Assessing coping skills in mental health nurses: is an

occupation specic measure better than a generic coping

skills scale?
Stephen McElfatrick
a
, Jerome Carson
a,
*, Judith Annett
b
, Cary Cooper
c
,
Frank Holloway
a
, Elizabeth Kuipers
a
a
Psychology Department, Institute of Psychiatry, De Crespigny Park, Denmark Hill London SE5 8AF, UK
b
Psychology Department, Glasgow Caledonian University, City Campus, Cowcaddens Road, Glasgow G4 0BA, UK
c
Manchester School of Management, UMIST, PO Box 88, Manchester M60 1QD, UK
Received 21 January 1999; received in revised form 2 June 1999; accepted 12 June 1999
Abstract
The aim of the present study was to compare the reliability and validity of two separate measures of
coping skills when used with mental health nurses. The study compared the PsychNurse Methods of
Coping Scale, a measure developed specically for this population, and the more generalisable coping
skills subscale from Cooper's Occupational Stress Indicator. Both measures were administered via a
postal questionnaire along with the Maslach Burnout Inventory, the General Health Questionnaire
(GHQ-12) and a demographic checklist. Questionnaires were returned by 175 nurses, a response rate of
25%. It was hypothesised that the PsychNurse Scale would be a more reliable and valid measure when
applied to mental health nurses. This prediction was conrmed. Specically the PsychNurse Scale had
higher item total correlations, better inter factor correlations, higher internal consistency, and better
predictive and item discriminative validity. Interestingly, community mental health nurses scored
signicantly higher on both coping scales than ward based mental health nurses. The PsychNurse Scale
is more psychometrically robust than a generic coping skills scale when applied to mental health
nurses. # 2000 Elsevier Science Ltd. All rights reserved.
Personality and Individual Dierences 28 (2000) 965976
0191-8869/00/$ - see front matter # 2000 Elsevier Science Ltd. All rights reserved.
PII: S0191- 8869( 99) 00152- X
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* Corresponding author. Tel.: +44-171-740-5550; fax: +44-171-740-5552.
E-mail address: jeromecar@aol.com (J. Carson).
1. Introduction
Despite receiving widespread attention and undergoing extensive analysis, the mechanisms of
stress and our eorts to deal with it still remain relatively poorly understood. A major barrier to
research is the inadequacy of many of the instruments used to measure stress levels and coping
skills and the multiplicity of denitions employed. The denition given by Folkman is, perhaps,
the most thorough and comprehensive, ``a relationship between the person and the environment
that is appraised by the person as taxing or exceeding his or her resources and as endangering his
or her well-being'' (Folkman, 1984). In keeping with this she denes `coping' as ``cognitive and
behavioural eorts to master, reduce or tolerate the internal and/or external demands that are
created by the stressful transaction'' (Folkman, op cit). Coping is the focus of the present study.
Measures of coping may suer from any of a variety of shortcomings ranging from poor
psychometric and predictive properties to low clinical relevance. Inadequate clinical relevance
may be particularly problematic and is often due to the fact that existing coping measures are
unsuitable. Statistical analyses conducted in a recent study, for example, showed that there
were problems when the coping skills subscale from the Occupational Stress Indicator (Cooper,
Sloan & Williams, 1988) was used with mental health nurses (Carson et al., 1996). The most
probable reason for this is that the Occupational Stress Indicator was designed for use with
individuals in business and industry and not those working in the eld of mental health.
Furthermore, because the stressors encountered by mental health nurses are unusual (Moore &
Cooper, 1998), a specic set of coping strategies may be required to deal with them. Such
strategies can only be properly measured by a scale that takes into account the uniqueness of
coping required by members of this profession.
The PsychNurse Methods of Coping Scale has recently been developed as a specic measure
of mental health nurses' coping skills in order to try and rectify the above omissions. The
purpose of the present study is to compare the statistical properties of the PsychNurse
Methods of Coping Scale with that of a more general measure of coping, namely the coping
skills subscale from the Occupational Stress Indicator (Cooper et al., 1988), when used with a
sample of mental health nurses. The main hypothesis for the study is that the PsychNurse scale
will have better reliability and validity than Cooper's scale when used with this occupation-
group, because it will have fewer ceiling eects and ambiguities.
2. Method
The initial pool of items for the PsychNurse Scale was taken from a wide variety of sources.
