Category: Mental Health

What is Co-Dependents Anonymous?

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Introduction

Co-Dependents Anonymous (CoDA) is a twelve-step programme for people who share a common desire to develop functional and healthy relationships.

Refer to Codependency.

Outline

Co-Dependents Anonymous was founded by Ken and Mary Richardson and the first CoDA meeting attended by 30 people was held October 22, 1986 in Phoenix, Arizona.

Within four weeks there were 100 people and before the year was up there were 120 groups.

CoDA held its first National Service Conference the next year with 29 representatives from seven states.

CoDA has stabilised at about a thousand meetings in the US, and with meetings active in 60 other countries and dozens online that can be reached at http://www.coda.org.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Co-Dependents_Anonymous >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Codependency?

Published on by Andrew Marshall1 Comment

Introduction

In sociology, codependency is a theory that attempts to explain imbalanced relationships where one person enables another person’s self-destructive behaviour such as addiction, poor mental health, immaturity, irresponsibility, or under-achievement.

Definitions of codependency vary, but typically include high self-sacrifice, a focus on others’ needs, suppression of one’s own emotions, and attempts to control or fix other people’s problems. People who self-identify as codependent exhibit low self-esteem, but it is unclear whether this is a cause or an effect of characteristics associated with codependency. Codependency is not limited to married, partnered, or romantic relationships, as co-workers, friends, and family members can be codependent as well.

Refer to Co-Dependents Anonymous.

Brief History

The term “codependency” most likely developed in Minnesota in the late 1970s from “co-alcoholic”, when alcoholism and other drug dependencies were grouped together as “chemical dependency.” The term is most often identified with Alcoholics Anonymous and the realisation that the alcoholism was not solely about the addict but also about the family and friends who constitute a network for the alcoholic.

The term “codependent” was first used to describe how family members and friends might interfere with the recovery of a person affected by a substance use disorder by “overhelping”. Application of the concept of codependency was driven by the self-help community.

In 1986, Psychiatrist Timmen Cermak wrote Diagnosing and Treating Co-Dependence: A Guide for Professionals. In that book and an article published in the Journal of Psychoactive Drugs, Cermak argued unsuccessfully for the inclusion of codependency as a separate personality disorder in the Diagnostic and Statistical Manual of Mental Disorders, DSM-III-R. He found that the condition could affect people close to people with any mental disorder, not just addiction.

Melody Beattie popularised the concept of codependency in 1986 with the book Codependent No More which sold eight million copies, with updated editions released in 1992 and 2022. Drawing on her personal experience with substance abuse and caring for someone with it, she also interviewed people helped by Al-Anon. Beattie’s work formed the underpinning of a twelve-step organisation called Co-Dependents Anonymous, founded in 1986, although the group does not endorse any definition of or diagnostic criteria for codependency.

Definition

Codependency has no established definition or diagnostic criteria within the mental health community. It has not been included as a condition in any edition of the DSM or ICD.

Codependency carries three potential levels of meaning. First, it can describe a didactic tool that, once explained to families, helps them normalise the feelings that they are experiencing and allows them to shift their focus from the dependent person to their own dysfunctional behaviour patterns. Second, it can describe a psychological concept, a shorthand means of describing and explaining human behaviour. Third, it can describe a psychological disorder, implying that there is a consistent pattern of traits or behaviours across individuals that can create significant dysfunction.

Discussion of codependency tends to focus on the disease model of the term, although there is no agreement that codependency is a disorder at all, or how such a disease entity might be defined or diagnosed.  In an early attempt to define codependency as a diagnosable disorder, Timmen Cermak wrote:

“Co-dependence is a recognisable pattern of personality traits, predictably found within most members of chemically dependent families, which are capable of creating sufficient dysfunction to warrant the diagnosis of Mixed Personality Disorder as outlined in DSM III.”

Timmen proceeded to list the traits he identified in self-suppressing supporting partners of people with chemical dependence or disordered personalities, and to provide a DSM-style set of diagnostic criteria.

In her self-help book, Melody Beattie proposes that, “The obvious definition [of codependency] would be: being a partner in dependency. This definition is close to the truth but still unclear.” Beattie elaborates, “A codependent person is one who has let another person’s behaviour affect him or her, and who is obsessed with controlling that person’s behaviour.” Another self-help author, Darlene Lancer, asserts that “A codependent is a person who can’t function from his or her innate self and instead organizes thinking and behavior around a substance, process, or other person(s).” Lancer includes all addicts in her definition. She believes a “lost self” is the core of codependency.

Co-Dependents Anonymous, a self-help organization for people who seek to develop healthy and functional relationships, “offer[s] no definition or diagnostic criteria for codependence”, but provides a list of “patterns and characteristics of codependence” that can be used by laypeople for self-evaluation. The organisation identifies patterns that may occur in codependency.

The Medical Subject Heading utilised by the United States National Library of Medicine describes codependency as “A relational pattern in which a person attempts to derive a sense of purpose through relationships with others.”

Theories

Under theories of codependency as a psychological disorder, the codependent partner in a relationship is often described as displaying self-perception, attitudes and behaviours that serve to increase problems within the relationship instead of decreasing them. It is often suggested that people who are codependent were raised in dysfunctional families or with early exposure to addiction behaviour, resulting in their allowance of similar patterns of behaviour by their partner.

Relationships

Codependent relationships are often described as being marked by intimacy problems, dependency, control (including caretaking), denial, dysfunctional communication and boundaries, and high reactivity. There may be imbalance within the relationship, where one person is abusive or in control or supports or enables another person’s addiction, poor mental health, immaturity, irresponsibility, or under-achievement.

Under this conception of codependency, the codependent person’s sense of purpose within a relationship is based on making extreme sacrifices to satisfy their partner’s needs. Codependent relationships signify a degree of unhealthy “clinginess” and needy behaviour, where one person does not have self-sufficiency or autonomy. One or both parties depend on their loved one for fulfilment. The mood and emotions of the codependent are often determined by how they think other individuals perceive them (especially loved ones). This perception is self-inflicted and often leads to clingy, needy behaviour which can hurt the health of the relationship.

Personality Disorders

Codependency may occur within the context of relationships with people with diagnosable personality disorders.

  • Borderline personality disorder: There is a tendency for loved ones of people with borderline personality disorder (BPD) to slip into “caretaker” roles, giving priority and focus to problems in the life of the person with BPD rather than to issues in their own lives. The codependent partner may gain a sense of worth by being perceived as “the sane one” or “the responsible one”.
  • Narcissistic personality disorder: Narcissists, with their ability to get others to “buy into their vision” and help them make it a reality, seek and attract partners who will put others’ needs before their own. A codependent person can provide the narcissist with an obedient and attentive audience. Among the reciprocally interlocking interactions of the pair are the narcissist’s overpowering need to feel important and special and the codependent person’s strong need to help others feel that way.

Family Dynamics

In the dysfunctional family the child learns to become attuned to the parent’s needs and feelings instead of the other way around. Parenting is a role that requires a certain amount of self-sacrifice and giving a child’s needs a high priority. A parent can be codependent toward their own child. Generally, a parent who takes care of their own needs (emotional and physical) in a healthy way will be a better caretaker, whereas a codependent parent may be less effective, or may even do harm to a child. Codependent relationships often manifest through enabling behaviours, especially between parents and their children. Another way to look at it is that the needs of an infant are necessary but temporary, whereas the needs of the codependent are constant. Children of codependent parents who ignore or negate their own feelings may become codependent.

Recovery and Prognosis

With no consensus as to how codependency should be defined, and with no recognised diagnostic criteria, mental health professionals hold a range of opinions about the diagnosis and treatment of codependency. Caring for an individual with a physical addiction is not necessarily treating a pathology. The caregiver may only require assertiveness skills and the ability to place responsibility for the addiction on the other. There are various recovery paths for individuals who struggle with codependency. For example, some may choose cognitive-behavioural psychotherapy, sometimes accompanied by chemical therapy for accompanying depression. There also exist support groups for codependency, such as Co-Dependents Anonymous (CoDA), Al-Anon/Alateen, Nar-Anon, and Adult Children of Alcoholics (ACoA), which are based on the twelve-step programme model of Alcoholics Anonymous, Celebrate Recovery and Life Recovery a Christian 12 step Bible-based group. Many self-help guides have been written on the subject of codependency.

It has been proposed that, in attempts to recover from codependency, people may go from being overly passive or overly giving to being overly aggressive or excessively selfish. Therapists may seek to help a client develop a balance through healthy assertiveness, which leaves room for being a caring person and also engaging in healthy caring behaviour, while minimising selfishness, bully, or behaviours that might reflect conflict addiction. Developing a permanent stance of being a victim (having a victim mentality) does not constitute recovery from codependency. A victim mentality could also be seen as a part of one’s original state of codependency (lack of empowerment causing one to feel like the “subject” of events rather than being an empowered actor). Someone truly recovered from codependency would feel empowered and like an author of their life and actions rather than being at the mercy of outside forces. A victim mentality may also occur in combination with passive-aggressive control issues. From the perspective of moving beyond victim-hood, the capacity to forgive and let go (with exception of cases of very severe abuse) could also be signs of real recovery from codependency, but the willingness to endure further abuse would not.

It is theorized that unresolved patterns of codependency may lead to more serious problems like alcoholism, drug addiction, eating disorders, sex addiction, psychosomatic illnesses, and other self-destructive or self-defeating behaviours. People with codependency may be more likely to attract further abuse from aggressive individuals (such as those with BPD or NPD), more likely to stay in stressful jobs or relationships, less likely to seek medical attention when needed and are also less likely to get promotions and tend to earn less money than those without codependency patterns. For some people, the social insecurity caused by codependency may progress into full-blown social anxiety disorders like social phobia, avoidant personality disorder or painful shyness. Other stress-related disorders like panic disorder, depression or PTSD may also be present.

Controversy

Codependency is not a diagnosable mental health condition, there is no medical consensus as to its definition, and there is no evidence that codependency is caused by a disease process. Without clinical definition, the term is easily applicable to many behaviours and has been overused by some self-help authors and support communities. In an article in Psychology Today, clinician Kristi Pikiewicz suggested that the term codependency has been overused to the point of becoming a cliché, and labelling a patient as codependent can shift the focus on how their traumas shaped their current relationships.

