The Sewerage System In Malaysia Construction Essay

The Sewerage System In Malaysia Construction Essay Sewerage frameworks are one of the most significant foundations in development of private, mechanical or business venture as it decides the personal satisfaction delighted in by a network. It comprises of a system of underground sewer pipes, siphon stations, sewage treatment plants and slop treatment offices. This framework as a rule works dependent on by gravity because of the incline of the funnel which decreases the significant expense required for siphoning. Sewers are additionally characterized into a couple of classes, which rely upon the sort of wastewater that every one of it conveys. For instance, storm sewers are intended to convey stormwater from rooftops, cleared regions, asphalts and streets; mechanical sewers are intended to convey wastewater produce from the business; sterile sewers are intended to convey the waste water from cooking and washing and the losses from latrines. There is another sort of sewer which is known as consolidated sewers. These sorts of sewers are intended to convey stormwater, modern squanders, and residential sewage. In Malaysia, numerous towns and urban areas utilize the different sewer framework. The wastewater is moved in isolated funnels from storm sewers, modern sewers and sterile sewers. This framework won't experience CSOs (Combine Sewer Overflows) which ordinarily happen to joined sewer. The flooding will cause by stormwater as it were. Sewerage framework is significant as it causes individuals to ship the squanders or sewage away from their places. Consequently, the framework must be working great in light of the fact that ill-advised working framework will prompt contamination and tainting of different parts of our encompassing which influence human life and wellbeing. Subsequently, ordinary upkeep must be done to the current sewerage framework and proper structure must be applied to the new sewerage frameworks to guarantee the sewerage frameworks are in acceptable condition. The effectiveness of the sewerage framework is influenced by the progression of the wastewater. In structuring a sewerage framework, the sort and size of the channel to be utilized must have the option to suit the pinnacle stream. The pinnacle stream depends on the populace equal which is an immediate estimation of the populace in a zone. When planning the sewerage, there is a norm and measures that ought to be followed. The standard code of training for sewerage structure in Malaysia (MS 1228:1991) was received from British Standard; BS 8005:1987. In any case, British Standard may not be as appropriate to Malaysia because of the period and atmosphere factor which have direct impact on the pinnacle stream. This is the fundamental explanation of doing this exploration to see if the standard is reasonable to be utilized in Malaysia. Issue Statement Any sewerage framework will be intended to convey a specific measure of sewage dependent on the populace equal (PE). In sewerage structure, the per capita stream and the pinnacle stream rate (Qpeak) are significant boundaries. In view of British Standard, the per capita stream is 225L/day/individual and the pinnacle stream factor, K is 4.7. Notwithstanding, a past report showed lower per capita stream and pinnacle stream factor in the sewerage framework in Malaysia albeit no definitive outcomes were acquired (Dayalan, 2007). A lower top stream factor will bring about littler channels which will bring about lower cost. Consequently, further exploration is expected to examine the reasonableness of current structure models for sewerage framework situated in tropical atmospheres. 1.3Research Objectives The goals of the examination are: To acquire stream information from pre-decided sewer tributary region. To assess the boundary in the pinnacle stream factor condition for medium scale sewerage catchment framework. To decide the connection between populace of a zone to the pinnacle stream of sewerage framework. 1.4 Scope of Research To gather important data of sewerage plan from chosen written works. To discover significant recipe gave in chosen codes to sewerage plan. To consider the pinnacle stream factor in sewer line that serve the PE estimation of 1000-10000. To quantify stream attributes by utilizing stream meter with work in sensor in sewer vents at Tropicana Indah. To contrast the outcomes acquired and the equation in the standard code. To make suggestion on the possibility of the code recipe to tropical atmosphere. Section 2: LITERATURE REVIEW 2.1 Sewerage System in Malaysia The sewerage framework is intended to gather wastewater or foul sewage created from private, modern and business territories through sewer channels and releases it to the treatment plants or offices to guarantee the sewage is discharged to the regular water bodies in a fitting condition and quality (Geoffrey, 2004). In Malaysia, sewerage frameworks extend from basic latrine with practically zero treatment gave to present day sewage treatment plants that treat the sewage to the ideal quality agreement to condition standard. There are two fundamental sorts of sewerage framework in Malaysia. A reason sewerage framework is either associated with an open sewage treatment plant or an individual septic tank. Indah Water Konsortium (IWK) is dependable to offer support and upkeep to open sewage treatment plants and all the underground channels and furthermore give desludging administrations to individual septic tanks (Abd Aziz, 2006). IWK chose to separate the underground funnel into two segments, open channel and private funnel (Figure 2.1) to ensure that every underground channel work with no issue. Open funnel is under the obligation of IWK and the private channel is under individual duty. An individual need to pay for the IWK administrations when the private channel requirement for overhauling. (Abd Aziz, 2006). http://www.usj23.com/planet_free/sewage_system/Sewage%20System.jpg Figure 2.1 Flow of wastewater from private channel to open funnel (USJ 23 Residence 2.2 Transportation of Wastewater Wastewater is typically moved through sewer pipes that are associated with the sewer mains by mud, cast-iron, or polyvinyl chloride (PVC) pipes that extend from 80-100mm width. The enormous sewer mains can be situated about 1.8m profound or more than that along the centerline of a road or pathway. The little and enormous sewer pipes are made by various material, in which the littler sewer pipes are made of dirt, cement, or asbestos concrete, and the huge sewer pipes are made of strengthened solid development. The progression of wastewater is not quite the same as water-gracefully framework. The water flexibly is shipped to each house by the utilization of weight. Notwithstanding, the wastewater from each house is moves through sewer pipes by gravity. Subsequently, the sewer pipe must laid on slant surface to permit the wastewater to stream at a speed of in any event 0.8m/s and not more than 4m/s. (MS1228:1991). On the off chance that the wastewater streams at speed lower than 0.8m/s, the strong material will in general settle in the funnel which will prompt blockage. Tempest water mains have comparable structure as clean sewers however they have an a lot bigger width than sterile sewers. In specific places, the urban sewer mains are associated with interceptor sewers, which would then be able to join to shape a trunk line. The storage compartment line will at that point release the wastewater into the wastewater-treatment plant. This transportation procedure is appeared in Figure 2.2. As the interceptors and trunk lines will convey the wastewater release from sewer principle, they are normally made of block or fortified solid which can convey more burden than the other funnel. In some cases, they are enormous enough for a truck to go through them. (Norhan Abd Rahman et.al, 2007) http://techalive.mtu.edu/meec/module21/pictures/CombinedSewer.jpg Figure 2.2 Transportation of Wastewater (Michigan Environmental Education Curriculum, Wastewater Treatment) 2.3 Concept Theory In structuring a sewerage pipe arrange, the siphon stations and sewage treatment plants are required to convey and siphon volumetric stream rate. The stream rates are normally estimated in cubic meter every second (m3/s) and should be determined for both existing area use and for anticipated future turn of events. There are two boundaries that are utilized to compute expected stream rates. One of the boundaries is per capita stream. This per capita progression of 225L/individual/day is a normal day by day stream, which implies an individual will deliver 225 liters of sewage in a day. Another structure boundary named populace comparable (PE) of a catchment can likewise be utilized to ascertain the stream rate. PE isn't a proportion of populace. In any case, it is utilized to quantify the assessed number of individuals that utilization the sewage offices. In local locations, the PE is an immediate estimation of the populace in a territory which is determined as five for every home. The PE has an alternate technique for estimation in business zone. It is determined from the floor territory and this PE esteem is viewed as corresponding to the quantity of individuals utilizing a reason during the day which doesn't mirror the populace living in a zone. 2.4 Quantity for Wastewater 2.4.1 Tributary Area Tributary territory is a zone from where the wastewater is being moved to a specific sewer segment. The sorts of exercises around there decide the amount of wastewater being gathered by a specific segment. A review must be done when there is no data accessible on existing regions so as to decide the number and arrangement of people and the sorts of ventures. (Guyer, 2010) Table 2.1 shows the technique for figuring the PE. Table 2.1 Equivalent Population, PE (MS1228:1991) No. Sort of Premises/Establishment Populace Equivalent (suggested) 1 Private 5 for each unit 2 Business: (incorporate amusement/recreational focuses, cafés, cafeteria, theaters) 3 for each 100m gross region 3 School/Educational Institutions: Day schools/foundations 0.2 per understudy Full private 1 for every understudy Halfway private 0.2 per understudy for non-private understudy and 1 for every understudy for private understudy 4 Clinics 4 for every bed 5 Inns (with eating and clothing offices) 4 for every room 6 Manufacturing plants (barring p

Reinventing Government in the United States Post Service :: Politics Mail Papers

Rehashing Government in the United States Post Service In this examination paper, I will talk about a review of rethinking government in the United States Postal Service. The motivation behind rethinking government is to make government work better, cost less, and get results. I will likewise give instances of how rehashing has affected the association. I will address a portion of the historical backdrop of the United States Postal Service, a portion of its arrangements for the year 2000, and how the idea of reexamining government has improved the voice of the client, representative and the business. President Bill Clinton, January 27, 2000 expressed the â€Å"we reevaluated government, changing it into an impetus for new thoughts that pressure both happenstance and duty, and give our kin the apparatuses they have to understand their own problems.† History US Postal Service goes back to 1775 when the Continental Congress named Benjamin Franklin the primary Postmaster General. The United States was a frail confederation of settlements dispersed along the eastern seaboard. The postal framework that was made by Congress helped tie the new country together and made conceivable the development of business. In 1971 the Post Office Department was changed into the United States Postal Service, a semi government company. It turned into a free foundation of the official part of the Government of the United States. The strategic the Postal Service continued as before, as expressed in Title 39 of the U.S. Code: â€Å"The Postal Service will have as its fundamental capacity the commitment to offer postal assistance to tie the Nation together through the individual, instructive, abstract, and business correspondence of the individuals. It will give quick, solid, and effective assistance to benefactors in all zones and will render postal support of all communities.† Today, William Henderson is the 71st Postmaster. He was selected the PMG and CEO of the United States Postal Service on May 16, 1998. The USPS is an office that utilizes 800,000 vocation and 100,000 brief representatives. There are 40,000 Post Offices, and USPS keeps up somewhere in the range of 300 plants across the nation. The Postal Service powers the nation’s economy and conveys a huge number of messages and billions of dollars in money related exchanges every day to 8,000,000 organizations and 250 million Americans. The United States Postal Service is getting increasingly professional and receptive to client needs. In the process they are better ready to rival different bearers, for example, Federal Express and United Parcel Service (UPS).

