INTRODUCTION

1.1. Introduction

Adolescents' psychological well-being is influenced by factors like locus of control, coping

styles, and stress levels. Studies have shown that adolescents with an external locus of
control tend to exhibit higher levels of aggression, while those with an internal locus of
control report lower perceived stress. Coping strategies play a crucial role in managing
stress, with urban adolescents often experiencing higher academic stress levels compared to
their rural counterparts. Effective coping mechanisms are essential for adolescents to
navigate the challenges they face, especially in academic settings where stress levels can be
significant. Understanding how locus of control, coping styles, and psychological distress
interplay among adolescents in Calicut district can provide valuable insights into promoting
their mental well-being.
The present study seeks to address this gap by examining the relationships between locus of
control, coping styles, and psychological distress among adolescents in Calicut District,
Kerala. By elucidating these dynamics within the local context, the study aims to contribute
to our understanding of adolescent mental health and inform culturally sensitive
interventions tailored to the specific needs of adolescents in the region. Through a
comprehensive exploration of these variables, we endeavor to empower adolescents with
the resources and support necessary to navigate the challenges of adolescence and cultivate
flourishing mental health outcomes. Despite the growing recognition of the importance of
locus of control, coping styles, and psychological distress in adolescent mental health,
empirical research within the Calicut District context remains limited. Existing studies
predominantly focus on urban populations or rely on samples from Western cultural
contexts, neglecting the unique socio-cultural nuances and challenges faced by adolescents
in Kerala, India. Moreover, the interplay between locus of control, coping styles, and
psychological distress among adolescents in Calicut District remains largely unexplored,
warranting systematic investigation.

Adolescence is a pivotal period characterized by significant psychological, emotional, and

social changes, representing a critical juncture in the development of mental health and
well-being (Steinberg, 2005). During this transformative phase, individuals navigate a
multitude of challenges, including identity formation, peer relationships, academic
pressures, and familial dynamics, all of which can profoundly impact their psychological
adjustment and resilience (Eccles & Roeser, 2011). Within the context of Calicut District,
located in the southern state of Kerala, India, these challenges are further compounded by
cultural, socio-economic, and environmental factors unique to the region.

Locus of control is the degree to which people believe that they, as opposed to external
forces (beyond their influence), have control over the outcome of events in their lives. The
concept was developed by Julian B. Rotter in 1954, and has since become an aspect of
personality psychology. A person’s “locus” (plural “loci”, Latin for “place” or “location”)
is conceptualized as internal (a belief that one can control one’s own life) or external (a
belief that life is controlled by outside factors which the person cannot influence, or that
chance or fate controls their lives).Individuals with a strong internal locus of control believe
events in their life are primarily a result of their own actions: for example, when receiving
exam results, people with an internal locus of control tend to praise or blame themselves
and their abilities. People with a strong external locus of control tend to praise or blame
external factors such as the teacher or the difficulty of the exam. Locus of control has
generated much research in a variety of areas in psychology. The construct is applicable to
such fields as educational psychology, health psychology, industrial and organizational
psychology, and clinical psychology. Debate continues whether domain-specific or more
global measures of locus of control will prove to be more useful in practical application.
Careful distinctions should also be made between locus of control (a personality variable
linked with generalized expectancies about the future) and attributional style (a concept
concerning explanations for past outcomes), or between locus of control and concepts such
as self-efficacy. Locus of control is one of the four dimensions of core self-evaluations –
one’s fundamental appraisal of oneself – along with neuroticism, self-efficacy, and self-
esteem. The concept of core self-evaluations was first examined by Judge, Locke, and
Durham (1997), and since has proven to have the ability to predict several work outcomes,
specifically, job satisfaction and job performance. In a follow-up study, Judge et al. (2002)
argued that locus of control, neuroticism, self-efficacy, and self-esteem factors may have a
common core.

