Behavioural sciences chapters
Coping, defence mechanisms, conflict and adjustment
How people cope with stress (problem-focused and emotion-focused coping), the main psychological defence mechanisms with clinical examples, types of conflict and frustration, and the difference between adjustment and maladjustment.
- Coping is the conscious effort to manage stress: problem-focused (change the situation) or emotion-focused (manage the feelings).
- Defence mechanisms are mostly unconscious ways the ego protects itself from anxiety (Freud): denial, repression, projection, displacement, rationalisation, reaction formation, regression, sublimation and others; mature ones (sublimation, humour, altruism, suppression) are healthy.
- Conflict arises from competing goals (approach-approach, approach-avoidance, avoidance-avoidance); frustration occurs when a goal is blocked; healthy adjustment meets needs in socially acceptable ways.
On this page
Overview
When stress strikes, people respond in two broad ways:
- Coping: conscious, deliberate efforts to manage the problem or the feelings.
- Defence mechanisms: mostly unconscious mental processes that protect a person from anxiety and painful emotions.
Recognising these in patients (and ourselves) helps doctors respond with understanding instead of irritation.
Coping
| Type | Aim | Examples |
|---|---|---|
| Problem-focused coping | Change the stressor or situation | Making a study plan, seeking information about an illness, getting treatment |
| Emotion-focused coping | Manage the emotional response | Talking to friends, prayer, relaxation, crying, distraction |
- Problem-focused coping works best when the situation can be changed.
- Emotion-focused coping helps when it cannot (a death, an incurable illness).
Adaptive coping: exercise, social support, problem solving, faith, humour, seeking help.
Maladaptive coping: smoking, alcohol and drugs, overeating, avoidance, self-harm, aggression.
Resources that help coping: good health, social support, money, problem-solving skills, positive beliefs and religious faith, a sense of control.
Defence mechanisms
Described by Sigmund Freud and developed by Anna Freud: the ego uses them to protect itself from anxiety arising from conflict between the id (instincts), the superego (conscience) and reality.
They are normal and often useful in the short term, but rigid or immature use causes problems.
| Mechanism | Meaning | Clinical example |
|---|---|---|
| Denial | Refusing to accept a painful reality | A woman with a breast lump insists it is "nothing" and delays seeing a doctor; the first reaction to bad news |
| Repression | Unconsciously pushing painful thoughts or memories out of awareness | No memory of a childhood trauma |
| Suppression (mature) | Consciously putting a worry aside to deal with later | A house officer sets aside worry about her own exam to manage an emergency |
| Projection | Attributing one's own unacceptable feelings to others | A man who feels hostile accuses others of hating him |
| Displacement | Redirecting feelings to a safer target | A patient angry at his illness shouts at the nurse |
| Rationalisation | Giving a logical but false excuse for behaviour or failure | "I failed because the paper was out of course" |
| Reaction formation | Behaving the opposite of one's true feelings | Being over-friendly to someone one dislikes |
| Regression | Returning to behaviour of an earlier stage of development | A child bedwets again after a sibling's birth; an adult patient becomes demanding and childlike in hospital |
| Intellectualisation | Focusing on facts to avoid feelings | A doctor discusses the statistics of his own cancer without emotion |
| Sublimation (mature) | Turning unacceptable impulses into socially valued activities | Aggressive energy put into sport or surgery |
| Identification | Taking on the qualities of another person | A student copying a respected consultant |
| Introjection | Taking blame or another's values into oneself | A bereaved son believes God is punishing him |
| Conversion | Psychological conflict expressed as a physical (neurological) symptom | Sudden "paralysis" of an arm after a traumatic event |
| Splitting | Seeing people as all good or all bad | A patient idealises one doctor and condemns another |
| Humour, altruism (mature) | Using humour, or helping others, to manage distress |
Displacement = feelings shifted to a safer target. Projection = own feelings attributed to others. Sublimation = the most mature defence.
Repression is unconscious; suppression is conscious and is a mature coping strategy.
Levels of maturity (Vaillant)
- Mature: sublimation, suppression, humour, altruism, anticipation.
- Neurotic: repression, displacement, reaction formation, intellectualisation, rationalisation.
- Immature: projection, denial, regression, acting out, splitting.
Conflict
Conflict is the presence of two or more competing motives or goals (Lewin):
| Type | Meaning | Example |
|---|---|---|
| Approach-approach | Choosing between two desirable goals | Two good job offers; the easiest to resolve |
| Avoidance-avoidance | Choosing between two undesirable options | Surgery or living with pain |
| Approach-avoidance | One goal with both good and bad features | Wanting to stop smoking but fearing weight gain; often the hardest, causing vacillation |
| Double approach-avoidance | Two options, each with good and bad sides | Choosing between a well-paid city job far from family and a low-paid job at home |
Frustration
Frustration is the feeling that arises when progress towards a goal is blocked.
Sources: external (delays, rules, lack of resources) or internal (personal limitations, lack of ability).
Reactions: aggression (the frustration-aggression hypothesis), withdrawal, apathy, regression, or constructive problem solving.
Adjustment and maladjustment
- Adjustment: the process of adapting to the demands of life and environment while meeting one's own needs in socially acceptable ways. A well-adjusted person copes realistically, maintains relationships and functions well.
- Maladjustment: failure to adapt: persistent anxiety, depression, aggression, substance misuse, withdrawal, or impaired work and relationships.
- Adjustment disorder: distressing emotional or behavioural symptoms that develop within about 3 months of an identifiable stressor and are out of proportion to it, usually settling within about 6 months once the stressor ends.
Most questions give a clinical scenario and ask which defence mechanism is shown. Know denial, repression vs suppression, projection, displacement, rationalisation, reaction formation, regression, intellectualisation, sublimation and conversion. Also expect problem- vs emotion-focused coping, the three types of conflict, frustration, and adjustment vs maladjustment.
Quick revision
- Coping: conscious; problem-focused or emotion-focused.
- Defence mechanisms: unconscious; protect the ego from anxiety (Freud).
- Denial (refuse reality), displacement (safer target), projection (onto others), regression (earlier behaviour).
- Repression unconscious; suppression conscious and mature.
- Mature: sublimation, suppression, humour, altruism.
- Conflicts: approach-approach, avoidance-avoidance, approach-avoidance (hardest).
- Adjustment disorder: within about 3 months of a stressor.
Written by The House Job from the Handbook of Behavioural Sciences by Mowadat H Rana (named in the UHS PGET syllabus).
FAQ
What is the difference between coping and defence mechanisms?
Coping is a conscious effort to manage stress; defence mechanisms are mostly unconscious ways the mind protects itself from anxiety.
What is displacement?
Redirecting feelings from their real source to a safer target, such as a patient shouting at a nurse because he is angry about his illness.
What is the most mature defence mechanism?
Sublimation: turning unacceptable impulses into socially useful activities.
What is an approach-avoidance conflict?
A conflict about a single goal that has both attractive and unattractive features.