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CHAPTER 1

Stress, Resilience, and Coping

RACHEL N. WARD*, ABBIE J. BRADY, REBEKAH JAZDZEWSKI, and MATTHEW M. YALCH
Department of Clinical Psychology, Palo Alto University, Palo Alto, CA, USA
*
Corresponding author. E-mail: rward@paloaltou.edu

ABSTRACT and terrorist attacks. An individual’s response

to stressors can be mental and/or physical,
Stress can have adverse effects on psychological depending on the individual’s psychological
functioning. This is evident by increases in symp- makeup, social and cultural resources, and the
toms of post-traumatic stress disorder, depres- needs of the situation. In this chapter, we will
sion, and other psychiatric disorders in those who discuss the nature of psychological stress, the
have experienced high levels of stress. However, types of factors that make an individual more
there are several factors that make people more or less resilient to psychological stress, and
at risk or more resilient to developing psycholog- methods of coping that may be useful in dealing
ical problems in the aftermath of experiencing with psychological stress.
high levels of stress. Similarly, there are several
methods of coping that are more or less effective
in the aftermath of stressful experiences. In this 1.2 THE NATURE AND EFFECTS OF
chapter, we will review the nature and impact of STRESSORS
stress, risk and resilience factors, and different
1.2.1 THE NATURE OF STRESSORS
methods of coping with stress.
One factor that influences an individual’s
response to stress is the nature of the stressor(s).
1.1 INTRODUCTION
Greater perceived severity of the stressor and
Psychological stress is the physical and/ longer duration of the stressor are associated
or psychological outcome of a perceived with more problematic stress responses (Dyb et
environmental demand on an individual (Cohen al., 2014; Gil, 2015; Sayed et al., 2015; Xue et
et al., 2007). The environmental demands al., 2015). Perceptions of stressor severity are
that promote psychological stress (stressors) subjective and can be quantified in a number of
can come in a number of forms, ranging from different ways. For example, research suggests
chronic stressors such as chronic illness and that greater perceived stressfulness and greater
community violence to time-limited high- interpersonal impact of stressors are associated
severity stressors, such as natural disasters with a worse stress response (Martin et al., 2013;
4 Emotion, Well-Being, and Resilience

Martinez-Torteya et al., 2009). Closer proximity an overload of numerous stressors of varied

to the stressor is also associated with worse severity may lead to allostasis, the breakdown
responses (Gil, 2015; Silwal et al., 2018). This of physiological processes from the overpro-
is especially evident in the case of vicarious duction of cortisol, creating negative effects for
traumas. For example, research suggests that brain, immune system, and cardiovascular func-
witnessing injury or death first-hand is especially tioning (McEwen, 1998).
predictive of outcomes such as post-traumatic There is a broad literature suggesting an
stress disorder (PTSD; Cheng et al., 2014; Xue association between psychological stress and
et al., 2015). Proximity can also be relational in physical health problems (for a theoretical
nature. This is evident in studies suggesting that review, see van der Kolk, 2014). The increased
events such as the death of a family member or levels of stress are associated with higher blood
colleague as well as exposure to human remains pressure (Taylor, 2010), increased likelihood
has been found to increase the risk of PTSD in of chronic medical conditions such as cardio-
9/11 first responders (Pietrzak et al., 2014). vascular, pulmonary, and metabolic diseases
Along these lines, stressors can be catego- (Agorastos et al., 2014; Finch et al., 2001),
rized into three general groups: negative events, decreased immune system (Segerstrom &
chronic strains, and traumatic stressors (Thoits, Miller, 2004) and neurological functioning (Qin
2010). Negative events are single aversive et al., 2009), and poorer perceived health more
demands on a person’s life. Meanwhile, chronic generally (Agorastos et al., 2014; Finch et al.,
strains are characterized by demands that are 2001). Risks of these adverse health outcomes
persistent or repeated. Traumatic stressors occur become more likely as the probability of allo-
in situations in which the individual believes stasis increases (Ehlert, 2013). Research further
that there is a threat to their life, bodily integ- suggests that the pernicious effects of stress may
rity, or sanity (Thoits, 2010). All three types of affect health more adversely than tobacco use
stressors prompt physiological and psycholog- and excessive drinking (Toussaint et al., 2016).
ical responses that impact physical and psycho-
logical health.
1.2.3 PSYCHOLOGICAL EFFECTS OF
STRESS
1.2.2 PHYSIOLOGICAL EFFECTS OF
STRESS Stress also has an impact on psychological
health. Higher levels of stress are associated
Psychological stress cues activation of the fight- with poorer perceived mental health, as well
or-flight system of the body. This involves the as increased likelihood of a number of psychi-
body’s production of adrenaline and subse- atric disorders (Folkman et al., 1986; Langner &
quent release of glucocorticoid hormones such Michael, 1963). With respect to these disorders,
as cortisol, which in turn initiates more overt the two syndromes most closely associated with
signals of physiological arousal such as the stress are PTSD and depression (Campbell et
increased heart rate (McEwen, 1998). Not all al., 2008; Colodro-Conde et al., 2017).
stressors result in full activation of the fight- The PTSD is by definition a disorder
or-flight response (Taylor, 2010). However, that develops following exposure to a severe
Stress, Resilience, and Coping 5