Central to understanding adolescent mental health is the concept of locus of control, which
refers to individuals’ beliefs regarding the extent to which they control the outcomes of
their lives (Rotter, 1966). Internals attribute events to their own actions and decisions,
fostering a sense of agency and empowerment, while externals perceive outcomes as
determined by external forces such as luck or fate, leading to feelings of helplessness and
dependency (Nowicki & Duke, 1974). Adolescents’ locus of control orientations plays a
crucial role in shaping their responses to stressors and adversity, influencing the adoption of
coping strategies and ultimately impacting their psychological well-being (Lefcourt, 2014).

Coping refers to conscious strategies used to reduce unpleasant emotions. Coping strategies
can be cognitions or behaviors and can be individual or social. To cope is to deal with and
overcome struggles and difficulties in life. It is a way for people to maintain their mental
and emotional well-being. Everybody has ways of handling difficult events that occur in
life, and that is what it means to cope. Coping can be healthy and productive, or destructive
and unhealthy. It is recommended that an individual cope in ways that will be beneficial
and healthy. “Managing your stress well can help you feel better physically and
psychologically and it can impact your ability to perform your best. Closely intertwined
with locus of control are coping styles, which encompass the cognitive and behavioral
strategies individuals employ to manage stressors and maintain emotional equilibrium
(Folkman & Lazarus, 1980). Adaptive coping involves active problem-solving, seeking
social support, and positive reframing, facilitating effective stress management and
psychological adjustment (Carver et al., 1989). In contrast, maladaptive coping strategies
such as avoidance, denial, and substance use offer temporary relief but often exacerbate
distress and undermine long-term resilience (Compas et al., 2001). Adolescents’ coping
styles reflect their cognitive appraisals of stressors and their perceived capacity to cope,
shaped in part by their locus of control orientations (Skinner et al., 2003).

Psychological distress refers to the unpleasant emotions or psychological symptoms an

individual has when they are overwhelmed, which negatively impacts their quality of life.
Psychosocial distress is most commonly used in medical care to refer to the emotional
distress experienced by populations of patients and caregivers of patients with complex
chronic conditions such as cancer, diabetes, and cardiovascular conditions, which confer
heavy symptom burdens that are often overwhelming, due to the disease’s association with
death. Due to the significant history of psychosocial distress in cancer treatment, and a lack
of reliable secondary resources documenting distress in other contexts, psychosocial
distress will be mainly discussed in the context of oncology. Psychological distress,
encompassing symptoms of anxiety, depression, and somatic complaints, represents a
common outcome of maladaptive coping and impaired locus of control among adolescents
(Kessler et al., 2005). High levels of psychological distress during adolescence are
associated with a myriad of adverse outcomes, including academic underachievement,
substance abuse, self-harm, and suicidal ideation (Patton et al., 2007). Identifying the
factors contributing to psychological distress among adolescents in Calicut District is
imperative for designing targeted interventions aimed at promoting resilience and
mitigating mental health disparities within the community.
 REVIEW OF LITERATURE
2.1. Introduction
A review of literature is an integral part of academic writing, especially in research. It
involves a critical analysis of existing literature on a specific topic or area of interest, aimed
at gaining familiarity and understanding of current research before carrying out a new
investigation. The primary purpose of a literature review is to provide an overview of the
existing research on a particular topic, identify the strengths and limitations of the research,
and highlight gaps in knowledge. The present study aims to explore the locus of control,
coping styles, and psychological distress among adolescents in Calicut district.
The study conducted by Kurtovic R.G, Vukovic et al (2018) on the effect of locus of
control on university students’ mental health: Possible mediation through self-esteem and
coping. The purpose of this study was to examine the effect of locus of control on
university students’ mental health and to examine possible mediational roles of self-esteem
and coping. A total of 418 university students completed Rotters I-E Scale, Self-liking/self-
competence Scale, Endlers Coping with Stressful Situations Scale and Depression, Anxiety
and Stress Scale. The results showed that external locus of control, lower self-liking and
self-competence, as well as less problem-focused and more emotion-focused coping predict
more symptoms of depression, anxiety, and stress in university students. However,
mediational analysis revealed that the effect of locus of control was fully mediated by self-
esteem and coping, with self-liking and emotion-focused coping being the strongest
mediators. Results suggest that beliefs about control affect beliefs about one’s self-worth
and coping strategies, which in turn can affect one’s mental health.

