Coping strategies: a case study of an African-American male.
Article Type: Case study
Subject: Hypertension (Development and progression)
African American men (Case studies)
African American men (Health aspects)
Stress (Psychology) (Research)
Stress (Psychology) (Health aspects)
Author: Norman, Mario V.
Pub Date: 09/22/2008
Publication: Name: Annals of the American Psychotherapy Association Publisher: American Psychotherapy Association Audience: Academic; Professional Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2008 American Psychotherapy Association ISSN: 1535-4075
Issue: Date: Fall, 2008 Source Volume: 11 Source Issue: 3
Topic: Event Code: 310 Science & research
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 187049614
Full Text: [ILLUSTRATION OMITTED]

African Americans are inclined to experience greater stress than their Euro-American counterparts. African Americans must daily suffer the annoying micro-aggressions such environments breed, such as, being ignored for service, assumed to be guilty of anything negative, treated inferior, stared at because of color, ridiculed because of hair texture, or singled out for being different (Carroll, 1998). Considering the disproportion of unemployment, access to health care, poverty and educational attainment, African Americans are arguably the most stressed population in the United States. Moreover, African Americans, particularly males, run a greater risk of hypertension and other illnesses at have been linked with stress. Although there are limited research findings on coping styles to reduce stress by African Americans, this study extends that body of research. A tape-recorded interview was used to explore the cognitive aspects of stress appraisal and coping. The findings supported three major themes: the importance of spirituality, being proactive in coping with stress, and routine exercise.

We live in a world that includes many stressful circumstances. Many use jogging, going to health clubs, and diet to reduce tension. Many corporations have developed stress management programs. According to the National Mental Health Association, 75-90% of visits to physicians are stress related (Bradley, 1997). These staggering statistics continue to escalate as people become busier. Stress-related disorders are a major cause of increasing health-care costs.

Television and news articles regularly warn about the dangers of stress. A certain amount of stress is adaptive. In fact, certain individuals may view stress as a motivator; others may not. The key is to maintain a balance between being challenged and being overloaded by stress. Stress may cause not only psychological problems but also contribute to physical illnesses ranging from a common cold to a heart attack. Many people may have difficulty discerning when stress has increased to dangerous levels (Bradley, 1997).

How can one tell if stress is excessive? Everyone faces strains from family, social, and personal pressures. Does this mean one is over-stressed? An individual's stress load is determined not so much by the demands of life or the number of stressors one has. What counts is one's response to those stressors. In other words, how well does one cope or handle those stressors?

Stress is one of those terms that is not easy to define. Mental health professionals and researchers debate whether or not stress is represented by threatening events or responses to these demands. Richard Lazarus (1966) has been an effective proponent of the need to define stress in terms of both a stimulus and the individual's response to the stimulus. He argues that stress arises not from life events themselves but from an individual's primary appraisal or cognitive evaluation of the challenge, threat, or harm proposed by a particular event (Lazarus & Folkman, 1984). Lazarus asserts that any given life event is a stressor only when it is considered stressful by the individual.

In some cases, a specific cultural group may be exposed to pervasive stress that is unique to that group (Berry & Ataca, 2000). Stressor disparities can be found by specific cultural groups (Mino, Profit, & Pierce, 2000). Feldman-Barrett and Swim (1998) emphasized that the discriminatory acts are often ambiguous (e.g., the salesperson seemed to be ignoring me). Hence, theorists assert that minority group members may experience stress not only from explicit discrimination in ambiguous situations but even from the anticipation of the possibility of discrimination in upcoming events (Weiten & Lloyd, 2006). In addition to discrimination, members of ethnic minorities experience stress because they are keenly aware of negative racial stereotypes and often worry that others will interpret their behavior in ways that confirm these derogatory stereotypes (Steele, 1997).

