
the somatic discomfort associated with anticipating or responding to
stressful situations.

81
Potentially Dysfunctional Somatic-Oriented Responses—Type B
The relationship between locus of control and increased use of
drinking alcohol and smoking to relieve the somatic distress associ-
ated with aversive situations failed to reach an acceptable level of
significance. However, the relationship was in the expected direction
with externals reporting more frequent use of these responses than
internals (r = .16, df = 96, £ = .06).

CHAPTER V
DISCUSSION

Locus of control is a statistically significant variable in the
choice of coping responses reported by community mental health out-
patient clients. As internality increased the use of direct action
and functional somatic-oriented responses increased. These findings
support Research Hypothesis 1A. As internality increased the use of
defensive responses and one type of potentially dysfunctional somatic-
oriented response, the use of medication as a response to stress,
decreased. There was also a decrease in drinking alcohol and smoking
with increased internality; however, this relationship was not statis-
tically significant (r = -.16, df = 96, £ = .06). These results only
partially support Research Hypothesis IB.

As predicted by Hypothesis 2A, greater externality was related
to decreased use of direct action and functional somatic-oriented re-
sponses. The prediction of Hypothesis 2B, of a significant positive
relationship between external locus of control and choice of defensive
and potentially dysfunctional somatic-oriented responses, was only
partially supported. The hypothesized relationship between external-
ity and use of defensive strategies was observed. However, only one
of two types of potentially dysfunctional somatic-oriented responses,
the use of medication, was significantly and positively related to
externality. The relationship between externality and drinking alco-
hol and smoking as a response to stress was in the expected direction
but failed to reach an acceptable level of significance (r = .16, df
= 96, £ = .06). 82

83

The magnitudes of the correlations between locus of control and
coping mechanisms, which ranged from .20 for defensive and functional
somatic-oriented responses and .40 for potentially dysfunctional
somatic-oriented--Type A responses (see Table 5), indicate that
although locus of control is a statistically significant variable
related to the choice of coping mechanisms it is not a major factor.

These findings offer limited support for Lazarus' (1964) theory
that personal perception of one's potential for mastery is a sig-
nificant factor related to coping strategy. Persons who believed that
outcomes were contingent on their behavior (internals) chose more
effective coping strategies than those who attributed outcomes to
chance, fate or powerful others (externals). Internals used more
direct action and fewer defensive responses than externals. Similar
results have been reported by Anderson (1977), Brown (1976) and
Pearlin and Schooler (1978). These results differ from those of
Chamberlain (1980) and Ritter (1980), who found no relationship be-
tween locus of control and coping mechanisms. The finding that
management of dysphoric somatic accompaniments of stress was also
handled more effectively by internals had not been reported previ-
ously, as no studies of this type of coping response were found in the
1 i terature.

This study supports Lazarus' (1977) theory that coping is a com-
plex process which includes some combination of direct action, defen-
sive and somatic oriented responses. A number of researchers
(Hamburg & Adams, 1967; Mechanic, 1962; Penman, 1980; Sanders &
Kardinal, 1977) had observed that persons who coped most effectively
with a variety of stressors used a coping style which combined direct

action with defensive strategies but relied most on direct action ap-
proaches. This pattern was also observed for the subjects of the
present study whether they are considered as a group or are looked
at in subgroups according to sex, race, marital status, age, years of
education, social class, primary presenting problem or referral
source (see Table 7). Additionally, the total group and each of the
subgroups used more functional somatic-oriented responses than dys-
functional somatic-oriented responses. Thus, for these subjects a
coping style emerged which included a combination of coping responses
used in the following order from highest to lowest frequency: direct
action, functional somatic-oriented, defensive and potentially dys-
functional somatic-oriented. This pattern remained for the total
group and for 28 of the 32 subgroups after combining the means of the
two forms of potentially dysfunctional somatic-oriented responses so
that the number of items included was equal to the number of items on
the defensive and functional somatic-oriented scales. Although there
are five items on the direct action subscale, compared with four items
on each of the others (after combining the two potentially dysfunc-
tional somatic-oriented subscales), one item could not have accounted
for the approximate 10-point difference between mean direct action re-
sponses and the means of the next most frequently reported responses,
functional somatic-oriented responses.

