When people first start therapy, I usually ask them what they hope to get out of our work together.
Nine times out of ten, their answer is some version of this:
I want some tools and coping strategies to deal with my anxiety/depression/anger/etc.
This is understandable. When you cut your finger chopping vegetables, you put a Band-Aid on it. When you get a headache, you take some Tylenol. And when you feel stressed, you take a hot bath or do some deep breathing exercises.
It makes sense, then, that when people develop more significant emotional struggles, they would show up to therapy asking for the bigger, stronger version of their coping strategies.
Because we’ve been trained to think of health as the absence of disease, we don’t really think about our health until something’s wrong—at which point we expect a pill, technique, surgical intervention, mantra, or some other coping strategy to make things better.
While this may work for the occasional scraped knee or headache, I’d like to suggest that coping is not an optimal approach to health—physical, emotional, or otherwise. But more than that, the overarching attitude of coping often leads to the exact opposite of its intended effect—emotional fragility and increased long-term suffering.
Of Gunshots and Paper Cuts
Like I said, there’s nothing wrong with a Band-Aid per se. If your problem is a simple scraped knee, coping with it by applying a bandage is a perfectly reasonable path toward health.
Unfortunately, most health problems—especially mental health problems—are rarely as simple as a scraped knee.
Suppose you wake up one morning feeling anxious and on edge. There’s no obvious cause or trigger for anxiety, so you brush it off and hop in the shower. But 30 minutes later as you’re making coffee, you realize the anxiety’s still there, and maybe a tad worse than it had been earlier.
So you reach into your “tool belt” of coping strategies and apply one: Maybe you pop a Xanax or throw a few shots of whiskey into your coffee; maybe you do a deep breathing technique or some mindfulness meditation for a few minutes; or maybe you flip through your notes from your last therapy session trying to recall that insightful quip about anxiety from your therapist.
Any one of these coping strategies may well “work” to alleviate your anxiety. But whether it genuinely works or not in the long-run depends on the nature of the problem itself.
Is your morning anxiety a random occurrence, like the occasional headache or paper cut? Perhaps. In which case, your coping skill may be a fine solution.
But what if it’s more than that? What if your anxiety isn’t a problem itself, but instead, a symptom of a deeper problem?
What if by trying to fix the emotion with a coping skill you’re actually shooting the messenger and ignoring the message?
Paper cuts and gunshot wounds are superficially similar in the sense of bleeding. But you don’t have to be an MD to realize they are actually completely different problems requiring completely different solutions.
While a little burst of nervousness or low mood doesn’t necessarily point to deeper emotional issues, it would be foolish to assume that they never do. Unfortunately, the coping skills approach to mental health encourages us to do just that.
The problem with coping skills is the mindset they foster.
To see the problem with coping skills, you have to look beyond the obvious and start to see second-order effects.
Superficially, a little deep breathing may help you feel less anxious. But the longer-term effect of coping with your anxiety is the message you’re reinforcing: that the solution to feeling bad emotionally is to do something that makes you feel good now.
Unfortunately, this is almost never the case.
The most effective treatment for most anxiety problems is exposure therapy, which means deliberately exposing yourself to the thing you’re afraid of in order to recalibrate your brain’s threat-detection mechanisms.
One of the most effective treatments for depression is behavioral activation, which means forcing yourself to do pleasurable or meaningful activities despite not feeling motivated to do so.
Much like addressing a gunshot wound means doing a painful surgery before the wound can truly heal, most emotional struggles require feeling worse before you can feel better.
Digging into the root cause of your morning anxiety may be painful. Perhaps your morning anxiety before work is actually a symptom of spending years and decades of your life doing something you don’t like and don’t find meaningful?
Coping with that anxiety with a little mindfulness meditation is like putting a Band-Aid on a gunshot wound. It might stop the bleeding for a minute or two, but at best you’re just kicking the can down the road. Unfortunately, it’s actually worse than that.
The more we therapists and mental health professionals push coping skills as a solution to emotional difficulties, the more we engender a coping skills theory of mental health in our clients. The second-order effect is that we train people to avoid searching for underlying root causes of their suffering. By emphasizing coping skills and the alleviation of short-term emotional pain, we ironically lead out clients toward emotional ignorance and long-term suffering.
How often do you use your emergency brake?
To be clear, I think coping skills have their place.
My concern is that precisely because they’re often an effective way to feel better now, they will lead to feeling far worse in the future.
Put another way, I think we easily become addicted to coping skills. And like most forms of addiction, while they feel good in the moment, the self-deception they can engender often leads to tragic long-term effects.
Like your car’s emergency brake, coping skills are good to have but should be used sparingly—and rarely relied upon.