With regard to race, Veroff, Douvan, and Kulka (1981) concluded that adult African Americans tend to experience greater stress than do Euro-Americans. Everyone, regardless of race, experiences work-related stress; however, African-American professionals often feel high-tensed stress because of individual working styles that conflict. There could also be frustration over being passed up for promotions and exclusion from information networks (Underwood, 1992). in a study of 520 African Americans, 96 percent of the respondents reported experiencing some type of racist discrimination in the most recent year, and 95 percent of these participants indicated that they found this discrimination to be stressful (Klonoff & Landrine, 1999). Some researchers point out that race-related stress may contribute to increased risk for disease, instability, and premature death (Gary, 1993). African-American males are faced with additional stressors (e.g., fewer job opportunities, lower income, and increased exposure to violence), which may place them at a greater risk for developing hypertension (Hediger, Schell, Katz, Gruskin, & Eveleth, 1984) and recurring symptomatology (Jones, 1989). Peters (2006) suggests that racism is an omnipresent, painful reality confronting African Americans on a routine basis; embedded in social norms and expressed interpersonally, institutionally, and culturally, racism is a chronic, cumulative stressor.

[ILLUSTRATION OMITTED]

There has been a significant amount of research activity focused on how individuals cope with stress (Oakland & Ostell, 1996). Empirical research is limited concerning the type of situations African Americans view as stressful as well as the coping strategies. Baldwin, Harris, and Chambliss (1997) suggested racial differences regarding the effects of stress may be attributed to different coping styles. Qualitative research would be useful in exploring the cognitive aspects of stress appraisal and coping with the African-American population (Baldwin, Harris & Chambliss, 1997).

The objective of this study was to identify coping styles through a case study of an African-American male who had been successful in managing stress. Additionally, these coping styles may be used to decrease health risks that are related to stress and may contribute a basis for further research. According to Folkman and Moskowitz (2000), most models of stress do not emphasize positive ways to deal with it or, adaptational significance. They do not describe the kinds of coping processes that people use to generate or sustain positive health given enduring stress. Folkman and Moskowitz's (2000) theory of positive affect of stress provided the basis for the quest to identify successful coping strategies.

African-American men are diverse in terms of their socioeconomic status, values, belief systems, political ideology, sexual orientation, racial identity, and other social variables; the one commonality among them is the experience of societal racism and oppression (Elligan & Utsey, 1999). Although often overlooked, qualitative methodologies are important sources of information and have been identified as an important research tool in the development of a more substantial research knowledge based on racialized minority groups (Sue, 1999).

Methodology

A case study approach was conducted to identify an African-American male's concept of stress and his successful coping styles. An interview that began with basic questions that were presented in an informal, conversational style was conducted to gather data. The basic questions inquired about his personal history including his age, education, and marital status. After this information was collected, the domains of the interview were discussed: How does the interviewee define and successfully manage stress? Moreover, the interviewee was asked to describe what behaviors were important in maintaining good health. How did he perceive stress to influence his health? The Human Subjects Review Board approved the study prior to the interview.

[ILLUSTRATION OMITTED]

The interviewee was a married, 24-year-old African-American male who was a college graduate. He was currently working as an account manager with hopes of returning to school to earn an advanced degree. The interviewee may have experienced some anxiety related to being interviewed and/or recorded. In the event of a reaction, the principal researcher's name and telephone number was given to the interviewee. The interviewee also had the right to withdraw from the study at any time.

Data Analysis

After the interview, the audiotape was transcribed verbatim by the principal investigator. The data were reviewed carefully to explore any emerging themes. The researcher listened to the audiotape several times and also re-read the transcriptions.

Findings

To the participant, defining stress was slightly problematic despite his perceived experience with stress. He indicated that stress "affects your normal routine, it causes tension and anxiety ... uncontrollable feelings that affect your performance in everyday life." There are several accepted definitions of stress depending on the context being addressed. Pioneering research was performed by Cannon (1935), Selye (1956), Lazarus (1966), Benson (1975), and Rahe & Arthur (1978). Recognizing that there are many definitions of stress, for the purpose of this case study, Lazarus' (2000) model of defining stress as both a stimulus and the individual's response to the stimulus was used.

