Hypothesis 6

As expected, emotion-focused coping was negatively related to years since injury with a decrease of this style of coping over 20 years. The slight increase after 20 years needs further investigation as only five participants had been caregivers for that length of time and no conclusions can be drawn that might generalise to other situations from this finding. That emotion-focused coping was used the most in the early years partially confirmed earlier results (Chappell & Dujela, 2009; Hanks et al., 2007; Kramer, 1993; Sander et al., 1997). Sander et al. (1997) found that TBI caregivers tended to use this style of coping more in the acute phase than in the longer post injury phase. However, the relationship was not significant, which the authors attributed to the small sample size (N=69), which was larger than in the current study. As the majority of participants in Sander’s study were only one and a half years post injury and the current findings showed that the use of emotion-focused coping remained steady for about the first six years before dropping off, suggest that the use of this style of coping persisted well past the acute stage. A study examining wife caregivers of husbands with Alzheimer’s disease found that duration of caregiving was significantly related to this style of coping, with wives who had been in this role for less time using more emotion-focused coping strategies (Kramer, 1993). A study of Alzheimer’s disease caregivers found a decrease of emotion-focused coping as well as problem-focused coping. The authors suggested that this was in line with the theory’s premise that coping is fluid (Chappell & Dujela, 2009). However, Chronister and Chan (2006) found no significant relationships between emotion-focused coping and time since injury in TBI caregivers. However, further investigation is required as the use of a variety of measures and conceptualisations, as well as sample differences in regards to time since injury did not allow for direct comparisons of the results.

According to the theory, emotion-focused coping is used to regulate, reduce, or limit emotional arousal associated with a stressful situation (Lazarus & Folkman, 1984). One would assume that the stress for TBI caregivers would be highest in the acute phase, when the main concern is for the survival and recovery of the family member. At high levels of stress a tendency to use emotion-focused coping has been found (Anderson, 1977). This would be followed by a period of adjustment, when the person has to adapt to the caregiving role and cope with the emotional responses to the injury and the rehabilitation process. The current finding would suggest stress and emotional arousal for the participants in this study was at its highest in the early years, and reduced over

112 time. Interestingly, the decrease in use of emotion-focused coping was not evident until after about six years, well past the immediately life threatening phase. This would suggest that the period of adjustment and the stress associated TBI caregiving with lasted for many years. However, this interpretation has to be made with caution, as the study was cross-sectional. Despite the theory’s assumption that coping is contextual rather than dispositional, longitudinal research is required to confirm that the use of coping strategies in TBI caregivers changes over time.

Further support for the decrease in use of emotion-focused coping is the theoretical assumption that this style of coping is used in situations that are appraised as threatening and uncontrollable. In the early stage after injury, especially in the acute phase, the main concern is often about the survival of the patient and an appraisal of the situation as threatening is to be expected. In addition, health professionals such as doctors, nurses and those involved in rehabilitation are using their professional expertise in caring for the injured person and making decisions to ensure survival and recovery. This could lead to the family member appraising the situation as one they have little control over and therefore depended more on emotion-focused coping strategies. As time since injury increases, caregivers become less involved with rehabilitation professionals and programmes, suggesting that their appraisal possibly changes to non- threatening and controllable with a decreased use of emotion-focused coping strategies (Murray, Maslany, & Jeffery, 2006).

A possible explanation for the relatively steady use of emotion-focused coping in the first six to seven years could be Lazarus and Folkman’s (1984) claim that coping strategies that are effective are used consistently in similar situations. Following from this emotion-focused coping might have been effective for the participants in the current study over several years after which it ceased to be effective, leading to reappraisal and the use of problem-focused coping. The slight increase in emotion-focused coping evident after about 20 years might have been due to life changes such as increasing age with its own considerations. It is possible that the caregivers were faced with retirement and a change in financial situation or decrease in health once again leading to threat appraisal and an increased use of emotion-focused coping. The continued use of emotion-focused coping over the years is also in line with the theory that people use a variety of coping strategies over time. The use of emotion-focused coping in later years would suggest that TBI caregiving always has aspects that are appraised as uncontrollable.

113 It is possible that the relationship was brought about by the use of accepting responsibility. Visual inspection of the data showed that the use of emotion-focused coping remained steady over the first six years before a decrease was evident, a pattern that was similar to the use of accepting responsibility with a decline after about ten years. The finding that accepting responsibility was negatively related to time since injury was a novel one and no comparative studies were found, neither in the caregiving nor in any other population. It is possible that this style of coping, which included items related to criticising and lecturing oneself by acknowledging one’s own role in the situation and attempting to put things right, was related to the guilt caregivers might have felt. According to Degeneffe and Olney (2010) family members in their study felt guilty for a range of reasons such as the fact that they were able to fully live their lives, while their injured sibling was not. In addition, family members who cared for totally dependent patients for many years, felt guilty for wanting to take time out (Koskinen, 1998). It is also possible that they felt they should have done something to prevent this tragedy from happening. Some caregivers might have had feelings of guilt dealing with the cognitive, behavioural and physical changes in their loved one and through the use of accepting responsibility as a coping strategy tried to make up for the negative emotions they experienced. The decrease in the use of this style of coping after ten years might have been a reflection of eventually coming to terms with those feelings of guilt. As accepting responsibility was one of the least used strategies, this could suggest that participants possibly did not experience feelings of guilt that frequently or that the use of this style of coping was ineffective in reducing emotional distress and led to reappraisal and the use of other styles of coping. Further research is required to clarify the use of accepting responsibility coping and its relation to time since injury.