Emotion-Focused Coping: A Primary Defense against Stress for People Living with Spinal Cord Injury

People living with spinal cord injuries (PWSCI) routinely encounter a variety of stressors. In addition to stressors realized by their able-bodied peers, they experience disability-related problems and stress. According to Livneh and Sherwood (1991), disability-related stress can come from threats to (a) life and well-being; (b) body integrity; (c) independence and autonomy; (d) fulfillment of familial, social, and vocational roles; (e) future goals and plans; and (f) economic stability. It is common for a typical day to present a long series of stressful situations, requiring a variety of coping methods. It is also common for PWSCI to believe they face this stress alone; it is sufficiently unique from able-bodied experiences to render consultation with others, even peers with similar disabilities, futile. Definition of Stress It has been said that stress is a stimulus and cause as well as a response and result (Gerhart, Weitzenkamp, Kennedy, Glass, & Charlifue, 1999). Stress can be a stimulus and cause for such adverse outcomes as heart disease, cancer, hypertension, migraine headaches, peptic ulcers, and allergies as well as adjustment problems and post-traumatic stress disorder. On the other hand, stress can also be the response and result of physical, psychological, and environmental factors that occur with illness, injury or disability, noise, crowding, temperature extremes, or inadequate finances or living situations. Lazarus and Folkman (1984) reported that two characteristics must be present for stress to have an impact on an individual: (a) a given situation must be perceived as being demanding or threatening and (b) the individual must believe he or she lacks sufficient resources to cope with the situation. One study investigated environmental barriers to participation as a significant source of frustrating limitations and consequent stress (Whiteneck, Mead, Dijkers, Tate, Bushnik, & Forchheimer, 2004). The top five barriers, in descending order, were the natural environment, transportation, help at home, health care, and government policies. These factors provided more stress for PWSCI than for able-bodied peers. A discussion of sources of stress begins with demographic factors and ways in which disability complicates already complex factors. Gender is one of the primary issues. Women face gynecological issues that can be complicated by disability. Most women with disabilities can still bear children. Men face issues of their own relating to impotence and low sperm count. When it comes to aging, PWSCI are faced with two sources; in addition to routine concerns related to chronological aging, they are concerned with years post injury. When combined, these two factors have a compound effect. As a result of this compound effect, the average person with quadriplegia starts to realize significant functional limitations at 49 years of natural age, while those with paraplegia begin manifestations at 54 years--many years in advance of when one might assume able-bodied people face the same limitations (Menter, 1993). The level of injury can be another stress factor. With higher levels of injury, the more severe paralysis is associated with more complex and stressful issues. Many people with quadriplegia require daily health aide assistance, have far more hypotension, and often live shorter lives than those with paraplegia (Trieschmann, 1980). Education is another issue. Menter (1993) cited the importance of high school and postsecondary education for PWSCI. He claimed that those educated about how their body functions stand a much better chance at successfully coping. Coping Mechanisms for Persons with Spinal Cord Injury In response to these sources of disability-related stress, PWSCI develop a variety of coping methods. Lazarus and Folkman (1984) defined coping as "constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person" (p. …