Despite repeated past findings that sex and SES were related to
direct action and defensive response styles (Brown, 1976; Brown et al . ,
1975: Calhoun, 1980; Parent, 1976; Pearlin & Schooler, 1978; Penman,
1980; Tanck & Robbins, 1979; Warheit, 1979), very little of the
shared variance between locus of control and coping mechanisms was

85

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87
accounted for by these two variables. Table 5 summarizes the relation-
ships between the correlational variables before the control vari-
ables are introduced, the relationships while controlling for sex,
the relationships while controlling for SES and the relationships
while controlling for both sex and SES simultaneously. The very small
differences between the first row of coefficients, before the variance
attributable to either of the control variables was removed and the
forth row, after the variance contributed by both sex and SES were
subtracted, indicates that sex and SES are of little importance in
understanding the relationship between locus of control and coping
strategies, at least for these subjects. The relatively minor in-
fluence attributable to SES may be the result of the somewhat con-
stricted range of social class scores for these subjects. The higher
social class groups, Classes I and II were grossly underrepresented
with only seven subjects between the two groups. The majority of
subjects fell into Classes III and IV (25 and 52, respectively) with
the lowest SES group, Class V, also being underrepresented (n = 16).

Table 6 shows the correlations between sex and each of the corre-
lational variables, between SES and each of the correlational vari-
ables and between sex and SES. There was a significant relationship
between SES and direct action responses, with subjects of higher
social class membership reporting more of these responses than sub-
jects of lower SES status. There was also a significant relationship
between sex and SES with males being members of higher SES groups
more often than females.

The small differences between males and females on each of the
coping response categories are shown in Table 7. There was a tendency

for females to use more direct action and medication responses than
males and for males to use more defensive, functional somatic-
oriented and potentially dysfunctional somatic-oriented--Type B
(smoking and drinking alcohol) responses than females. To determine
if these differences were statistically significant a series of t
tests were run. No significant differences were found. These differ-
ences are probably due to chance and therefore, will not be discussed
further.

SES differences were also small. Because Classes I and II are
underrepresented (n = 2 and u = 5, respectively) their scores will not
be discussed. Members of social Class III reported the highest fre-
quency of direct action and functional somatic-oriented responses.
Members of social Class IV used fewer defensive responses to stress
than any other class group. Membership in SES group V was associated
with the lowest frequency of direct action and functional somatic-
oriented responses. There was a trend toward using fewer direct
action responses as social status decreased. This trend has been
observed by other researchers (Brown, 1976; Brown et al . , 1975; Parent,
1976; Penman, 1980; Warheit, 1979). There was also a trend toward use
of fewer functional somatic-oriented responses with decreasing social

status.

Exploratory Data
Although there is a statistically significant relationship be-
tween locus of control and mechanisms for coping with stress, the
correlations between these variables are small. Therefore, knowledge
of one's control orientation is of limited usefulness in understanding
how that person responds to stressful life experiences. This is true

even when the sex and SES of the respondent are taken into consider-
ation. In an effort to discover other variables related to choice
of coping strategies, the mean scores on each of the coping response
categories were examined for subgroups based on race, marital status,
age, years of education, presenting problem and referral source. The
results are shown in Table 7.
Relationship of Race to Coping Mechanisms

Because minority racial groups were underrepresented in this
study, mean coping responses for subgroups based on race will not be
discussed.
Relationship of Marital Status to Coping Responses

Never married and divorced subjects reported more frequent use
of defensive and potentially dysfunctional somatic-oriented responses
(drinking alcohol and smoking) and less frequent use of functional
somatic-oriented responses than married or widowed subjects. Married
subjects reported the least frequent use of defensive and both types
of potentially dysfunctional somatic-oriented responses. There were
too few widowed subjects (_n = 3) to discuss their pattern of response
scores.
Relationship of Age to Coping Mechanisms

Subjects under the age of 30 reported the greatest use of direct
action, defensive and potentially dysfunctional somatic-oriented
responses (drinking alcohol and smoking). Subjects ranging in age
from 30 through 49 reported using medication as a response to stress-
ful events less frequently than any of the other age groups. Sub-
jects between 50 and 65 used fewer defensive and functional somatic-
oriented responses and more potentially dysfunctional somatic-oriented