Discussing the influence of stress on health resulted in conversations about the influence of stress on his health. The participant responded, "I know that there is a direct correlation with stress and my health. Ugh, during the course of the winter months, sometimes if it (stress) hangs around too long I can feel my immune system kind of getting weak. Then I can feel a cold coming on." He was later asked about his perception that his stress contributed to his immune deficiency. He added that he knew of this from reading and watching television but more so from experience.

Lazarus (1993) and Haan (1992) suggested that coping represents a subset of adaptational activities that involve effort. From this perspective, coping is a conscious choice. According to Lazarus and Hann, automatized adaptive behavior that requires neither concentration nor effort does not qualify as coping. For example, the participant found that his routine of "predicting and role-playing stressful situations" was usually successful in managing stress. Wills (1997) argued that over time, effective coping strategies may become routinized. Although such thoughts and behaviors are no longer conscious or requiring great effort, they are nonetheless examples of coping.

There is a growing recognition that, along with negative outcomes, there are positive outcomes of stress (Park, Cohen, & Murch, 1996). Accordingly, researchers and theorists have begun to explore a range of novel concepts including, among many others, stress-related growth. To illustrate, the participant indicated that stress "motivates me to exercise regularly." This, in turn, may result in better overall health. He added that, "I immediately feel better after working out ... depending on the week I may run about six to nine miles per week." He indicated that his lifestyle had modified to incorporate time for exercise and relaxation.

Examples of spirituality were plentiful in the interview. The participant was a self-identified Christian who indicated several times that reading his Bible and praying were helpful in coping with stress. Having a strong belief in God seemed to be an important coping mechanism for the participant, whether he was facing discrimination, frustration, or trying to lighten a potentially explosive situation. He explained, "I think that anybody who has Jesus Christ as his Lord and Savior knows that there is nothing to be stressed out about. You will have those days where you feel that you can conquer those situations. But even if you don't conquer those situations, I mean, you can have satisfactory peace of mind knowing that however things turn out, that you have a Savior who paid the ultimate price for your salvation, and that's what put me at ease." In addition to the beneficial impact of religiosity on health and well-being outcomes, it is possible that spirituality may serve as a protective function as well (Wallace & Bergeman, 2002). Overall, religion and spirituality are conceptualized as resources from which individuals draw in times of stress to help cope with and adapt to changing life circumstances (Wallace & Bergeman). In a study conducted by Wallace and Bergeman, spirituality and religiosity were used as a coping resource in a variety of ways, not just in response to crises, but also in dealing effectively with life's daily hassles. Throughout its history, the African-American church has played a significant role in the provision of social support and services.

By understanding African-American men's perspectives on stress and coping and the implications on health, professionals can assist that population in maintaining and promoting a high quality of life. There is additional need within mainstream literature to consider the influence of racial and ethnic background, as well as social positions and societal contexts (e.g., socioeconomic status) as contributors of coping styles among African Americans (Greer, 2007). Research must proceed in this area to help meet the needs of this portion of the population. Many studies have researched the implications of stress; however, only a few studies have focused on African-American males. Although case studies are well known to have a lack of generalizability, this study represents a beginning step in defining successful coping strategies for African-American men.

The final aspect of this study relates to the identification of several healthy behaviors in which the participant engaged. The findings of this study supported three major themes: the importance of spirituality, taking an active role in coping as he demonstrated the ability to predict and role-play potential stressful situations, and routine exercise to help relieve stress while promoting better physical health. By incorporating African-American men's perceptions of stress and coping and the implications into health-care professionals' frame of reference, a higher level of quality of life can be achieved, along with a higher level of compliance with treatment plans, which maybe developed collaboratively.

Coping with Stress

Regardless of race, many Americans experience stress on a daily basis, whether by work, school, or personal stressors. Stress can be a positive addition, when it drives a person to move out of harm's way. It can also be a physical detriment when it occurs repeatedly and builds inside the individual.