(traumatic) stressor (American Psychiatric to stressful experiences is referred to as resil-

Association, 2013). Research suggests that ience (Southwick et al., 2014). Resilience is an
greater duration and chronicity of exposure to umbrella term encompassing a number of over-
the stressor(s), as well as whether the stressor lapping facets, including social, psychological,
is man-made (e.g., a trauma perpetrated by a and cultural factors (Hobfoll, 1989; Southwick
person vs. a natural disaster), are associated et al., 2014).
with more severe and complex PTSD symptoms
(e.g., Kira et al., 2008; for theoretical review,
see Herman, 1992). Greater severity of PTSD 1.3.1 SOCIAL ASPECTS OF RESILIENCE
symptoms is also associated with increases in
somatic (e.g., chronic pain), externalizing (e.g., The support a person receives from his or her
substance use), and internalizing (e.g., anxious, social network has a strong influence on that
depressive) symptoms (Campbell et al., 2008; person’s ability to respond adaptively to stress,
Miller et al., 2008). with higher levels of social support leading to
For its part, depression is a syndrome with reduced psychological problems in the after-
a high genetic component (Kendler et al., math of stressors. A number of studies suggest
2010). However, research suggests that stressful that social support is negatively associated with
events interact with the genetic vulnerability for symptoms of PTSD in veterans, first responders
depression to produce an increased likelihood to the 9/11 terrorist attacks, and survivors of
of developing depressive symptoms (Colodro- natural and man-made disasters (e.g., Cheng
Conde et al., 2017; Kendler et al., 2010). As et al., 2014; Dyb et al., 2014; Galea et al.,
with PTSD, certain kinds of stressors are partic- 2008; Pietrzak et al., 2014; Sayed et al., 2015).
ularly associated with depression. Research This may be particularly the case for financial
suggests that single high-intensity stressors, support. Research suggests that a lack of finan-
interpersonal stressors, and stressors that have cial support is associated with greater severity
the potential to alter a person’s identity, such of PTSD symptoms following natural disasters
as a loss of a job or a loved one, are especially (Cheng et al., 2014; Galea et al., 2008).
likely to lead to depressive symptoms (Brown Findings appear to be similar with respect
& Harris, 1986; Soria-Saucedo et al., 2018). to the association between social support and
Other research suggests that lifetime exposure depression. Several studies of parenting-related
to stress in general and exposure to childhood stress reported by mothers indicate that social
trauma in particular are associated with depres- support is negatively associated with depres-
sion (Hammen, 2005). sive symptoms (Aneshensel & Frerichs, 1982;
Cairney et al., 2003). Research further suggests
that emotional support is particularly linked to
1.3 RESILIENCE TO STRESS lower levels of depression in expecting mothers
(Jones et al., 2005). Thus, the role of social
Not everyone develops physical or psycholog- support appears to be beneficial regardless of
ical problems in the aftermath of stressful expe- the stressor, although the specific type of support
riences, even when the stressors are severe. The that is most effective may vary depending on the
degree to which a person can respond adaptively situation.
6 Emotion, Well-Being, and Resilience