90
--Type B responses (drinking alcohol and smoking) and the most fre-
quent use of functional somatic-oriented responses.
Relationship of Education to Coping Mechanisms

Subjects with less than 12 years of education used fewer direct
action, defensive and functional somatic-oriented responses than the
other groups. Subjects with a high school education reported the
greatest use of both forms of potentially dysfunctional somatic-
oriented responses and the least frequent use of medication as a
response to stress. Subjects with a college degree and those with
graduate training reported the most frequent use of defensive re-
sponses and the least frequent use of potentially dysfunctional
responses to stress.
Relationship of Presenting Problem to Coping Mechanism

Subjects who identified an interpersonal relationship as their
primary problem reported the highest frequency of direct action and
the lowest frequency of both types of potentially dysfunctional
somatic-oriented responses. Subjects who reported that anxiety was
their major problem (_n = 4) used the fewest direct action and func-
tional somatic-oriented responses and the most defensive and poten-
tially dysfunctional somatic-oriented--Type B responses (drinking
alcohol and smoking), the most maladaptive combination of responses
for any problem type. When means were computed for subjects who
reported anxiety in addition to any one other problem (n = 23), the
pattern remained, although the differences between this group and
those reporting other combinations of problems were small. Subjects
reporting a problem other than interpersonal relationship, depression

91
or anxiety used the highest frequency of functional somatic-oriented
responses and the lowest frequency of defensive responses.
Relationship of Referral Source to Coping Mechanisms

Those who referred themselves to treatment reported the highest
frequency of defensive and potentially dysfunctional somatic-oriented
--Type B responses. Subjects referred by a family member or friend
reported the greatest frequency of functional somatic-oriented
responses. Those referred by other agencies such as the courts or
Health and Rehabilitative Services reported the highest frequency of
direct action responses and the lowest frequency of medication taking
responses. Subjects referred by family physicians reported the lowest
frequency of direct action, defensive, functional somatic-oriented and
drinking alcohol and smoking responses. They also reported the
highest frequency of medication taking responses.
Locus of Control

Mean locus of control scores for the subjects of the present
study (see Table 7) were very similar to those reported by Rosenweig
(cited in Nowicki, 1979) for adult psychiatric outpatients (males,
13.18; females, 14.11). These mean scores are higher than those of
nonpatient community subjects of approximately the same age (males,
10.61; females 11.43) (Nowicki, 1979). Greater externality in psy-
chiatric clients has been observed by Brannigan et al . (1977), Duke
& Mullens (1973), Joe (1971) and Nowicki (1979). The finding that
females were slightly more external than males was also reported by
Nowicki (1979).

92
General izability of Findings

These results can be generalized to the clients of other urban
community mental health centers who serve populations which are
demographically similar to the present subjects. The findings of
this study should not be generalized to rural populations nor to
mental health clinics whose catchment areas include large numbers
of minority group members.

Implications for Counseling

Because locus of control and coping style have been found to
relate to each other, therapeutic efforts to increase internal ity
are likely to have some effect in improving coping mechanisms as well.
Likewise, interventions directed toward improving coping responses
will impact upon clients' beliefs regarding capacity to influence
the courses of their lives.

Connolly (1980) offered some practical strategies for changing
locus of control orientation. These included facilitating aware-
ness of externality, reinforcing responsibility for oneself and
helping clients generate and evaluate alternatives. An early step
in changing external expectations is to identify verbal and behav-
ioral expressions of externality and in so doing increase awareness
of externality on the part of the client. When a client verbalizes
expressions of blame, weakness or rigidity, as well as belief in fate,
chance or wishful thinking, the therapist can take the opportunity to
explore with the client the feelings of helplessness and powerless-
ness which are associated with these beliefs. Behaviors which give
rise to these feelings can also be identified. Helping the client
to identify behaviors which are deficient, to generate options and

93
evaluate their consequences provides a vehicle for making the client
aware of both choice and control.