Some scholars and treatment providers assert that codependency should be understood as a positive impulse gone awry, and challenge the idea that interpersonal behaviours should be conceptualised as addictions or diseases, as well as the pathologising of personality characteristics associated with women. A study of the characteristics associated with codependency found that non-codependency was associated with masculine character traits, while codependency was associated with negative feminine traits, such as being self-denying, self-sacrificing, or displaying low self-esteem.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Codependency >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Emotional Eating?

Published on by Andrew Marshall2 Comments

Introduction

Emotional eating, also known as stress eating and emotional overeating, is defined as the “propensity to eat in response to positive and negative emotions”. While the term often refers to eating as a means of coping with negative emotions, it also includes eating for positive emotions, such as eating foods when celebrating an event or eating to enhance an already good mood. In these situations, emotions are still driving the eating but not in a negative way.

Background

Emotional eating includes eating in response to any emotion, whether that be positive or negative. Most frequently, people refer to emotional eating as “eating to cope with negative emotions.” In these situations, emotional eating can be considered a form of disordered eating, which is defined as “an increase in food intake in response to negative emotions” and can be considered a maladaptive strategy. More specifically, emotional eating in order to relieve negative emotions would qualify as a form of emotion-focused coping, which attempts to minimise, regulate, and prevent emotional distress.

One study found that emotional eating sometimes does not reduce emotional distress, but instead it enhances emotional distress by sparking feelings of intense guilt after an emotional eating session. Those who eat as a coping strategy are at an especially high risk of developing binge-eating disorder, and those with eating disorders are at a higher risk to engage in emotional eating as a means to cope. In a clinical setting, emotional eating can be assessed by the Dutch Eating Behaviour Questionnaire, which contains a scale for restrained, emotional, and external eating. Other questionnaires, such as the Palatable Eating Motives Scale, can determine reasons why a person eats tasty foods when they are not hungry; sub-scales include eating for reward enhancement, coping, social, and conformity.

Characteristics

Emotional eating usually occurs when one is attempting to satisfy his or her hedonic drive, or the drive to eat palatable food to obtain pleasure in the absence of an energy deficit but can also occur when one is seeking food as a reward, eating for social reasons (such as eating at a party), or eating to conform (which involves eating because friends or family wants the individual to). When one is engaging in emotional eating, they are usually seeking out palatable foods (such as sweets) rather than just food in general. In some cases, emotional eating can lead to something called “mindless eating” during which the individual is eating without being mindful of what or how much they are consuming; this can occur during both positive and negative settings.

Emotional hunger does not originate from the stomach, such as with a rumbling or growling stomach, but tends to start when a person thinks about a craving or wants something specific to eat. Emotional responses are also different. Giving in to a craving or eating because of stress can cause feelings of regret, shame, or guilt, and these responses tend to be associated with emotional hunger. On the other hand, satisfying a physical hunger is giving the body the nutrients or calories it needs to function and is not associated with negative feelings.

Major Theories behind Eating to Cope

Current research suggests that certain individual factors may increase one’s likelihood of using emotional eating as a coping strategy. The inadequate affect regulation theory posits that individuals engage in emotional eating because they believe overeating alleviates negative feelings. Escape theory builds upon inadequate affect regulation theory by suggesting that people not only overeat to cope with negative emotions, but they find that overeating diverts their attention away from a stimulus that is threatening self-esteem to focus on a pleasurable stimulus like food. Restraint theory suggests that overeating as a result of negative emotions occurs among individuals who already restrain their eating. While these individuals typically limit what they eat, when they are faced with negative emotions they cope by engaging in emotional eating. Restraint theory supports the idea that individuals with other eating disorders are more likely to engage in emotional eating. Together these three theories suggest that an individual’s aversion to negative emotions, particularly negative feelings that arise in response to a threat to the ego or intense self-awareness, increase the propensity for the individual to utilise emotional eating as a means of coping with this aversion.

The biological stress response may also contribute to the development of emotional eating tendencies. In a crisis, corticotropin-releasing hormone (CRH) is secreted by the hypothalamus, suppressing appetite and triggering the release of glucocorticoids from the adrenal gland. These steroid hormones increase appetite and, unlike CRH, remain in the bloodstream for a prolonged period of time, often resulting in hyperphagia. Those who experience this biologically instigated increase in appetite during times of stress are therefore primed to rely on emotional eating as a coping mechanism.

Contributing Factors

Negative Affect

Overall, high levels of the negative affect trait are related to emotional eating. Negative affectivity is a personality trait involving negative emotions and poor self-concept. Negative emotions experienced within negative affect include anger, guilt, and nervousness. It has been found that certain negative affect regulation scales predicted emotional eating. An inability to articulate and identify one’s emotions made the individual feel inadequate at regulating negative affect and thus more likely to engage in emotional eating as a means for coping with those negative emotions. Further scientific studies regarding the relationship between negative affect and eating find that, after experiencing a stressful event, food consumption is associated with reduced feelings of negative affect (i.e. feeling less bad) for those enduring high levels of chronic stress. This relationship between eating and feeling better suggests a self-reinforcing cyclical pattern between high levels of chronic stress and consumption of highly palatable foods as a coping mechanism. Contrarily, a study conducted by Spoor et al. found that negative affect is not significantly related to emotional eating, but the two are indirectly associated through emotion-focused coping and avoidance-distraction behaviours. While the scientific results differed somewhat, they both suggest that negative affect does play a role in emotional eating but it may be accounted for by other variables.

Childhood Development

For some people, emotional eating is a learned behaviour. During childhood, their parents give them treats to help them deal with a tough day or situation, or as a reward for something good. Over time, the child who reaches for a cookie after getting a bad grade on a test may become an adult who grabs a box of cookies after a rough day at work. In an example such as this, the roots of emotional eating are deep, which can make breaking the habit extremely challenging. In some cases, individuals may eat in order to conform; for example, individuals may be told “you have to finish your plate” and the individual may eat past the point in which they feel satisfied.

Related Disorders

Emotional eating as a means to cope may be a precursor to developing eating disorders such as binge eating or bulimia nervosa. The relationship between emotional eating and other disorders is largely due to the fact that emotional eating and these disorders share key characteristics. More specifically, they are both related to emotion focused coping, maladaptive coping strategies, and a strong aversion to negative feelings and stimuli. It is important to note that the causal direction has not been definitively established, meaning that while emotional eating is considered a precursor to these eating disorders, it also may be the consequence of these disorders. The latter hypothesis that emotional eating happens in response to another eating disorder is supported by research that has shown emotional eating to be more common among individuals already suffering from bulimia nervosa.

Biological and Environmental Factors

Stress affects food preferences. Numerous studies – granted, many of them in animals – have shown that physical or emotional distress increases the intake of food high in fat, sugar, or both, even in the absence of caloric deficits. Once ingested, fat- and sugar-filled foods seem to have a feedback effect that damps stress-related responses and emotions, as these foods trigger dopamine and opioid releases, which protect against the negative consequences of stress. These foods really are “comfort” foods in that they seem to counteract stress, but rat studies demonstrate that intermittent access to and consumption of these highly palatable foods creates symptoms that resemble opioid withdrawal, suggesting that high-fat and high-sugar foods can become neurologically addictive. A few examples from the American diet would include: hamburgers, pizza, French fries, sausages and savoury pasties. The most common food preferences are in decreasing order from: sweet energy-dense food, non-sweet energy-dense food then, fruits and vegetables. This may contribute to people’s stress-induced craving for those foods.

The stress response is a highly-individualised reaction and personal differences in physiological reactivity may also contribute to the development of emotional eating habits. Women are more likely than men to resort to eating as a coping mechanism for stress, as are obese individuals and those with histories of dietary restraint. In one study, women were exposed to an hour-long social stressor task or a neutral control condition. The women were exposed to each condition on different days. After the tasks, the women were invited to a buffet with both healthy and unhealthy snacks. Those who had high chronic stress levels and a low cortisol reactivity to the acute stress task consumed significantly more calories from chocolate cake than women with low chronic stress levels after both control and stress conditions. High cortisol levels, in combination with high insulin levels, may be responsible for stress-induced eating, as research shows high cortisol reactivity is associated with hyperphagia, an abnormally increased appetite for food, during stress. Furthermore, since glucocorticoids trigger hunger and specifically increase one’s appetite for high-fat and high-sugar foods, those whose adrenal glands naturally secrete larger quantities of glucocorticoids in response to a stressor are more inclined toward hyperphagia. Additionally, those whose bodies require more time to clear the bloodstream of excess glucocorticoids are similarly predisposed.

These biological factors can interact with environmental elements to further trigger hyperphagia. Frequent intermittent stressors trigger repeated, sporadic releases of glucocorticoids in intervals too short to allow for a complete return to baseline levels, leading to sustained and elevated levels of appetite. Therefore, those whose lifestyles or careers entail frequent intermittent stressors over prolonged periods of time thus have greater biological incentive to develop patterns of emotional eating, which puts them at risk for long-term adverse health consequences such as weight gain or cardiovascular disease.

Macht (2008) described a five-way model to explain the reasoning behind stressful eating:

  1. Emotional control of food choice;
  2. Emotional suppression of food intake;
  3. Impairment of cognitive eating controls;
  4. Eating to regulate emotions; and
  5. Emotion-congruent modulation of eating.

These break down into subgroups of: Coping, reward enhancement, social and conformity motive. Thus, providing an individual with are stronger understanding of personal emotional eating.

Positive Affect

Geliebter and Aversa (2003) conducted a study comparing individuals of three weight groups: underweight, normal weight and overweight. Both positive and negative emotions were evaluated. When individuals were experiencing positive emotional states or situations, the underweight group reporting eating more than the other two groups. As an explanation, the typical nature of underweight individuals is to eat less and during times of stress to eat even less. However, when positive emotional states or situations arise, individuals are more likely to indulge themselves with food.