Some of the items came from responses to a past study of mental health nurses (Carson, Fagin
& Ritter, 1995), in which 568 nurses were asked, ``What is the main method you use to help
you cope with stress?'' Others resulted from interviews with mental health nurses which were
part of a separate study (Carson, Bartlett, Leary, Gallagher & Senapati-Sharma, 1993) and the
rest were taken from existing measures of coping including the Coping Resources Inventory
(Moos, 1990), and the coping measure used in the National Medical Technologist Study
(Matteson, 1979). This generated a pool of 108 items. These were then given to a group of
mental health nurses, who were asked to rate items according to how much they utilised each
S. McElfatrick et al. / Personality and Individual Dierences 28 (2000) 965976 966
strategy. Items which were not endorsed as coping strategies by the nurses were eliminated. A
50 item version was then piloted with a sample of 76 nurses. Psychometric analyses of this data
led to the 35 item scale used in the present study.
The PsychNurse Methods of Coping Scale (Appendix A) and the coping skills subscale from
the Occupational Stress Indicator (which will from here on be referred to as the O.S.I, see
Appendix B) were administered to 700 mental health nurses in various areas of Northern
Ireland. The Maslach Burnout Inventory, a measure of emotional exhaustion,
depersonalisation and personal accomplishment (Maslach & Jackson, 1986), the General
Health Questionnaire (the 12 item version), a measure of stress and psychological disturbance
(Goldberg & Williams, 1988) and a demographic check-list were also administered. In total,
175 mental health nurses (25%) responded to the study. This response rate is slightly lower
than many comparable studies. It is dicult to state the reason for this. It is possible that as
the research was being conducted as part of an undergraduate research dissertation, that this
may have lowered the response rate. Ninety eight nurses (56%) were ward-based and 70 (40%)
were community-based. Seven (4%) of the nurses did not report the type of setting in which
they work. All nurses were of grade C or above. (For those not familiar with British nursing,
this denotes that all were qualied state registered nurses.)
Comparisons were made between the two scales in terms of item-total correlations, item-
factor score correlations, inter-item correlations, inter-factor correlations and factor-total
correlations. Tests for restriction of range and excessive endorsement frequency and tests for
discriminant and predictive validity and internal consistency were also conducted.
3. Results
3.1. Preliminary analyses
The rst comparison involved an examination of the coecients with which the items from
each scale correlated with the total scores for each scale, using Spearman's Rho. All 35 items
from the PsychNurse Methods of Coping Scale were found to correlate with the total score for
the scale with a coecient of greater than 0.2. However, of the O.S.I. coping skills subscale's
28 items, two correlated with the scale's total score with a coecient of less than 0.2. The
items were numbers 3 (``Buy time and stall the issue'') and 27 (``Try to avoid the situation'').
For these items the correlation coecients with the scale's total score were 0.16 and 0.14
respectively.
Each scale has the following factor structure:
Factor PsychNurse OSI
1. Diverting one's attention away from work Social support
2. Self-regulation and self-attitude Task strategies
3. Social support at work Logic
4. Positive attitude towards one's role at work Home & work rels
5. Emotional comfort Time
6. Involvement
S. McElfatrick et al. / Personality and Individual Dierences 28 (2000) 965976 967
Factor analysis of the PsychNurse Scale was conducted using the Principal Components
method with varimax rotation. All items had a loading in excess of 0.4 and ve factors
accounted for 53.6% of the variance. Factor 1=23.5%, Factor 2=10.9%, Factor 3=8.4%,
Factor 4=7.1% and Factor 5=4.9%. The factor structure of the OSI scale was largely
established by content analysis as factor analysis produced only three main factors (see Cooper
et al., 1988, for further details).
Correlations between item scores and factor scores were examined for both scales. All of the
items from the PsychNurse scale met the required criterion of correlating with their
corresponding factor's score with a coecient of greater than 0.4 (Streiner, 1994). However,
two items from the O.S.I. coping skills scale failed to meet this criterion. Item 1 (``Deal with
problems immediately as they occur'') correlated with its corresponding factor (O.S.I. factor 5)
with a coecient of 0.39 while item 27 (``Try to avoid the situation'') correlated with its
corresponding factor (O.S.I. factor 2) with a coecient of 0.33. For both scales, no two items
correlated with one another with a coecient greater than 0.6.
