NCLEX · Coping and Defense Mechanisms

A client recently diagnosed with a chronic illness states, 'Well, at least this will give me time to focus on my family and work on my writing.' This is an example of which adaptive coping strategy?

Correct answer

Positive reframing (finding meaning or silver linings in adversity) — an adaptive cognitive coping strategy associated with better psychological outcomes

  1. A Denial
  2. B Positive reframing (finding meaning or silver linings in adversity) — an adaptive cognitive coping strategy associated with better psychological outcomes
  3. C Repression
  4. D Regression

Why this is the answer

POSITIVE REFRAMING (also called cognitive reappraisal or benefit-finding) is an adaptive coping strategy in which the person identifies potential positive aspects or growth opportunities within a difficult situation. This is DIFFERENT from denial: REFRAMING acknowledges the reality of the illness while finding meaning within it; DENIAL would refuse to acknowledge the illness at all. Research shows that positive reframing is associated with: better psychological adjustment to illness; lower rates of depression and anxiety; better immune function; higher quality of life; greater engagement with treatment. COPING STRATEGIES — ADAPTIVE (healthy): PROBLEM-FOCUSED: identifying and addressing the source of stress (seeking information, problem-solving, planning); EMOTION-FOCUSED: managing the emotional response (journaling, talking to someone, exercise, mindfulness); POSITIVE REFRAMING; SPIRITUAL COPING; SEEKING SOCIAL SUPPORT; HUMOR; ACCEPTANCE. MALADAPTIVE (unhealthy): DENIAL (prolonged); SUBSTANCE USE; SOCIAL WITHDRAWAL (excessive); SELF-BLAME (rumination); CATASTROPHIZING; AVOIDANCE; VIOLENCE. RESILIENCE: the ability to adapt well in the face of adversity; can be developed and strengthened; resilience factors include social support, problem-solving skills, optimism, sense of purpose, self-efficacy. PN ROLE: recognize and affirm adaptive coping; avoid pathologizing normal responses; provide a therapeutic environment for clients to explore their feelings; connect clients to support resources; help identify coping strategies that have worked in the past; model non-judgmental acceptance.
Source: NCLEX-PN Test Plan: Psychosocial — Coping, Adaptive Strategies