Proactive coping in schizophrenia: examining the impact of neurocognitive variables.

Introduction Stress-vulnerability models of schizophrenia have long suggested that multiple confluent variables influence disease outcome, including individual vulnerability and environmental factors (Nuechterlein & Dawson 1984). In general, people with schizophrenia tend to employ poor problem-solving strategies, are more likely to adopt passive coping styles, tend to use fewer types of coping strategies and have a propensity to avoid stressors (Thurm & Haefner 1987, Wiedl 1992, Macdonald et al. 1998, Horan & Blanchard 2003, Lysaker et al. 2003). These tendencies have an adverse effect on symptoms, social functioning, quality of life and risk of relapse, particularly when patients face stressful life events (Norman & Malla 1993, Horan et al. 2007). Although the classical view of coping conceptualizes coping as a compensatory and reactive set of strategies in response to a stressor, a more positive, future-oriented and preventive means of coping, called proactive coping, has more recently been proposed (Greenglass 2002, Schwarzer 2004). Proactive coping, a concept derived from the positive psychology movement, integrates processes of personal quality of life management and selfregulatory goal striving, encouraging individuals to view environmental demands as stimulating challenges rather than as stressors (Greenglass 2002, Greenglass et al. 2006). Proactive coping emphasizes the accumulation and mobilization of resources when needed and allows individuals to manage potential stressful events before they occur to promote personal growth in general and to enhance one’s sense of self-determination (Greenglass et al. 2005, Greenglass & Fiksenbaum 2009). Yanos & Moos (2007) suggest that goal attainment and proactive coping are crucial for the achievement of positive outcomes in schizophrenia. As a multidimensional process, proactive coping requires diverse abilities such as volition, planning, mental simulation, hypothesis generation, monitoring and intentional action according to a plan (Schwarzer 1999, Aspinwall 2005). For this reason, we hypothesize that proactive coping behaviours in schizophrenia depend on a patient’s neurocognitive state. Deficits to a variety of cognitive functions may limit the rate at which people with schizophrenia can learn coping strategies and may also interfere with a patient’s ability to form associations in order to do more than avoid difficulties in his/her daily life. Indeed, cross-sectional data indicate that neurocognitive impairment, particularly on measures of executive functioning, memory and sustained attention, predicts passive avoidance strategies and decreased preference for approachbased coping responses (WilderWillis et al. 2002, Lysaker et al. 2004, 2005, Ventura et al. 2004). In the absence of severe life events, patients with fewer cognitive resources, as estimated by an electrophysiological measure (P300 amplitude), exhibited poorer adaptive coping skills and an elevated risk of relapse (Pallanti et al. 1997). To date, however, no studies have examined the effects of neurocognition on proactive coping in people with schizophrenia. The purpose of the current study was to examine associations between neurocognitive measures and a variety of coping domains, with a primary focus on proactive coping.