Section 1 -- Question 4 ----------------------- Satellites Orbit The E

Area 1 - Question 4 - - Satellites circle the earth doing our offering in manners that advance the lives of practically we all. Through electronic eyes from many miles overhead, they lead miners to mineral stores invisble on earth's surface. Transferring correspondences at the speed of light, they recoil the planet until its most far off individuals are just a brief moment separated. They pillar world climate to our lounge TV and guide dispatches through tempests. Plunging low over zones of conceivable threatening vibe, spies in the sky keep up a reconnaissance that helps keep harmony in an unstable world. What number of items, exaclty, are circling out there? The present check is 4,914. The satellites start with a dispatch, which in the U.S. happens at Cape Canaveral in Florida, NASA's Wallops Flight Center in Virginia, or, for polar orbiters, Vandenberg Air Force Base in California. One satellite in 20 is injured by the shock of lift-off, or bites the dust in the inferno of an impe rfect rocket impact, or is pushed into ill-advised circle. A couple basically disappear into the giganticness of space. At the point when a satellite rises up out of the rocket's defensive cover, radiotelemety consistently provides details regarding its wellbeing to nonstop teams of ground controllers. They watch over the temperatures and voltages of the specialty's electronic sensory system and other essential organs, consistently basic with machines whose sunward side might be 300 degress more smoking than the concealed part. When a satellite accomplishes circle - that fragile condition wherein the draw of earth's gravity is coordinated by the outward hurl of the Page 2 - makes speed- - unobtrusive weights cause it to go off to some far away place. Sun based flares cause the satellite to leave circle. Wisps of external environment drag its speed. Like strands of spiderweb, gravity feilds of the earth, moon, and sun pull at the circling spacefarer. Indeed, even the daylight's delic ate stroke applies a delicate push. Should a satellite start to meander, ground groups fire little fuel streams that steer it back on course. This is done sparingly, for weariness of these gases closes a specialty's valuable vocation. Under such burdens, numerous satellites most recent 2 years. At the point when demise is just a second away, controllers may order the specialty to hop into a high circle, so it will climb away from earth, shielding orbital ways from getting excessively jumbled. Others become ensnarled in the gravity web; gradually they are brought into gravitational that fill in as space burial grounds. A satellite for correspondences would truly be an extraordinary reception apparatus tower, hundreds or even a great many miles over the earth, equipped for transmitting messages promptly over the seas and mainlands. Not long after the dispatch of ATWS-6, the Teacher in the sky, (a satellite intended to help individuals) NASA ground controllers prepared its recieving wi re on Appalachia. There is brought evening school classes to teachers whose separation denied open door for headway. The utilization of Satellites is developing quickly as is the various occupations for them.

Why I hate writing free essay sample

Composing is an approach to communicate delightful considerations through paper; there have been individuals who are unpleasant conversationalists yet with a pen and paper make a story that has more importance than any words that left my mouth. At that point there’s me. I’m going to simply come out and state it I abhor composing I completely decidedly loathe it. In the event that I needed to pick among composing and getting a tooth pulled let’s simply state that I would be feeling the loss of a ton of teeth. The reasons I abhor composing are various. I can’t simply single out one of them and state â€Å"This is the reason I despise composing! At that point go on some sensational tirade of an encounter I had years back that drove me to despising composing today. There are numerous things that add to this scorn, one being that I completely detest accounting for myself. I generally have since I was a kid. Straightforward inquiries like â€Å"What did you learn in school today? † irritated the poop out of me, caused me to feel like I was being questioned. I love hearing things in detail yet placing things in detail for another person is a long irritating procedure to me, which sucks on the grounds that such a large amount of composing is detail. At the present time I’m sort of stuck among majors and I’m understanding that I’m requiring composing to an ever increasing extent, there is definitely no chance to get for me to run from it any longer so I should grasp it. Before the finish of this semester I will pick whether I’ll keep being a law major or go with my first decision and study archaic exploration, which has been a fantasy of mine since I was in fifth grade. Whichever way composing is going to have a major influence in the two fields, particularly since I need to get my doctorate. I need composing classes since I need to show individuals how wise I am on paper and face to face. At the point when I distribute a book I need my perusers to feel like they were at the burrow with me or really they’re watching me in court. Another explanation composing has caused me such a great amount of nervousness throughout the years is on the grounds that in all honesty; I have nothing delightful to state. OK I realize that sounds peculiar yet journalists have an approach to make each day exhausting things sound mysterious like â€Å"Her eyes were a sea blue, I had a feeling that I could suffocate in the shade of her eyes. † See, my model wasn’t even great. I basically can’t do it. Why? I don’t know perhaps I’m not in contact with my ladylike side enough to make someone’s eyes appear to be enchanted or make a night sky appear something besides sky. My words doesn’t even have an ounce of magnificence in them, I’m no artist using any and all means; in the event that anything I have the talking examples of an alcoholic at a bar. I need to have the option to paint a picture for my perusers, have them feel what I feel. Truly I’m mindful that I have far to go before I arrive yet I’m ready to attempt. The third explanation composing has been my chief rival throughout the years would be my syntax. I never thought about how to utilize appropriate sentence structure incompletely in light of the fact that accentuation never premiums me and somewhat on the grounds that in any event, when I attempted to learn great syntax it generally turns out wrong. However in the event that I could return in time I would really set aside the effort to learn legitimate language and accentuation or approach the instructor for additional assistance; since right now I understand that there are presumably such huge numbers of linguistic mistakes in this exposition that cause me to appear to be an imbecile. There are times that I do not understand when to utilize a period, comma, or a semi-colon; keeping in touch with me is basically a speculating game 90% of the ideal opportunity for me. Truly, I’ve shown signs of improvement yet my dread of some language Nazi getting tightly to my paper and ridiculing me has made me maintain a strategic distance from endeavoring to compose a paper without being constrained since I was more youthful. What a great many people don’t acknowledge about me is that on the off chance that I could turn into a nice essayist I could never stop. I love talking and composing a paper is simply me talking relentless without some getting irritated and instructing me to quiet down. In the event that I was acceptable author nobody could ever observe me again on the grounds that I would be continually in my home composing something on the web. I’m effectively fixated on blogging sites. Improving my composing abilities would simply take my fixation to an unheard of level. I would get one of those individuals who have a huge number of supporters in light of the fact that I’m continually on the PC blogging something new. Truly I do understand this sounds insane yet I’m revealing to you it would happen I would just leave my space to go to work, school and to discover something to eat. Presently I’m not saying this is correct and positively nobody should live like that however it’s something liable to transpire. I respect my preferred creators who are stunning at symbolism and placing things into subtleties, their ability to cause me to feel like I’m entirely the spot they made is astonishing and I wish I even had a bit of their ability. Furthermore the manner in which somebody composes educates so much concerning how insightful somebody is. My expectation that perhaps this class can assist me with my unreasonable feelings of trepidation with regards to composing, possibly on the off chance that I put forth a concentrated effort in this class I’ll understand that all the years I’ve been abstaining from composing was crazy and absurd. Who knows truly, however I’m ready to attempt which is something I haven’t done previously. So yes I’m not the best with regards to being point by point or making things sound excellent and my language structure is loathsome however I have an entire semester to attempt to compensate for a long time of composing disappointment. Since regardless of whatever sentiments I have about composing it’s a flat out actuality that I can not, at this point flee from it in the event that I ever need to be the best legal advisor/paleontologist I can be and composing is going to have a major impact in my future.

Law Management Business Trade Practices

Question: Examine about the Law Management for Business Trade Practices. Answer: 1. A) With its beginning and initiation in 1914, Wesfarmers, a broadened organization functioning as Western Australias ranchers helpful has supported qualities and reasonable practices in its exchange rehearses. They have accomplished worldwide authority will the assistance of these practices. The organization accomplishes the lucky position it appreciates today through the utilization the arrangement of products and enterprises in an expert and serious premise in this way fulfilling the need of a client (Griggs et al., 2012). The organization works with respectability and trustworthiness both inside and outside reacting to the requirements of the networks. The techniques are taken by the organization in sorting out reasonable exchange are as per the following:- The organization follows hostile to pay off act consenting to the severe laws and guidelines and standards set by the Australian strategy creators. A feasible relationship is kept up with the accomplices working with the breath of approaches and principles set by the organization Wesfarmers (Burrell and McGinn, 2009). Moral sourcing strategies are applied and set as least principles in any event, when working under various conditions and different geo-political areas where rules and guidelines are not so exacting. The organization applies their arrangements and guidelines set by the prohibitive exchange practice area of Competitions and Consumers Act. They work value understanding guideline set by the gauges by fixing a cost underneath which affiliates cannot sell an item. They consent to the strategies set by the Cartel arrangements found in Part IV, Division 1 of Competitions and Consumers Act (Homburg, 2008). B) All the representatives work under moral treatment practice and to expanding flexibly chain straightforwardness. The organization considers it as the need to change an arrangement of finish to elevate culmination not to limit the approaches to build up the business. The organization follows one-sided findings in duty on imported merchandise, and they need to lessen or expelled them to the most reduced levels. The organization additionally follows the assurance of the issuance of exchange hours inside the state or region ward (Thomas, 2010). They likewise maintain the standards of rivalry from the administration fabricates merchandise and items and work on the social and financial cases. The supports are finished by Wesfarmers on the suggestion of marker issuances and appraisals that help in the flourishing of rivalry. The organization complies with the rules set by CCA on the arrangement of segment 46 (1AA) which alludes to the ruthless estimating by a partnership with a considerable offer in the market. This demonstration otherwise called Birdsville Amendment Act places rivalry regarding estimating and piece of the pie and Wesfarmers moves in the direction of nullifying that. Segment 46 additionally gives a dream obscure in nature among energetic and gainful rivalry and this segment ought to likewise should be changed by Wesfarmers (Miller, Sims and Miller, 2013). The organization additionally neutralizes the elements of out of line contracting set the Australian Consumer Law 2010 for business to business contracts. The organization expresses that the law ought to be taken with more consideration to the most extreme degree accessible. The organization has adhered to the principles and guideline of Competition and Consumer Act 2010, guarantees wellbeing security, equivalent business openings and reasonable exchange rehearses. C) The organization will have the option to build its reasonable worth by following the reasonable exchange practice. Fair culmination is predominant in the component of laws, and they ought to adhere to the laws to the best impact. They can make supportable associations with their partners along these lines making a brand picture notwithstanding monetary and lawful developments. They should make their corporate and representatives adhere to the guidelines and guidelines both set out by the cartel law and their laws of hostile to pay off. Reasonable rivalry guarantees great market an incentive as well as help continue the money related practicality of the organization (Tony Ciro, et.al, 2014). The organization ought to be working pair with the policymakers gadgets to make the picture and furthermore empowering the organization has a solid business cycle. The shoppers of their organization ought to get a legitimate item on the best market cost provisioned by the Cartel Law segment part I V, and the clients ought to get an appropriate valuation of their cash. The administrators ought to have the option to fix costs of a specific costs remaining under the arrangements and laws set by the rule of Competition and Consumers Act. Business to business agreements or autonomous business agreements ought to be set under the best possible rules giving explicit terms and conditions (Borgeon and Cellich, 2012). The mean to be taken by the organization is to have both natural and inorganic development that is developing from within with its benefits and funds and furthermore developing inorganically through mergers and acquisitions remaining under the rules set by the demonstration gave by the Competition and Consumer discussion. The fiscal summary ought to be an indispensable declaration in giving the statistical data points of the organization. The organization will have the option to pull in more crowds and financial specialists on the off chance that they remain under the rules wrote by the administering body. The organization will likewise have the option to avoid legitimate hardships since policymakers and administrative associations are viewing the exercises of the organization with a falcon eye see. An unlawful practice from the organization's part will upset the organization's picture before open and speculators the same, and they should show unnatural misfortunes. The counter arrangement laws whenever executed over an organization will give enough alternative of excusing piece of the pie through the assistance of budgetary misfortunes and punishment to be paid (White, 2009). So the organization ought to be adhering to the guidelines and guideline of fixing the cost and market rivalry through the use of resale value upkeep appropriate execution over merger and acquisitions without making any abuse of their given market power. 2. To: the Board of Directors, Bungee World From: Date: Subject: A clarification on the grounds of carelessness and demonstrating of suggestions for settling the potential harm of open. Sir, The case that occurred inside Bungee World demonstrates past certainty that the mishap happened unwittingly. The chief who was accountable for the specific station and security activities of bungee hopping game ought to be considered answerable for the whole demonstration. As a chief of wellbeing activities he ought to have been progressively wary towards his activity. It is the chiefs obligation to check and cross check a wide range of gear and additional consideration needs to suffered as they are chipping away at experience sports with high adrenaline surge (Ong, 2007). Rivalries and Consumer Act puts significance of exchange rehearses done reasonably and morally through all ranges of business doings. Competency gauges of Australian designing delineate the breaking of individual responsibility commitments to network as gave by the proportions of Act II of the National Professional Engineers Register. The demonstration additionally accentuates on the specialized capability and ince ntive to be thought of and given in a specific work environment. As per competency standard of the Australian designing of stage (ii) expresses the penetrating of the individual commitments to the network, work environment worth and specialized capability competency principles 2012 of National Professional Engineers Register (Engineer Australia, 2016). The people arranging the whole occasion ought to have the option to consider all clinical and wellbeing gauges according to the laws and rules. Ailments with adequate control ought to be delineated a doctor or nursing specialist ought to be provisioned to check the parameters of surprising pulse, variation from the norm in the heart musicality, breathing difficulty, back and leg wounds and a few other head wounds. Bungee hopping is viewed as a super experience sport. A great deal of disaster can occur from the bungee hopping occasion. These sorts of occasions can plan a few kinds of wounds including head and spine wounds, eye wounds a nd a few different sorts including eye wounds. On account of Loki a speculation investor, the security saddle appeared to bomb driving this sort of an incident. The stage which holds the security saddle over the bungee hopping stage stopped up out based on harm which may have acquired because of the nearness of sea dampness. The Australian position makes severe arrangements and rule guaranteeing the security of its item and administration based clients Moreover, a person. The wellbeing directors shortcoming was that he has not had the option to relate to this standards and rules of security in this way coming about into an accident which could have been stayed away from by means of appropriate investigation of all wellbeing measures over all divisions. The administration ought to consider the perspectives against the scene of someones valuable life. The flexible rope utilized for the bungee bouncing execution was broken and the organization delivering it ought to likewise be held at risk for imperiling the existence an individual (Nottage, 2010). The broken nature of rope obviously delineates that the organization creating it are not actualizing the rules set by the Competition and Consumer Act, which guarantees the security of a person. The flawed piece is an aftereffect of some low reviewed creation office with no utilization of moral or different laws. Flexible rope considered for bungee hopping comprises of numerous latex strings which once included makes an intense external spread and external part. For this situation the sturdiness is by all accounts missing. With every single due thought put forth to this defense, the steel part appended that the versatile rope that goes about as an equalization creator and setting of a bung ee bounce is by all accounts in a terrible shape. This specific base is answerable for the production of open harms and other physical damage caused to an individual. The demonstration of carelessness is by all accounts directed by the administrator to maintain a strategic distance from this sort