Impact

Emotional eating may qualify as avoidant coping and/or emotion-focused coping. As coping methods that fall under these broad categories focus on temporary reprieve rather than practical resolution of stressors, they can initiate a vicious cycle of maladaptive behaviour reinforced by fleeting relief from stress. Additionally, in the presence of high insulin levels characteristic of the recovery phase of the stress-response, glucocorticoids trigger the creation of an enzyme that stores away the nutrients circulating in the bloodstream after an episode of emotional eating as visceral fat, or fat located in the abdominal area. Therefore, those who struggle with emotional eating are at greater risk for abdominal obesity, which is in turn linked to a greater risk for metabolic and cardiovascular disease.

Treatment

There are numerous ways in which individuals can reduce emotional distress without engaging in emotional eating as a means to cope. The most salient choice is to minimise maladaptive coping strategies and to maximise adaptive strategies. A study conducted by Corstorphine et al. in 2007 investigated the relationship between distress tolerance and disordered eating. These researchers specifically focused on how different coping strategies impact distress tolerance and disordered eating. They found that individuals who engage in disordered eating often employ emotional avoidance strategies. If an individual is faced with strong negative emotions, they may choose to avoid the situation by distracting themselves through overeating. Discouraging emotional avoidance is thus an important facet to emotional eating treatment. The most obvious way to limit emotional avoidance is to confront the issue through techniques like problem solving. Corstorphine et al. showed that individuals who engaged in problem solving strategies enhance one’s ability to tolerate emotional distress. Since emotional distress is correlated to emotional eating, the ability to better manage one’s negative affect should allow an individual to cope with a situation without resorting to overeating.

One way to combat emotional eating is to employ mindfulness techniques. For example, approaching cravings with a non-judgemental inquisitiveness can help differentiate between hunger and emotionally-driven cravings. An individual may ask his or herself if the craving developed rapidly, as emotional eating tends to be triggered spontaneously. An individual may also take the time to note his or her bodily sensations, such as hunger pangs, and coinciding emotions, like guilt or shame, in order to make conscious decisions to avoid emotional eating.

Emotional eating can also be improved by evaluating physical facets like hormone balance. Female hormones, in particular, can alter cravings and even self-perception of one’s body. Additionally, emotional eating can be exacerbated by social pressure to be thin. The focus on thinness and dieting in our culture can make young girls, especially, vulnerable to falling into food restriction and subsequent emotional eating behaviour.

Emotional eating disorder predisposes individuals to more serious eating disorders and physiological complications. Therefore, combatting disordered eating before such progression takes place has become the focus of many clinical psychologists.

Stress Fasting

In a lesser percentage of individuals, emotional eating may conversely consist of reduced food intake, or stress fasting. This is believed to result from the fight-or-flight response. In some individuals, depression and other psychological disorders can also lead to emotional fasting or starvation.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Emotional_eating >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What are Personal Boundaries?

Published on by Andrew Marshall1 Comment

Introduction

Personal boundaries or the act of setting boundaries is a life skill that has been popularised by self help authors and support groups since the mid 1980s.

It is the practice of openly communicating and asserting personal values as way to preserve and protect against having them compromised or violated. The term “boundary” is a metaphor – with in-bounds meaning acceptable and out-of-bounds meaning unacceptable. Without values and boundaries our identities become diffused and often controlled by the definitions offered by others. The concept of boundaries has been widely adopted by the counselling profession.

Usage and Application

This life skill is particularly applicable in environments with controlling people or people not taking responsibility for their own life.

Co-Dependents Anonymous recommends setting limits on what members will do to and for people and on what members will allow people to do to and for them, as part of their efforts to establish autonomy from being controlled by other people’s thoughts, feelings and problems.

The National Alliance on Mental Illness (NAMI) tells its members that establishing and maintaining values and boundaries will improve the sense of security, stability, predictability and order, in a family even when some members of the family resist. NAMI contends that boundaries encourage a more relaxed, non-judgemental atmosphere and that the presence of boundaries need not conflict with the need for maintaining an understanding atmosphere.

Overview

The three critical aspects of managing personal boundaries are:

AspectOutline
Defining ValuesA healthy relationship is an “inter-dependent” relationship of two “independent” people. Healthy individuals should establish values that they honour and defend regardless of the nature of a relationship (core or independent values). Healthy individuals should also have values that they negotiate and adapt in an effort to bond with and collaborate with others (inter-dependent values).
Asserting BoundariesIn this model, individuals use verbal and nonverbal communications to assert intentions, preferences and define what is inbounds and out-of-bounds with respect to their core or independent values. When asserting values and boundaries, communications should be present, appropriate, clear, firm, protective, flexible, receptive, and collaborative.
Honouring and DefendingMaking decision consistent with the personal values when presented with life choices or confronted or challenged by controlling people or people not taking responsibility for their own life.

Having healthy values and boundaries is a lifestyle, not a quick fix to an relationship dispute.

Values are constructed from a mix of conclusions, beliefs, opinions, attitudes, past experiences and social learning. Jacques Lacan considers values to be layered in a hierarchy, reflecting “all the successive envelopes of the biological and social status of the person” from the most primitive to the most advanced.

Personal values and boundaries operate in two directions, affecting both the incoming and outgoing interactions between people. These are sometimes referred to as the ‘protection’ and ‘containment’ functions.

Scope

The three most commonly mentioned categories of values and boundaries are:

  • Physical: Personal space and touch considerations; physical intimacy.
  • Mental: Thoughts and opinions.
  • Emotional: Feelings; emotional intimacy.

Some authors have expanded this list with additional or specialised categories such as spirituality, truth, and time/punctuality.

Assertiveness Levels

Nina Brown proposed four boundary types:

Boundary TypeOutline
SoftA person with soft boundaries merges with other people’s boundaries. Someone with a soft boundary is easily a victim of psychological manipulation.
SpongyA person with spongy boundaries is like a combination of having soft and rigid boundaries. They permit less emotional contagion than soft boundaries but more than those with rigid. People with spongy boundaries are unsure of what to let in and what to keep out.
RigidA person with rigid boundaries is closed or walled off so nobody can get close either physically or emotionally. This is often the case if someone has been the victim of physical, emotional, psychological, or sexual abuse. Rigid boundaries can be selective which depend on time, place or circumstances and are usually based on a bad previous experience in a similar situation.
FlexibleSimilar to spongy rigid boundaries but the person exercises more control. The person decides what to let in and what to keep out, is resistant to emotional contagion and psychological manipulation, and is difficult to exploit.

Unilateral vs Collaborative

There are also two main ways that boundaries are constructed:

  • Unilateral boundaries: One person decides to impose a standard on the relationship, regardless of whether others support it. For example, one person may decide to never mention an unwanted subject and to make a habit of leaving the room, ending phone calls, or deleting messages without replying if the subject is mentioned by others.
  • Collaborative boundaries: Everyone in the relationship group agrees, either tacitly or explicitly, that a particular standard should be upheld. For example, the group may decide not to discuss an unwanted subject, and then all members individually avoid mentioning it and work together to change the subject if someone mentions it.

Setting boundaries does not always require telling anyone what the boundary is or what the consequences are for transgressing it. For example, if a person decides to leave a discussion, that person may give an unrelated excuse, such as claiming that it’s time to do something else, rather than saying that the subject must not be mentioned.

Situations that can Challenge Personal Boundaries

Communal Influences

Freud described the loss of conscious boundaries that may occur when an individual is in a unified, fast-moving crowd.

Almost a century later, Steven Pinker took up the theme of the loss of personal boundaries in a communal experience, noting that such occurrences could be triggered by intense shared ordeals like hunger, fear or pain, and that such methods were traditionally used to create liminal conditions in initiation rites. Jung had described this as the absorption of identity into the collective unconscious.

Rave culture has also been said to involve a dissolution of personal boundaries, and a merger into a binding sense of communality.

Unequal Power Relationships

Also unequal relations of political and social power influence the possibilities for marking cultural boundaries and more generally the quality of life of individuals. Unequal power in personal relationships, including abusive relationships, can make it difficult for individuals to mark boundaries.

Dysfunctional Families

Overly Demanding ParentsIn the dysfunctional family the child learns to become attuned to the parent’s needs and feelings instead of the other way around.
Overly Demanding ChildrenParenting is a role that requires a certain amount of self-sacrifice and giving a child’s needs a high priority. A parent can, nevertheless, be codependent towards a child if the caretaking or parental sacrifice reaches unhealthy or destructive levels.
Codependent RelationshipsCodependency often involves placing a lower priority on one’s own needs, while being excessively preoccupied with the needs of others. Codependency can occur in any type of relationship, including family, work, friendship, and also romantic, peer or community relationships.
While a healthy relationship depends on the emotional space provided by personal boundaries, codependent personalities have difficulties in setting such limits, so that defining and protecting boundaries efficiently may be for them a vital part of regaining mental health.
In a codependent relationship, the codependent’s sense of purpose is based on making extreme sacrifices to satisfy their partner’s needs. Codependent relationships signify a degree of unhealthy clinginess, where one person does not have self-sufficiency or autonomy. One or both parties depend on the other for fulfilment. There is usually an unconscious reason for continuing to put another person’s life first - often the mistaken notion that self-worth comes from other people.
Mental Illness in the FamilyPeople with certain mental conditions are predisposed to controlling behaviour including those with obsessive compulsive disorder, paranoid personality disorder, borderline personality disorder, and narcissistic personality disorder, attention deficit disorder, and the manic state of bipolar disorder.
Borderline personality disorder (BPD): There is a tendency for loved ones of people with BPD to slip into caretaker roles, giving priority and focus to problems in the life of the person with BPD rather than to issues in their own lives. Too often in these relationships, the codependent will gain a sense of worth by being “the sane one” or “the responsible one”. Often, this shows up prominently in families with strong Asian cultures because of beliefs tied to the cultures.
Narcissistic personality disorder (NPD): For those involved with a person with NPD, values and boundaries are often challenged as narcissists have a poor sense of self and often do not recognise that others are fully separate and not extensions of themselves. Those who meet their needs and those who provide gratification may be treated as if they are part of the narcissist and expected to live up to their expectations.


