Stress and Coping

We say things like "I'm stressed this week" or "how are you coping?" with such frequency that these are almost generic terms for any unpleasant psychological experience we might have. The words "stress" and "coping" have become so much a part of the vernacular that we might forget they were originally technical terms used by psychologists. We probably have a sense that stress is on a continuum, less intense than things like depression or PTSD but also more than everyday hassles. And we likely also think about different ways of coping (if we think about coping at all), with the inherent idea that some ways of coping are probably healthier than others in some undefined way. The terms "stress" and "coping" are like the "Kleenex" of psychology -- former brand-name terms that now have acquired a much broader and more diffuse meaning than they originally had.

The 1984 book Stress, Appraisal, and Coping, by Richard Lazarus and Susan Folkman, was the landmark publication that crystalized these terms into popular awareness. The book in fact includes some deep scholarly thought, and attempts to integrate multiple previous understandings of human experience. From the perspective of 40 years later, there's a lot in this work that still rings true. 

The term stress has been used in various ways -- as Lazarus wrote, it's "an organizing concept for understanding a wide range of phenomena in human and animal adaptation." For instance, a "stressor" can be viewed as an environmental challenge to an organism's physiology, like heat or cold. Freud used the term stress to refer to society's frustration of an internal drive, the conflict arising between what the id wants us to do and what the superego forbids. Even without the psychodynamic jargon, a stressor could be a social pressure to which a person feels compelled to conform. Alternately, a stressor could be something completely external to the individual: a cataclysmic external event like a war or a natural disaster, or a prolonged experience like imprisonment or homelessness. Stressors might also refer to life events affecting only a single person or a small group, like divorce, job loss, or the death of a loved one. And on the less-extreme end of the scale, the same term might refer to minor daily hassles like a sick child, an argument with a spouse, or feeling lonely around the holidays. Lazarus and Folkman in fact created a "daily hassles scale" to measure this type of stressor (later retitled "hassles and uplifts" to also capture things a person might be grateful for), which complemented the already-existing "life events scale" that measured major changes in the course of a person's life. 

The first column of the diagram at the top of the page, labeled "causal antecedents," captures various factors that go into an event being experienced as a stressor. Interestingly, it already includes some things about the person -- values and beliefs -- with the implication that some people will be more resilient than others in the face of stressors, and the further implication that this resilience is specifically connected to a belief system rather than to other personal characteristics (e.g., glucose processing ability, race and gender, economic status, or cardiovascular fitness). In 2024, I think we would say that there are a lot more person-level characteristics that affect resilience, many of them having to do with social position or opportunities and either partially or completely outside the person's control. Belief systems are more controllable and I agree that they are likely to make a difference (this is the downstream effect of the Narrative Mind on behavior), but they are far from the entire story here.

In view of the wide range of things that could be considered a "stressor," Lazarus and Folkman propose a strong role for the individual's interpretation of events in deciding whether something was stressful or not: "Psychological stress is a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being" (Lazarus & Folkman, p. 19, emphasis added). The appraisal process is what transforms an event into a stressor, which makes coping theory a classic cognitive model of psychology. You can see in this position the echoes of Rosencrantz's dictum that "there is nothing good or bad, but thinking makes it so" (from Shakespeare's Hamlet, Act II Scene 2). In support of this theory, Lazarus and Folkman cite the famous study by Schachter and Singer in which participants received epinephrine to increase their heart rate and breathing, and then interacted with a confederate who was either friendly or angry. (Back in 1962, they apparently called the confederate a "stooge"!) The confederate's behavior affected the participant's own emotions, which they were more likely to label as "excited" in the friendly-confederate condition and "angry" in the angry-confederate one. And when people were informed about epinephrine's effects on the body, they did not attribute their own reactions to an emotion, but instead blamed the drug. Therefore, Schachter and Singer argued, an emotion consists of first a physiological state and second a label applied by the person, with unlabeled states consisting only of "arousal," and not specifically stress. Lazarus and Folkman adopt this view.

Cognitive appraisal occurs in the second column of the diagram at the top of the page, and is separated into "primary" and "secondary." Lazarus and Folkman write that these terms correspond to "the two main evaluative issues of appraisal, namely, 'Am I in trouble or being benefitted, now or in the future, and in what way?' and 'What if anything can be done about it?'" (p. 31). Primary and secondary appraisal don't necessarily imply a sequence of first one and then the other; instead, the two judgments may be reached at the same time. In this model, however, the evaluative step of appraisal is needed before any event can be labeled as a stressor. A stressful event is one that the person's primary appraisal suggests to be threatening, harmful, challenging, or creating some important loss. Secondary appraisals then might also classify a threat as likely vs. unlikely (outcome expectancy), controllable vs. uncontrollable (self-efficacy), important vs. unimportant, and so forth. All of this appraisal happens in step 2 of the model. Steps 3 and 4 comprise the short-term (physiological reaction, social behavior, emotion) and long-term (social adaptation, physical health) effects of appraisal. The model therefore gives a great deal of weight to thinking -- ideas and beliefs of which the person is consciously aware, and which can be articulated in language.