Examination of the inter-factor correlations for each scale revealed the PsychNurse Scale's
factors to be less empirically distinct from one another than the factors of the O.S.I. coping
skills subscale. The highest inter-factor correlation for the O.S.I. coping skills scale was 0.55
(the correlation between O.S.I. factors 1 and 6) whereas for the PsychNurse scale there were
three correlations over 0.6. These were between PsychNurse factors 2 and 4 (0.60), 3 and 5
(0.66) and 4 and 5 (0.65). However, the interpretation of this nding may be questioned when
a point made by Folkman, Lazarus, Dunkel-Schetter, DeLongis and Gruen (1986) is taken
into consideration; that a single coping strategy may very easily fall into two or more
categories of coping.
For the PsychNurse scale, all ve of its factor scores correlated with the scale's total score
with a coecient of greater than 0.6, the highest correlation involving PsychNurse factor 4
(0.85). The factor-total correlations for the O.S.I. coping skills subscale were much lower. Two
correlations, those involving O.S.I. factors 3 and 5, fell below 0.6 with coecients of 0.46 and
0.59 respectively. This strongly suggests that O.S.I. factors 3 and 5 (particularly factor 3) are
each measuring an entity which is not strictly consistent with what the overall subscale is
measuring.
Items from both scales were also checked for restriction in range and excessive endorsement
frequency. A slightly restricted answering range was found in certain items from both scales.
Eight items from the PsychNurse scale: (5, 7, 12, 14, 20, 26, 28 and 32), were consistently rated
at either 2, 3, 4 or 5 according to the Likert scoring method and ten items from the O.S.I.
coping skills subscale: (1, 2, 9, 15, 17, 18, 19, 21, 22, 26), were consistently rated at either 2, 3,
4, 5 or 6. No items from either scale were found to have an excessive endorsement frequency,
i.e., 70% or more of respondents answering in the same Likert scoring category.
3.2. Reliability
Cronbach's alpha was used to estimate the internal consistency of each scale as well as that
of each scale's sub-scales. The alpha statistic for the overall O.S.I. coping subskills subscale
was 0.80, suggesting poorer reliability than that shown by the PsychNurse scale for which an
alpha statistic of 0.90 was obtained. In addition to this, the alphas obtained for each of the
S. McElfatrick et al. / Personality and Individual Dierences 28 (2000) 965976 968
PsychNurse scale's ve sub-scales indicate adequate reliability (PsychNurse factor 1;
alpha=0.71, factor 2; alpha=0.67, factor 3; alpha=0.76, factor 4; alpha=0.78, factor 5;
alpha=0.71) whereas the alphas for the O.S.I. coping skills scale's sub-scales mostly indicate
very poor reliability (O.S.I. factor 1; alpha=0.53, factor 2; alpha=0.44, factor 3; alpha=0.41,
factor 4; alpha=0.61, factor 5; alpha=0.06, factor 6; alpha=0.50).
3.3. Validity
Face and content validity for the PsychNurse Methods of Coping Scale were ensured during
the rst stage of the scale's development (see Section 2).
The predictive validity of each scale was assessed primarily by examining the extent to which
the size of one's coping range, as measured by each of the two scales, determines whether one
will experience high, moderate or low levels of emotional exhaustion, depersonalisation and
personal accomplishment, as measured by the Maslach Burnout Inventory (Maslach &
Jackson, 1986). Firstly, KruskalWallis Anovas were carried out on the three Maslach
emotional exhaustion groups (high, moderate and low) based on how members of each of these
groups scored on the PsychNurse Methods of Coping Scale. The same was then done on the
Maslach depersonalisation and personal accomplishment groups. In each case, the extent of
coping was found to be signicantly dierent for those in the high, moderate and low groups.
The resulting statistics for the PsychNurse scale are as follows; emotional exhaustion: Kruskal
Wallis Anova, chi-square=17.78, D.F.=2, p <0.01; depersonalisation: KruskalWallis Anova,
chi-square=17.71, D.F.=2, p < 0.01; personal accomplishment: KruskalWallis Anova, chi-
square=24.94, D.F.=2, p < 0.01. In each case the direction of the eect indicates that the
wider the coping range, the lower the amount of burnout experienced. For the O.S.I. coping
skills subscale, none of the resulting statistics came close to being signicant.
Similar tests were then carried out on the two measures using a dierent, though equally
well established stress outcome measure, the General Health Questionnaire (GHQ-12).