Anger

Anger is a normal emotion that involves a strong uncomfortable and emotional response to a perceived provocation. Often, it indicates when one’s personal boundaries are violated. Anger may be utilised effectively by setting boundaries or escaping from dangerous situations.

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What is Group Analysis?

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Introduction

Group analysis (or group analytic psychotherapy) is a method of group psychotherapy originated by S.H. Foulkes in the 1940s. Group psychotherapy was pioneered by S.H. Foulkes with his psychoanalytic patients and later with soldiers in the Northfield experiments at Hollymoor Hospital. Group analysis combines psychoanalytic insights with an understanding of social and interpersonal functioning. There is an interest, in group analysis, on the relationship between the individual group member and the rest of the group resulting in a strengthening of both, and a better integration of the individual with his or her community, family and social network.

Deriving from psychoanalysis, Group Analysis also draws on a range of other psychotherapeutic traditions and approaches: systems theory psychotherapies, developmental psychology and social psychology. Group analysis also has applications in organisational consultancy, and in teaching and training. Group analysts work in a wide range of contexts with a wide range of difficulties and problems.

Method

Group analysis is based on the view that deep lasting change can occur within a carefully formed group whose combined membership reflects the wider norms of society. Group analysis is a way of understanding group processes in small, median or, large groups. It is concerned with the relationship between a person and the network of activity in the many groups of which he or she might belong. Through these group processes we can explore what bearing the public and private aspects of a person’s life have on one another, and the dialectic between group and personal development. Group members are supported, through shared experience and joint exploration within the group, in coming to a healthier understanding of their situation. Problems are seen at the level of group, organisation or institutional system; not solely in the individual sufferer, as they do in prevailing medical models. Problems within are recast as obstacles without. The way in which the group functions is central to this. Democracy and co-operation are the pillars through which group-mediated solutions to problems can flow in ways that are enduring. It is based on the principles developed by S.H. Foulkes in the 1940s and is rooted in psychoanalysis and the social sciences.

Group analysis is the dominant psychodynamic approach outside the US and Canada. It is an approach that views the group as an organic entity and insists that the therapist take a less intrusive role, so as to become the group’s conductor (as in music) rather than its director. The group is seen as not merely a dynamic entity of its own, but functions within a sociocultural context that influences its processes. In group analytic technique, the therapist weans the members from excessive and inappropriate dependency towards becoming their own therapists – both to themselves and to the other group members.

The Group Analytic Society and the Institute of Group Analysis were organisations established by Foulkes and others to promote Group Analysis and to train practitioners.

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What is Communal Coping?

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Introduction

Communal coping is the collective effort of members of a connected network (familial or social) to manage a distressing event (Lyons, Michelson, Sullivan and Coyne, 1998). This definition and the scope of the concept positions communal coping as an offshoot of social support.

According to Lyons et al. (1998), the communal coping conceptual framework emerged for two reasons. First, to expand the research that supports the claim that the coping process sometimes requires individual and collective effort (e.g. Fukuyama, 1995). Second, the need for a specific framework for investigating the cooperative characteristic of coping. To support the need for a framework which explores the social aspect of coping as a combined effort, the authors argued that the communal coping conceptual framework emphasizes the connectedness and reliance on personal network for coping. Developments to the communal coping framework include the explanation of the complex nature of the communal coping process (Afifi, Helgeson & Krouse, 2006) and specific personal outcomes (Helgeson, Jakubiak, Vleet, & Zajdel, 2018) following a communal coping process.

Background

Lyons et al. (1998) introduced the communal coping framework. The first model Lyons et al. (1998) proposed mainly distinguished between communal coping and existing perception of coping as an individualistic or prosocial process. Also, the model provided a lens for examining other aspects of coping such as the benefits, cost and influential factors. Afifi, Hutchinson, and Krouse (2006) noted some of the achievements of the model is that it accounts for the relational process within coping and shifts the focus of researchers from treating the phenomenon as mainly a psychological process but also a relational or communication.

However, despite the contributions of the model to the coping research, some questions still need an answer and a couple of research challenges remained unaddressed. For instance, Afifi et al. (2006) noted some researchers confused the process of communal coping for collective coping, types, provision and seeking of social support. The scholars attributed the lack of conceptualisation of communal coping as one of the factors responsible for the confusion. To address this gap in research and advance the existing model by Lyon’s and colleagues, Afifi et al. proposed a theoretical framework. The scholars anticipated the model will serve as a template for measuring communal coping.

The goals for designing the new model were specifically to understand the communal coping process within naturally occurring groups (e.g. post-divorce families). Through the new model, Afifi et al. (2006) attempted to:

  1. Provide a description of the complexities that characterise relying on other people to cope with a stressful event;
  2. Expand the discourse on the dynamic and interactive nature of the coping process;
  3. Explore the various factors that contribute to stressors within groups;
  4. Identify how characteristics of the group such as its structure, the beliefs, norms, and perspectives of its members are likely to influence the coping process; and
  5. Examine how context, source, and nature of the stressor impact the coping process.

The refinement of the model addressed the problems Lyon and colleagues’ model could not account for. Nonetheless, one question remained unanswered ‘how does communal coping influence coping outcome?’. Thereby still leaving a gap in research. Helgeson, Jakubiak, Vleet, and Zajdel (2018) attempted to fill this gap by proposing a model that acknowledges the adjustment process and outcome of communal coping.

Similar to prior models, Helgeson et al’s (2018) framework identified supportive communication as a significant aspect of communal coping that is linked to individual adjustment to a stressor (e.g. illness). A core tenet within the model is that communication enhances coping outcomes. In this vein, Helgeson et al’s model purports the outcomes of communal coping for stressed individuals include:

  1. A high sense of control over the stressor;
  2. Perception of the stressor as less stressful;
  3. Enhanced feeling of self- regulatory capacity; and
  4. Experiencing quality relationships.

Components of Communal Coping

The existing research on coping (Lazarus & Folkman, 1984) served as a backdrop for the development of the communal coping framework. Zimmer-Gembeck and Skinner (2009, p.333) defined coping as:

“how people of all ages mobilize, guide, manage, coordinate, energize, modulate, and direct their behavior, emotion, and orientation (or how they fail to do so) during stressful encounters”.

From this definition, one can infer coping researchers consider the management of a stressor as an individual effort. In addition, despite the significant contribution of coping studies to empirical knowledge in research areas such as coping resources (Lazarus & Folkman, 1980) and maintaining these resources (Hobbfall, 1989) it is still important to understand how collective coping efforts could make a difference in coping outcome of collective stressors such as the death of a breadwinner, natural disasters, environmental hazards, and epidemics. During these kinds of events, the desire to cope may not necessarily be for self-interest but the preservation of existing relationships and promoting the wellbeing of others that are affected. In these cases, collectively coping as part of a community or family supersedes individual effort to manage the distress. In this vein, Lyons et al. (1998) suggested the components of communal coping are salient and activated in such situations where at least one person treats the distressing event as ‘our problem’. Therefore, the components of the communal coping process require a communal coping orientation, communication about the stressor and cooperative action to address the stressor.

The components of communal coping may be defined as active steps towards achieving a positive coping outcome as part of a social unit. Lyons et al. (1998) proposed these active steps begin with one person adopting a communal orientation about how to manage the distressing event. The outcome of this action is the individuals involve share a mutual understanding of how to manage and overcome the stressor as a social unit versus ‘your problem’ where a specific individual is responsible for managing and overcoming the stressor. The actualisation of this first step largely depends on and is completed through communication. In other words, the individuals involved need to communicate about the stressor.

Communication allows for a conversation about the situation, circumstances, and likely solutions. The conversations at this point may be controlled by the individual experiencing the stressor to inform members of their network who are willing to share responsibility for the stressor on how the issue should be addressed. Or, the conversation may be controlled by members of the personal network of the individual experiencing the stressor to negotiate their involvement in how to manage the stress. Irrespective of the direction the communication takes, the primary goal is to share a common sense of responsibility for the stressor as “our problem” among the people involved.

The outcome of the first two steps le toad the emergence of a sense of cooperative action. At this point, everyone works cooperatively to create strategies for alleviating the problem or stressor. Given that there is a likelihood for the processes of the three components of communal coping to unfold differently across situations and for affected individuals, it is not unusual to find differences in communal coping styles. Some of the factors responsible for these differences include the sense of obligation experienced by the connected individuals (Stack 1974) or compassion for others (Nussbam, 1990); the type and purpose of the relationship as well as the characteristics of the individual in the leadership role and personalities of members within the communal coping network (Lyon et al. 1998). However, despite these differences in coping styles, communal coping is beneficial for the management of and recovery from a distressing event.

Influences on Communal Coping

Lyon et al. (1998) suggested four factors that influence how people use communal coping – situation, cultural context, characteristics of the personal relationship and sex. For instance, in a study on the role of marriage on health behaviours, Lewis, McBride, Pollak et al. (2006) discovered the transformation of motivation influenced how one chooses to help the other cope through a stressor. The scholars argued that in the case of romantic relationships, one partner’s mere realization that a stressor (e.g. health treat) poses a danger to relationship quality could motivate the need for communal coping.

In addition, the perceived salience of communal coping within certain situations is defined by the severity of the stressor. Therefore, the ways individuals define the severity of a problem are likely dependent on:

  • The priority or relevance attached to the problem;
  • If they are directly or indirectly affected; and
  • The decision whether to employ an individual or collective coping strategy.

In this vein, following their studies on communal coping within post-divorce families, Afifi, Hutchinson, and Krouse (2006, p.399) argued the “specific demands or requirement of a stressor” influence the communal coping process.

The cultural context in which the distressing event occur also influence the salience of communal coping in alleviating the stressor. The concepts of collectivism and individualism are often used in cultural comparative studies about a phenomenon. Cultures that promote group interest (collectivist cultures) over personal goals (individualist culture) are more likely to invest in communal coping (refer to Bryer, 1986). Given that culture is a way of life, it reflects in the performance of our relationships such as how we define close relationships and depend on these relationships (Lyons et al., 1998). Therefore, one can conclude that relationships in which strong relational ties exist will perhaps guarantee better performance of communal coping than relationships without strong relational ties.