1.3.2 PSYCHOLOGICAL ASPECTS OF and extraversion, is associated with moderate

RESILIENCE levels of PTSD and other symptoms in individ-
uals exposed to traumatic stressors. In contrast,
There are a number of psychological factors high neuroticism combined with low extraver-
that also convey resilience to stress. Much of sion leads to comparatively higher PTSD and
this research has focused on personality traits, comorbid internalizing symptoms, and high
defined as stable individual differences between neuroticism combined with low agreeableness
people that influence their responses to the and conscientiousness leads to higher PTSD and
environment (McCrae & Costa, 2008; Widiger comorbid externalizing symptoms (e.g., Forbes
& Smith, 2008). One trait of particular rele- et al., 2010; Miller et al., 2003, 2004; Miller
vance with resilience is neuroticism, the general & Resick, 2007). With respect to dominance,
predisposition to experience negative affect, results of one study incorporating a clinical
especially in response to stress (Widiger, 2009). sample with a high rate of exposure to traumatic
Research suggests that not only is neuroticism stressors indicated that individuals who were
positively associated with a broad swath of high in dominance had a shorter duration of
mental and physical health problems (including PTSD symptoms compared to those who were
but not limited to PTSD and depression; see low in both dominance and warmth (Thomas et
Jakšić al., 2012; Kotov et al., 2010; Lahey, 2009), al., 2014).
but at high levels also exacerbates (i.e., reduces Another relevant psychological factor that
resilience to) the effects of stress, resulting in influences resilience to stress is self-efficacy,
higher levels of PTSD, depression, and related which can be defined as an individual’s capacity
symptoms (Kendler et al., 2004; Lawrence & to believe in his or her ability to succeed in specific
Fauerbach, 2003; Yalch et al., 2017; Yalch & situations and achieve specific goals (Benight
Levendosky, 2017). Another important trait & Bandura, 2004). Social cognitive theorists
is dominance, which at high levels buffers the hypothesize that high self-efficacy increases
effect of stress on symptoms of PTSD, depres- human agency, thereby improving individuals’
sion, anxiety, and other psychological problems ability to respond effectively to traumatic and
(Bernard et al., 2019; Yalch et al., 2013; Yalch otherwise stressful experiences (e.g., Benight &
et al., 2015). High dominance as well as high Bandura, 2004). Research suggests that high self-
warmth are also associated with less self-crit- efficacy in the face of stress is associated with
ical appraisals of stress (Yalch & Levendosky, lower symptoms of PTSD (Ikizer et al., 2015)
2016), which may indicate a potential pathway and depression (Sawatzky et al., 2012; Tsay &
through which the effects of these traits might Chao, 2002). Similarly, research suggests that
occur. an individual’s belief in their ability to manage
These and other personality traits do not act their anxiety also buffers the effects of stress on
in isolation, but rather interact with each other symptoms of PTSD and depression as well as on
to provide resilience to stressors (for theo- the use of drugs (Schroder et al., 2017). There
retical review, see Miller, 2003). Specifically, is also a reason to believe that unlike person-
research suggests that low levels of neuroticism ality traits, which are viewed as largely stable,
combined with high levels of more adaptive self-efficacy is more fluid and can be modified
traits, such as agreeableness, conscientiousness, to increase resilience to stress. One study found
Stress, Resilience, and Coping 7

that an intervention to increase self-efficacy in language tutors, case managers, etc.), practicing
nurses not only increased levels of self-efficacy, culture consistent with their country of origin,
but also decreased levels of secondary traumati- and having a high degree of religiosity also
zation (Berger & Gelkopf, 2011). increase resilience (Sajquim de Torres & Lusk,
2018; Goodman et al., 2017). For individuals
identifying as sexual minorities, connection
1.3.3 CULTURAL ASPECTS OF RESILIENCE to a community with a similar sexual identity
also promotes resilience (McConnell et al.,
In addition to social and psychological influ- 2018; Monin et al., 2017). In sum, this research
ences on resilience, there are also aspects of suggests that although membership of a margin-
culture that affect resilience. Boardman (2004) alized identity brings with it unique stressors,
found that the stability of the neighborhood affiliation with those who share that marginal-
in which an individual lives can mitigate the ized identity can be a form of resilience.
negative effects of stress on physical health. Other factors that affect individuals’ response
Living in a stable neighborhood increases social to stress are age and sex. Older age is related
capital, the social resources that can be drawn to fewer symptoms of anxiety, depression, and
upon when in need, thus increasing emotional general distress (Jorm, 2000). In contrast, younger
and material resources and creating a sense of age has been associated with decreased resil-
meaning through community (Marmot, 2005). ience when undergoing a stressor, which may be
Neighborhoods tend to differ in terms demo- related to research suggesting that younger indi-
graphic factors that affect individuals’ responses viduals have more pronounced negative affect
to stress, including race, immigrant status, and in response to a stressor than older individuals
identification as a marginalized sexual minority. (Diehl et al., 2012). Other research has supported
There are also resources related to race and this finding, suggesting that older adults react in
ethnicity associated with increased resilience. more adaptive ways to stress than younger adults
Higher levels of socialization with and higher (Schilling & Diehl, 2015). With respect to sex,
perceived social support from one’s racial/ the research suggests that women are more likely
ethnic group are related to increased resilience to report exposure to stressful experiences that
in the face of adversity in African American and are interpersonal in nature, including traumatic
Mexican American samples (Berkel et al., 2010; stressors perpetrated by people close to them,
Brown, 2008). Socialization with people who and exhibit more psychological symptoms (e.g.,
are similar racially/ethnically is postulated to be of PTSD and depression) in response to these
a protective factor against the negative psycho- stressors than men (Goldberg & Freyd, 2006;
logical effects of racial discrimination (Brown Martin et al., 2013; Nolen-Hoeksema, 2001; Tang
& Tylka, 2011; Neblett et al., 2006), which is & Freyd, 2012; Tolin & Breslau, 2007). Women
itself a unique stressor for minority subscul- are also less resilient to stress compared to men
tures (Finch et al., 2001; Flores et al., 2008; following a loss of social support (Olff, 2017). In
Williams et al., 1997). Similarly, the research contrast, men have been found to be more vulner-
suggests that among immigrant populations, able to the cardiovascular effects of stress than
giving and receiving social support, as well as women and children (Allen et al., 1997).
having access to social resources (childcare,
8 Emotion, Well-Being, and Resilience