Participants were split into two groups, those with high GHQ scores (indicating high stress
levels, scores of 3 or more) and those with low GHQ scores (indicating low stress levels, scores
of 2 or less). MannWhitney U tests were then carried out to detect dierences in the extent to
which the high and low stress groups utilise various coping methods. This time, both scales
yielded statistics that were signicant, (PsychNurse scale: MannWhitney U Test, u=1540, p
< 0.01; O.S.I. coping skills subscale: MannWhitney U Test, u=2253, p < 0.05). The
PsychNurse scale is better at dierentiating between the two GHQ groups. Notably, for both
scales the direction of the eect indicates that the wider one's coping range is, the lower one's
stress levels are likely to be.
Also examined were individual items' predictive power over outcomes. The PsychNurse scale
was found to contain a much greater number of items eective (to a signicant level) in
predicting the extent of emotional exhaustion suered by nurses than the O.S.I. coping skills
subscale. Twenty items out of 35 (57%) from the PsychNurse scale yielded a signicant statistic
when subjected to a KruskalWallis Anova (i.e., the mean emotional exhaustion levels for high
and low usage of these items were signicantly dierent from one another). The Anova
statistics for each of these signicant items can be found in Table 1 below. Interestingly, the
direction of the eect in most cases indicates that high usage results in decreased stress levels.
S. McElfatrick et al. / Personality and Individual Dierences 28 (2000) 965976 969
However, for item 1 (``making plans that have nothing to do with work'') and item 26
(``looking forward to going home at the end of each day''), the eect is in the opposite
direction indicating that high usage of these methods results in increased stress levels. These
methods would appear, therefore, to be ``maladaptive'' rather than ``adaptive'' (i.e., they
increase emotional exhaustion instead of reducing it), although it is important to note that the
context in which a strategy is employed plays a substantial role in determining whether it will
be adaptive or maladaptive (Mullen & Suls, 1982). From the O.S.I. coping skills subscale only
ve out of 28 items (18%) were found to yield a signicant statistic (i.e., revealed a signicant
dierence between the mean emotional exhaustion levels for frequent and infrequent users).
For items 6, 16, 17 and 25 the direction of the eect indicated that high usage helps reduce
emotional exhaustion, but for item 10 (``suppress emotions and try not to let the stress show'')
the eect was in the opposite direction indicating that high usage of this strategy contributes to
emotional exhaustion, indicating that it is a maladaptive rather than an adaptive coping
strategy. The Anova statistics for each of these items can be found in Table 2.
The discriminant validity of each scale was assessed using item discrimination analysis. For
each scale, participants were divided into two groups; those who utilise a wide range of coping
strategies (i.e., those whose coping score was in the top 20% of the overall sample's coping
scores) and those who utilise a rather limited range of coping strategies (i.e., those whose
coping score was in the bottom 20% of the overall sample's coping scores). Examination was
then made of how many participants from each group rated items highly (i.e., with a score of 4
Table 1
Statistics (resulting from KruskalWallis Anovas) for those items from the PsychNurse methods of coping scale
showing sound predictive validity
Item no. Chi-square D. F. Level at which signicant
1 9.99 4 p <0.05
7 8.46 3 p <0.05
8 10.07 4 p <0.05
10 32.69 4 p <0.01
13 28.77 4 p <0.01
14 18.13 3 p <0.01
17 13.91 4 p <0.01
18 21.29 4 p <0.01
19 26.09 4 p <0.01
20 15.80 3 p <0.01
21 16.83 4 p <0.01
22 10.62 4 p <0.05
24 28.94 4 p <0.01
26 9.47 3 p <0.05
27 15.45 4 p <0.01
29 15.97 4 p <0.01
30 24.66 4 p <0.01
31 11.79 4 p <0.05
32 10.13 3 p <0.05
35 19.91 4 p <0.01
S. McElfatrick et al. / Personality and Individual Dierences 28 (2000) 965976 970
or 5 on PsychNurse items or with a score of 5 or 6 on O.S.I. items). Then, for every item, the
number of participants from the ``wide coping range'' group who scored highly, was subtracted
from the number of participants in the ``narrow coping range'' who scored highly and the
resulting dierence for each item was scrutinised. If a strict criterion is taken (i.e., that items
should be rated as ``high'' by a dierence of at least 50% between the two groups), for the OSI
subscale only 6 items (16.7%) meet this criterion, but for the PsychNurses Scale 17 items
(48.6%), meet the criterion. The mean dierence per item for the ``wide'' and ``narrow'' groups
was 15.71 for the OSI and 17.74 for the PsychNurse Scale. Hence items from the PsychNurse
Scale are better able to discriminate between nurses with high or low coping skills.