Letting Go of Control

Letting Go of Control Its easy to pretend were in control of every aspect of our lives. Societal norms and tireless advertisements reinforce this message: you run the show; life is what you make of it; have it your way. You are the sovereign king of your own bite-sized kingdom. But much of what occurs around us day-to-day is utterly outside our jurisdiction. We dont know if that oncoming Ford pick-up is going to veer left-of-center and collide head-on with our vehicle. We cant possibly predict that a maniac is going to rob the bank as we drop-in during our lunch break to cash a paycheck. We cant anticipate the brutal storm that floods every basement in the neighborhood. No matter the amount of rigorous planning, the unexpected will occur. Last week, we announced Ryans private mentoring sessions, and the first-day response was astounding. Everything was progressing swimminglyâ€"Ryans mentoring calendar filled up for nearly two monthsâ€"but then, unexpectedly, our website crashed, our files were corrupted, and it would take a couple days to restore everything. In the meantime, no one could access our site, and thus no one else would know about Ryans big announcement. Many thousands of people visit our site each day, so being out of commission for two days was far from ideal. Rome was burning and we couldnt locate an extinguisher. The problem was simply outside our control. Wed never experienced a major website outage before, and we didnt know what to do. As far as we could see, we had two clear options: 1) panic, or 2) let our friends at our hosting company work their magic. If we panicked, the site would still be down, but at least wed be in control, right? Panicking, after all, is just a strange way to regain order in an otherwise disorderly situation. This type of control, however, does no good, and is in fact harmful, unproductive, and detrimental to our mental health. However, if we relied on our hosting company to fix the problem, then we were letting go of control, placing our faith in someone else to do the right thing, which can feel like being stripped naked, exposed while waiting for someone to fetch us dry clothes. The simple fact is that we are not in control. Not of everything, at least. Instead, we control our odds, and if we place ourselves in the most ideal situations often enough, then, odds are, things will sway our way more often than not. Everything else requires a little leap of faith. Perhaps letting go of control is the best way to regain total control. Subscribe to The Minimalists via email.

Odysseus Cyclops Essay - Free Essay Example

Why not take these cheeses, get them stowed, come back, throw open all the pens, and make a run for it? How sound that was (Lines 166-171) This quote implies that Odysseus even knew that the best idea would be to leave quietly and discreetly. He already had everything he needed, and his greedy curiosity would prove to be the downfall of several of his men. The final reason Odysseus was in the wrong for choosing to remain in that forsaken cave, was the fact that he is supposed to be a leader. Leaders are people who make hard decisions and sacrifice things for the safety of his men, and the accomplishment of his goals. Odysseus did neither of those things on the island. As he states I refused. I wished to see the caveman, what he had to offer- no pretty sight, it turned out, for my friends. As stated earlier, Odysseus knew with 100% certainty that he had everything he could possibly need from this island, and had acquired it pretty easily. There was no need to risk everything, especially at the cost of men and mission. One could argue that yes, it is by custom that all hosts treat their guests with respect and kindness, often accompanied by a gift. Odysseus could have reasonably believed that the Cyclops would have felt obligated to help them. He even said, here we stand, beholden for your help, or any gifts you give as a custom is to honor strangers (Line 211-213) His reasoning here is likely that Polyphemus could help him even further. However, this is no reason at all to justify staying in the cave. As stated earlier, Odysseus is a leader of men. Leaders, especially in times of war and struggle, are rational, smart people that are able to judge risks and decide what would be the best for their men. It doesnt take a genius to make a decision to leave that cave. The crew had everything they needed, had taken little time, and had lost nothing. Why risk everything for a gift that may not even exist? The answer; you dont. Odysseus was certainly in the wrong for his actions on the island, especiall y the one to stay in the cave. At this point in The Odyssey, it is safe to say that his character needs to grow if he is to make it home to Ithaca.

The Lathe of Heaven by Ursula K. LeGuin Essay - 568 Words

Sometimes your dreams seem better than reality; sometimes they can be worse than your nightmares. In Ursula K. LeGuin’s The Lathe of Heaven, we follow the character George Orr as his dreams alter the reality of his dystopian world. Sometimes for the better, sometimes for the worse. After an attempt to control his subconscious with drugs, George Orr is forced to attend sessions of psychotherapy with a man named Dr. Haber, the antagonist of the story. He discovers Orr’s ability to dream a new reality and tries to use the power for the greater good of Earth by manipulating Orr’s dreams with an â€Å"Augmentor†. As the new reality begins taking shape throughout the story, the dreams rapidly become more destructive. George also hires an†¦show more content†¦Ã¢â‚¬ËœI suppose that you suggested that there be no more color problems. No question of race.’ † In trying to abolish racism, everyone’s skin is turned gray. No African Americans, no white people. This complicates things when the dream creates a reality where Heather Lelache no longer exists. George cannot let this new normal stand, as the love of his life is now non-existent. Without an issue like this getting in the way, ridding the world of racism is quite a brilliant idea. After previous failed experiments, Haber decides to shoot for all-around world peace. â€Å"Presently he felt a heavy hand on his shoulder. ‘Bad time again? Damn, I thought I’d let you off easy. Told you to dream about peace.’,† Haber says to George. This also proves to be a problem as dreams can never be exactly as we wish they could be. In dreaming about world peace, it is accomplished. However, there is only peace on Earth because there is distress beyond the planet. Aliens are invading the moon, which results in a war between mankind and the extraterrestrials. This unites Earth in peace to fight another species. Seen in all the exa mples, Haber wishes to fix big problems. They just never went right. If Haber had not lost this mind within the power and chaos, he could have been seen as a noble, unsung hero. HisShow MoreRelated Ursula K. LeGuins The Lathe of Heaven and Science Fiction and the Future1234 Words   |  5 PagesUrsula K. LeGuins The Lathe of Heaven and Science Fiction and the Future What will happen in a couple of days? a month ? a year? or twenty years from now? The answer is not known. Author Ursula K. LeGuin gives us the answers about the future from her point of view which can be seen through her article Science Fiction and the Future and her novel, The Lathe of Heaven. Ursula K. LeGuin believes people try to control the future they may have when in reality they have no control over the futureRead MoreThe Dystopian Novel Of Literature2214 Words   |  9 Pagesacross Other Dystopian Texts Along with Fahrenheit 451 another book that continues to bend the minds of readers is The Lathe of Heaven. The Lathe of Heaven is a dystopian/science fiction novel written by Ursula K. LeGuin. In the novel, LeGuin created a character named George Orr who has a supernatural power. The power to turn his dreams into a reality. In the beginning of the book LeGuin lets the reader know that George has been taking pills that would keep him from falling asleep. George was avoidingRead More Perfection in Ursula LeGuins The Lathe of Heaven Essay1933 Words   |  8 PagesPerfection in Ursula LeGuins The Lathe of Heaven Is there such a place where ideal perfection exists? Can our views on social, political, and moral issues ever concur with one another? The answer to these questions is simple - no. The world we live in today is full of social, political, and moral imperfections that hinder our ability to live a life free of evil. In Ursula LeGuins The Lathe of Heaven, this imperfect lifestyle is the foundation on which the desire for a utopian society sits

