2599.2 Coping Behaviors
Patients will exhibit a variety of coping behaviors and strategies. Some of their strate-
gies are more likely to lead to positive outcomes such as acceptance and adaptation.
Others, when used predominantly and/or for too long, may hinder desired outcomes.
Djurdjinovic ( 2009 ) identifies eight coping behaviors, which she defines as strat-
egies for solving problems or for modifying the meaning of an experience. Three of
these coping styles―seeking social support, plan, and positive reappraisal―
have the greatest likelihood of leading to positive outcomes for patients. The other
five are more likely to lead to negative outcomes if used exclusively and for very
long periods of time:
- Seek social support: talks with others in the hope of learning more (e.g., attend-
ing support groups for people with similar genetic conditions). - Plan: identifies next steps and follows through on them.
- Positive reappraisal: tries to see any possible positive results or outcomes (e.g.,
“I’m glad I found out that I am BRCA positive, because now I can do something
to lower my risks”). - Confrontative: tries to change the opinions of the person who is in charge (e.g.,
genetic counselor, physician, etc.) - Distancing: acts as if nothing has happened (e.g., the patient leaves the session
after learning that he has a very high risk for having the gene for a form of colon
cancer, and therefore his children are at risk and says, “Well, I really didn’t learn
anything new today”). - Self-controlling: keeps feelings to oneself (e.g., when asked how she is feeling
after receiving abnormal test results, the patient says, “I’m fine” and says nothing
more). - Accept responsibility: criticizes or blames one’s self (e.g. “My doctor told me a
while ago that I should be tested for BRCA, but I didn’t follow through. Now I
have advanced cancer, and it’s my fault for not having testing sooner”). - Escape-avoidance: hopes for a miracle.
9.2.1 Defense Mechanisms
Defense mechanisms are attempts to cope as a way of maintaining some measures
of personal control and self-esteem and to reduce painful emotions in the face of a
threat (Clark 1991 ). Defense mechanisms temporarily protect an individual from
painful feelings such as anxiety, grief, guilt, shame, remorse, embarrassment, and
fear; they allow an individual to continue believing the world is the way she/he
thinks it is or wishes it to be (Weil, 2010 ). Defenses “that function flexibly and in a
midrange of intensity are normal and essential to adaptive psychological function-
ing” (Weil 2000 , p. 159). Defense mechanisms are not necessarily conscious behav-
iors, but they are used to some extent by all individuals, including genetic counselors
(Reeder et al. 2017 )! Keep in mind that although all defense mechanisms are attempts
to cope (coping behaviors), not all coping behaviors are defense mechanisms.
9.2 Coping Behaviors