The present study conducted Christiansen D.M, Hansen et al (2014) on the topic
Correlates of coping styles in an adolescent trauma sample by used a cross-sectional design
to investigate the combined effect of personality traits, attachment, locus of control, and
social support on rational (problem-focused), avoidant, and emotion-focused coping in 320
trauma-exposed adolescents. The combined variables only explained 20-23 % of the
variance in avoidant and rational coping, and 49 % of the variance in emotion-focused
coping. The largest contributing variable for emotion-focused coping was neuroticism,
possibly due to a confounding of emotion-focused coping with distress. Thus, other
variables are needed to fully account for coping style choice Arslan C, Dilmac B et al
(2009) conducted a study Coping with stress and trait anxiety in terms of locus of control:
A study with Turkish university students. The purpose of this study was to determine
whether trait anxiety and coping with stress vary significantly according to locus of control.
The study was carried out with 514 (286 female and 228 male) Turkish university students,
aged between 18 and 27. It was found that average trait anxiety scores of the students with
internal locus of control were significantly lower than those of the students with external
locus of control and that average problem-focused coping with stress scores of the students
with internal locus of control were significantly higher than those of the students with
external locus of control. There was no significant difference in incidence of avoidance and
seeking social support between the students with internal locus of control and those students
with external locus of control.

The study was conducted by Susan A Meijer, Sinnema G et al (2002) on the topic Coping
styles and locus of control as predictors for psychological adjustment of adolescents with a
chronic illness. This study examines the way coping styles and locus of control contribute
to the prediction of psychosocial adjustment in adolescents with a chronic illness.
Psychosocial adjustment of 84 adolescents aged 13–16 years with a chronic illness was
assessed with measures of social adjustment, global self-esteem and behavior problems.
Linear regressions were performed with demographic factors (age and gender) and stress-
processing factors (coping style and locus of control) as predictor variables. Results
indicated that coping styles were related to most aspects of social adjustment. The coping
styles ‘seeking social support’ and ‘confrontation’ were important predictors for positive
social adjustment; the coping style ‘depression’ was a predictor for poor adjustment, viz.
low social self-esteem and high social anxiety. Avoidance and locus of control were not
strongly associated with psychosocial adjustment. Clinical implications of these findings
were discussed in terms of preventive interventions for adolescents with a chronic illness.

Liu X, Kurita H et al (2000) conducted a study on Life events, locus of control, and
behavioral problems among Chinese adolescents. This study examined associations of life
events and locus of control with behavioral problems among 1365 Chinese adolescents by
using the Youth Self‐Report (YSR), Adolescent Self‐Rating Life Events Checklist
(ASLEC), and the Nowicki–Strickland Locus of Control Scale for Children. Results
indicated that the overall prevalence of behavioral and emotional problems was 10.7%
(95% CI = 9.9–11.5%). Logistic‐regression analyses showed that a total of 13 negative life
events mainly coming from academic domain and interpersonal relationships, high life‐
stress score, and high external locus score significantly increased the risk for behavioral
problems. Life stress and locus of control significantly interacted with behavioral problems.
These findings support the linkage between stressful life events and psychopathology in a
general population of adolescents from mainland China, and demonstrate the stress‐
moderating effects of locus of control on psychopathology as well

Hallis D & Slone M (1999) conducted study on Coping strategies and locus of control as
mediating variables in the relation between exposure to political life events and
psychological adjustment in Israeli children. The relation between political life events and
distress was examined with particular emphasis on coping strategies and locus of control as
two possible mediators. Subjects were 88 Israeli children. Results partially supported a
linear relation between reported impact of exposure and distress. Findings for coping
strategies as a mediator suggested, counterintuitively, that greater use of coping strategies is
related to more experienced distress. Findings for locus of control as a mediator suggested
that subjects with external locus of control experience greater distress, other than in the case
of depressive symptomatology. These results indicate that coping strategies and locus of
control play a complex role in the stress-outcome relation, the precise nature of which
remains to be resolved. Theoretical, clinical and political implications of the findings are
discussed.