Moreover, the language of the affected individual also influences the coping process. Researchers (e.g. Rohrbaugh, Shoham, Skoyen, Jensen, and Mehl, 2012) labelled communal coping language as ‘we – talk’. In their studies of addiction and cessation (cigarette and alcohol) due to health threats, Rohrbaugh and colleagues discovered the pronoun used by couples in their study influenced the communal coping outcomes. In the cases where couples defined the addiction as “our problem” versus “your problem” or “my problem”, there were implicit adaptive problem-solving outcomes.

Lastly, gender roles influence the performance of communal coping. Wells, Hobfoll and Lavin (1997) suggested the multiple roles some women take on tend to result in stressors. However, Women tend to be the fervent giver of social support making members of this gender community an active performer in the communal coping process (Vaux 1985, Bem 1993). Lyon et al. (1998) noted women’s tendency to give social support to others supersedes receiving support as maintaining relationship quality is important for this group. The downside to this sense of responsibility is women manage and overcome their stressor alone which take an emotional and psychological toll.

Benefits of Communal Coping

Adapting the communal coping strategy after a distressing event is beneficial for the coping process itself, the self and relationships (Afifi, Helgeson & Krouse, 2006). As a beneficial strategy for the coping process communal coping holds the potential to allow connected individuals to increase their resources and ability to deal with the situation. For example, a single stressful event may require reliance on other people or the exploration of others’ financial resources to cope with the situation.

Another significant benefit of communal coping as a coping strategy is the facilitation of emotional social support which in turn facilitates psychological wellbeing. Individuals who can share their emotional distress with others are less likely to experience depression and burnout (Williamson & Shultz, 1990)or commit suicide (LaSalle, 1995).

Under certain circumstances, the constant encouragement of communal coping among connected individuals promotes a likelihood of consistent availability of social support. In these cases, communal coping may serve as a form of long-term investment. The last two statements are not intended to categorise communal coping and social support as the same phenomenon but rather to argue that the former creates a conducive social and relational climate for the later. According to Lyons et al. (1998), some of the long-term investments of communal coping may result in rewards such as food and money.

Moreover, in the event of a common disaster such as earthquakes and wars, communal coping allows the people involved to experience a sense of ‘solidarity’ or a feeling of ‘I am not the only victim’. This realisation promotes mutual disclosure among all the affected individuals, a behaviour found to buffer stress as well as ameliorate negative feelings and concerns (Pennebaker & Haber, 1993). In their study on how the process of communal coping unfolds after social support resources have diminished, Richardson and Maninger (2016) discovered that a sense of mutuality and shared problem increased.

Taken together, there is enough evidence that communal coping has a significant impact on relationships. These impacts are evident in the development and maintenance of relationships; the desire or obligation to cater to the wellbeing of others and the collective good (Lyon et al., 1998). Perhaps, in well-established relationships, communal coping is likely to strengthen relationship characteristics such as trust. For instance, the confidence that people within a connected network will exchange support during or after a distressing situation promotes a sense of dependence which may improve the quality of a relationship.

Lyons and colleagues argued the actualisation of relationship development and maintenance regarding relational trust or improving relationship quality emerge from a sense of compassion (empathy-driven) or obligation (responsibility – driven) towards the wellbeing of others in the relationship. Although empathy-driven and obligation – driven motives are distinct based on the type of relational tie, in most cases the end goal is for the collective good.

The benefits of communal coping described to this point focus on the intention to meet the emotional need of others during a stressful life event. However, the self can also benefit from participating in the process. There is a likelihood for the person offering empathy-driven or obligation – driven support to experience a sense of fulfilment. Lyons et al. (1998) used social integration and excitement to explain self-benefits of communal coping. In their explanation of social integration as a benefit of communal coping, Lyons et al. noted people who consider themselves resourceful in the coping process of others consider themselves competent, valued, loved and indispensable. In the same vein, communal coping fosters a sense of togetherness and cooperation. Excitement usually results from a sense of togetherness and cooperation that yield positive results.

Given that people and resources such as money, time and goods are exchanged in the process of communal coping during certain stressful events, there is a likelihood for some of the individuals involved to experience discomfort. Lyons et al. (1998) alluded to this discomfort as costs of communal coping.

Costs of Communal Coping

A significant characteristic of communal coping is ‘dependency’. Cultural (collectivism versus individualism) and social factors play into how we expect others to depend on us and how much we are willing to depend on others. Communal coping will perhaps be perceived as a cost in situations where there is a lack of mutual understanding and expectation within a social unit consisting of members experiencing a common or personal stressful event. In such instances, Lyon et al. (1998) noted individuals in the social unit will need to deal with issues such as equity and individual-adaptation.

The equity problem arises from a lack of agreement or existing social norms on the expectation of individual efforts channelled towards communal coping. In a comparison of gender roles after a distressing event, women specifically wives and mothers were expected to hold higher responsibility for helping others manage and recover from a stressor. More so, given that communal coping requires significant reliance on other people, individuals who are used to this style of coping during or after a stressful event may experience trouble adapting to a situation or circumstance in the absence of someone to rely on. There is evidence for this in studies about how people embedded in a strong community experience difficulty after a change of location for the pursuit of life goals.

One drastic consequence of communal coping is the possibility of stress contagion to occur. In this case, rather than working towards alleviating the stressor, connected individuals wallow in negative emotions and feelings. This behaviour escalates old and fosters new stressors for all the people involved. These factor provide evidence that the communal coping process follows a complicated pattern likely to yield contradictory results. Even more, some complex factors influence how people use communal coping. The complex nature of these factors is evident in how they are not universal or consistent.

Concept Application

The communal coping framework is relatively new and there has not been much variation in the context to which the concept has been applied. Mickelson, Lyons, Sullivan and Coyne (2001) argue for the need to apply the communal coping conceptual framework to less collective stressors such as recovery from natural disaster (e.g. Richardson & Maninger, 2018) to more individualistic stressors such as job loss and illness (e.g. Vleet, Helgeson, Seltman, Korytwoski, Hausmann, 2018). Scholars who have attempted to apply the communal coping framework to context outside of illness and natural disaster have looked at the concept in relation to relational transgression (Pederson & Faw, 2019); the experience of athletes and members of their family (Nelly, McHugh, Dun & Holt, 2017) and ; the experience of refugees (Afifi, Afifi, Merill & Nimah, 2016).

Concept Critique

The communal coping framework is very dynamic in the sense that it can be applied to distinct research contexts yet facilitate empirical and general knowledge that aligns with the tenets of its models. This strength also lies in the weakness of the framework. Some scholars within the distinct field to which the concept has been applied propose models for communal coping with little to significant variations. For instance, Lyons and colleagues (1998) from the field of psychology proposed the first model. Their model served as a backdrop for the emergence of other models from experts in communication (Afifi, Helgeson & Krouse, 2006); sociology and anthropology (Helgeson, Jakubiak, Vleet, & Zajdel, 2018). Keefe, LeFevbre, Egert, et al. (2000) also advocated for a communal coping model of pain catastrophising. With the growth in the application of the conceptual framework, it might be beneficial to consider developing a model for studying the phenomenon that can be used across all fields or areas of research. A probable benefit of this suggestion is the promotion of jointly agreed conceptualisation of the communal coping phenomenon.

References and Further Reading

  • Afifi, T. D., Afifi, W. A., Merrill, A. F., & Nimah, N. (2016). ‘Fractured communities’: uncertainty, stress, and (a lack of) communal coping in Palestinian refugee camps. Journal of Applied Communication Research, 44(4), 343-361doi:10.1080/00909882.2016.1225166
  • Afifi, T. D., Hutchinson, S., & Krouse, S. (2006). Toward a theoretical model of communal coping in postdivorce families and other naturally occurring groups. Communication Theory, 16(3), 378–409.
  • Berg, C. A., Meegan, S. P., & Deviney, F. P. (1998). A social-contextual model of coping with everyday problems across the lifespan. International Journal of Behavioral Development, 22(2), 239–261.
  • Coyne, J. C., & Fiske, V. (1992). Couples coping with chronic and catastrophic illness.
  • Fiske, Veronica; Coyne, James C.; Smith, David A. (1991). “Couples coping with myocardial infarction: An empirical reconsideration of the role of overprotectiveness”. Journal of Family Psychology. 5(1): pp.4-20.
  • Fukuyama, F. (1995). Trust: The social virtues and the creation of prosperity (Vol. 99). New York, NY: Free press.
  • Lyons, R. F., Mickelson, K. D., Sullivan, M. J., & Coyne, J. C. (1998). Coping as a communal process. Journal of Social and Personal Relationships, 15(5), 579–605.
  • Keefe, F. J., Lefebvre, J. C., Egert, J. R., Affleck, G., Sullivan, M. J., & Caldwell, D. S. (2000). The relationship of gender to pain, pain behavior, and disability in osteoarthritis patients: the role of catastrophizing. Pain, 87(3), 325–334.
  • Helgeson, V. S., Jakubiak, B., Van Vleet, M., & Zajdel, M. (2018). Communal coping and adjustment to chronic illness: Theory update and evidence. Personality and Social Psychology Review, 22(2), 170–195.
  • Hobfoll, S. E., & London, P. (1986). The relationship of self-concept and social support to emotional distress among women during war. Journal of Social and Clinical Psychology, 4(2), 189–203.
  • Hobfoll, S. E. (1989). Conservation of resources: A new attempt at conceptualizing stress. American psychologist, 44(3), 513.
  • Lazarus, R. S., & Folkman, S. (1984). Coping and adaptation. The handbook of behavioral medicine, 282325.
  • Lewis, M. A., McBride, C. M., Pollak, K. I., Puleo, E., Butterfield, R. M., & Emmons, K. M. (2006). Understanding health behavior change among couples: An interdependence and communal coping approach. Social science & medicine, 62(6), 1369–1380.
  • Lyons, Renee F.; Mickelson, Kristin D.; Sullivan, Michael J.L.; Coyne, James C. (October 1998). “Coping as a Communal Process”. Journal of Social and Personal Relationships. 15 (5): 579–605.
  • Rohrbaugh, M. J., Shoham, V., Skoyen, J. A., Jensen, M., & Mehl, M. R. (2012). We‐talk, communal coping, and cessation success in a couple‐focused intervention for health‐compromised smokers. Family process, 51(1), 107–121.
  • Nussbaum, M. C. (1990). Love’s knowledge: Essays on philosophy and literature. OUP USA.
  • Skinner, E. A., & Zimmer‐Gembeck, M. J. (2009). Challenges to the developmental study of coping. New directions for child and adolescent development, 2009(124), 5–17.
  • Pennebaker, J. W., & Harber, K. D. (1993). A social stage model of collective coping: The Loma Prieta earthquake and the Persian Gulf War. Journal of Social Issues, 49(4), 125-145
  • Richardson, B. K., & Maninger, L. (2016). “We were all in the same boat”: An exploratory study of communal coping in disaster recovery. Southern Communication Journal, 81(2), 107–122.
  • Stack, C. B. (1975). All our kin: Strategies for survival in a black community. Basic Books.
  • Wells, J. D., Hobfoll, S. E., & Lavin, J. (1997). Resource loss, resource gain, and communal coping during pregnancy among women with multiple roles. Psychology of Women Quarterly, 21(4), 645–662.
  • Vaux, A. (1990). An ecological approach to understanding and facilitating social support. Journal of social and personal relationships, 7(4), 507-518
  • Van Vleet, M., Helgeson, V. S., Seltman, H. J., Korytkowski, M. T., & Hausmann, L. R. (2019). An examination of the communal coping process in recently diagnosed diabetes. Journal of social and personal relationships, 36(4), 1297–1316.
  • Wellman, B., Carrington, P., & Hall, A. (1983). Networks as personal communities. Centre for Urban and Community Studies, University of Toronto.
  • Williamson, G. M., & Schulz, R. (1990). Relationship orientation, quality of prior relationship, and distress among caregivers of Alzheimer’s patients. Psychology and Aging, 5(4), 502.

