Approach, avoidance, and coping with stress.

The study of stress and coping points to two concepts central to an understanding of the response to trauma: approach and avoidance. This pair of concepts refers to two basic modes of coping with stress. Approach and avoidance are simply metaphors for cognitive and emotional activity that is oriented either toward or away from threat. An approach-avoidance model of coping is presented in the context of contemporary theoretical approaches to coping. The research literature on coping effectiveness, including evidence from our laboratory, is discussed, and speculations are made about the implications for future research. The study of stress and coping has become quite popular in recent years, particularly in regard to traumatic life events. Although the area is broad and the coping process is complex, there is a striking coherence in much of the literature. This coherence is based on two concepts central to an understanding of coping with trauma: approach and avoidance. In its simplest form, this pair of concepts refers to two basic orientations toward stressful information, or two basic modes of coping with stress. Approach and avoidance are shorthand terms for the cognitive and emotional activity that is oriented either toward or away from threat. In this article we will present the case for utilizing the concepts of approach and avoidance to provide a coherent theoretical structure to our understanding of coping with stress. Several different formulations of the approach-avoidance dimension will be reviewed, followed by a brief review of the coping effectiveness literature. Several studies from our laboratory will be used to illustrate the relationship between coping and outcome. Finally, a general approach-avoidance model of coping will be presented, with suggestions for further research to corroborate or extend the theory. The study of coping with stress has been split into two areas: anticipation of future stressful events and recovery from trauma. These areas have been kept remarkably distinct in both theory and research on coping. Although there are clearly important differences between the two cases, we have chosen not to emphasize this distinction. For any given stress, anticipation and recovery are not always clearly separable; dealing with a trauma involves coming to terms with the event itself and with the threat of recurrence in the future. More important, Correspondence concerning this article should be sent to Susan Roth, Department of Psychology, Duke University, Durham, NC 27706. we have identified the same processes as central to coping in both anticipation and recovery periods. A p p r o a c h A v o i d a n c e Formula t ions The approach-avoidance distinction is not new, having historical roots in psychoanalytic theories of defense and working through (e.g., Freud, 1915/1957), and in views of conflict from the behavioral (e.g., Hovland & Sears, 1938; Miller, 1944) and phenomenological (e.g., Lewin, 1951) traditions. In the more recent literature on coping with stress, approach-avoidance distinction is a core idea. One is struck by the extent to which the concepts of approach and avoidance underlie the personality or individual difference variables studied in the anticipatory threat literature, and also the dimensions of coping studied in traumatic stress reaction research. Table l briefly describes 14 of these coping formulations. In the anticipatory threat literature, the repressionsensitization distinction is paradigmatic of the approachavoidance dimension of individual difference: Repression involves an avoidance of anxiety-arousing stimuli and their consequences and is a general orientation away from threat. Sensitization, on the other hand, is the approach toward anxiety-arousing stimuli and their consequences and is an orientation toward threat. Although, as we shall see, there is no clear-cut evidence regarding the effects of individual differences along the approach and avoidance dimensions, the issues for coping and adaptation seem to be the following: Avoidant strategies seem useful in that they may reduce stress and prevent anxiety from becoming crippling. Approach strategies, on the other hand, allow for appropriate action and/or the possibility for noticing and taking advantage of changes in a situation that might make it more controllable. Approach strategies also allow for ventilation of affect. Individual differences along the approach-avoidance dimension have also been a focus of study in the traumatic stress reaction research. For example, Shontz (1975) discussed fragmentation versus containment in response to illness, whereas McGlashan, Levy, and Carpenter (1975) referred to integration and sealing over as two distinct styles of recovery from schizophrenia. To illustrate, fragmentation is a form of denial in which people split themselves off from their illness, resulting in an unstable selfsystem. Containment is the incorporation of threat into an integrated self-structure, without overwhelming the self. Horowitz's (1976, 1979) formulation of the approach-avoidance dimension in response to stress is the most fully developed and will be discussed in more detail. July 1986 9 American Psychologist Copyright 1986 by the American Psychological Association, inc. 0003-066X/86/$00.75 813 Table 1 Summary of Approach-Avoidance Coping Formulations Coping formulation Avoidance Approach Measurement Perceptual defenseperceptual vigilance (Bruner & Postman, 1947) Avoidance-vigilance (Cohen & Lazarus, 1973; Janis, 1958, 1977, 1982) Repression-sensitization (Bell & Byrne, 1978; Byrne, 1964) Repression-sensitization (Gudjonsson, 1981; Houston & Hodges, 1970) Nonvigilant-vigilant (Averill & Rosenn, 1972) Selective inattentionselective attention (Kahnemann, 1973) Inaccurate-accurate expectations (Johnson & Leventhal, 1974) Reducers-augmenters (Petrie, 1978) Blunting-monitoring (Miller, 1980; Miller & Mangan, 1983) Rejection-attention (Mullen & Suls, 1982) Sealing over-integration (McGlashan, Levy, & Carpenter, 1975) Relative deficit in perceiving threatening stimuli Procrastination, giving up of personal responsibility, inadequate search of environmental cues, restricting thought about the stressor, and failure to appraise the situation and make contingency plans Avoidance of anxietyarousing stimuli and their consequents, selective inattention and forgetting, and low anxiety Low subjective distress plus high electrodermal indicators of distress Preferences for unsignaled shock, even when avoidance possible Inattention to selected (eg , threatening) elements of the perceptual field Not having accurate information about what to expect regarding a threatening situation Ignoring warning signals and information about hazards; tolerance for pain Seeking distraction, relaxing, denying threat, practicing detachment and intellectualization Orientation away from stressor and one's reactions to it In regard to recovery from a schizophrenic episode, a lack of curiosity about the experience, a shifting of responsibility onto others, a negative view of the episode, an isolation of the episode from the rest of the person's life, and a failure to grow from the experience Relative readiness to perceive threatening stimuli Alertness; self-responsibility; thorough, active searching; seeking knowledge; careful appraisal and planning Orientation toward anxietyarousing stimuli and their consequents, selective attention and recall, and high anxiety High subjective distress plus low electrodermal indicators of distress Preference for signaled shock, even when no avoidance possible Attention to threatening elements of perceptual field Having accurate information about what to expect regarding a threatening situation Attending to warning signals; intolerance for pain Vigilance, anxiety, and orientation toward threat Orientation toward stressor Curiosity about the experience, taking selfresponsibility, positive view of episode, incorporation of episode into the person's life Tachistoscope word recognition paradigm Interviews or observer ratings