The study was conducted on the topic Locus of control and avoidant coping: Direct,
interactional and mediational effects on maladjustment in adolescents by Gomez R
(1998).This study examined the association of locus of control (LOC) and avoidant coping
(AVC) with anxiety/depression (ANX/DEP) in terms of additive, interactional and
mediational models. A total of 468 male and female subjects between 14 and 17 years of
age completed questionnaires covering LOC, AVC and ANX/DEP. Results showed that
both LOC and AVC were directly related to ANX/DEP. Among males, as LOC increased in
externality, the level of ANX/DEP increased for those with low AVC, but decreased for
those with high AVC. For females, the interaction between LOC and AVC did not
influence the level of ANX/DEP. Results also showed partial mediation by LOC on the
relation between AVC and ANX/DEP, and partial mediation by AVC on the relation
between LOC and ANX/DEP. These findings are discussed in terms of how LOC and AVC
are related to adolescent maladjustment.

Present study conducted on the topic Coping and locus of control: Cross-generational
transmission between mothers and adolescents by Hoffman M.A & Shiff R.L (1994). To
address the role of maternal coping and control beliefs in the development of coping and
locus of control in their adolescent children, 68 yoked pairs of Israeli mothers and their
male, seventh- and eighth-grade children completed questionnaires related to coping styles
and locus of control. Regression analyses revealed a strong similarity between adolescents’
coping profiles and those of their mothers in a manner relecting the hypothesized impact of
modeling. As expected, locus of control was found to be associated with the active patterns
of coping in mother and adolescent alike. However, little empirical support was found for
the hypothesis of developmental similarities in locus of control Rather, the pattern of
findings was consistent with an alternate interpretation involving the potential impact of
maternal coping on the development of adolescent locus of control. Study findings are
discussed in regard to models of cross-generational transmission.

The study on Coping styles and psychological distress among Chinese adolescents in Hong
Kong by Lee H.B, Chan W.D et al (1992). The present study examined the relationship
between coping styles and psychological distress in a nonclinical sample of 832 Hong Kong
Chinese adolescents. Measures included the General Health Questionnaire and an
Adolescent Coping Scale adapted from both Western and Eastern sources. Results from
factor analyses suggested that adolescents used relatively similar coping strategies when
confronted with problems. Thus four broad coping styles were identified. The coping style
of avoidance blaming was consistently found to be a significant and moderately strong
predictor of psychological distress in four different problem areas relating to academic
difficulties, conflicts with elders, conflicts with friends, and future concerns. Although
males and females used similar coping styles when confronted with difficulties, they
differed in the frequency with which they might use a particular coping style when dealing
with a particular problem. Limitations of the study and implications for future research in
adolescent coping are also discussed

Locus of control and self-esteem as moderators of stressor-symptom relations in children

and adolescents studied by Kliewer W & Sandler I.N (1992). Locus of control and self-
esteem were examined as moderators of links between negative life events and
psychological symptoms in 238 young people 8 to 16 years old. Results indicated that locus
of control buffered the effects of stressors on psychological symptoms, and the pattern of
buffering did not differ by age or gender. Self-esteem buffered the link between Stressors
and symptoms, but only for girls. Further analyses with girls only revealed a conjunctive
moderation effect of locus of control and self-esteem: When faced with many negative life
events, girls who have both an external locus of control and low esteem show the highest
psychological maladjustment.
Kliewer W (1991) conducted a study Coping in middle childhood: Relations to
competence, Type A behavior, monitoring, blunting, and locus of control. Examines roles
that social competence, Type A behavior, monitoring, blunting, and locus of control play in
coping with everyday stressors. 48 2nd-and 52 5th-graders were interviewed individually 3
times over an 8-wk period to assess perceptions of everyday stressors and associated coping
behaviors. Teachers rated social competence and Type A behavior; the remaining predictors
were self-reported at the start of the study. Results of multivariate analyses of variance
(MANOVAs) revealed that, except for Type A behavior, coping was associated with the
predictors. Strongest associations were found for social competence, which was related to
greater use of avoidant actions and cognitive avoidance and less use of problem behavior.
The predictors were un associated with ratings of coping efficacy. (Psyc INFO Database
Record (c) 2016 APA, all rights reserved)