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A Brief Outline of Self-Verification Theory

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Introduction

Self-verification is a social psychological theory that asserts people want to be known and understood by others according to their firmly held beliefs and feelings about themselves, that is self-views (including self-concepts and self-esteem). It is one of the motives that drive self-evaluation, along with self-enhancement and self-assessment.

Because chronic self-concepts and self-esteem play an important role in understanding the world, providing a sense of coherence, and guiding action, people become motivated to maintain them through self-verification. Such strivings provide stability to people’s lives, making their experiences more coherent, orderly, and comprehensible than they would be otherwise. Self-verification processes are also adaptive for groups, groups of diverse backgrounds, and the larger society, in that they make people predictable to one another thus serve to facilitate social interaction. To this end, people engage in a variety of activities that are designed to obtain self-verifying information.

Developed by William Swann (1981), the theory grew out of earlier writings which held that people form self-views so that they can understand and predict the responses of others and know how to act toward them.

William Swann

William B. Swann (born 1952) is a professor of social and personality psychology at the University of Texas at Austin. He is primarily known for his work on identity, self and self-esteem, but has also done research on relationships, social cognition, group processes, accuracy in person perception and interpersonal expectancy effects. He received his Ph.D. in 1978 from the University of Minnesota and undergraduate degree from Gettysburg College.

Difference between Positive and Negative Self-Views

There are individual differences in people’s views of themselves. Among people with positive self-views, the desire for self-verification works together with another important motive, the desire for positive evaluations or “self enhancement”. For example, those who view themselves as “insightful” will find that their motives for both self-verification and self-enhancement encourage them to seek evidence that other people recognise their insightfulness.

In contrast, people with negative self-views will find that the desire for self-verification and self-enhancement are competing. Consider people who see themselves as disorganized. Whereas their desire for self-enhancement will compel them to seek evidence that others perceive them as organised, their desire for self-verification will compel such individuals to seek evidence that others perceive them as disorganised. Self-verification strivings tend to prevail over self-enhancement strivings when people are certain of the self-concept and when they have extremely depressive self-views.

Self-verification strivings may have undesirable consequences for people with negative self-views (depressed people and those who suffer from low self-esteem). For example, self-verification strivings may cause people with negative self-views to gravitate toward partners who mistreat them, undermine their feelings of self-worth, or even abuse them. And if people with negative self-views seek therapy, returning home to a self-verifying partner may undo the progress that was made there. Finally, in the workplace, the feelings of worthlessness that plague people with low self-esteem may foster feelings of ambivalence about receiving fair treatment, feelings that may undercut their propensity to insist that they get what they deserve from their employers (see: workplace bullying).

These findings and related ones point to the importance of efforts to improve the self-views of those who suffer from low self-esteem and depression.

Effects on Behaviour

In one series of studies, researchers asked participants with positive and negative self-views whether they would prefer to interact with evaluators who had favourable or unfavourable impressions of them. The results showed that those with positive self-views preferred favourable partners and those with negative self-views preferred unfavourable partners. The latter finding revealed that self-verification strivings may sometimes trump positivity strivings.

Self-verification motives operate for different dimensions of the self-concept and in many different situations. Men and women are equally inclined to display this tendency, and it does not matter whether the self-views refer to characteristics that are relatively immutable (e.g. intelligence) or changeable (e.g. diligence), or whether the self-views happen to be highly specific (e.g. athletic) or global (e.g. low self-esteem, worthlessness). Furthermore, when people chose negative partners over positive ones, it is not merely in an effort to avoid interacting with positive evaluators (that is, out of a concern that they might disappoint such positive evaluators). Rather, people chose self-verifying, negative partners even when the alternative is participating in a different experiment. Finally, recent work has shown that people work to verify self-views associated with group memberships. For example, women seek evaluations that confirm their belief that they possess qualities associated with being a woman.

Self-verification theory suggests that people may begin to shape others’ evaluations of them before they even begin interacting with them. They may, for example, display identity cues (see: impression management). The most effective identity cues enable people to signal who they are to potential interaction partners.

  • Physical appearance, such as clothes, body posture, demeanour. For example, the low self-esteem person who evokes reactions that confirm her negative self-views by slumping her shoulders and keeping her eyes fixed on the ground.
  • Other cues, such as the car someone buys, the house they live in, the way they decorate their living environment. For example, an SUV evokes reactions that confirm a person’s positive self-view.

Self-verification strivings may also influence the social contexts that people enter into and remain in. People reject those who provide social feedback that does not confirm their self-views, such as married people with negative self-views who reject spouses who see them positively and vice versa. College roommates behave in a similar manner. People are more inclined to divorce partners who perceived them too favourably. In each of these instances, people gravitated toward relationships that provided them with evaluations that confirmed their self-views and fled from those that did not.

When people fail to gain self-verifying reactions through the display of identity cue or through choosing self-verifying social environments, they may still acquire such evaluations by systematically evoking confirming reactions. For example, depressed people behave in negative ways toward their roommates, thus causing these roommates to reject them.

Self-verification theory predicts that when people interact with others, there is a general tendency for them to bring others to see them as they see themselves. This tendency is especially pronounced when they start out believing that the other person has misconstrued them, apparently because people compensate by working especially hard to bring others to confirm their self-views. People will even stop working on tasks to which they have been assigned if they sense that their performance is eliciting non-verifying feedback.

Role of Confirmation Bias

Self-verification theory predicts that people’s self-views will cause them to see the world as more supportive of these self-views than it really is. That is, individuals process information in a biased manner. These biases may be conscious and deliberate, but are probably more commonly done effortlessly and non-consciously. Through the creative use of these processes, people may dramatically increase their chances of attaining self-verification. There are at least three relevant aspects of information processing in self-verification:

  • Attention: People will attend to evaluations that are self-confirming while ignoring non-confirming evaluations.
  • Memory retrieval: self-views bias memory recall to favour self-confirming material over non-confirming elements.
  • Interpretation of information: people tend to interpret information in ways that reinforce their self-views.

These distinct forms of self-verification may often be implemented sequentially. For example, in one scenario, people may first strive to locate partners who verify one or more self-views. If this fails, they may redouble their efforts to elicit verification for the self-view in question or strive to elicit verification for a different self-view. Failing this, they may strive to “see” more self-verification than actually exists. And, if this strategy is also ineffective, they may withdraw from the relationship, either psychologically or in actuality.

Related Processes

Preference for Novelty

People seem to prefer modest levels of novelty; they want to experience phenomena that are unfamiliar enough to be interesting, but not so unfamiliar as to be frightening or too familiar as to be boring.

The implications of people’s preference for novelty for human relationships are not straightforward and obvious. Evidence that people desire novelty comes primarily from studies of people’s reactions to art objects and the like. This is different when it concerns human beings and social relationships because people can shift attention away from already familiar novel objects, while doing so in human relationships is difficult or not possible. But novel art objects are very different from people. If a piece of art becomes overly stimulating, we can simply shift our attention elsewhere. This is not a viable option should our spouse suddenly begin treating us as if we were someone else, for such treatment would pose serious questions about the integrity of people’s belief systems. Consequently, people probably balance competing desires for predictability and novelty by indulging the desire for novelty within contexts in which surprises are not threatening (e.g. leisure activities), while seeking coherence and predictability in contexts in which surprises could be costly – such as in the context of enduring relationships.

Tension with Self-Enhancement

People’s self-verification strivings are apt to be most influential when the relevant identities and behaviours matter to them. Thus, for example, the self-view should be firmly held, the relationship should be enduring, and the behaviour itself should be consequential. When these conditions are not met, people will be relatively unconcerned with preserving their self-views and they will instead indulge their desire for self-enhancement. In addition, self-reported emotional reactions favour self-enhancement while more thoughtful processes favour self-verification.