Readers who are familiar with my Two Minds Theory can predict what I'm going to say next: I just don't buy it. I will start by pointing out that Lazarus and Folkman's explanation here isn't even consistent with the Schachter and Singer results, in which a physical sensation came first and only then was followed by interpretation. In Lazarus and Folkman's model, appraisal comes first and is followed by physical reactions like a rise in heart rate or blood pressure. Second, there's extremely good evidence that the body's stress reaction is physiological first, originating in the deep-brain amygdala structure that perceives environmental threats. Although this was known in animal studies as far back as the 1930s, human evidence for the amygdala's importance wasn't solid until the 1990s, after Lazarus and Folkman's major work. The prefrontal cortex (Narrative Mind) is clearly activated only after the amygdala signals a threat, and either after or simultaneous with signals to the endocrine system to release stress hormones into the body. Once epinephrine is flowing, we are back in the Schachter and Singer scenario, but without a drug-induced explanation for why we are feeling so keyed-up all of a sudden. There may indeed be some further processing and self-talk at this point, but the process of revving up the body to fight or flee is already well on its way before the Narrative Mind gets its say.

Besides the misplaced timing of physiological stress reactions, what's wrong with Lazarus and Folkman's model? The model also confuses environmental forces with our internal thoughts about them. To return to Schachter and Singer's example, the behavior of the confederate was pre-scripted for anger or friendliness, and was in fact based on random assignment. The experiment therefore shows that different social environments produce different emotions. The investigators assumed that an interpretation was happening -- a reasonable idea based on what we know about humans' propensity for social mirroring -- but that interpretation wasn't necessarily cognitive, self-aware, or based in language. Instead, it seems more likely that the Intuitive Mind took over, combining information about rapid heart rate with social perceptions of another person's behavior, and produced a particular reactions without waiting for the Narrative Mind to consult. In contrast to the idea that thoughts intervened between a physical sensation and an emotion, it seems equally reasonable to assume that there was no thinking involved in the experimental conditions, and that the provision of emotionally "neutralizing" information about epinephrine's effects in the control group instead short-circuited the initial Intuitive Mind response. That provided a pause in which the participants' Narrative Minds could intervene.

Lazarus and Folkman also write about underlying beliefs or schemas, similar to the way Beck talked about them in cognitive therapy (indeed, the two models evolved at the same time, and were mutually informing), and about personal vulnerabilities that result from individual life circumstances or genetics. For example, a person who has the underlying belief that "people are dangerous" will be more likely to have a stress response to an ambiguous interpersonal situation. A person with a lot going on in their life already may be less able to adapt to one more everyday hassle, which provokes the thought "oh, not another thing." Someone with a more nervous personality may be adversely affected by events that a less-nervous person could just shrug off. And someone with a firm commitment to stoic philosophy might have trained themself to see life challenges as surmountable -- definitely a Narrative Mind effect, but one that becomes a precondition for the Intuitive Mind's quick response because it is ingrained or habitual after long practice. All of these factors are clearly involved in whether a person has a stress response to everyday events. But none of them involve the "self-talk" type of cognitions or beliefs that are prioritized by Coping Theory (even the most cognitive of these examples, stoic philosophy, only works as a habitual response).

The coping portion of Lazarus and Folkman's model is much more behavioral, and accordingly I have less trouble with it. The figure above shows 3 types of coping -- problem-focused, emotion-focused, and social support seeking -- which have held up relatively well in subsequent research. The "problem-focused vs. emotion-focused" dimension may be better characterized as "approach vs. avoidance coping," and either type may be useful depending on the particular stressor experienced, but this is a quibble. Another major contribution from Lazarus and Folkman's work was the Ways of Coping Questionnaire, which is included in their 1984 book. This is a well-validated tool to evaluate different coping behaviors, which can be used to predict mental and physical health outcomes in studies of many different types of stressors. As a description of diverse coping behaviors, Lazarus and Folkman's work has stood the test of time.

A final chapter on treatment approaches is just as broad-ranging as the rest of the book, taking a deep look at contemporary psychotherapeutic methods ranging from psychoanalysis to dynamic therapy to Beck or Ellis-style cognitive therapy to purely behavioral treatments. The book even takes a look at Wolpe's systematic desensitization (Lazarus and Wolpe didn't get along), and tries to layer a cognitive component on top of the behaviorist extinction procedure (maybe this is why they disagreed). My assessment is that Lazarus and Folkman try to have it many different ways in this chapter: "feelings can shape thought and action; actions can shape thought and feeling; and thoughts can shape feeling and action. ... One way or another, however, if there is to be therapeutic change, there must be changes in cognitive appraisal and coping" (p. 374). The first of these statements is overly broad, but might be seen simply to reflect the diversity of effective approaches for changing behavior -- Two Minds Theory does that too, serving as an integrative model to select among various therapeutic approaches. But the second statement about cognitive appraisal is a theoretical commitment instead of an empirical statement. It is perfectly possible to change behavior without having any interaction at all with a person's cognitive appraisals, as has been amply demonstrated by the literature in behavioral economics.

Overall, Coping Theory has had a massive impact on both psychologists and the popular imagination. Its analysis of coping behaviors is still highly relevant and continues to fuel research on the best ways to cope under various conditions. But its analysis of stress is limited by a cognitive model that assumes rational thought is universally involved in a person's response to stressors. Subsequent generations of neuroscience research have shown that this simply isn't true, and in fact our new understanding suggests that the original studies that informed Coping Theory might be understood in different ways. Stress is such a useful concept that non-specialists talk about it all the time. But for professionals, it's important to divorce that common concept of stress from its previous cognitive-theory-laden meanings. Being clear about when and how cognition gets involved -- after the initial stress response -- can help us to avoid erroneous assumptions about how people perceive stress and what can be done about it.