The study on Psychological distress among Canadian adolescents conducted by Arcy C.D
& Siddique C.M (1984). This paper examines a comprehensive set of data on the
prevalence and correlates of psychological distress in a sample of 1038 adolescent students
in a major urban area of a Canadian prairie province. About 27% of the students reported 6
or more symptoms of psychological distress on the GHQ-30. The frequency of symptoms
varied with age, grade level and average marks, with sex being the most significant
variation. ‘Anxiety’ and ‘social dysfunction’ were the most frequent symptom dimensions
reported. More detailed analysis of possible predictors of mental health showed that the
nature and quality of family life strongly affected adolescent mental health. Adolescents'
positive evaluation of their school atmosphere and peer group life and their locus of control
orientation also positively influenced their psychological well-being.
 METHODOLOGY

3.1 Introduction

This chapter outlines the methodology employed in investigating the relationship between
locus of control, coping styles, and psychological distress among adolescents in Calicut
district.

3.2 Research Design

A quantitative research design with a correlational approach is adopted to examine the

associations between locus of control, coping styles, and psychological distress among
adolescents.

3.3 Statement of Problem

General aim of the study to explore in research. Hence the study has been entitled as locus
of control, coping styles, and psychological distress among adolescents in Calicut district.

3.4 Objectives of the Study

The specific objectives of the study are as follows:

1. To assess the levels of locus of control, coping styles, and psychological distress among
adolescents in Calicut district.
2. To examine the relationships between locus of control, coping styles, and psychological
distress among adolescents.
3. To investigate the influence of demographic variables such as age, gender, and socio-
economic status on locus of control, coping styles, and psychological distress among
adolescents.
3.5 Hypotheses used in this study

The following hypothesis were formulated for the study:

H1: There will be no significant relationship between locus of control and coping styles
among adolescents in Calicut district.
H2: There will be a significant no relationship between internal locus of control and
psychological distress among adolescents in Calicut district.
H3: There will be a significant relationship between adaptive coping styles and
psychological well-being among adolescents in Calicut district.
H4: Gender, age, and socio-economic status will not significantly moderate the relationship
between locus of control, coping styles, and psychological distress among adolescents in
Calicut district.

3.6 Operational Definitions

Locus of Control: Locus of control refers to the degree to which individuals believe they
have control over events in their lives. It encompasses the extent to which individuals
attribute outcomes to their own actions (internal locus of control) versus external factors
such as luck or fate (external locus of control) (Rotter, 1966).

Coping Styles: Coping styles are cognitive and behavioral strategies individuals use to
manage stress. These strategies may include problem-focused coping (engaging in actions
to address the stressor), emotion-focused coping (regulating emotions in response to the
stressor), and avoidance coping (distancing oneself from the stressor) (Lazarus & Folkman,
1984)

Psychological Distress: Psychological distress refers to the subjective experience of

emotional suffering and discomfort, often manifesting as symptoms of depression, anxiety,
and stress. It can impact various aspects of an individual's life, including their mood,
thoughts, and behaviors (Lovibond & Lovibond, 1995).

3.7 Sample

Stratified random sample techniques to be used for selecting sample for research
Inclusion Criteria:

● Adolescents aged 13 to 19 years.

● Residents of Calicut district.