But if people with firmly held negative self-views seek self-verification, this does not mean that they are masochistic or have no desire to be loved. In fact, even people with very low self-esteem want to be loved. What sets people with negative self-views apart is their ambivalence about the evaluations they receive. Just as positive evaluations foster joy and warmth initially, these feelings are later chilled by incredulity. And although negative evaluations may foster sadness that the “truth” could not be kinder, it will at least reassure them that they know themselves. Happily, people with negative self-views are the exception rather than the rule. That is, on the balance, most people tend to view themselves positively. Although this imbalance is adaptive for society at large, it poses a challenge to researchers interested in studying self-verification. That is, for theorists interested in determining if behaviour is driven by self-verification or positivity strivings, participants with positive self-views will reveal nothing because both motives compel them to seek positive evaluations. If researchers want to learn if people prefer verification or positivity in a giving setting, they must study people with negative self-views.

Self-Concept Change

Although self-verification strivings tend to stabilise people’s self-views, changes in self-views may still occur. Probably the most common source of change is set in motion when the social environment recognises a significant change in a person’s age (e.g. when adolescents become adults), status (e.g. when students become teachers), or social role (e.g. when someone is convicted of a crime). Suddenly, the community may change the way that it treats the person. Eventually the target of such treatment will bring his or her self-view into accord with the new treatment.

Alternatively, people may themselves conclude that a given self-view is dysfunctional or obsolete and take steps to change it. Consider, for example, a woman who decides that her negative self-views have led her to tolerate abusive relationship partners. When she realises that such partners are making her miserable, she may seek therapy. In the hands of a skilled therapist, she may develop more favourable self-views which, in turn, steer her toward more positive relationship partners with whom she may cultivate healthier relationships. Alternatively, when a woman who is uncertain about her negative self-concept enters a relationship with a partner who is certain that she deserves to view herself more positively, that woman will tend to improve the self-concept.

Criticism

Critics have argued that self-verification processes are relatively rare, manifesting themselves only among people with terribly negative self views. In support of this viewpoint, critics cite hundreds of studies indicating that people prefer, seek and value positive evaluations more than negative ones. Such sceptical assessments overlook three important points. First, because most people have relatively positive self-views, evidence of a preference for positive evaluations in unselected samples may in reality reflect a preference for evaluations that are self-verifying, because for such individuals self-verification and positivity strivings are indistinguishable. No number of studies of participants with positive self-views can determine whether self-verification or self-enhancement strivings are more common. Second, self-verification strivings are not limited to people with globally negative self-views; even people with high self-esteem seek negative evaluations about their flaws. Finally, even people with positive self-views appear to be uncomfortable with overly positive evaluations. For example, people with moderately positive self-views withdraw from spouses who evaluate them in an exceptionally positive manner.

Other critics have suggested that when people with negative self-views seek unfavourable evaluations, they do so as a means of avoiding truly negative evaluations or for purposes of self-improvement, with the idea being that this will enable them to obtain positive evaluations down the road. Tests of this idea have failed to support it. For example, just as people with negative self-views choose self-verifying, negative evaluators even when the alternative is being in another experiment, they choose to be in another experiment rather than interact with someone who evaluates them positively. Also, people with negative self-views are most intimate with spouses who evaluate them negatively, despite the fact that these spouses are relatively unlikely to enable them to improve themselves. Finally, in a study of people’s thought processes as they chose interaction partners, people with negative self-views indicated that they chose negative evaluators because such partners seemed likely to confirm their self-views (an epistemic consideration) and interact smoothly with them (a pragmatic consideration); self-improvement was rarely mentioned.

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What is Dyscopia?

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Introduction

Dyscopia consists of the Latin root copia, which means abundance or plenty (see cornucopia), and the Greek prefix dys-, which means “bad”, “abnormal”, “difficult” or “impaired”.

This word has assumed two meanings, both of which are essentially a pun based on the similarity of the sound of the words “copy” and “cope” with copia.

In the field of neurology, dyscopia is used to describe a type of developmental coordination disorder related to dyslexia and dysgraphia (inability to read or write). Specifically, it is taken to mean difficulty with coping. Sometimes a similar word, “acopia”, is mistaken to mean the same, although this is not a medical term and has no basis in Latin.

The term “dyscopia” has also crept into general medical parlance as a tongue-in-cheek shorthand notation for patients who, after being examined and found to have no specific medical condition, are deemed to be not coping with certain aspects of their lives, and are presumed to be seeking treatment as a form of comfort from the medical profession. More recently, and controversially, the term has been used in this context as a diagnosis for admission to hospital.

The words have also been used in medical notes as a cryptic indication that certain members of a seriously ill patient’s family are not coping with the situation and should be afforded some extra consideration to their feelings when the case is being discussed.

As Dystranscribia

In neurology, the word “dyscopia” is used to describe a condition which is common as one of the sequelae of cerebral commisurotomy, a neurosurgical procedure in which the left and right hemispheres of the brain are separated by severing the corpus callosum. This procedure has been shown to reduce the frequency and severity of seizures in extreme cases of epilepsy.

An affected individual will exhibit difficulty with copying simple line drawings. This is often accompanied to lesser or greater degree by difficulty with writing and other fine motor skills.

As ‘Not Coping’ in Medical Usage

Terms such as “social admission”, “atypical presentation”, and even the derogatory terms “bed blocker” or “crumblie” have been used in medical notes synonymously with dyscopia or acopia as a reason for hospital admission.

The use of the term has become sufficiently commonplace in medical notes that a recent publication of a psychiatric dictionary even cites it as an actual diagnosis (Campbell’s Psychiatric Dictionary; first published in 1940 and on its eighth edition as of 2004).

Patients who are likely to be labelled with one of these terms are sometimes frail and elderly or people with long-term disabilities. Their failure to cope is often a result of inadequate social support coupled with a deterioration of functional capability which is not clearly linked to an obvious or specific medical or psychiatric pathology.

Sometimes, however, despite the fact that terms such as acopia and social admission can be considered tongue-in-cheek by those adhering to the strictest of medical and psychiatric terminology, they can frequently describe a range of “symptoms”, such as extreme lability and emotionality when demands are not met and the unwillingness of a minority of patients that might be encountered in psychiatry, to function and make ends meet, despite the fact that such patients might be lucid and able-bodied.

A possible controversy associated with using dyscopia and acopia as diagnoses could arise when wrongfully applied to those who have genuine problems with mobility, i.e. genuine medical conditions may be overlooked. Investigation of symptoms is a legitimate reason for admission, and if medical staff are too swift to dismiss concerns by use of such informal labels, genuine symptoms may not be taken seriously and investigated. This may lead to treatable conditions being overlooked, and in turn, result in compromised quality of life and unnecessary suffering.

Dyscopia (and likewise acopia), in this context, is not generally used by the medical community for fear of insulting the patient and bringing the caregiver’s professional standing into question.

Colloquial Usage

Acopia has been adopted as the name of a company based in Crawley, UK, presumably referring the correct Latin root of the word copia meaning abundance.

The words also appear to be gaining traction in common usage as colloquialisms meaning emotional lability over trivial events or circumstances. This may well assist in demystifying the term and discouraging its usage in medical circles.

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What is Invisible Support?

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Introduction

In psychology, invisible support is a type of social support in which supportive exchanges are not visible to recipients.

There are two possible situations that can qualify as acts of invisible support. The first possibility entails a situation where “recipients are completely unaware of the supportive transaction between themselves and support-givers”. For example, a spouse may choose to spontaneously take care of housework without mentioning it to the other couple-member. Invisible support also occurs when “recipients are aware of an act that takes place but do not interpret the act as a supportive exchange”. In this case, a friend or family member may subtly provide advice in an indirect manner as a means to preserve the recipient’s self-esteem or to defer his or her attention from a stressful situation. Invisible support can be viewed on both ends of an exchange, in which the recipient is unaware of the support received and the provider enacts support in a skilful, subtle way.

Background

It is known that perceptions of social support availability predict better adjustment to stressful life events; it has been found that the perception of support availability is inherently comforting, and can serve as a psychological safety-net that motivates self-reliant coping efforts in the face of stress. Although the perception of support availability is associated with better adjustment, the knowledge that one has been the recipient of specific supportive acts has often been unhelpful to effectively reduce stress. The knowledge of receiving help may come at a cost with decreased feelings of self-esteem and self-efficacy, because it increases recipients’ awareness towards their personal difficulties to manage stressors. People’s well-intentioned support attempts may also be miscarried, and their efforts could either fail or even worsen the situation for a person under stress. Since supportive acts benefit recipients but their actual knowledge of receiving support is sometimes harmful, it has been theorised that the most effective support exchange would involve one in which the provider reports giving support but the recipient does not notice that support has occurred. From a cost-benefit point of view, invisible support would be optimal for the recipient because the benefits of provision are accrued while the costs of receipt are avoided. Using the same idea, it also implies that the least effective type of support would be one in which the provider does not report providing support but the recipient reports receiving it.

The first investigation of invisible support involved a couples study in which one member was preparing for the New York State Bar Exam. Support receipt and provision were measured by having both couple members complete daily diary entries. Over the course of one month, stressed individuals who reported low frequency of received support (but whose partner ranked their own actions as highly supportive) rated themselves low on anxiety and depression compared to other individuals who reported high frequency of received support.

Compared to Visible Support

A substantial body of work has evidence to suggest that support is most effective when it is invisible or goes unnoticed by recipients. While invisible support has been shown to benefit recipients over visibly supportive acts in some cases, there have also been instances where recipients have benefitted from visible support as well. For example, greater observed support enacted by intimate partners during couples’ support-relevant exchanges have been shown to build feelings of closeness and support, boost positive mood and self-esteem, and foster greater goal achievement and relationship quality across time.

It has been recently suggested that acts of invisible support and visible support may be beneficial or costly depending on different circumstances. To investigate this idea, a recent study in 2013 compared the short-term and long-term effects of visible and invisible support reception during romantic couples’ discussions of each partner’s personal goal. It was found that either type of support was more beneficial depending on the emotional distress that recipients felt at the time. Visible emotional support (support through reassurance, encouragement, and understanding) was associated with perceptions of greater support and discussion success for recipients who felt greater distress during the discussion. In contrast, invisible emotional support was not associated with recipients’ post-discussion perceptions of support or discussion success. For long-term support effects, it was found that only invisible emotional support predicted greater goal achievement across the following year.

