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What can we learn from IMMERSE about coping in daily life?

Throughout our daily lives it is natural to encounter highs and lows, both in terms of the external events we face but also in terms of our own internal thoughts and feelings. We can quite often swing from feeling quite calm, to stressed, within a matter of seconds (for example when I realise an important email I was supposed to send is still sitting in my drafts). Our ability to navigate these ups and downs successfully without feeling insuperably overwhelmed, is suggested to be a marker of good psychological wellbeing.

The current understanding of how we manage these daily life highs and lows, is that each individual carries a ‘toolkit’ of strategies. It is thought that as we steer through each up and down, we subconsciously select from this toolkit and apply these strategies to help us regulate ourselves and cope with each situation at hand. This is known as emotion regulation (or also coping) and it is something we all do to some degree. One key strategy, and the strategy I am most interested in in my PhD, is experiential avoidance. Experiential avoidance is an umbrella term used to describe the process by which an individual may attempt to cope with stressful situations or feelings by avoiding them all together. This may result in the individual actively attempting to reduce the frequency of situations, behaviours, emotions, or thoughts, which are perceived to be painful (Hayes et al. 1996).

Research around coping strategies, including avoidance, has leaned towards categorising strategies as helpful (adaptive) or unhelpful (maladaptive), in terms of their utility in helping us regulate ourselves and deal with stressful situations and in terms of our mental health. Intuitively, this may make sense. For example, the ability to re-appraise a situation to lessen its emotional impact seems like it may be helpful when managing a stressful situation; avoidance of the issue and suppressing these feelings seems as though it can only lead to negative outcomes.

However, more recently it has been proposed that to assume each strategy is either adaptive or maladaptive is a fallacy. Instead, focusing on avoidance, I seek to demonstrate in my PhD (using data from the IMMERSE project) that is it not the degree to which you do, or do not, use certain strategies in day-to-day life that predicts mental health symptomology and negative outcomes but rather how you use them as well as the context within which you might use them. Let me provide a real-world example to demonstrate this idea. Say you have multiple essays due in close succession. We are all likely to feel fairly stressed about this, so it is natural to suppress these overwhelming feelings of stress and to try to avoid thinking about the next few essays, so that you can focus on the current one. In this case, applying this ‘tool’ (avoidance) to this situation can actually allow us to focus on writing each essay as it comes and helps us avoid feeling overwhelmed by the stress of multiple other deadlines. Indeed, in this situation applying avoidance could be considered adaptive. However, imagine that you not only start to avoid thinking about the other essays, but you also start to procrastinate writing the current one because you are feeling so stressed. Imagine it gets to the point where you avoid going to the class that the essay is due for as it reminds you of this stress, or imagine you actually stop thinking about the essay altogether to avoid the feeling of panic. This demonstrates the tipping point in which a strategy is no longer helpful and is actually maladaptive.

So, how does this all relate to the IMMERSE project? Well, the IMMERSE project has designed an app based on Experience Sampling Methodology which allows us to capture a patients’ mental health symptoms, and the coping strategies they use, in their day-to-day lives. We are also able to understand how effectively someone might be applying these strategies in their daily life. In my PhD I am aiming to better understand how the variability within which a patient applies avoidance in their daily life might predict mental health symptoms. The idea being, the better someone can flexibly apply avoidance across different contexts and emotions, the better their mental health may be. I am also interested to see whether the variability within which someone is able to apply avoidance improves throughout therapeutic intervention and therefore whether it may be a viable target mechanism of change in therapy.

The IMMERSE project provides the perfect way to look at these questions as patients will use the app to track their mood and coping for multiple timepoints across a year. Check back in when recruitment is finished to find out if I have any preliminary results!

References

Hayes SC, Wilson KG, Gifford EV, Follette VM, Strosahl K. Experimental avoidance and behavioral disorders: a functional dimensional approach to diagnosis and treatment. J Consult Clin Psychol. 1996 Dec;64(6):1152-68. doi: 10.1037//0022-006x.64.6.1152. PMID: 8991302.