Is Hamlet Insane or Is He Not - 745 Words

Is Hamlet insane or is he not? There is no right answer to that question because some argue that he is and others argue that he is not. I however do not consider Hamlet insane. I believe that he is depressed because of the death of his father and the hasty marriage of his mother to his uncle not too long after his father’s death. Hamlet does not understand why his mother is still not grieving the death of his father like he is. I feel that he is upset with his mother because he see her new marriage to his uncle as her being unfaithful to the marriage that she had with his father. Hamlet expresses his disappointment of his mother for disregarding the death of husband. When he expressed his disappointment of her he called her â€Å"frailty, thy name is woman† (1.2.148). In the beginning of play we find out that Hamlet fathers ghost has been seen by Horatio, Marcellus and Bernardo. Horatio advises them that they should tell Hamlet about seeing the ghost of his father. Since he was not able to get the ghost to speak to him. He does not think that the ghost will refuse to speak to his son Hamlet. When they tell Hamlet that they saw the ghost, he insisted on going back with them to speak with the ghost. The ghost made Hamlet follow him so that he could inform him of how he was murdered by Claudius hands and orders Hamlet to avenge his death. Hamlet decides that he needed to find more evidence to support the claim the ghost made. However, the Devil can adopt a pleasing form that canShow MoreRelatedSanity in William Shakespeares Hamlet Essay1037 Words   |  5 PagesShakespeares Hamlet Hamlet is a play about a man who has had a father killed by his uncle, after this act of treachery the uncle then marries Hamlet’s mother. Hamlet is sane in this play because prior to going â€Å"insane† he informs us he is going to. If Hamlet were truly insane he would not be able to tell others that he is going to act insane as of a certain point in time. Hamlet would try to deny insanity, not pride himself in the fact that he is insane. Hamlet uses insanityRead MoreAll that Hamlet has Gone Through887 Words   |  4 PagesHamlet is a character which has gone through a lot.Throughout the play it is not sure if he has gone insane or if he is just truly pretending to be. Needless to say he went through some things that could make anyone go insane. In such a short amount of time his life turned upside down. His dad died, which by itself can make anyone go crazy. To make matters worse shortly after his dad dies, his mom decides to marry his uncle. His uncle who becomes king after he murders Hamlets dad. Although HamletRead MoreWas Hamlet Faking His Insanity? Essay572 Words   |  3 PagesIn Hamlet, he seems to be mad, but there is a question that everyone asks when reading or watching this play â€Å"was it, or was it not true that Hamlet was faking his insanity, really suffering, or maybe even both.† First, this is what insanity is: insanity is acting crazy, but not knowing that they ’re acting crazy. Also, it’s going through a lot of stress at the same time causing you to act stranger then a normal person. Hamlet was not totally insane. It doesn’t fit. I’m not saying that Hamlet wasRead MoreHamlet, By William Shakespeare866 Words   |  4 PagesHamlet, the son of the former King of Denmark is in a state of depression due to his father’s murder which was committed by his uncle. This is followed by the marriage of his mother and the same uncle who killed his father; this forces Hamlet into a state of misery. Upon learning that his father was murdered, Hamlet is also told by his father’s ghost to get revenge. Throughout the play, Hamlet often pretends to be insane or in a state of madness. This is all apart of how he will plan to kill is murdererRead MoreThe Complexity Of Vessity Insanity In William Shakespeares Hamlet1016 Words   |  5 PagesOne of his famous tragedies play is Hamlet, which based on Prince Hamlet’s revengeful plan against his uncle, King Claudius. However, some critics question Hamlet’s insanity and they believe Hamlet is actually pretending to be insane. The purpose of this essa y is to examine the extent to which the character, Hamlet, is insane. Despite different critics’ opinions regarding Hamlet’s insanity, it seems Hamlet is not insane at the beginning but becomes insane when he confronts his mother. The followingRead MoreHamlet by William Shakespeare788 Words   |  3 PagesInsane or Not Insane? In the tragedy, Hamlet by William Shakespeare, the audience is presented with a character who suffers inner and external conflicts. Hamlet, the young prince, continues to mourn his father’s death from the beginning of the play until the end. Hamlet’s inner conflict is that he discovers Claudius, his uncle, has committed the murder of his father. Hamlet does not analyze how he will seek revenge and murder his Uncle Claudius without his conscience interfering. The external conflictRead MoreMadness And Madness In Hamlet1455 Words   |  6 Pagesâ€Å"Hamlet, a revenge tragedy, is about Hamlet, the prince of Denmark, trying to figure out the mist behind his father’s death. By talking to his father’s ghost, Hamlet realizes that his father, King Hamlet, was killed by his own uncle, Claudius† (Kara 2). Throughout the play, the theme of madness often occurs from multiple characters. Madness can be defined as a mental disability or a pathological condition of the mind eliminating all rational thoughts caused by an unthinkable injury. These injuriesRead More Use of Insanity and Madness in Hamlet Essay1141 Words   |  5 Pages It is or is it not true that Hamlet was faking his insanity? I’m not saying Hamlet was faking the whole thing. The meaning for insanity on Dictionary.com is â€Å"a permanent disorder of the mind.† I dont think Hamlet had a permanent disorder of the mind he knew what he was doing and even planned the majority of the events that happened. Most of the time anyway. Having your father die is bad enough, but to have your mother marry your uncle, within a few weeks of your father’s death? Then to seeRead MoreHamlets Personality Faults1306 Words   |  6 PagesThroughout Hamlet, written by Shakespeare, Hamlet’s emotions, actions, and thoughts cause much trouble during the play. Hamlet encounters stages of sarcasm, inanity, suicidal tendencies/self-deprecation, and procreation/indecision which develop not only his personality but the play itself. Hamlet uses sarcasm to express his emotions, pretends to be insane (ultimately leading him to become truly insane), self-deprecates throughout the play due to family events, and procrastinates because he is indecisiveRead MoreInsanity In Hamlet Essay975 Words   |  4 PagesQuestioning the Sanity of Hamlet In Hamlet by William Shakespeare, Hamlet’s sanity is questionable throughout the play. Insanity is defined as the â€Å"unsoundness of mind or lack of the ability to understand† (Merriam-Webster). In the play, Hamlet’s father, King Hamlet, is murdered by Claudius, Hamlet’s uncle, in secrecy. To make matter’s worse, Claudius then continues on to get married in an inscetuous relationship with Hamlet’s mother, the queen. Emotions are heightened when Hamlet then see’s a ghost that

Jane Addams And Gloria Steinem - 1903 Words

Feminism has been a controversial topic since as early as the 19th century. Feminism has had a profound effect on women’s roles in society as well as their everyday life. There are countless feminists whose achievements are still recognized and remembered today. Jane Addams is a historical feminist who changed the lives for the women of her time, and is still talked about to this day. While feminism was huge in the earlier years of America, there are contemporary feminists who fight for the rights and equality of women that are still not met. In recent years, Gloria Steinem has spoken up for the equality of women and pushed for social reform. Jane Addams and Gloria Steinem are more than feminists, they are activists with many accomplishments that changed the lives for every woman of their time. Jane Addams is a well-known historical feminist, activist, social worker, and leader in women’s suffrage whose legacy still lives on today. Although she was considered radical fo r her time, she thought of ways to push for social and political reforms in socially acceptable ways. Her achievements created an abundance of opportunities for women that would change their roles in society. September 6, 1860 Addams was born in Cedarville, Illinois to a family with a great amount of money. Since her teens, Addams had big dreams to do something useful in the world. Addams was full of ambition that stemmed from her childhood experiences. Her mother passed away when Addams was only two years

Compare And Contrast John Smith And William Bradford

Compare/Contrast Essay In the early 1580-1590 two Englishman named John Smith and William Bradford establish colonies, but they were two different leaders in that time. They both wrote journals to explain what happens in those months one in first person and the other in third person. â€Å" Such actions have ever since the worlds beginnings and been subject to such accidents, and everything of what is found full of difficulties, and but nothing so difficulties†Ã¢â‚¬ ¦. I think what John means that you cant get everything life easily you need to work for it and earn it like you should and everyone does when it comes to hard working. Also, that life has obstacles, but you can overcome them with a positive attitude. â€Å" They were good people†¦show more content†¦His journal was about himself and everyone else, especially about his crew and what happens during those months. He wrote his book in first person, but he never braggart no he was very humble. â€Å" They were good people, in ot her words, Christians they all got along with each other out when they were unhealthy and when it comes to surviving.†(Willam) What he meant that they were religious and they brought women and children to their colonies, not just men. The difference between Jamestown and Plymouth they were opposites from each other, Especially how they care themselves during the difficult times. Jamestown they only care about themselves, no one else besides them they didnt care if they were sick or dying, they just left them alone and did their only thing. But Plymouth was more caring they were good people who want to help a person out if they throw up or were very sick. Some things they had in common were they both wrote journals, but John in 3rd person and William in the first person. Also, both English men had starvation times and good times as well. But the most was probably deaths they had so many people but only half them survives. Finally, they both got attacked by native American because they wanted to protect the land that the white man is trying to take over and native American .had no spare it was more like dangerous. The two men, both wanted something they both wanted to know how the New World is gonnaShow MoreRelatedC omparison Between John Smith and William Bradford737 Words   |  3 PagesEngland by John Smith The author John Smith, a pilgrim who arrived to the Americas, wrote a description of the new land in his book â€Å" A Description of New England †. In this book Smith shows a wonderful world of vast food and pleasure. Also, William Bradford another pilgrim who arrived to Plymouth on the coast of Massachusetts, wrote a book called â€Å" Of Plymouth Plantation † in which he describes what really happened, how the pilgrims actually lived. The purpose of this essay is to compare and contrastRead More Analysis of A Description of New England by John Smith Essay646 Words   |  3 PagesEngland by John Smith The author John Smith, a pilgrim who arrived to the Americas, wrote a description of the new land in his book â€Å" A Description of New England †. In this book Smith shows a wonderful world of vast food and pleasure. Also, William Bradford another pilgrim who arrived to Plymouth on the coast of Massachusetts, wrote a book called â€Å" Of Plymouth Plantation † in which he describes what really happened, how the pilgrims actually lived. The purpose of this essay is to compare and contrastRead MoreCompare And Contrast Of Smith And Bradford935 Words   |  4 Pages Rust 1 Mrs. Myers September 20, 2016 Compare and Contrast of Smith and Bradford On April 10, 1606, John Smith (an adventurer) explorer and author, and his crew were sent by King James I to start a colony in Jamestown. In December 1606 the company sent out three ships carrying 106 settlers to start the new colony. On May 13, 1607 John Smith named the colony Jamestown in honor of the King. Years later on September 6, 1620 William Bradford (an English Separatist) went to Cape Cod, MassachusettsRead MoreSimilarities And Differences Between Plymouth And Jamestown1185 Words   |  5 PagesLeaders of Plymouth and Jamestown are both compare because they both came from England, Native Americans aided the newly incorporated groups by supplying them for food, and both empires resulted in the starvation and death. However, in Jamestown, John Smith set a goal to make money and get rich, developed the idea of everyone for themselves, men were the dominant gender, and Smith abandoned the colony and never decided to return. As for Plymouth, William Bradford s’ goal was to have religious freedomRead MoreInterpreting Bias Within Historical Accounts1501 Words   |  7 Pagestreat an author’s bias as an opportunity to uncover â€Å"truths† that can be even more meaningful than the unattainable accurate representation of facts. A primary example of how history can be obscured by writers is the way in which two Englishmen, William Bradford (1590-1657) and Thomas Morton (1579-1647), provide two very different accounts of the same events in Of Plymouth Plantation and in New English Canaan respectively. Both men are affected by the desire to promote their beliefs and to make theirRead MoreAmerican Revolution and Study Guide Essay example5377 Words   |  22 PagesIndians. What specific developments illustrate that the English living in the plantation colonies tried to apply these lessons? (25 pts) 2. Compare and contrast the ways in which tobacco and sugar affected the social and economic development of colonial America (10pts) Chapter 3 Study Guide â€Å"Settling the Northern Colonies† 1. Compare and contrast the motives of the their founders, religious and social orientation, economic pursuits, and political developments of TWO of the early colonialRead MoreRethinking Mercantalism Essay15042 Words   |  61 PagesRethinking Mercantilism: Political Economy, the British Empire, and the Atlantic World in the Seventeenth and Eighteenth Centuries Author(s): Steve Pincus Reviewed work(s): Source: The William and Mary Quarterly, Vol. 69, No. 1 (January 2012), pp. 3-34 Published by: Omohundro Institute of Early American History and Culture Stable URL: http://www.jstor.org/stable/10.5309/willmaryquar.69.1.0003 . Accessed: 06/09/2012 12:18 Your use of the JSTOR archive indicates your acceptance of the TermsRead MoreHistory of Management Thought Revision17812 Words   |  72 Pagesthat management is not a science in an academic sense, but Taylor intended to use a scientific fact-finding method to determine a better way): a. Time study -- this was prescriptive in that Taylor sought to identify the time a job should take (contrast this with Charles Babbage who measured only the length of a work cycle). b. Time study was analytical, breaking the job into its components and eliminating useless movements; and constructive, building a file of movements that were common to otherRead MoreDebt vs. Equity and Asymmetric Information: a Review16933 Words   |  68 Pagesequilibrium is generally used in models in which the uninformed agent moves first by offering a menu of incentive compatible choices (contracts) from which the informed self-select, revealing their private information through their choice. 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Coping and Health A Comparison of the Stress and Trauma Literatures Free Essays