In regard to coping mechanisms, it is important for the therapist
to be aware of how the client is presently responding to the stressful
event or series of events which have resulted in seeking professional
help. This information can be gained by administering an inventory
such as the CRI or through asking the client what kinds of things
have been done in an effort to resolve the situation. Direct action
responses are increased naturally in therapy as the client discusses
the problem, expresses feelings concerning it, evaluates alternatives,
makes decisions and implements them. Focusing on the problem auto-
matically decreases defensive responses which function to deny or
distort the event or its personal significance. Functional somatic-
oriented responses can be increased by teaching the client healthy
methods of reducing the anxiety associated with coping with stressful
situations. Progressive relaxation training can be incorporated into
the therapy, as well as suggestions of how clients can use behaviors
which they find pleasurable to relieve their present somatic dis-
comfort. Clients can be encouraged to participate in a physical ac-
tivity of their choice such as swimming, bicycling or walking. As
clients use more functional somatic-oriented responses to relieve ten-
sion, use of dysfunctional ones should decrease.

These techniques to increase internal ity and improve coping
mechanisms can be integrated in a number of therapeutic styles and
theoretical approaches. Hopefully, clients will internalize these
improved coping mechanisms and beliefs concerning personal mastery so
that they become a part of their approach to resolution of future
stressful situations.

94

Limitations of the Study and
Suggestions for Future Research

The results of this research are based on correlational data and,
therefore, provide no information concerning causation. This study
was limited by the necessity of focusing on a few variables so as to
make the research manageable as a dissertation project. As has been
observed, coping is a complex process which is influenced by a myriad
of personal, environmental and situational variables. A true under-
standing of the coping process will be achieved only when studies are
undertaken which combine all of these variables. The present study
suggests that age, marital status and type of problem may be important
variables in understanding the way an individual copes with stressful
events and should be considered in future research of coping mecha-
nisms.

The findings of the present study are based on a sample of clients
seen in a public clinic. They were primarily white, lower middle and
upper lower class persons, less than fifty years of age who reside in
an urban community. Before these findings can be generalized to other
clinical populations who differ significantly on demographic variables,
additional research is needed. Research which focuses on nonpsychi-
atric populations is also needed to understand the coping process in
psychologically healthy individuals. Additionally, outcome studies
must be undertaken to determine if therapeutic interventions which are
directed toward changing external expectancies and improving coping
skills can achieve these results more cost effectively than other
therapies without such a focus.

95
Summary of Study

A study of the relationship between locus of control and mecha-
nisms for coping with stressful life events was conducted with 100 male
and female community mental health outpatient clients serving as sub-
jects. At the end of the initial intake interview, each of the five
outpatient therapists, including the researcher, asked new clients who
were judged to be nonpsychotic and who had not received counseling
during the preceding 6 months to participate in the research. Those
who indicated their willingness to participate by signing a statement
of informed consent were given a packet containing a demographic data
form, the CRI, a 24-item rating scale developed by the researcher to
measure behavior engaged in as a response to stressful situations and
the ANS-IE, a 40-item measure of locus of control orientation. Five
subjects who were asked to participate declined to do so. Another
seven subjects who agreed to take part in the study did not return their
questionnaires. Five more subjects were dropped from the analysis be-
cause of failure to respond to all the questions.

A partial correlation analysis was conducted using the SPSS sub-
program Partial Corr to assess the linear relationship between the
independent variable, locus of control, and each of five dependent
variables—direct action, defensive, functional somatic-oriented and
two forms of potentially dysfunctional somatic-oriented coping re-
sponses. Sex and SES, two variables which have been shown to relate
to coping behavior, were defined as control variables and their linear
effects removed from both the independent variable and the dependent
variabl es.

96
It was hypothesized that internal ity was related to effective
coping behavior and that externality was related to maladaptive coping.
Specifically, a statistically significant positive linear relationship
was predicted between internality and choice of direct action and
functional somatic-oriented responses to stressful events and a nega-
tive linear relationship was predicted between internality and use of
defensive and potentially dysfunctional somatic-oriented responses.
Externality was predicted to covary positively with defensive and
potentially dysfunctional somatic-oriented responses and negatively
with direct action and functional somatic-oriented responses. The
hypothesized relationships were observed between locus of control and
direct action, defensive, functional somatic-oriented responses and
between locus of control and one of two types of potentially dysfunc-
tional somatic-oriented responses. The correlation between locus of
control and a second form of potentially dysfunctional somatic-oriented
response was not found to be statistically significant. Sex and SES
were found to contribute little to the relationship between locus of
control and coping mechanisms, although there was a tendency for per-
sons of higher SES to use more direct action responses and for males
to be members of higher social class groups more often than females.
The rather low correlations between locus of control and coping
responses indicated that although a person's belief concerning ability
to influence outcomes is a factor related to the choice of response to
a stressful event, it is not a major one. Other factors not included
in the main hypotheses of the study which appeared to influence coping
style were marital status, age and the type of problem a person was
coping with. Married individuals used more functional somatic-oriented