Possible signs of stress

* Anxiety

* Back pain

* Constipation or diarrhea

* Depression

* Fatigue

* Headaches

* High blood pressure

* Insomnia

* Problems with relationships

* Shortness of breath

* Stiff neck

* Upset stomach

* Weight gain or loss

Once you are able to recognize the signs of stress, there are simple actions that can diminish its ill effects. Doctors suggest that exercise, balanced eating, deep breathing rituals, and meditation can produce calming effects. They also recommend recognizing what you can control and what you cannot and setting realistic goals.

For more information on treating symptoms of stress, please visit your family doctor.

American Academy of Family Physicians. (2006, December). Stress: How to cope better with life's challenges. Retrieved August 19, 2008, from http://familydoctor.org/online/famdocen/home/common/ mentalheahh/stress/167.html

LEARNING OBJECTIVES

After studying this article, participants should be better able to do the following:

1. Identify positive coping styles of an African-American male.

2. Conceptualize how race may influence the perception of stress.

3. Describe how mental health professionals can assist in promoting a high quality of life by implementing positive coping strategies among African-American men.

ABSTRACT

African Americans are inclined to experience greater stress than their Euro-American counterparts. African Americans must daily suffer annoying micro-aggressions, such as being ignored for service, assumed to be guilty of anything negative, treated inferior, stared at because of color, ridiculed because of hair texture, or singled out for being different (Carroll, 1998). Considering the disproportion of unemployment, access to health care, poverty and educational attainment, African Americans are arguably the most stressed population in the United States. Moreover, African Americans, particularly males, run a greater risk of hypertension and other illnesses that have been linked with stress. Although there are limited research findings on coping styles to reduce stress by African Americans, this study extends that body of research. A tape-recorded interview was used to explore the cognitive aspects of stress appraisal and coping. The findings supported three major themes: the importance of spirituality, being proactive in coping with stress, and routine exercise.

KEY WORDS: African Americans, coping, stress, stress management, males

TARGET AUDIENCE: therapists, social workers

PROGRAM LEVEL: Basic DISCLOSURE: The author bas nothing to disclose.

PREREQUISITES: none

POST CE TEST QUESTIONS

1. Identify the successful means of how the interviewee was able to cope with stress.

a) spirituality

b) exercise

c) predicting a stressful situation by role playing

d) all of the above

2. African-American men are faced with additional stressors such as

a) better jobs

b) higher income

c) increased exposure to violence

d) better job benefits

3. Some researchers point out that race-related stress may contribute to

a) increased risk for disease

b) longer life expectancy

c) better job opportunities

d) better educational opportunities

4. According to the National Mental Health Association, what percentage of visits to the physician were stress related?

a) 95% to 100%

b) 10% to 20%

c) 75% to 90%

d) 40% to 50%

Stress may contribute to

a) the common cold

b) hypertension

c) mental health issues

d) all of the above

[ILLUSTRATIONS OMITTED]

References

Baldwin, D. R., Harris, S. M., & Chambliss, L. N. (1997). Stress and illness in adolescence: Issues of race and gender. Adolescence, 32, 839-854.

Benson, H. (1975). The relaxation response. New York: Morrow.

Berry, J. W., & Ataca, B. (2000). Cultural factors. In G. Fink (Ed.), Encyclopedia of stress (Vol. 1, pp. 604-610). San Diego: Academic Press.

Bradley, A. C. (1997). Under pressure: Identifying and coping with stress. American Fitness, 15, 26(7).

Cannon, W. B. (1935). Stress and strains of homeostasis. American Journal of Medical Science, 189, 1-14.

Carroll, G. (1998). Mundane extreme environmental stress and African American families: A case for recognizing different realities. Journal of Comparative Family Studies, 29, 271-288.

Elligan, D., & Utsey, S. (1999). Utility of an African-centered support group for African American men confronting societal racism and oppression. Cultural Diversity and Ethnic Minority Psychology, 5(2), 156-165.

Feldman-Barrett, L., & Swim, J. K. (1998). Appraisals of prejudice and discrimination. In J.K. Swim & C. Stangor (Eds.), Prejudice: The target's perspective (pp. 11-36.). New York: Academic Press.