Coping and Health: A Comparison of the Stress and Trauma Literatures Carolyn M. Aldwin and Loriena A. Yancura Dept. We will write a custom essay sample on Coping and Health: A Comparison of the Stress and Trauma Literatures or any similar topic only for you Order Now of Human and Community Development University of California, Davis Chapter prepared for P. P. Schnurr B. L. Green (Eds. ), Physical Health Consequences of Exposure to Extreme Stress. Washington, DC: American Psychological Association. COPING AND HEALTH Even a cursory review of PsychLit reveals that well over 20,000 articles on stress and coping processes have been published in the past two decades (Aldwin, 1999). A smaller proportion of these has specifically examined how individuals cope with trauma. Due to differences between researchers in how trauma is defined, a definitive number is difficult to 2 determine. However, a search for the key words trauma and coping yielded 1,000 articles. Given the magnitude of this literature, we will not attempt to provide a full review. However, we will briefly outline the different theoretical and methodological approaches to coping (for more complete reviews see Aldwin, 1999; Lazarus, 2000; Parker Endler, 1996; Schwarzer Schwarzer, 1996). Then we will examine the similarities and differences between coping with general problems and coping with trauma. Finally, we will provide whether a brief review of the relationship between coping and health outcomes, and focus on whether coping strategies can affect both the psychological and physical outcomes of trauma. THEORETICAL AND METHODOLOGICAL APPROACHES TO COPING There are four basic theoretical and methodological approaches to coping. Psychoanalytic approaches focus on the use of defense mechanisms, while personality approaches focus on coping styles. Both of these assume that adaptation is primarily a function of personal characteristics. In contrast, the coping process approach draws upon cognitive behavioral models, and is more likely to emphasize environmental demands and influences on coping. Coping process approaches tie the coping strategies to a particular stressful episode. Finally, COPING AND HEALTH daily coping processes use experience sampling techniques to examine how individuals cope throughout the course of the day with a wide variety of problems. Psychoanalytic Approaches Research on how individuals adapt grew out of early psychoanalytic studies of defense mechanisms, which are considered to be unconscious ways of warding off anxiety. DSM-IV (American Psychiatric Association, 1994) currently identifies seven major types of defense mechanisms, and orders them hierarchically from more to less severe. The most severe is defensive dysregulation, which refers to frankly psychotic processes involving projection, denial, and delusion. Action refers to acting out, passive aggression, or apathetic withdrawal, and major image-distorting mechanisms include autistic fantasy, projective identification, and splitting. The less severe or â€Å"immature† mechanisms include disavowal (denial, projection, and rationalization), minor image-distorting (devaluation, idealization, and omnipotence), and mental inhibitions (displacement, dissociation, intellectualization, repression, and the like). High adaptive or â€Å"mature@ defense mechanisms include altruism, humor, and sublimation, as well as suppression. Cramer (2000) compared the similarities and differences between defense mechanisms and coping processes. Defense mechanisms are unconscious, nonintentional, dispositional, hierarchical, and associated with pathology, while coping processes are conscious, used intentionally, situationally determined, nonhierarchical, and associated with normality. In other words, defense mechanisms are designated a priori as being more or less adaptive, and are not COPING AND HEALTH 4 consciously chosen. Individuals nonetheless can be characterized by primary defensive styles or defense mechanisms that they are most likely to exhibit under a wide variety of circumstances. In contrast, coping processes are thought to be consciously chosen and are responsive to environmental demands. Rather than hierarchically ordered, the effectiveness of coping processes is thought to vary as a function of appropriateness to environmental demands. Defense mechanisms are traditionally studied via the use of intensive interviews and case studies. However, a number of inventories have been developed to assess defense mechanisms via self-report, including Gleser Ihilevich (1969), Haan (1965) and Joffe Nadich (1977). However, the psychometric properties of these scales are questionable (Cramer, 1991; Davidson MacGregor, 1998). Of more recent vintage is a Defense Style Questionnaire (Bond, Gardiner, Sigel, 1983). However, as Cramer (2000) points out, there is a logical inconsistency in asking individuals to report on unconscious processes, and researchers are more likely to use observational methods and/or rely upon qualitative research coding interview or projective materials. In part because of the difficulty of systematically assessing defense mechanisms, there have been few large-scale studies of the adaptational outcomes of defensive strategies. Indeed, more research has been directed to identifying the developmental trajectory of defense mechanisms (Vaillant, 1977, 1993), as well as in identifying predictors of the use of immature defenses, including personality and affective disorders (see Cramer, 2000, for a review). Nonetheless, the study of defense mechanisms truly set the stage for understanding how people cope with both stress and trauma. COPING AND HEALTH Coping Styles. A major outgrowth of the psychoanalytic literature was the conception of coping styles, 5 which borrowed some of the language from psychoanalysis but was more focused on how people deal with information than how they deal with emotions per se. The earliest typology was repression-sensitization (Byrne, 1964). Repressors avoid or suppress information, while sensitizers seek or augment information. This dichotomy has reappeared in many different guises over the past 30 years, with blunting-monitoring (Miller, 1980) and approach-avoidance (Roth Cohen, 1986) being the current manifestation of dichotomy. In general, approachmonitoring-vigilant coping styles have been shown to be associated with better outcomes in a variety of situations, while repression-avoidant-blunting styles are associated with poorer outcomes (for reviews, see Aldwin, 1999; Roth Cohen, 1986). Dichotomizing coping strategies into two broad modalities can be psychometrically appealing. Certainly Endler and Parker (1990) have shown that the factor structure of coping style inventories, which currently focus more on problem- vs. emotion-focused coping, are more stable than process measures, and often correlate reasonably well with psychological symptom inventories. However, even early research by Lazarus and his colleagues showed that both types of coping were used in over 80% of episodes, and often individuals in highly stressful situations alternate between approaching and avoiding the problem (Folkman Lazarus, 1980; Lazarus, 1983). Nonetheless, the use of particular emotion-focused coping strategies may be more consistent across time and strategies, suggesting that individuals may have characteristic ways of dealing with and/or expressing emotion (see Aldwin, 1999). COPING AND HEALTH Coping Process As mentioned earlier, the coping process approach draws upon the cognitive behavioral perspective, and argues that coping is flexible and responsive to environmental demands, as well as personal preferences. In this model, how individuals cognitively appraise situations is the primary determinant of how they cope. The four primary appraisals are benign, threat, harm/loss, and challenge, and these are influenced both by environmental demands and individual beliefs, values, and commitments (Lazarus Folkman, 1984). Rather than examining general coping styles, coping process approaches examine how individuals cope with a particular stressor. Coping process approaches have recently come under attack from a variety of perspectives. Critics have charged that the factor structure for such inventories as the Ways of Coping is not stable, either across time or across samples (Endler Parker, 1990) although the factor structure for the COPE (Carver, Scheier, Weintraub, 1989), another widely-used coping measure, is also less than satisfactory (Schwarzer Schwarzer, 1996). However, the factor structure for coping process measures may not be stable precisely because they are responsive to environmental demands (Schwartz Daltroy, 1999). Coyne Racioppo (2000) also criticized coping inventories as being to o vague to generate clinically meaningful results, and argued for more situation-specific inventories (which, however, would also create problems of generalizability across situations). Nonetheless, there is broad agreement concerning the types of coping strategies that exist. There are five general types: problem-focused coping, emotion-focused coping, social support, COPING AND HEALTH 7 religious coping, and making meaning. Note that coping strategies are not mutually exclusive, and even strategies which may seem orthogonal, such as suppressing and expressing emotions, may be used sequentially in the same situation. Within each general type of coping strategy, there may be several subtypes. Problem-focused coping includes cognitions and behaviors that are directed at analyzing and solving the problem. It may include â€Å"chunking† or breaking a problem into more manageable pieces, seeking information, and considering alternatives, as well as direct action. Sometimes delaying or suppressing action is seen as a separate problem-focused strategy. Delaying action or decisions may be used in health circumstances in which people are waiting for the outcome of tests, and suppressing action may be useful in avoiding actions which may make a problem worse, such as acting in anger. Emotion-focused coping is often seen as a strategy in and of itself, but is best conceived as involving different sub-types. Avoidance and withdrawal may be different from expressing emotion, and suppression, setting one’s emotions aside in the service of a problem-solving effort, is clearly different from the use of substances to regulate emotion. Avoidance, withdrawal, and substance use are most generally associated with poor outcomes (Aldwin Revenson, 1987). Seeking social support and religious coping are strategies that involve elements of both problem-focused and emotion-focused coping. Support seeking may include asking for advice, concrete aid, emotional support, or justification for one’s perceptions and/or actions (Thoits, 1986). Similarly, religious coping, which includes prayer, is generally considered a form of emotion-focused coping, but may involve asking for advice or even concrete aid. The study of COPING AND HEALTH religious coping strategies is as yet in its infancy (Pargament, 1997), and the associations of to outcome measures by vary by religious denomination (Park, Cohen, Herb,1990). In general, religious coping may be most helpful with uncontrollable stressors (Aldwin, 1994) or for lower socioeconomic status groups (Cupertino, Aldwin, Schulz, 2000). Social support, conceptualized as social integration (Berkman Syme, 1994), and social disclosure (Smythe, 1998) are almost always associated with better mental and physical health outcomes, in coping studies. However, seeking social support is almost always associated with poorer outcomes (Monroe Steiner, 1986). The reasons for this are not well understood, but may devolve around negative reactions from others (Rook, 1998), or perhaps the act of seeking support may be indicative of poor networks or a catastrophizing coping style. Finally, making meaning is a strategy that is least well understood. It involves trying to make sense of the problem, and, in the general coping literature, may be called â€Å"cognitive reframing. † It involves such strategies as â€Å"looking for the silver lining† or trying to perceive 8 positive aspects of the current problem. Making meaning may be most often used in coping with extreme stressors, such as trauma or major losses (Mikulincer Florian, 1996), and thus will be discussed in greater detail in the trauma section. Daily Process Coping Daily process coping involves the assessment of coping strategies generally directed at specific problems once or more per day. Respondents may be asked to fill out questionnaires every evening, or they may be beeped and fill out mini inventories on the spot. To date, only a handful of coping studies have utilized this method (for a review, see Tennen, Affleck, Armeli, COPING AND HEALTH 9 Carney, 2000). The correlation between process and retrospective measures of coping is a matter of some controversy. While some claim that it is fairly low (Ptacek, Smith, Espe, Raffety, 1994), examination of the raw data reveals that, in at least one study (Stone et al. , 1998), the correlation is actually quite high, about . 