When put together, these findings suggest that visible support and invisible support have unique functions for well-being. When people are under distress, visible support appears to be a short-term remedy to reassure recipients that they are cared for and supported. These benefits are only present when recipients are actually distressed during the time that the supportive act takes place. On the other hand, while invisible support tends to go unnoticed by recipients, it seems to play an integral role in the long-term success of goal-maintenance. This increasingly complex view of the implications of support visibility is reinforced by a growing body of research suggesting the effects of invisible social support – as with visible support – are moderated by provider, recipient, and contextual factors such as recipients’ perceptions of providers’ responsiveness to their needs, or the quality of the relationship between the support provider and recipient.

Effects on Support Providers

Refer to Social Support, Psychology, Stress (Psychological; Eustress and Distress), Coping (Psychology), Self-Esteem, and Self-Efficacy.

The effects of invisible support on recipients have been extensively investigated, but the consequences of invisible support on providers are less known. One study in 2016 investigated the benefits and costs of invisible support on couple-members who enacted supportive behaviours by differentiating the processes of invisible emotional support (support through reassurance, encouragement, and understanding) from processes of invisible instrumental support (providing tangible aid such as sending money or childcare). No costs of support-giving were found for providers when they demonstrated acts of invisible emotional support. The effects for invisible instrumental support told a different story, where providers who reported high relationship satisfaction were unaffected, but providers who reported low relationship satisfaction were negatively affected by their acts of invisible instrumental support with an increase in negative mood. These findings suggest that emotional comfort may be a more central function to maintain close relationships than instrumental support. Therefore, providing invisible emotional support may lead to less perceptions of a costly inequity than providing invisible instrumental support on average. However, since invisible instrumental support did not incur costs for providers who reported high relationship satisfaction, it implies that high relationship satisfaction may buffer potential costs that would otherwise be felt by support-providers. The differential results between invisible instrumental and emotional support indicate that a solid distinction between instrumental and emotional social support may be useful to take into account when investigating effects of invisible support as a whole.

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What is Mindfulness-Based Stress Reduction?

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Introduction

Mindfulness-based stress reduction (MBSR) is an eight-week evidence-based programme that offers secular, intensive mindfulness training to assist people with stress, anxiety, depression and pain.

Developed at the University of Massachusetts Medical Centre in the 1970s by Professor Jon Kabat-Zinn, MBSR uses a combination of mindfulness meditation, body awareness, yoga and exploration of patterns of behaviour, thinking, feeling and action. Mindfulness can be understood as the non-judgemental acceptance and investigation of present experience, including body sensations, internal mental states, thoughts, emotions, impulses and memories, in order to reduce suffering or distress and to increase well-being. Mindfulness meditation is a method by which attention skills are cultivated, emotional regulation is developed, and rumination and worry are significantly reduced. During the past decades, mindfulness meditation has been the subject of more controlled clinical research, which suggests its potential beneficial effects for mental health, as well as physical health. While MBSR has its roots in Buddhist wisdom teachings, the programme itself is secular. The MBSR programme is described in detail in Kabat-Zinn’s 1990 book Full Catastrophe Living.

Brief History

In 1979, Jon Kabat-Zinn founded the Mindfulness Based Stress Reduction Clinic at the University of Massachusetts Medical Centre, and nearly twenty years later the Centre for Mindfulness in Medicine, Health Care and Society at the University of Massachusetts Medical School. Both these institutions supported the growth and implementation of MBSR into hospitals worldwide. Kabat-Zinn described the MBSR program in detail in his bestselling 1990 book Full Catastrophe Living, which was reissued in a revised edition in 2013. In 1993, the MBSR course taught by Jon Kabat-Zinn was featured in Bill Moyer’s Healing from Within. In the year 2015, close to 80% of medical schools are reported to offer some element of mindfulness training, and research and education centres dedicated to mindfulness have proliferated.

Programme

A meta-analysis described MBSR as “a group programme that focuses upon the progressive acquisition of mindful awareness, of mindfulness”. The MBSR programme is an eight-week workshop taught by certified trainers that entails weekly group meetings (2.5 hour classes) and a one-day retreat (seven-hour mindfulness practice) between sessions six and seven, homework (45 minutes daily), and instruction in three formal techniques: mindfulness meditation, body scanning and simple yoga postures. Group discussions and exploration – of experience of the meditation practice and its application to life – is a central part of the program. Body scanning is the first prolonged formal mindfulness technique taught during the first four weeks of the course, and entails quietly sitting or lying and systematically focusing one’s attention on various regions of the body, starting with the toes and moving up slowly to the top of the head. MBSR is based on non-judging, non-striving, acceptance, letting go, beginners mind, patience, trust, and non-centring.

According to Kabat-Zinn, the basis of MBSR is mindfulness, which he defined as “moment-to-moment, non-judgmental awareness.” During the programme, participants are asked to focus on informal practice as well by incorporating mindfulness into their daily routines. Focusing on the present is thought to heighten sensitivity to the environment and one’s own reactions to it, consequently enhancing self-management and coping. It also provides an outlet from ruminating on the past or worrying about the future, breaking the cycle of these maladaptive cognitive processes. The validity and reliability of a weekly single-item practice quality assessment have been confirmed by research. Increases in practice quality predicted improvements in self-report mindfulness and psychological symptoms but not behavioural mindfulness, and longer practice sessions were linked to better practice quality.

Scientific evidence of the debilitating effects of stress on human body and its evolutionary origins were pinpointed by the work of Robert Sapolsky, and explored for lay readers in the book Why Zebras Don’t Get Ulcers. Engaging in mindfulness meditation brings about significant reductions in psychological stress, and appears to prevent the associated physiological changes and biological clinical manifestations that happen as a result of psychological stress. According to early neuroimaging studies, MBSR training has an influence on the areas of the brain responsible for attention, introspection, and emotional processing.

Extent of Practice

According to a 2014 article in Time magazine, mindfulness meditation is becoming popular among people who would not normally consider meditation. The curriculum started by Kabat-Zinn at University of Massachusetts Medical Centre has produced nearly 1,000 certified MBSR instructors who are in nearly every state in the US and more than 30 countries. Corporations such as General Mills have made MBSR instruction available to their employees or set aside rooms for meditation. Democratic Congressman Tim Ryan published a book in 2012 titled A Mindful Nation and he has helped organise regular group meditation periods on Capitol Hill.

Methods of Practice

Mindfulness-based stress reduction classes and programs are offered by various facilities including hospitals, retreat centres, and various yoga facilities. Typically the programs focus on teaching

  • mind and body awareness to reduce the physiological effects of stress, pain or illness
  • experiential exploration of experiences of stress and distress to develop less emotional reactivity
  • equanimity in the face of change and loss that is natural to any human life
  • non-judgemental awareness in daily life
  • promote serenity and clarity in each moment
  • to experience more joyful life and access inner resources for healing and stress management
  • mindfulness meditation

Evaluation of Effectiveness

Mindfulness-based approaches have been found to be beneficial for healthy adults for adolescents and children, healthcare professionals, as well as for different health-related outcomes including eating disorders, psychiatric conditions, pain management, sleep disorders, cancer care, psychological distress, and for coping with health-related conditions. As a major subject of increasing research interest, 52 papers were published in 2003, rising to 477 by 2012. Nearly 100 randomised controlled trials had been published by early 2014.

The development of therapies to improve individuals’ flexibility in switching between using and not using emotion regulation (ER) methods is necessary because it is linked to better mental health, wellbeing, and resilience. According to research, those who attended MBSR training exhibited greater regulatory decision flexibility. In post-secondary students, research on mindfulness-based stress reduction has demonstrated that it can reduce psychological distress, which is common in this age range. In one study, the long-term impact of an 8-week Mindfulness-Based Stress Reduction (MBSR) treatment extended to two months after the intervention was completed.

Individuals with eating disorders have benefited from the mindfulness-based approach. MBSR therapy has been found to assist individuals improve the way they view their bodies. Interventions, such as mindfulness-based approaches, which focus on effective coping skills and improving one’s relationship with themselves through increased self-compassion can positively impact a person’s body image and contribute to overall well-being.

Research suggests mindfulness training improves focus, attention, and ability to work under stress. Mindfulness may also have potential benefits for cardiovascular health. Evidence suggests efficacy of mindfulness meditation in the treatment of substance use disorders. Mindfulness training may also be beneficial for people with fibromyalgia.

In addition, recent research has explored the ability of mindfulness-based stress reduction to increase self-compassion and enhance the well-being of those who are caregivers, specifically mothers, for youth struggling with substance use disorders. Mindfulness-based interventions allowed for the mothers to experience a decrease in stress as well as a better relationship with themselves which resulted in improved interpersonal relationships.

It has been demonstrated that mindfulness-based stress reduction has beneficial impacts on healthy individuals as well as suffering individuals and those close to suffering individuals. Roca et al. (2019) conducted an 8-week mindfulness-based stress reduction programme for healthy participants. Five pillars of MBSR, including mindfulness, compassion, psychological well-being, psychological distress, and emotional-cognitive control were identified. Participants psychological functioning were examined and assessed using questionnaires. Mindfulness and overall well-being was significant between the five pillars observed.

Mindfulness-based interventions and their impact have become prevalent in every-day life, especially when rooted in an academic setting. After interviewing children, of the average age of 11, it was apparent that mindfulness had contributed to their ability to regulate their emotions. In addition to these findings, these children expressed that the more mindfulness was incorporated by their school and teachers, the easier it was to apply its principles.

Mindfulness-based stress approaches have been shown to increase self-compassion. Higher levels of self-compassion have been found to greatly reduce stress. In addition, as self-compassion increases it seems as though self-awareness increases as well. This finding has been observed to occur during treatment as well as a result at the conclusion, and even after, treatment. Self-compassion is both a result and an informative factor of the effectiveness of mindfulness-based approaches.

MBIs (mindfulness-based intervations) showed a positive effect on mental and somatic health in social when compared to other active treatments in adults. This effects may be gender dependent. However, the effects seemed independent of duration and compliance with these kind of intervention.

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