1.4 STRESS, RESILIENCE, AND COPING (Schilling & Diehl, 2015). The preference for
task-focused coping in older adults appears to be
Coping refers to behaviors to manage stress that mediated by a positive affect such that as people
crosses a threshold of tolerability (Lazarus & age they become more positive, and therefore
Folkman, 1984). Coping comes in a number of more likely to focus directly on a stressful task.
different forms and can be categorized as task- Engaged (vs. disengaged) coping refers to
focused versus emotion-focused coping and how active a coping behavior is. Engaged coping
engaged versus disengaged coping (Booth & involves actively approaching either the stressful
Neill, 2017; Feinstein et al., 2017; Chen et al., task (e.g., studying for an upcoming exam) or
2018; Delahaij & van Dam, 2017). the aversive emotion (actively managing anxiety
Task- versus emotion-focused coping refers about an upcoming exam). Disengaged coping
to whether a given coping behavior is targeted involves avoiding the stressor and its sequelae
toward the stressor itself (e.g., an upcoming (e.g., by avoiding thinking about an exam and
exam) or the emotions stemming from recog- how anxious one is about one’s lack of prepara-
nizing the stressor (e.g., anxiety). To use an tion for it by playing video games). Research
upcoming exam as an example of a stressor, task- suggests that engaged coping is generally more
focused coping might involve studying for the adaptive than disengaged coping (Feinstein et
exam, whereas emotion-focused coping might al., 2017).
involve taking deep breaths to manage anxiety The level of psychopathology may also influ-
about how well one might do in the exam. With ence how flexible an individual’s use of coping
respect to the efficacy of task- versus emotion- is. The connection between coping styles and
focused coping, research suggests that task- psychopathology can be dynamic and multidi-
focused coping is more effective for stressors rectional such that not only can certain styles
over which an individual might have some of coping lead to psychopathology, but psycho-
element of control, whereas emotion-focused pathology can predispose individuals to certain
coping is more appropriate in the context of coping styles (Heffer & Willoughby, 2017).
uncontrollable stressors (Delahaij & van Dam, Research suggests people who are depressed are
2017; Lee et al., 2016). However, emotion- less likely to seek out and use a broader array
focused coping is most beneficial when coupled of coping strategies (Heffer & Willoughby,
with task-focused coping (Lee et al., 2016). In 2017). This is problematic as people who are
the absence of task-focused coping, focusing on depressed and/or suicidal are more likely to
negative emotions is associated with symptoms rely on emotion-focused versus task-focused
of depression and anxiety, especially among coping. In contrast, someone who is more flex-
women (Hundt et al., 2013; Kelly et al., 2008). ible in their coping (perhaps because they are
There appears to be an association between age not overwhelmed by high levels of symptoms),
and the use of task- versus emotion-focused upon realizing that emotion-focused coping
coping. Research suggests that as people age (e.g., via using deep breathing) has not reduced
they become more likely to use task-focused their anxiety may change their coping strategy
coping (Chen et al., 2018), which may be related to something more task-focused (e.g., trying to
to research suggesting that as people age, they solve the stress-inducing problem; Lee et al.,
become more effective at coping with stress 2016). This suggests that adaptive coping is
Stress, Resilience, and Coping 9