7 (although only the r2 was reported). Further, Schwarzer and Schwarzer (1996) have criticized the psychometric properties of daily process measures, as they are of necessity quite short and often consist of single items. Nonetheless, the associations between momentary coping and process outcome measures tend to be encouraging, although there are within-subject and between-subject (aggregated) analyses may differ in some curious ways which merit further investigation. For example, Affleck et al. (2000) examined daily diary associates between coping and alcohol consumption in moderate- to heavy-drinking men and women. Aggregating the data, they found problem-focused coping had no effect average consumption, emotion-focused coping was negatively-related to consumption, but avoidant coping was positively related. However, a very different pattern of results emerged from the within subjects analyses. Instead of the aforementioned pattern, they found an inverse relationship between problem-focused coping and alcohol consumption. The reasons for this are unclear, but may relate to average differences in alcohol consumption. For similar reasons, it would make sense that within-subject analyses of pain patients should show a more protective effect of coping strategies on pain than between-subject analyses (Tennen Affleck, 1996). COPING WITH TRAUMA COPING AND HEALTH 10 It is one thing to describe individual differences in dealing with everyday stressors or even life events, but it is quite another thing to generalize this to traumatic situations. By definition, traumatic situations are generally outside of individuals’ usual experience, and most individuals have not developed the necessary repertoires to know how to deal with such events (although military personnel and some categories of civil servants such as police, firefighters, and emergency medical technicians do receive training). Indeed, at first glance, the initial reaction to major trauma seems stereotypical reports of emotional numbing, cognitive impairment, and aimless wandering have been reported for such disparate traumas as tornadoes (Wallace, 1956), concentration camps (Bettelheim, 1943), nuclear blasts (Lifton, 1968), and combat (Solomon, 1993). It would be tempting to argue that the environmental press of trauma is so great that there are few individual differences in reaction to it. However, closer examination of the trauma literature reveals marked individual differences in how people cope even with traumatic situations, although clearly environmental factors may constrain choices. Further, as we shall see, how coping strategies can influence the long-term psychological and perhaps physical responses to the trauma. Aldwin (1999) identified four ways in which the pattern of coping responses in traumatic situations differs from that from ordinary life events. First, individuals in traumatic situations may feel they have less control over their cognitions and behaviors. Solomon (1993, p. 3) quoted a crack paratrooper during the Yom Kippur war, who, despite his elite training, found himself frozen in the middle of action, unable to move to help his fellow soldiers. Such freezing reactions may also be common in rape (Burgess Holstrom, 1976). In naturalistic descriptions COPING AND HEALTH 11 of people in traumatic situations, the use of defense mechanisms such as di ssociation, repression, and denial may be much more widespread (Ward, 1988). Indeed, when being tortured, either by one’s political enemies or one’s parents, dissociation may be the only option available (Figley, 1983). Second, disclosure may be of particular importance in traumatic situations. While seeking social support may be associated with poorer outcomes with everyday stressors, in trauma situations, individuals who disclose to others typically do much better both in terms of short and long-term outcomes (Smythe, 1998; Lee, Vaillant, Torrey, Elder, 1995). However, the reaction of others in the social environment may moderate this relationship. In particular, individuals who experience negative reactions from others may have worse outcomes than individuals who did not disclose (Silver, Holman, Gil-Rivas, 2000). Third, the process of coping with trauma is usually much more extended than is coping with general hassles or even life events, especially if an individual develops post-traumatic stress disorder (Horowitz, 1986). Indeed, the sequellae of major trauma has been documented to last for decades (Aldwin, Levenson, Spiro, 1994; Kahana, 1992; Schnurr, Spiro, Aldwin, Stukel, 1998). Epstein (1991) has referred to trauma as the ‘atom-smasher’ of personality, and the process of reconstructing both lives and sense of identity may take years (Lomranz, 1990). Thus, it is not surprising that fourth difference, ‘making meaning’, is a strategy which has particular utility in traumatic situations (Mikulincer Florian, 1996). Making meaning may entail both reorganization of existing cognitive-motivational structures, as well as reappraisal or reinterpretation of not only the event but also the context of the event in a person’s life. Loss COPING AND HEALTH events may also entail a search for meaning, especially if those events are sudden or traumatic (Wortman, Battle, Lemkau, 1997). While this search for meaning may be painful in and of itself, and sometimes fruitless, as Wortman and her colleagues have often documented, it may 12 also set the stage of post-traumatic growth (Aldwin Sutton, 1998; Lieberman, 1992; Tedeschi, Park, Calhoun, 1998). Indeed, of the most intriguing aspects of the coping with trauma literature are the hints that trauma may constitute a major avenue for personality change in adulthood. For example, Schnurr, Rosenberg, Friedman (1993) examined change in MMPI scores from college to midlife as a function of combat exposure. They found that MMPI scores were most likely to improve in men who had moderate levels of combat exposure, compared to those who had heavy exposure — or none at all. Similarly, Park, Cohen, Murch (1996) found that students who perceived growth as a result of a major stressor increased in optimism over the course of a year. While some aspects of personality are widely believed to change as a function of trauma exposure (Epstein, 1991), more studies documenting this are needed. In particular, the possible mediating function of coping strategies merits further investigation (Aldwin, Lachman, Sutton, 1996). In addition to these four differences, another way in which studies of coping with trauma differ from general studies of coping with stress is that trauma studies sometimes focus on just one strategy. Examples of such studies include self-blame (Davis, Lehman, Silver, Wortman, Ellard, 1996; Delhanty et al. , 1997), â€Å"undoing† (Davis, Lehman, Wortman, Silver Thompson, 1995), and â€Å"temporal orientation† (Holman Silver, 1998). Surprisingly, while self-blame in everyday situations is generally associated with poor outcomes, in traumatic situations such as COPING AND HEALTH rape or automobile accidents, self-blame may be associated with positive outcomes in that it 13 provides at least an illusion of control in what are often uncontrollable situations. For example, if a rape victim blames herself for approaching a stranger in a car, she may feel that she would be able to avoid such circumstances in the future. Undoing is a particularly intriguing strategy, but may not be specific to trauma. Indeed, it would be very interesting to see how often and under what circumstances this strategy is used in everyday coping. Nonetheless, there have been a number of studies of trauma using standardized coping checklists, and, as we shall see, the process of coping with trauma may be more important for health outcomes than the exposure to trauma itself (Wolfe, Keane, Kaloupek, Mora, Winde, 1993). COPING AND HEALTH OUTCOMES There is a large literature on trauma and long-term health outcomes that will be reviewed by Baum and Dougall (this volume); instead, we will focus on the coping and health outcomes literature. The relationships detailed in this literature are highly complex, in large part because it is atheoretical, and thus difficult to organize effectively. Therefore, we will organize this review by type of outcomes, limiting it to physical health outcomes, with the exception of PTSD. The first section will focus on PTSD, as it is particularly germane to trauma, and the second to selfreported health outcomes. The third will focus on biomedical indicators such as cortisol, immune, cardiovascular reactivity, and lipids, while the fourth section summarizes research on coping and the progression of disease or disease outcomes. Finally, we will review the coping intervention COPING AND HEALTH literature, that is, studies which have actively sought to change how individuals cope with the particular stressor they are facing in an attempt to modify disease progression or outcomes. Coping and PTSD There is a growing recognition that how individuals cope with trauma may be more important in the development of post-traumatic stress disorder (PTSD) than the occurrence of 14 the trauma itself (Aldwin, 1999; Mikulincer Florian, 1996). For example, Fairbank, Hansen, Fitterling (1991) compared coping strategies of three groups of WWII male veterans, prisoners of war (POWs) ith PTSD, those without, and veterans who were not POWs. POWs with PTSD were more likely to use wishful thinking, self-blame, and self-isolation, whereas POWs without PTSD were more likely to use reappraisal coping. Aldwin, Levenson, Spiro (1994) also found that the perceived benefits of military service also resulted in lower PTSD symptoms in WWII veterans. Vietnam veterans who used more emot ion-focused coping were also more likely to report PTSD. The Israelis have also conducted a number of studies in this area. One prospective study of combat soldiers in the Lebanon War found that wishful thinking and denial were also predictive of PTSD over the course of a year (Solomon, Mikulincer, Benbenishty, 1989). Concurrent use of problem-focused coping was inversely related to PTSD two to three years after the war in the same population (Solomon, Mikulincer, Abitzur, 1988). Israeli civilians who used palliative coping during the SCUD missile bombing were more likely to experience negative stress reactions (Zeidner Hammer, 1992). COPING AND HEALTH 15 As mentioned earlier, the impact of emotional disclosure of trauma may be moderated by the reactions of others in the environment. Specifically, Stephens and Long (2000) found that New Zealand police officers who received positive peer communication and who could easily talk about trauma had lower PTSD scores and lower levels of physical symptoms. The effects of trauma on health may be mediated through the development of PTSD (Baum, Cohen, Hall, 1993; Davidson Baum, 1993; Schnurr, Spiro, Paris, 2000). Once again, coping strategies may have an indirect effect on health. If their use can prevent the development of PTSD, the adverse heath effects of trauma may be ameliorated. Coping and Self-Reported Health Outcomes While there is a fairly extensive literature on coping and mental health outcomes (for reviews see Aldwin, 1999; Lazarus Folkman, 1994; Zeidner Saklofske, 1996), there are surprisingly few studies of coping and self-reported physical health symptoms in general populations. Most occur in the context of clinical populations and disease progression, which usually include both biomedical and self-report outcomes, and are reviewed below. However, we did find a few studies which used either worker or student populations. . Eriksen, Hege Ursin (1999) examined the interaction between psychological demands, coping, and control in a large sample of Norwegian postal service workers. They found that individual coping styles were more important for subjective health complaints than were either control or organizational factors. Specifically, coping, as assessed by the Utrecht Coping List, moderated the effects of job stress such that individuals with low demands and high coping had the fewest health complaints, while those with high demands and low coping reported the COPING AND HEALTH 16 most. Interestingly, individuals with high demands and high coping had high perceptions of job stress but did not report high levels of symptoms. Pisarsi, Bohle, Callan (1998) examined coping and physical symptoms among shift workers. There were both direct and mediated effect of coping on health outcomes. Specifically, disengagement coping strategies were directly related to increased physical symptoms, but emotional expression was mediated through both conflicts and support. Thus, emotion expression appeared to increase physical symptoms via increased work conflicts and concomitant psychological symptoms, but to decrease physical symptoms through increased family support. Unfortunately, this study did not provide any test of the statistical significance of the indirect paths, and thus we cannot contrast the relative strengths of the indirect paths. However, it does make a certain amount of sense that complaining to coworkers may increase distress and result in more physical symptoms, while complaints to family may elicit more support and thus decrease symptoms. Finally, two studies found that the relationship between coping and physical symptoms disappeared once controlling for personality factors such as neuroticism (Costa McCrae, 1986) and anxiety (Hemenover Dienstbier, 1998). However, both of these studies used coping style measures with general outcomes, and thus it is not surprising that the personality traits would better predict a general outcome. More work is needed to determine if the relationship between coping processes and a time-specific measure of physical symptoms would be similarly overwhelmed by personality. Based on prior research with psychological symptom outcomes, (Bolger, 1990), we suspect that the effect of personality on health is at least partially mediated COPING AND HEALTH 17 through coping strategies, but that coping strategies will have independent effects on symptoms, but research is needed to confirm that. Coping and Biomedical Outcomes There are literally hundreds of studies in humans showing that stress affects both the neuroendocrine and immune systems, and there is a general agreement that there are individual differences in the effects of stress. Situational constraints such as controllability and personality factors such as Type A have been extensively studied (for reviews see Biondi Picardi, 1999; Cohen Herbert, 1996; Frankenhauser Johansson, 1986; Herbert Cohen, 1993; Olff, 1999). However, it is more difficult to actually demonstrate a relationship between coping strategies per se and Ahard@ biomedical outcomes, in part because there are surprisingly few published studies (although the number of studies examining disease outcomes is growing). Although Biondi and Picardi (1999), in their otherwise excellent review of stress and neuroendocrine factors, state that there is ‘a large body of evidence that coping strategies may significantly influence hormonal responses to both laboratory stressors and real life stress situations’ (p. 133), closer examination reveals that they based this conclusion on only four published studies. Further, most reviews focus on a particular biomedical outcome, and we felt that providing an overview of several outcomes might prove instructive. Our initial strategy was to divide the coping and biomedical outcomes literature into laboratory, field, disease outcomes, and intervention studies, separately by coping with stressors vs. coping with trauma in order to provide meaningful contrasts. However, the gaps in the literature made this strategy over-optimistic. While it is not surprising that there were no COPING AND HEALTH 18 laboratory studies on coping with trauma, it turns out that most of the field studies of coping and neuroendocrine outcomes involved traumatic situations. Thus, we will combine both stressor and trauma studies in the same categories, noting differences and similarities, where appropriate. Laboratory studies. Most laboratory studies examining the effect of coping on neuroendocrine outcomes rely on personality assessments of defenses or coping styles. In these often unpublished studies, defensiveness, avoidance, and repression are typically associated with higher cortisol levels (Biondi Picardi, 1999). Bossert et al. (1988) found no relationship between coping styles and cortisol, but their sample size was very small (12 men). Van