Escaping reality is a poor coping method for dealing with spinal cord injury


TF Smith (Division of Behavioural Genetics, Rhode Island Hospital, Providence, USA) and others, reported in Spinal Cord that adolescent spinal cord injury patients who use escape-oriented methods, such as wishful thinking, to come to terms with their injury have lower psychosocial health scores than patients who use more active coping methods. 

Smith et al reported: “A youth’s ability to effectively cope with spinal cord injury related daily challenges and lifelong consequences may promote adaption across the domains of functioning.” However, they added that little was known about the coping patterns that adolescents use to deal with a spinal cord injury. Therefore, the aim of their study was to describe the coping strategies that adolescents with spinal cord injury use and review how these coping strategies affect both demographic-/injury-related factors and psychosocial health.

Using data from 182 adolescents (aged 13–18) with a spinal cord injury from a large multisite project, Smith et al found that the two most commonly used coping strategies were cognitive restructuring and resignation. However, the adolescents in the study actually perceived social support and emotional regulation (fifth and sixth, respectively, in the list of most common coping strategies) to be the most effective methods. Furthermore, although wishful thinking was the third most common coping method, it was perceived as being the least effective (alongside self blame).

Overall, escape-oriented methods (which, as well as wishful thinking, includes blaming others and self criticism) were associated with poorer psychosocial outcomes. The authors reported: “Higher scores on the escape-oriented factor were associated with lower PedsQL [a quality of life measure] psychosocial health scores on parent-report (p<0.004) and child-report (p<0.004) forms. In addition, increases in escape-oriented factor scores were associated with higher Children’s Depression Inventory (p<0.004) and Revised Children’s Manifest Anxiety Survey total scores (p<0.004).” They added that active coping strategies were unrelated to psychosocial outcomes. Of those who did use escape-oriented methods, the authors noted that they were generally older, recently injured, or had tetraplegia.

Smith et al commented: “Adolescents with spinal cord injury who largely use escape-oriented strategies may be at greater risk for maladjustment. Therefore, in order to support adolescents with spinal cord injury both during rehabilitation and after rehabilitation, clinicians may attempt to decrease the use of these strategies through the use of techniques such as cognitive behavioural therapy.”

Taylor Smith told Spinal News International: “Although escape-oriented coping may be beneficial in the short-term (eg., using distraction techniques, such as playing video games or watching television, to cope with discomfort), the continued reliance on escape-oriented strategies may make it more difficult to adapt to spinal cord injury in the long-term. Longitudinal research is needed for a more thorough examination of the dynamic process of coping in youth with spinal cord injury.”

This study was funded by Shriners Hospitals for Children.