97
and fewer defensive and potentially dysfunctional somatic-oriented re-
sponses than never married or separated/divorced subjects. Younger
subjects took less medication and drank alcohol and smoked more in
response to stressful situations than older subjects. Persons who
identified anxiety as their major reason for seeking counseling evi-
denced a maladaptive coping response pattern, which included low
frequencies of direct action and functional somatic-oriented responses
and high frequencies of defensive and potentially dysfunctional somatic-
oriented responses compared to subjects reporting other problems.

APPENDIX A
QUESTIONNAIRES

ANS-IE

PLEASE INDICATE YOUR ANSWER BY PLACING A CHECK IN THE APPROPRIATE BLANK
TO THE RIGHT OF EACH QUESTION. MAKE SURE THAT YOU ANSWER EVERY
QUESTION.

YES NO

1. Do you believe that most problems will
solve themselves if you just don't
fool with them?

2. Do you believe that you can stop your-
self from catching a cold?

3. Are some people just born lucky?

4. Most of the time did you feel that
getting good grades meant a great
deal to you?

5. Are you often blamed for things that
just aren't your fault?

6. Do you believe that if somebody studies
hard enough he or she can pass any
subject?

7. Do you feel that most of the time it
doesn't pay to try hard because things
never turn out right anyway?

8. Do you feel that if things start out
well in the morning that it's going to
be a good day no matter what you do?

9. Do you feel that most of the time
parents listen to what their children
have to say?

10. Do you believe that wishing can make
good things happen?

11. When you get punished does it usually
seem it's for no good reason at all?

12. Most of the time do you find it hard
to change a friend's (mind) opinion?

13. Do you think that cheering more than
luck helps a team to win?

99

100

14. Did you feel that it was nearly
impossible to change your parent's
mind about anything?

15. Do you believe that parents should
allow children to make most of their
own decisions?

16. Do you feel that when you do something
wrong there's very little you can do
to make it right?

17. Do you believe that most people are
just born good at sports?

18. Are most of the other people your
age stronger than you are?

19. Do you feel that one of the best ways
to handle most problems is just not
to think about them?

20. Do you feel that you have a lot of
choice in deciding whom your friends
are?

21. If you find a four leaf clover, do
you believe that it might bring you
good luck?

22. Did you often feel that whether or not
you did your homework had much to do
with what kind of grades you got?

23. Do you feel that when a person is
angry at you, there's little you can
do to stop him or her?

24. Have you ever had a good luck charm?

25. Do you believe that whether or not
people like you depends on how you act?

26. Did your parents usually help you if
you asked them to?

27. Have you felt that when people were
angry with you it was usually for no
reason at all ?

ANS-IE
YES NO

101

28. Most of the time, do you feel that you
can change what might happen tomorrow
by what you do today?

29. Do you believe that when bad things
are going to happen they just are
going to happen no matter what you
try to do to stop them?

30. Do you think that people can get their
own way if they just keep trying?

31. Most of the time do you find it
useless to try to get your own way
at home?

32. Do you feel that when good things
happen they happen because of hard
work?

33. Do you feel that when somebody wants
to be your enemy there's little you
can do to change matters?

34. Do you feel that it's easy to get friends
to do what you want them to do?

35. Do you usually feel that you have little
to say about what you get to eat at home?

36. Do you feel that when someone doesn't
like you there's little you can do
about it?

37. Did you usually feel that it was almost
useless to try in school because most
other children were just plain smarter
than you were?