Eck, Nicholson, Berkhof, Sulon (1996), using a larger sample, also found no relationship between coping style and salivary cortisol. Bohnen, Nicholson, Sulon, Jones (1991) found that ‘comforting cognitions’, a type of cognitive reframing, was negatively associated with cortisol response. A handful of studies have also examined specific coping strategies and cardiovascular outcomes. Tomaka, Blascovich, Kelsey (1992) found no association between repressive coping and psychophysiological reactivity to stress, once the effect of social desirability was controlled. However, Vitaliano, Russo, Paulsen, Bailey (1995) examined cardiovascular recovery from laboratory stressors in older adults, and found that avoidance coping was positively related to diastolic blood pressure and heart rate. The same laboratory also found similar findings among caregivers of Alzheimer patients (Vitaliano et al. , 1993). Controlling for standard risk factors such as smoking, avoidance coping was associated with higher levels of cardiovascular reactivity. COPING AND HEALTH Individuals who show the highest levels of cardiovascular reactivity also show the 19 reatest immune system disturbances to stress (Herbert, Coriell, Cohen, 1994). While there is a growing literature on stress and immune functioning (for reviews, see Cohen Herbert, 1996; Herbert Cohen, 1993; Kiecolt-Glaser Glaser, 1995), we located no laboratory studies which examined induced stressors, coping, and immune outcomes. This is surprising in view of the fact that the immune response to stressors occu rs in minutes (Eriksen, Olff, Murison, Ursin, 1999), even before cortisol responses, and thus the immediate impact of coping on immune function could be studied. However, most of the coping and neuroendocrine lab studies were done in the 1970’s and 1980’s, when the specificity of coping was not as yet well understood and most studies relied on defenses and coping styles. Thus, the absence of coping and immune studies in the laboratory may reflect a more mature understanding of coping. Nonetheless, carefully constructed laboratory studies could clear up some of the conflicting findings in the field studies. Field studies. Although animal studies have indicated that coping style is linked to neuroendocrine profiles in feral animals (Koolhaas et al. 1999), there are a limited number of field studies assessing the effects of coping on neuroendocrine outcomes in humans. Perhaps the most consistent finding is between urinary cortisol and the effectiveness of defenses. Vickers (1988) reviewed five field studies with stressors ranging from military basic training to having a fatally ill child, each of which found that individuals with e ffective defenses had lower levels of urinary cortisol. COPING AND HEALTH 20 Studies of coping strategies and neuroendocrine outcomes have yielded mixed results. For example, an early study by Schaeffer Baum (1984) showed that stress associated with the nuclear power plant disaster at Three Mile Island was related to urinary cortisol, as were psychological and physical symptoms, but coping styles were not. However, coping styles were related to lower levels of distress (Baum, Fleming, Singer, 1983), which presumably should have some effect, albeit indirect, on cortisol and catecholamines outcomes. Arnetz et al. (1991) conducted a prospective study of 354 employees of a telecommunications plant that was being downsized. Not surprisingly, long-term unemployment was associated with high levels of serum cortisol. However, coping was only indirectly related to cortisol via its effect on mastery. Emotion-focused coping was negatively related to mastery, which in turn was inversely associated with cortisol. Avoidance coping may be more directly related to cardiovascular outcomes. In a study of caregivers, avoidance coping was associated with higher levels of cholesterol fractions such as triglycerides, and low density lipoproteins (LDLs), but with lower levels of high density lipoproteins (HDLs) (Vitaliano, Russo, Niaura, 1995). Aldwin, Levenson, Spiro, Ward (1994) found that instrumental action was positively associated with HDLs and negatively with triglycerides, while self-blame showed the opposite pattern. Thus, the relations between coping and cholesterol may actually be more consistent that than between coping and cortisol, but many more studies are needed to show a consistent effect. A handful of studies have examined coping and immune system outcomes. Jamner, Schwartz, Leigh (1988), in a study of outpatients with stress-related disorders, found that COPING AND HEALTH repressive coping was negatively related to monocyte counts, but positively related to eosinophile counts. However, the repressors were also more likely to be taking antihistamines, so interpretation of this study is difficult. In a study of undergraduates, repressors had significantly higher antibody titers to Epstein-Barr, an indicator of a stressed immune system (Esterling, Antoni, Mahendra, Schneiderman, 1990). This pattern was not replicated by Solomon, Segerstrom, Grohr, Kemeny, and Fahey (1997) in their study of earthquake victims. 1 Repressive coping, as indicated by a Type C personality inventory, was unrelated to a variety of immune system outcomes, including lymphocyte subjects, lymphoid cell mitogenesis, and NK cell cytotoxity. However, there was an interaction between generalized distress and life disruption, such that individuals with high levels of disruption who did not report being distressed had impaired immune functioning (lower levels of CD3+ an d CD8+). The authors’ interpretation was that this was indirect support for the impact of repressive coping on immune function. With the exception of this last article, all of the studies reviewed in this section examined the main effects of coping on biomedical outcomes. However, coping is thought to be a moderator of the effects of stress, which would necessitate the examination of the interaction effects between stress and coping on outcomes. We located only two studies which did so, and thus merit some examination in depth. In a small sample of 11 seropositive males, Goodkin, Fuchs, Feaster, Leeka, Rishel (1992) found main effects of active coping on CD4+ cells; Active coping was associated with higher cell counts. While the interaction did not reach significance, contrast comparisons of COPING AND HEALTH 22 means within the high stressor group suggested that there were also significant differences in both total lymphocyte and T4 cells, with highly stressed active copers having higher cell counts than highly stressed passive copers. Goodkin and his colleagues (1992) repeated this study in a larger sample of 62 seropositive males. Carefully controlling for a variety of nutritional and lifestyle factors which affect immune function, there were main effects of coping on natural killer cell counts (NKCC), while venting emotions was associated with lower NKCCs. The interaction effect between stress and active coping was not significant. However, there was no indication that the authors centered the interaction terms to account for multicollinearity (cf. , Cohen Cohen, 1975). There was evidence of bouncing betas, as the beta for stress in the main effects model was . 72 but -25. 69 in the interaction effects model. Thus, the lack of significance of the interaction terms is difficult to interpret. Summary. Despite the hundreds of biomedical studies that have been done on stress and biomedical outcomes, relatively few studies have linked actual coping strategies with such indicators. The early laboratory studies relied primarily on trait measures of defenses, and various indices of what basically is emotional repression were related to higher cortisol levels. In addition, avoidant and repressive coping are related to greater cardiovascular reactivity and impaired immune function. However, there is some indication that positive coping is related to better outcomes. Problem-focused or active coping is related to higher natural killer and CD4+ cell counts and higher HDL levels. The results regarding coping and cholesterol are promising, but need more replication. COPING AND HEALTH 23 Besides its sparseness, a big limitation of this area is that most studies examine only main effects; given that coping is thought to be a moderator of stress, more studies should examine interaction effects. Barron Kenny (1986) caution, however, that valid examination of interaction effects often require very large sample sizes, which may be difficult to achieve in very small samples typical of psychoneuroendocrine and immune (PNI) studies (cf. , Mishra, Aldwin, Colby, Oseas, 1991). Another possible solution is for small sample studies to use jack-knife or boot-strap statistical techniques, which may provide more accurate assessments of the standard errors in small PNI samples (Aldwin, Spiro, Clark, Hall, 1991). Coping and Disease Outcomes There is a much more extensive literature on coping and disease outcomes. Several studies have examined pain and symptomology for individuals with chronic illnesses such as rheumatoid arthritis, the progression of serious illnesses such as AIDS and cancer, and even mortality (for reviews, see Garssen Goodkin, 1999; McCabe, Schneiderman, Field, Skylar, 1991; Tennen Affleck, 1996; Zautra Manne, 1992). These reviews often highlight the complex relationship between coping and outcomes. A variety of personal and contextual factors may moderate the effects of coping on health outcomes. For example, a review of studies on coping with rheumatoid arthritis (Zautra Manne, 1992) showed that there were some strategies that were associated with positive and negative outcomes such as pain. However, the results were often inconsistent, and depended upon coping efficacy, family environments, and personality dispositions. For example, the effect of relying on others has different effects depending upon the severity of illness. Relying on COPING AND HEALTH 24 thers led to increased psychological distress among women with rheumatoid arthritis who were in relatively good health, but lower levels of distress for women who were in poorer health (Reich Zautra, 1995). Helgeson, Cohen, Schulz, Yasko (2000) showed that social support groups had the most positive effect on physical functioning for those breast cancer patients who lacked natural support or had fewer personal resources, but were harmful for those women who had high levels of support. Further, the effects may vary by type of arthritis disease. Affleck et al. 1999) found that emotion-focused coping was positively associated with increased pain in rheumatoid arthritis patients, but decreased pain in osteoarthritis patients. The emotion-focused coping coded in this study involved seeking support and venting to others. Affleck et al. suggested that the differences between these two groups were due to the response of the caregivers. Osteoarthritis pain is specific to movement and thus may be more understandable to caregivers, whereas the pain involved in rheumatoid arthritis (swollen joints and fatigue) is more global and may evoke less sympathetic responses. This fits in very nicely with the trauma literature reviewed above, in which the effects of social disclosure were also moderate by the response of others in the social environment. There is also evidence that coping may have indirect or mediated effects on outcomes. Billings, Folkman, Acree, Moskowitz (2000) showed that coping affected positive and negative affect among men who were caregiving for AIDS patients. Social support coping predicted increases in positive affect, which in turn were related to fewer physical symptoms. COPING AND HEALTH 25 Avoidant coping, however, was related to increases in negative affect, which were related to more physical symptoms. Coping may also be related to the progression of AIDS. One prospective study of a sample of asymptomatic HIV+ men and women also reported that avoidance and passive coping was positively correlated with development of symptoms, while planful coping was negatively related to progression of HIV symptoms (Vassend, Eskild, Halvorsen, 1997). A crosssectional study also found that individuals diagnosed with AIDS were lower in planful problemsolving than HIV negative individuals (Krikorian, Kay Liang, 1995). A Dutch longitudinal study over one year also found that active confrontational coping predicted slower disease progression HIV+ men (Mulder et al. , 1995). A follow-up study also showed that individuals who used avoidant coping had a more rapid deterioration of CD4 cell counts over seven years (Mulder, de Vroome, van Griensven, Antoni, Sandfort, 1999). While there is at best weak evidence for the relationship between coping and the development of cancer (Garssen Goodkin, 1999), coping strategies may affect the response to cancer treatments. Women who used confrontive coping reported fewer side effects from chemotherapy than those who used avoidant strategies (Shapiro et al. , 1997). A few studies have directly looked at coping and the progression of cancer, primarily breast cancers. A series of British studies showed that women who used active coping styles lived longer, especially in those women with early, nonmetastatic cancer (Greer, 1991; Greer Morris, 1975; Morris et al. , 1981). In contrast, a study of women with breast cancer showed that repressors had elevated COPING AND HEALTH 26 evels of mortality, with a risk ratio of 3. 