● Both males and females.

Exclusion Criteria:

● Adolescents outside the age range of 13 to 19 years.

● Non-residents of Calicut district.

3.8 Study Instruments

The following instruments will be used:

a) Locus of Control Scale (Rotter, 1966):

The Locus of Control Scale measures the extent to which individuals believe they can
control events affecting them. This scale consists of X items to be rated on a X-point
Likert scale, where 1 indicates "Strongly Disagree" and X indicates "Strongly Agree".
Higher scores suggest an internal locus of control, while lower scores suggest an
external locus of control.

b) Coping Styles Inventory (CSI) - Adolescent Version (Carver et al., 1989):

The Coping Styles Inventory assesses various coping strategies used by adolescents to
manage stress and difficult situations. It consists of X items rated on a X-point Likert
scale, ranging from 1 (Not at all like me) to X (Exactly like me). The inventory
categorizes coping styles into problem-focused, emotion-focused, and avoidant coping.
Higher scores indicate a higher tendency to use a particular coping style.

c) Psychological Distress Scale (Kessler et al., 2002):

The Psychological Distress Scale measures the severity of psychological distress

experienced by adolescents. It includes X items rated on a X-point Likert scale, where
 1 signifies "Not at all" and X signifies "Extremely". Higher scores indicate higher
levels of psychological distress.

d) Socio-Demographic Sheet:
The demographic information sheet collects essential information about the
participants, including age, gender and socio-economic status
e) Consent:
A Consent form was given to each patient and explained about the purpose and
nature of the study.

3.9 Data Collection Procedure

Self-administered questionnaires will be distributed to adolescents in schools, community

centers, and other relevant locations in Calicut district.

3.10 Data Analysis

Descriptive statistics and inferential analyses, including correlation and multiple regression,
will be conducted using appropriate statistical software.

3.11 Ethical Considerations

The study will adhere to ethical guidelines, ensuring confidentiality, anonymity, and
voluntary participation of participants. Institutional ethical approval will be obtained.

3.12 Statistical Techniques

Descriptive and inferential statistics will be used. The data will be analyzed using SPSS
software. Correlation, ‘t’ test and one-way ANOVA will be used to analyze the data.

3.13 Schedule of Activities

1. Related Literature Survey - One Week

This involves reviewing existing literature on locus of control, coping styles, and
psychological distress among adolescents. One week should provide ample time to
gather relevant research articles, books, and other scholarly sources.
2. Selecting Questionnaire - Three Days
 Developing or selecting a suitable questionnaire tailored to the study's objectives
and the target population. This process involves designing questions that effectively
capture information on locus of control, coping styles, and psychological distress.

3. Administration of Questionnaire - Two Weeks

Distributing the questionnaire to the selected sample of adolescents in the Calicut
district. This timeframe allows for sufficient time to coordinate with schools, youth
centers, or other relevant institutions for questionnaire administration.
4. Data Collection - Four Weeks
This involves collecting completed questionnaires from the respondents. Four weeks
should provide adequate time to gather responses from the targeted adolescent
population, ensuring a comprehensive dataset for analysis.
5. Data Analysis - Two Weeks
Analyzing the collected data using appropriate statistical methods and software.
This process includes organizing the data, conducting statistical tests (e.g.,
correlation analysis, regression analysis), and interpreting the results.
6. Data Interpretation - One Week
Interpreting the findings of the data analysis in the context of the study's objectives
and the existing literature. This involves drawing conclusions, discussing
implications, and suggesting recommendations based on the study's results.