38. Are you the kind of person who believes
that planning ahead makes things turn
out better?

39. Most of the time do you feel that you
have little to say about what your
family decides to do?

ANS-IE
YES NO

102

ANS-IE
YES NO

40. Do you think it's better to be smart than
to be lucky?

END

Please check to see if you have answered all questions.

THANK YOU FOR YOUR PARTICIPATION.

103

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APPENDIX B
DEMOGRAPHIC DATA FORM

DEMOGRAPHIC DATA FORM

INSTRUCTIONS

The following questionnaires are to be used in a study of the ways
that people cope with stressful situations. These forms do not contain
your name and will be seen only by the researcher. When you have com-
pleted these forms, please drop them in the box marked "Questionnaires"
which is located on the table in the reception area of the front lobby.

IMPORTANT: Be sure to answer every question--DO NOT OMIT ANY.

Years of Education

Hispanic

Separated or Divorced

Widowed

Age

Male
Female

Caucasian

Negro

Marital Status:

Never Marri

ed

Married

Occupation: (ANSWER EVEN IF YOU ARE NOT PRESENTLY EMPLOYED;

Type of problem for which you requested counseling:

Interpersonal relationship (problem with spouse, boyfriend/

girlfriend, family member, roommate, friend, etc.)

Depression

Anxiety

Other (Specify]

Who referred you to the Center?

Self

Family member or friend

Another agency (e.g. HRS, Parent Child Study Center, etc.

Family physician

109

APPENDIX C
INFORMED CONSENT FORM

INFORMED CONSENT

I am conducting a study to determine the relationship between
personality characteristics and the ways that people cope with stress-
ful situations. I would like you to fill out three questionnaires
which will be given to you by your therapist and deposit them in the
box marked "Questionnaires" which is located on the table in the re-
ception area of the front lobby. Your name will not appear on the
questionnaires nor will they be made a part of your record. It is
hoped that the information gained from this study will enable us to
better understand the coping process and to provide counseling services
which most effectively meet the needs of those who seek professional
help in dealing with stressful life events.

Your participation in this study is voluntary. No monetary com-
pensation will be given. You are free to withdraw your consent and
to discontinue participation at any time without prejudice. I will
be happy to answer any questions that you have concerning the
questionnaires.

If you would like to take part in the research described above,
please sign this form and return it to your therapist.

"I have read and I understand the procedure described above.
I agree to participate in the procedure and I have received a
copy of this description."

Signatures :

Subject ~~~" ~ ~ ' """ Date Witness Date

Relationship if other Date Margie Stevenson Date
than subject 506 Gale Place

West Palm Beach, FL

111

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BIOGRAPHICAL SKETCH
Margie K. Stevenson was born on August 16, 1939, in New Orleans
Louisiana. She received the Bachelor of Arts degree from the Univer-
sity of Florida with a major in psychology in August, 1975. She and
her husband have two children, Michael and Pamela.

119

I certify that I have read this study and that in my opinion it
conforms to acceptable standards of scholarly presentation and is
fully adequate, in scope and quality, as a dissertation for the degree
of Doctor of Philosophy.

Ju.

./-.—

jL a-

Theodore Landsman, Chairman
Professor of Counselor Education

I certify that I have read this study and that in my opinion it
conforms to acceptable standards of scholarly presentation and is
fully adequate, in scope and quality, as a dissertation for the degree
of Doctor of Philosophy.

M

Uc.

Ruth H. Alexander

Professor of Physical Education

I certify that I have read this study and that in my opinion it
conforms to acceptable standards of scholarly presentation and is
fully adequate, in scope and quality, as a dissertation for the degree
of Doctor of Philosophy.

,x/~v

,v-cx QJU: kp^qs^

Janies Algina
Associate Professor o
of Education

Foundations

I certify that I have read this study and that in my opinion it
conforms to acceptable standards of scholarly presentation and is
fully adequate, in scope and quality, as a dissertation for the degree
of Doctor of Philosophy.

/

David Suchman

Associate Professor of Psychology

This dissertation was submitted to the Graduate Faculty of the Depart-
ment of Counselor Education in the College of Education and to the
Graduate Council, and was accepted as partial fulfillment of the re-
quirements for the degree of Doctor of Philosophy.

December, 1982

Dean for Graduate Studies and
Research

^'VERS'Ty OF FLORIDA

3 1262 08553 1209