7 (Weihs, Enright, Simmens, Reiss, 2000). However, Buddeberg et al. (1996) found modest associates between coping and death from breast cancer. Individuals using problem tackling and self-encouragement were less likely to die, while individuals using distrust pessimism were more likely to die. COPING AND HEALTH 27 Summary. It is not at all surprising that coping skills and strategies shoul d affect disease progression, especially in those diseases such as AIDS and cancer that have very arduous treatment regimens. It makes perfect sense that individuals who are good planful problem solvers are more able to handle these regimens and have better outcomes, whereas avoidant copers have worse outcomes. More sobering, however, is the recognition that a variety of personal and contextual factors may moderate the relationship between coping and health outcomes such as pain. The effectiveness of coping strategies may vary by the stage of the illness, the type of illnesses, and the responsiveness of others in the environment. This suggests that interventions need to be very specifically tailored to individuals, which is often not the case. Intervention Studies One of the simplest and most dramatic coping interventions in the literature is a written emotional expression task. In this paradigm, individuals are encouraged to write about stressful episodes, especially traumatic ones. In a review of this literature, Smyth (1998) found that disclosure lead to significantly better health outcomes in a variety of biomedical outcomes, cardiovascular reactivity and risk factors, immune outcomes, physiological functioning, and health behaviors. No studies on neuroendocrine outcomes were included in this review. A drawback of these studies is that they utilize primarily undergraduate populations, and their utility varies as a function of duration of the writing task. While single intervention episodes can have significant effects, these tend to be weaker than interventions with multiple writing episodes, as narratives tend to become more focused and coherent over time. It is also unclear whether this is due to cognitive processing or the reversal of emotional repression. A review by COPING AND HEALTH Esterling, L’Abate, Murray, Pennebaker (1999) suggests that both mechanisms may be employed, but for different types of outcomes. Both cognitive processing and the reporting of positive emotions are predictive for emotional well-being, but the reversal of emotional repression may be important for neuroendocrine and immune system outcomes. A large number of ‘coping interventions’ in the behavioral medicine literature consist of psychoeducational interventions (for a review Compas et al. , 1998). The most dramatic and consistent results are seen with pain interventions. In a meta-analysis of 191 studies, Devine (1992) found that statically reliable, albeit modest, effects were found on recovery, postoperative pain, and psychological. Nearly all (79%) of these studies found a shorter length of 28 hospitalization. Interestingly, adding specific coping skills training to standard pain management treatment programs greatly improved pain control (Kole-Snijders et al. , 1999). Perhaps the most dramatic of interventions studies was conducted by Fawzy and his colleagues (Fawzy, Cousins et al. , 1990; Fawzy, Kemeny et al. 1990; Fawzy et al. , 1993; Fawzy Fawzy, 1994), who did specific coping skills interventions with melanoma patients. This was a six-week structured program with multiple components, including health education, psychological support, and training in both problem-solving and stress management. Short-term, the experimental subjects were more likely to use active behavior coping than the controls, and also had more positive affect. Differences in immune functioning were evident between the two groups at the six months assessment. Specifically, experimental subjects had a greater percentage of large granular lymphocytes, more NK cells, and better NK cytotoxicity. While coping strategies were not directly associated with immune cell changes, they were correlated with COPING AND HEALTH affect, which in turn was associated with immune functioning. This supports our supposition 29 that the effects of coping on biomedical outcomes may be mediated through affect. At a five-year follow-up, a third of the control group had died, compared to less than 10% of the experimental group. Longer survival was associated with more active coping at baseline. Towards a Theoretical Model As mentioned earlier, the literature on coping and health outcomes is difficult to disentangle, primarily because so little of it is guided by specific theories. In an early study, Aldwin and Revenson (1987) suggested that there are two possible models, direct effects and moderated effects. Escape/avoidant coping appeared to have primarily direct affects, that is, it tends to increase psychological symptoms, regardless of the stressfulness of the event. In contrast, problem-focused coping was more likely to have moderating or buffering effects. However, the current literature suggests that there are five possible models of the relationship between coping and health outcomes, which are illustrated in Figure 1. (1) Direct Effects. Most of the studies reviewed in this chapter examined only the direct effects of coping on outcome. That is, with notable exceptions, most used a simple correlational paradigm to examine whether coping strategies were related to outcomes. (2) Moderated Effects. Relatively few studies examined whether coping moderates or buffers the effects of stress; the few that did were hampered either by very small sample sizes or poorly constructed statistical analyses. COPING AND HEALTH (3) Mediated Effects. A number of studies suggested that the effects of coping were mediated 30 through other variables, especially affect. That is, coping related to outcome variables only to the extent that it modified affect. (4) Contextual Effects. A number of studies also suggested that the effects of coping, especially emotional expression, were moderated by the reaction of other individuals in the context. 5) Spurious Effects. A handful of studies suggested that the effect of coping on outcomes was spurious; that is, once controlling for personality, the relationship between coping and health outcomes disappeared. This was primarily true for studies with self-reported health outcomes which used coping styles measures. It appears from the literature reviewed here that different models apply to different types of outcome measures. Given the relatively few studies in each of these different areas, definitive conclusions cannot be drawn; rather, these hypotheses are offered as a useful heuristic that may guide future research. Table 1 represents our attempt to summarize this literature, and indicates which models were supported for different coping strategies by outcomes. Given the wide variety of coping measures used, we chose to roughly group strategies into instrumental action, avoidance (including escapism, wishful thinking, and self-isolation), meaning making, cognitive reframing, self-blame, and social support (which includes emotional expression and disclosure). We did try to differentiate between process and styles measures, although the distinction was not always clear from the studies. Unless otherwise noted, the direct effects of instrumental action, cognitive reframing, and meaning making are assumed to decrease or be associated with lower levels of health problems (indicated by a downward arrow), while avoidant and self-blame COPING AND HEALTH strategies are assumed to increase or be associated with higher levels of health problems 31 (indicated by an upward arrow). Tests for other types of models are indicated simply with an X. Question marks indicate contradictory or inconsistent findings. As indicated in Table 1, studies of coping with trauma consistently show that instrumental action and meaning making are associated with lower levels of PTSD, while avoidant coping strategies are associated with higher levels. The effects of social support, generally in the form of disclosure, depend upon the context: if the social network is supportive and responds positively, disclosure works well, but if the network is unsupportive, the individual may be worse off than if s/he had not disclosed their experience with trauma. Similarly, self-blame may be associated with oorer outcomes, but if self-blame allows an individual to maintain at least an illusion of controllability, than self-blame may be associated with positive effects. For example, if a rape victim blames herself for approaching strangers in a car, then theoretically at least she should be able to avoid such situations in the future and therefore decrease her risk of another attack. It is surprising that apparently no s tudies of coping with trauma examined any of the more complex models, such as moderated, mediated, or, for that matter, spurious. All of the self-reported symptoms studies reviewed here examined coping with ordinary stressors, not with trauma. Given the common findings of increased physical symptoms with trauma, is very surprising that none of the coping studies Nonetheless, the results are similar to those found with PTSD. Instrumental action is generally associated with fewer symptoms, and avoidant styles with higher symptoms. As with trauma, however, the effects of social support appear to be contextual. The one study that examined a mediated model found contradictory COPING AND HEALTH 32 athways: emotional expression increased coworker conflict, but also increased family support. Thus, it would appear that the effect is actually contextual — that is, emotional expression in the workplace may increase stress and therefore increase symptoms, but venting to family and friends may increase support and therefore decrease symptoms. It is not surprising that studies using coping styles find that the effect drops out once personality factors such as anxiety are controlled. Given the vast literature on stress and neuroendocrine function, it is surprising that the results were so inconsistent. While some early studies found that those with â€Å"effective defenses† had lower catecholamine levels, it was not clear exactly what this meant, and it was omitted from the table. More recent laboratory studies were just as likely to find no effects of coping styles in general or avoidant styles in particular as they were to find any effects, and none of the field studies found direct effects of coping on neuroendocrine function. However, both the trauma and job loss literatures suggest that the effects may be mediated through affect, although more direct tests are needed. Given the strength of the animal literature and the theoretical models, it is extremely surprising that stronger effects of coping on neuroendocrine function were not found. At first, our inclination was to attribute this to the problem of timing in field studies. Catecholamines have very rapid responses to stress, it is unlikely that the time periods of the coping behaviors and urine collection adequately overlapped. If the coping resulted in long-term changes in affect, then mediated effects might be seen. However, Stanford’s (1993) review of stress and catecholamines suggests an alternative hypothesis. She suggests that, in adapting to stress, COPING AND HEALTH 33 anxiety is associated with high levels of catecholamines, while depression is associated with low levels. Failure to differentiate between the reactions might well lead to the contradictory findings in the literature. In other words, avoidant coping may lead to depression or anxiety, that is, to lower or higher levels of catecholamines. Thus, we hypothesize that the relationship between coping is complex, and mediated not only by level of negative affect but by type as well. Only a handful of studies have examined coping and biomedical outcomes, and only one was in the context of coping with trauma. Avoidant strategies appear to be associated with higher levels of cardiovascular reactivity, while the effect of repressive style is spurious when controlling for anxiety. Similarly, instrumental action is associated with higher levels of HDL and lower levels of LDL and triglycerides, while avoidance and self-blame shows the opposite pattern. The very early studies on coping and immune outcomes are very difficult to interpret, given poor coping measures, specialized samples, and inconsistent results. Tentatively, instrumental action appears to be associated with higher levels of CD4+ and NKCC, while social support, in the form of emotional venting, was associated with lower levels of NKCC. Clearly there is a huge gap in the literature. More studies needed on the effects of coping on biomedical outcomes, especially in the context of trauma, and more sophisticated models need to be examined than simple direct effects. Finally, a more extensive literature exists on coping and disease outcomes. The results are much more consistent and give cause for optimism. Nearly every study has found that instrumental action is associated with slower disease progression, fewer side effects of treatment, and fewer symptoms, while avoidant coping shows the opposite pattern. Given the importance COPING AND HEALTH 34 of adherence to medical regimens and dietary restrictions in coping with chronic illnesses, it is not surprising that problem focus coping leads to better outcomes, and avoidant coping to poorer ones. Interestingly, though, Billings et al. (2000) suggests that all of the effects of coping (at least on physical symptoms in AIDS patients) are mediated through affect. Certainly more studies are needed which examine the mediators of coping on disease outcomes, especially vis-a-vis adherence and affect. The effect of social support on disease outcomes presents a more sobering picture. It is clear that the effects of support are primarily contextual, and have very different effects depending upon the type of illness, reactions to others, and needs of the individual. Clearly, if individuals are severely disabled or relatively socially isolated, provision of positive support may be very beneficial. However, if the primarily caretaker is unresponsive to genuine or creates dependency when support is no needed, then utilization of social support can have harmful effects. In summary, then, it is clear that much more research is needed in order to understand the effects of coping on physical outcomes, whether in the context of everyday stressors, chronic illness, or trauma. The trauma literature is especially deficient with regard to the effect of coping on biomedical outcomes. While most studies have simply examined direct effects, there are hints in the literature that reality is much more complicated. In particular, it is likely that nearly all of the effects of coping on biomedical and disease outcomes are mediated through affect, and, in the context of chronic illness, to adherence to medical regimes. The effects of social support, however, are highly contextual, and depend upon the needs of the individual and the COPING AND HEALTH 35 responsiveness of others in the environment. Given that nearly all of the theoretical models posit coping as a stress buffer, it is extremely surprising that almost no-one bothers to test this. Despite these gaps, however, the evidence does exist that how individuals cope with problems does have an effect on their physiology, and coping interventions can have sometimes dramatic effects on disease outcomes COPING AND HEALTH AUTHOR ACKNOWLEDGMENTS Preparation of this chapter was supported by Hatch Funds from the University of California Cooperative Extension Service. We would like to thank Dr. Crystal Park for her helpful comments on an earlier version of this chapter. 36 COPING AND HEALTH REFERENCES 37 Affleck, G. , Tennen, H. , Keefe, F. , Lefebvre, J. , Kashikar-Zuck, S. , Wright, K. , Starr, K. , Caldwell, D. (1999). Everyday life with osteoarthritis or rheumatoid arthritis: Independent effects of disease and gender on daily pain, mood, and coping. Pain, 83, 601-609. Aldwin, C. M. (August, 1994). 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