3.4. Demographic factors
3.5.1. Age
The sample was dichotomised into a younger group, <35 years (n =87) and an older group
>36 years (n = 81). There were no signicant dierences in coping skills on the PsychNurse
Scale. On the OSI, younger nurses scored signicantly higher on items 3 and 28, and older
nurses on item 10.
3.5.2. Sex
Women (n = 117), used Social Support signicantly more than men on the OSI (17.34 vs
15.93, MannWhitney, p < 0.01), while men used Logic more ( 12.63 vs 11.91, Mann
Whitney, p < 0.01). Groups diered on items 8, 12, 22 and 28. On the PsychNurse Scale
women were more likely to use Emotional Comfort as a coping strategy (19.74 vs 18.25,
MannWhitney, p <0.05). Groups diered on items 15, 25, 30 and 31.
3.5.3. Grade
The sample was divided into junior sta (grade E and below, n = 106), and higher grades
(grade F and above, n = 67). On the PsychNurse Scale higher grade sta used signicantly
more coping on items 3, 21, 34 and 35. On the OSI, higher grade sta used item 5 signicantly
more and junior sta item 27 more.
3.5.4. Work setting
The biggest dierences in coping skills were seen in terms of whether nurses worked in
Table 2
Statistics (resulting from KruskalWallis Anovas) for those items from the O.S.I. coping skills subscale showing
sound predictive validity
Item no. Chi-square D. F. Level at which signicant
6 17.65 5 p <0.01
16 19.96 5 p <0.01
17 11.69 4 p <0.05
25 12.07 5 p <0.05
10 27.44 5 p <0.01
S. McElfatrick et al. / Personality and Individual Dierences 28 (2000) 965976 971
hospital or community settings. On the PsychNurse Scale community nurses scored
signicantly higher on Factors 2, 3, 4 and 5. Total PsychNurse score was 133.89 vs 125.33,
(MannWhitney, p < 0.01). Community nurses scored signicantly higher on 15/35 individual
items. On the OSI, community nurses also scored signicantly higher on two Factors, 1 and 5
and their Total scores were 115.21 vs 111.02, ( MannWhitney, p < 0.05). They scored
signicantly higher on six individual items.
Of the four demographic factors, clearly work setting is the most important in determining
the use of coping skills.
4. Discussion
The PsychNurse Scale would appear to be the more reliable and clinically relevant choice for
identifying the coping methods employed by mental health nurses. It shows good overall
reliability and validity. The O.S.I. coping skills subscale was found to be lacking in both areas,
especially in predictive validity. This conrms the main hypothesis of the study, thereby
strengthening the argument that the coping habits of a single occupational group can only be
measured properly if an occupation-specic measure is used.
Interestingly, very few coping scales have been designed specically for use with a single
occupational group. Kirmeyer and Dougherty (1988), have developed a coping skills scale for
police ocers. Such scales boast far greater clinical relevance than more generalisable measures
(Latack & Havlovic, 1992). That is not to say that more generalisable measures are not useful
(there are many situations in which highly generalisable measures represent the more logical
choice, for example, when comparing the coping strategies used by two dierent occupational
groups). These results suggest that studies which concentrate on a single occupational group
ought to take advantage, if possible, of an instrument that is intended exclusively for members
of the group under observation as it will yield more accurate ndings.
The most adaptive and maladaptive coping strategies employed by mental health nurses need
to be accurately identied so that the signicant problem of stress among members of this
occupation can be better addressed. For example, one key way to facilitate reductions in work-
related stress would be to initiate intervention schemes and social support programmes (such
schemes have been found to benet many dierent occupational groups; Aneshensel & Stone,
1982; Cobb, 1976; Cohen, 1990; Dean & Lin, 1977; Gore, 1981; Scalzi, 1988; USDHHS, 1991).
However support mechanisms cannot be eectively established without a sound knowledge
base of the best (and worst) ways that stress can be dealt with (Fagin & Bartlett, 1995;
McAbee, 1994; Moore-Schaefer & Peterson, 1992; Dewe, 1987). These rely on accurate
measures. To date only two studies are reported in the worldwide literature that specically
address the issue of coping in mental health nurses (Trygstad, 1986; Kipping, 1998), and
neither of these used a standardised coping skills measure.