more related to using a flexible range of coping personality) utilize more adaptive coping strate-
styles than it is the use of any one specific style gies and therefore develop increased resilience
(Booth & Neill, 2017; Lee et al., 2016). (Gloria & Steinhardt, 2014). These individuals
with increased resilience in turn tend to utilize
multiple coping strategies at once, likely due to
1.4.1 COPING AND RESILIENCE an ability to identify the most adequate strategy
for each stressor and then employ it, instead of
There is a close association between coping restricting themselves to using a single strategy
and resilience such that a person’s resilience (Lee et al., 2016).
affects what coping strategies are used, and the Resilience and coping may also be influ-
ability to cope effectively with stress affects a enced by the age at which a person is first called
person’s resilience (Booth & Neill, 2017; Lee on to be resilient to and cope with stress. There
et al., 2016). For example, individuals’ coping is some research suggesting that some degree
responses are often affected by their appraisals of early life stressors exerts a positive influ-
of stress, which as research suggests are influ- ence on resilience (Booth & Neill, 2017). One
enced by individual differences such as person- reason for this is that early life stressors change
ality traits (Lazarus & Folkman, 1984). There the perception of stress in later life and influ-
are two general types of stress-related appraisals: ence coping patterns (Turner & Lloyd, 1995).
primary and secondary appraisals. Primary However, research suggests that children who
appraisals concern how severe (e.g., dangerous) experience highly stressful environments early
the stressor is and secondary appraisals concern in their development may be more likely to use
whether and how one can manage the stressor avoidant or aggressive coping styles (Repetti et
(Lazarus & Folkman, 1984). Both kinds of al., 2002), suggesting that in order to be helpful,
appraisals are influenced by psychological early life stress should not be too severe.
resilience factors, such as personality traits in
the case of primary appraisals (e.g., see Yalch
& Levendsky, 2016) and self-efficacy in the 1.5 CONCLUSION
case of secondary appraisals (e.g., see Benight
& Bandura, 2004; Delahaij & van Dam, 2017). Stress can have deleterious effects on indi-
Personality traits can also influence the selec- viduals. This is evident in increases in phys-
tion of coping strategies directly (Parker & ical health problems such as chronic medical
Wood, 2008). For example, high levels of traits conditions and psychological problems such as
such as extraversion may make an individual depression and PTSD. The nature and severity of
more likely to select engaged coping strategies, the stressor both influence the degree of stress-
such as utilizing social support, whereas high related physical and psychological problems.
levels of neuroticism may make an individual However, individual differences in resilience
more likely to utilize disengaged emotion- also influence physical and psychological prob-
focused coping (Pereira-Morales et al., 2018). lems in the aftermath of stressful experiences.
With respect to the dynamic interaction between Resilience includes social, psychological, and
resilience and coping, individuals who experi- cultural aspects as well as the methods individ-
ence more positive emotions (due in part to uals use to cope with stressful events. Resilient
10 Emotion, Well-Being, and Resilience

individuals have robust social support and Benight, C. C., & Bandura, A. (2004). Social cognitive
cultural networks, high levels of agreeableness, theory of posttraumatic recovery: The role of perceived
self-efficacy. Behavior Research and Therapy, 42,
conscientiousness, dominance and extraversion, 1129–1148.
low levels of neuroticism, and a self-efficacious Berkel, C., Knight, G. P., Zeiders, K. H., Tein, J.-Y., Roosa,
view of themselves. Resilient individuals use a M. W., Gonzales, N. A., & Saenz, D. (2010). Discrimina-
range of coping methods with a preference for tion and adjustment for Mexican American adolescents:
engaged, task-focused coping. Overall, indi- A prospective examination of the benefits of culturally
related values. Journal of Research on Adolescence, 20,
viduals’ resilience to stress is idiosyncratic, 893–915.
based upon the interaction of multiple factors Berger, R., & Gelkopf, M. (2011). An intervention for
and leading to a multidetermined physical and reducing secondary traumatization and improving
psychological response. professional self-efficacy in well baby clinic nurses
following war and terror: A random control group trial.
International Journal of Nursing Studies, 48, 601–610.
Bernard, N. K., Yalch, M. M., Lannert, B. K., & Leven-
KEYWORDS dosky, A. A. (2019). Main and moderating effects of
interpersonal style on the association between dating
violence and PTSD symptoms. Violence and Victims,
 coping 34(3), 522–535.
 personality Boardman, J. D. (2004). Stress and physical health: The role
of neighborhoods as mediating and moderating mecha-
 resilience nisms. Social Science and Medicine, 58, 2473–2483.
 self-efficacy Booth, J., & Neill, J. (2017). Coping strategies and the
 stress development of psychological resilience. Journal of
Outdoor and Environmental Education, 20, 47–54.
Brown, D. L. (2008). African American resiliency: Exam-
ining racial socialization and social support as protective
factors. Journal of Black Psychology, 34, 32–48.
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