Folkman, S., & Moskowitz, T. (2000). Positive affect and the other side of coping. American Psychologist, 55, 647-654.

Gary, L. E. (1993). Health status of African-American men. The Urban League Review, 16, 21-31.

Greer, T. M. (2007). Measuring coping strategies among African Americans: An exploration of the Latent Structure of the COPE Inventory. Journal of Black Psychology, 33(3), 260 277.

Haan, N. (1992). The assessment of coping, defense, and stress. In L. Goldberger & S. Breznitz (Eds.), Handbook of stress: Theoretical and clinical aspects (2nd ed., pp. 258-273). New York Free Press.

Hediger, M., Schell, J., Katz, S., Gruskin, A., & Eveleth, P. (1984). Resting blood pressure and pulse rate distribution in black adolescents: The Philadelphia blood pressure project. Pediatrics, 74, 1016-1021.

Jones, R. L. (1989). Black adolescents. Berkeley, CA: Cobb and Henry Publishers.

Klonoff, E. A., & Landrine, H. (1999). Cross-validation of the schedule of racist events. Journal of Black Psychology, 25(2), 231-254.

Lazarus, R. S. (1993). Coping theory and research: Past, present, and future. Psychosomatic Medicine, 55, 234-247.

Lazarus, R. S. (1966). Psychological stress and the coping process. New York: McGraw-Hill.

Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.

Mino, I., Profit, W. E., & Pierce, C. M. (2000). Minorities and stress. In G. Fink (Ed.), Encyclopedia of stress (Vol. 1, pp. 771-776). San Diego: Academic Press.

Oakland, S., & Ostell, A. (1996). Measuring coping: A review and critique. Human Relations, 49(2), 133-155.

Park, C. L., Cohen, L. H., & Murch, R. L. (1996). Assessment and prediction of stress-related growth. Journal of Personality, 64, 71-105.

Peters, R. M. (2006). The relationship of racism, chronic stress emotions, and blood pressure. Journal of Nursing Scholarship, 38(3), 234-240.

Rahe, R. H., & Arthur, R. J. (1978). Life and change and illness studies: Past history and future directions. Journal of Human Stress, 4, 3-15.

Selye, H. (1956). The stress of life. New York: McGraw Hill.

Steele, C. M. (1997). A threat in the air: How stereotypes shape intellectual identity and performance. American Psychologist, 52, 613-629.

Sue, S. (1999). Science, ethnicity, and bias: Where have we gone wrong? American Psychologist, 54, 1070-1077.

Underwood, A. (1992). Coping with on-the-job stress. Black Enterprise, 23, 86-89.

Veroff, J., Douvan, E., & Kulka, R. A. (1981). The inner American: A self portrait from 1957 to 1976. New York: Basic Books.

Wallace, K. A., & Bergeman, C.S. (2002). Spirituality and religiosity in a sample of African American elders: A life story approach. Journal of Adult Development, 9, 141-154.

Weiten, W., & Lloyd, M. (2006). Psychology applied to modern life: Adjustment in the 21st century. (8th ed.). Belmont, CA: Thomson Wadsworth.

Wills, T. A. (1997). Modes and families of coping: An analysis of downward comparison in the structure of other cognitive and behavioral mechanism. In B. P. Buunk & E X. Gibbons (Eds.), Health, coping, and well-being: Perspectives from social comparison theory. Mahwah, NJ: Lawrence Erlbaum Associates Publishers.

Mario V. Norman, PhD, is an Associate Professor of Psychology at Clayton State University. His teaching interests are cross-cultural psychology, social problems, and psychological adjustment with research interests in African-American psychology, stress, and resilience. He perceives professorship in a multicultural context, which is important in his research interests and his style of teaching. His clinical experience includes working with adolescents and adults with a wide range of diagnoses.
Gale Copyright: Copyright 2008 Gale, Cengage Learning. All rights reserved.


 
Previous Article: Demystifying HIPAA.
Next Article: Encounters in the waiting room.