Good Coping Skills May Curb Anxiety in the Face of Adversity

Liam Davenport

September 07, 2017

PARIS ― Good coping skills that are based on a coherent and meaningful perspective on life may protect against the development of anxiety in the face of adversity, new research suggests.

The retrospective analysis of more than 10,000 women showed that those who lived in deprived areas and had weak coping skills were almost twice as likely to develop generalized anxiety disorder (GAD) as those who lived in more affluent areas. This association between deprivation and GAD disappeared for women with good coping skills.

The research focused on an individual's sense of coherence (SOC), a coping mechanism in which life is perceived as being comprehensible, manageable, and meaningful.

Lead author Olivia Remes, a PhD candidate in the Department of Public Health and Primary Care, University of Cambridge, United Kingdom, said in a statement that coping mechanisms such as SOC can be taught to individuals and can yield major benefits.

"In general, people with good coping skills tend to have a higher quality of life and lower mortality rates than people without such coping skills. Good coping can be an important life resource for preserving health," said Remes.

"For the first time, we show that good coping skills can buffer the negative impact of deprivation on mental health, such as having generalized anxiety disorder." Although more work needs to be done, "this points us in an important direction," she added.

The findings were presented here at the 30th European College of Neuropsychopharmacology (ECNP) Congress.

Value in Teaching Coping Skills

"These data suggest a trial of training in coping skills could be valuable for women lacking in them ― such training needs to developed, and then a study of its efficacy needs to be carried out," former president of the ECNP David Nutt, MD, PhD, Edmond J. Safra Professor of Neuropsychopharmacology at Imperial College London, United Kingdom, said in a release.

Because few patients with GAD receive treatment, and of those who are treated, few experience improvements in their symptoms, there has been growing interest in other ways of reducing anxiety, including coping mechanisms.

After showing that living in deprived areas significantly increases the risk for GAD, particularly in women, the researchers wanted to examine whether a woman's SOC has a moderating effect on the link between deprivation and GAD.

They examined data from the Norfolk cohort of the population-based European Prospective Investigation of Cancer, which included 30,445 individuals older than 40 years. The cohort completed a battery of questionnaires between 1993 and 2000 that assessed demographic characteristics, social class, medical conditions, and psychiatric disorders.

In addition, 20,921 male and female participants in the study completed the Health and Life Experiences Questionnaire (HLEQ), which contained questions on comprehensibility, manageability, and meaningfulness ― three factors that are related to SOC. From partipants' responses on the HLEQ, a diagnoses of GAD were made, using diagnostic criteria from the DSM-IV.

The coping mechanism of SOC was first described by Aaron Antonovsky, PhD, and is part of his salutogenesis theory.

The investigators also used the Townsend Index, which is a composite measure of four variables included in the UK 1991 Census, to determine area deprivation for each participant.

Weak, Strong SOC

Results showed that 261 of 10,277 (2.5%) women included in the study met DSM-IV criteria for GAD. Of those, 164 were deemed to have a weak SOC; the remaining 97 had a strong SOC.

Baseline data indicated that among women with GAD, the weak and strong SOC groups were relatively well balanced with respect to sociodemographic characteristics, health status, lifetime history of major depression, prevalence of physical disease, and level of disability.

Notably, persons in the GAD group who had a weak SOC were more likely to live in an area of deprivation than those with a strong SOC, at 27.4% vs 19.6%, respectively.

Among women with a weak SOC, those living in deprived areas were at significantly increased risk of having GAD than those living in less deprived areas (odds ratio [OR], 1.98; 95% confidence interval [CI], 1.35 - 2.92).

However, the association between living in an area of deprivation and the risk of having GAD became nonsignificant among women with a strong SOC (OR, 1.29; 95% CI, 0.77 - 2.18).

There was also no significant interaction between an individual's SOC and risk fot GAD (P = .23).

Remes told Medscape Medical News that the lack of significance may be related to the relatively small number of GAD patients in the study.

She said that if they had investigated anxiety in general, "we would have had way more cases, but we wanted to be rigorous and to have it stringent, so we used criteria based on the DSM."

A Good Starting Point

The study is a "good starting point for other people to look at anxiety and coping," and for future studies to determine whether patients have GAD, as well as social anxiety, panic disorder, and other disorders.

Remes noted that the ultimate goal is to explore measures to improve coping skills, although she emphasized that much more research is required.

"It's important to try to improve people's sense of coping and coherence. But as Prof Nutt said, I think it's important to do a trial first to see, if some people are taught these coping measures, [whether] you get a significant difference. Then you can go to doctors or psychotherapists and say, 'I think this should be given to your patients.' "

Remes noted that patients are often given medication for mental disorders, such as anxiety or depression, but outcomes are not always favorable or there is no improvement in symptoms. "But if you're looking at coping mechanisms, they have no side effects," she pointed out.

"If you teach people how to feel more in control of their lives and how to find meaning and purpose in life, that can not only improve your mental health, but it can make you happy. And if you can give people these strategies that they can use for the rest of their lives, then that would be great."

The study was funded by the Medical Research Council and Cancer Research UK. Olivia Remes has received support from the National Institute for Health Research.

30th European College of Neuropsychopharmacology (ECNP) Congress. Poster P.4.a.015, presented September 5, 2017.

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