One of the most intriguing ndings to emerge from the present research was that on both
coping skills scales, community mental health nurses use signicantly more coping skills than
the ward based counterparts. The largest research study to date, the Claybury CPN Stress
Study (Carson et al., 1995), found no signicant dierences on the OSI in favour of
community sta. It was for precisely this reason that we felt it was necessary to develop an
S. McElfatrick et al. / Personality and Individual Dierences 28 (2000) 965976 972
occupation specic measure of coping skills, as the OSI had been developed in an industrial
and not a health context. If this nding is conrmed by other studies it will have implications
for stress management interventions.
Appendix A. The PsychNurse Methods of Coping Questionnaire
The following items represent some of the dierent methods a mental health nurse might use
to cope with work related stress. For each item, please circle the number which most accurately
describes the extent to which you use the stated strategy. The key is as follows;
1 = Never 2 = Rarely 3 = Occasionally 4 = Often 5 = All the time
I DEAL WITH STRESS. . .
1. by making plans for myself that have nothing to do with work
2. by having condence in my own ability to do the job well
3. by having condential `one-to-one' supervision
4. by knowing that there are those who hold me dear
5. by discussing with colleagues problems as they arise at work
6. by having a stable home life that is kept separate from my work life
7. through being able to draw upon my own knowledge and experience when necessary
8. through having team supervision
9. by reminding myself that others have placed their trust in me
10. by knowing that, should I ever need them, support and advice are available
11. by having a satisfying sex life
12. by believing in and feeling good about myself
13. through having support from my manager
14. by taking a mature view of the situation
15. by talking to people I get on well with
16. by having a steady partner to turn to
17. by managing my time eciently
18. by knowing that I can depend on other members of sta
19. by having a sense of usefulness and purpose
20. by knowing that my life outside work is healthy, enjoyable and worthwhile
21. by reminding myself that the work I do is being appreciated
22. by detaching myself from work matters when necessary
23. by making a concerted eort to keep myself relaxed and in control
24. by having a good, positive atmosphere around me at work
25. by having a good moan to a friend or loved one
26. by looking forward to going home at the end of each day
27. by being optimistic that everything will work out in the end
28. by having pastimes and hobbies outside work
29. through sleeping restfully
S. McElfatrick et al. / Personality and Individual Dierences 28 (2000) 965976 973
30. by having the freedom to express my views openly
31. by nding out how others have coped in the same situation
32. through the satisfaction I derive from seeing a task through to completion
33. by reminding myself that I am doing my best to help
34. by taking a moment away from it all to gather my thoughts
35. by searching for a positive side to every problem
Appendix B. The Occupational Stress Inventory's Coping skills subscale
How you cope with stress you experience
Whilst there are variations in the ways individuals react to sources of pressure and the eects
of stress, generally speaking we all make some attempt at coping with these diculties
consciously or subconsciously.
This nal questionnaire lists a number of potential coping strategies which you are required
to rate in terms of the extent to which you actually use them as ways of coping with stress.
>Please answer by circling the number of your answer on the scale shown.
Very extensively used by me 6
Extensively used by me 5
On balance used by me 4
On balance not used by me 3
Seldom used by me 2
Never used by me 1
1. Deal with the problems immediately as they occur
2. Try to recognise my own limitations
3. `Buy time' and stall the issue
4. Look for ways to make the work more interesting
5. Reorganise my work
6. Seek support and advice from my superiors
7. Resort to hobbies and pastimes
8. Try to deal with the situation objectively in an unemotional way
9. Eective time management
10. Suppress emotions and try not to let the stress show
11. Having a home that is a refuge
12. Talk to understanding friends
13. Deliberately separate `home' and `work'
14. `Stay busy'
15. Plan ahead
16. Not `bottling things up' and being able to release energy
17. Expand interests and activities outside work
18. Have stable relationships
S. McElfatrick et al. / Personality and Individual Dierences 28 (2000) 965976 974
19. Use selective attention (concentrating on specic problems)
20. Use distractions (to take your mind o things)
21. Set priorities and deal with problems accordingly
22. Try to `stand aside' and think through the situation
23. Resort to rules and regulations
24. Delegation
25. Force one's behaviour and lifestyle to slow down
26. Accept the situation and learn to live with it
27. Try to avoid the situation
28. Seek as much social support as possible
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