Overall, the entire schedule for conducting the study on "Locus of control, coping styles,
and psychological distress among adolescents in Calicut district" would span approximately
eleven weeks. However, it's essential to remain flexible as unexpected delays or challenges
may arise during the research process.
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https://my.clevelandclinic.org/health/articles/6392-stress-coping-with-lifes-
stressors
D'Arcy, C., & Siddique, C. M. (1984). Psychological distress among Canadian
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Appendices

Appendix 1: Rotter's Locus of Control Scale

Appendix 2: Coping Styles Inventory (CSI) - Adolescent Version

Appendix 3: Psychological Distress Scale

Appendix 4: Socio-Demographic Sheet

 Appendix 1:

Rotter's Locus of Control Scale

 Appendix 2:
Coping Styles Inventory (CSI) - Adolescent Version

We are interested in how people respond when they confront difficult or stressful events in
their lives. There are lots of ways to try to deal with stress. This questionnaire asks you to
indicate what you generally do and feel, when you experience stressful events. Obviously,
different events bring out somewhat different responses, but think about what you usually
do when you are under a lot of stress.
Then respond to each of the following items by blackening one number on your answer
sheet for each, using the response choices listed just below. Please try to respond to each
item separately in your mind from each other item. Choose your answers thoughtfully, and
make your answers as true FOR YOU as you can. Please answer every item. There are no
“right” or “wrong” answers, so choose the most accurate answer for YOU–not what you
think “most people” would say or do. Indicate what YOU usually do when YOU experience
a stressful event.

1 = I usually don’t do this at all

2 = I usually do this a little bit
3 = I usually do this a medium amount
4 = I usually do this a lot

1. I try to grow as a person as a result of the experience.

2. I turn to work or other substitute activities to take my mind off things.
3. I get upset and let my emotions out.
4. I try to get advice from someone about what to do.
5. I concentrate my efforts on doing something about it.
6. I say to myself “this isn’t real.”
7. I put my trust in God.
8. I laugh about the situation.
9. I admit to myself that I can’t deal with it, and quit trying.
10. I restrain myself from doing anything too quickly.
11. I discuss my feelings with someone.
12. I use alcohol or drugs to make myself feel better.
13. I get used to the idea that it happened.
14. I talk to someone to find out more about the situation.
15. I keep myself from getting distracted by other thoughts or activities.
16. I daydream about things other than this.
17. I get upset, and am really aware of it.
18. I seek God’s help.
19. I make a plan of action.
20. I make jokes about it.
21. I accept that this has happened and that it can’t be changed.
22. I hold off doing anything about it until the situation permits.
23. I try to get emotional support from friends or relatives.
24. I just give up trying to reach my goal.
25. I take additional action to try to get rid of the problem.
26. I try to lose myself for a while by drinking alcohol or taking drugs.
27. I refuse to believe that it has happened.
28. I let my feelings out.
29. I try to see it in a different light, to make it seem more positive.
30. I talk to someone who could do something concrete about the problem.
31. I sleep more than usual.
32. I try to come up with a strategy about what to do.
33. I focus on dealing with this problem, and if necessary let other things slide a little.
34. I get sympathy and understanding from someone.
35. I drink alcohol or take drugs, in order to think about it less.
36. I kid around about it.
37. I give up the attempt to get what I want.
38. I look for something good in what is happening.
39. I think about how I might best handle the problem.
40. I pretend that it hasn’t really happened.
41. I make sure not to make matters worse by acting too soon.
42. I try hard to prevent other things from interfering with my efforts at dealing with this.
43. I go to movies or watch TV, to think about it less.
44. I accept the reality of the fact that it happened.
45. I ask people who have had similar experiences what they did.
46. I feel a lot of emotional distress and I find myself expressing those feelings a lot.
47. I take direct action to get around the problem.
48. I try to find comfort in my religion.
49. I force myself to wait for the right time to do something.
50. I make fun of the situation.
51. I reduce the amount of effort I’m putting into solving the problem.
52. I talk to someone about how I feel.
53. I use alcohol or drugs to help me get through it.
54. I learn to live with it.
55. I put aside other activities in order to concentrate on this.
56. I think hard about what steps to take.
57. I act as though it hasn’t even happened.
58. I do what has to be done, one step at a time.
59. I learn something from the experience.
60. I pray more than usual.
 Appendix 3:
Psychological Distress Scale