title: Approach-avoidance coping conflict in a sample of burn patients at risk for posttraumatic stress disorder.
abstract: BACKGROUND
  Following an acute burn injury, higher distress is consistently observed among individuals exhibiting a conflict between approach coping (e.g., processing) and avoidance coping (e.g., suppression) relative to those individuals who use only one of these methods. Study objectives were to determine if contradictory coping messages would lead to such approach-avoidance coping conflict and to determine if experiment-induced coping conflict is also associated with higher distress.
  
  
  METHODS
  Participants (n=59 adults hospitalized with acute burn injuries) were assigned randomly to experimental conditions differing in the order in which training was provided in two ways of coping with posttrauma re-experiencing symptoms (i.e., process-then-suppress versus suppress-then-process). The primary dependent variable was coping behavior during the 24-hr posttraining period. Coping behavior was categorized as approach coping (processing), avoidance coping (suppressing), or approach-avoidance coping conflict (both) on the basis of median splits on subscales assessing these behaviors. Secondary analyses examined the relationship between this experiment-induced coping conflict and re-experiencing symptoms.
  
  
  RESULTS
  Results indicated that participants in the process-then-suppress condition, relative to the suppress-then-process condition, were significantly more likely to exhibit approach-avoidance coping conflict (i.e., above median split on both processing and suppressing) during the next 24 hr. Furthermore, approach-avoidance coping conflict was associated with greater re-experiencing symptoms assessed via self-report and by blinded coding of recorded speech.
  
  
  CONCLUSIONS
  It is concluded that the order of coping skill training can influence treatment outcome, success of coping methods, and overall levels of distress. therefore, training in stabilizing and calming methods should precede training in active processing following stressful life events.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. jfauerba@jhmi.edu
authors.forename: James A
authors.initials: JA
authors.lastname: Fauerbach
authors.forename: John W
authors.initials: JW
authors.lastname: Lawrence
authors.forename: Joshua
authors.initials: J
authors.lastname: Fogel
authors.forename: Linda
authors.initials: L
authors.lastname: Richter
authors.forename: Gina
authors.initials: G
authors.lastname: Magyar-Russell
authors.forename: Jodi B A
authors.initials: JB
authors.lastname: McKibben
authors.forename: Una
authors.initials: U
authors.lastname: McCann
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001143:Arousal; D001362:Avoidance Learning; D001521:Behavior Therapy / Q000379:methods; D002056:Burns / Q000523:psychology*; D003220:Conflict, Psychological; D018592:Cross-Over Studies; D003674:Defense Mechanisms; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D012094:Repression, Psychology; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology*