In this paper, I discuss how coping with stress in times of crisis can offer opportunities to strengthen family bonds. The main thesis of this paper is that crises and their concomitant stress can either have devastating effects on families or become opportunities for resilience and growth depending on the ways in which family members approach these events. On the one hand, stress can lead to greater dysfunction by constraining the ways in which family members spend time together, communicate with one another, or share positive experiences – all of which are essential resources for promoting close relationships. On the other hand, growth and resilience may come as a result of family members’ commitment to protect and nurture their bonds and coping with stress in ways that prioritize not only the individual, but also their family relationships. In turn, strong and healthy family bonds can protect against the harmful effects of chronic stress on the individual’s physical and emotional well-being.
I approach this discussion from a secular perspective that integrates three decades of clinical experience, my research on couples’ stress and coping processes in the U.S. and in Argentina (including systematic reviews of the empirical and conceptual literature on stress and coping), collaborations with stress and coping researchers from various countries, as well as programs that I have developed and implemented to assist low-income couples cope with relationship and financial stress. Throughout the paper, I refer to family as all relationships that individuals choose to define as such (including family of origin and/or choice). Additionally, considering the infinite number of expected and unexpected internal and external challenges that families may encounter, the present discussion will only refer to some of the external stressors that families have commonly experienced in the last decade. As such, the discussion in the present paper will include: (a) definitions of stress and coping; (b) an account of the most significant chronic external stressors that families have been facing before and during the COVID-19 pandemic; (c) the harmful impact of stress on individuals’ physical and mental health and their relationships; (d) coping strategies that only focus on the individual and the limitations of such strategies; (e) relational coping approaches that protect and strengthen family relationships; (f) recommendations to help families strengthen their bonds when coping with stress; and (g) the description of a community program for couples whose goals and results are consistent with such recommendations.
Stress, Stressors, and Coping – Definitions
The origins of the word stress in English dates back to the 14th century as a shortening of the word distress. The Middle English distress derives from the word estresse (narrowness, oppression) in French, which in turns derives from the Latin word strictus (tight, compressed, drawn together) [1]. Before it was a precise scientific term in the 19th century, the term stress was already used as part of everyday language to denote “an external disturbing event or the perturbation resulting from it” [2]. In the early 1900s, the physiologist Walter Cannon defined stress as a process in which the somatic homeostasis is unsettled by external threats that lead to the mobilization of resources to cope with the situation [3]. In fact, Cannon also introduced the notion that organisms react to stress with a fight-or-flight response. Thus, it was not until recent history that stress was clearly recognized as an internal reaction to external events.
More recently, in the 1980s, psychologists Lazarus and Folkman [4] introduced a cognitive appraisal model that has prevailed in the field of psychology since then: Stress is not the stimulus (stressor), but rather the perception that the “demands of a situation exceed the personal and social resources the individual is able to mobilize”. In particular, primary appraisal refers to the way in which individuals evaluate the significance of the stressor to their well-being (e.g., “Is it a threat or a loss?”), whereas secondary appraisal involves an assessment of coping resources available to address the perceived threat/loss (e.g., “Can I cope with this situation?”). Resources can be physical (e.g., health, energy, food), social (e.g., social support), psychological (e.g., perceived control), or material (e.g., money). Stressors can be acute (short-term), episodic acute (frequent acute stress), chronic (long term), expected (e.g., beginning of school or new job) and/or unexpected (e.g., natural disaster, car accident). Lazarus and Folkman refer to coping as the use of “cognitive and behavioral efforts to master, reduce or tolerate the internal and/or external demands that are created by the stressful transaction” [4] In the present paper, I will follow Lazarus and Folkman’s definitions of stress, stressor, and coping.
External Stressors for Families Before the COVID-19 Outbreak
Before discussing the way that families can strengthen their bonds during times of crisis, it is important to describe the increasing number of external stressors that families have experienced even before the COVID-19 pandemic. Although I provide examples of chronic stressors that have affected U.S. families, families in other parts of the world also experience similar ones. At the outset, I need to underline that this review is necessarily brief; detailed discussions of every stressor is well beyond the scope of this paper.
Before the pandemic, individuals and families were already reporting higher levels of chronic stress in their everyday lives. In the U.S. this increase was followed closely by the annual Stress in America survey conducted by the American Psychological Association (APA). Since its initial implementation in 2007, between 60% and 80% of respondents have consistently reported that their major sources of stress are money, workload, family responsibilities, and healthcare and housing costs [5]. Clearly, finances have been a chronic source of stress for families due to the increasing costs of housing, food, education, and medical care, all of which have increased at a faster pace than wage growth [6] and have resulted in higher family debt (e.g., student loans, mortgage, personal loans, etc.) [7]. The higher cost of living has resulted in an increase in more households with two working parents [8]. These families experience the chronic stress that comes from balancing work and family life responsibilities and finding affordable informal or institutional child and adult care.
For some families the stress from financial and work-family balance struggles is exacerbated by the presence of other chronic stressors. Poor families may only afford to live in neighborhoods with high rates of crime and drug/alcohol use; this may result in additional concerns over safety and protection of family members [9]. Immigrant families experience daily stress from language barriers, limited information and understanding of norms and cultural values, lack of knowledge about medical/educational/legal systems, racial and/or ethnic discrimination, acculturation pressures, fears about their immigration status, and/or finding jobs [10]. And most importantly, several populations in the U.S. continue to experience chronic stress from systemic, institutional, and interpersonal discrimination based on aspects of their identity, including their race, country of origin/ethnicity, religion, income, education level, gender, sexual orientation, and/or disability status. A recent study demonstrated that various minority groups in the U.S. continue today to experience discrimination when interacting with the police, applying for jobs, trying to rent a room/apartment or buying a house, or going to the doctor or health clinic [11].
In addition to these chronic stressors, families have also been coping more frequently with natural disasters such as floods, tornados, hurricanes, droughts, and fires caused by climate change. Families affected by these natural disasters as well as those living in war zones have dealt with the stress created by the disruption to all aspects of life, material and human losses, serious health issues, and the threat to their own existence [12]. The increasing levels of chronic stress endured by families in modern life beyond the stress caused by their own unique circumstances (e.g., healthy conditions, accidents, divorce, etc.) are concerning, and definitely alarming in the case of unprivileged populations. It is undeniable that families need to learn to cope with this chronic stress to protect their members and their relationships.
Additional External Stressors for Families Since the COVID-19 Outbreak
The COVID-19 pandemic has profoundly affected families around the world by adding stressors and/or exacerbating existing ones across virtually all domains of life [13, 14, 15, 17, 29]. School closures, lockdowns, social distancing, and other measures imposed by governments to contain the spread of the coronavirus deeply affected the economy and family life. Reductions in work hours, layoffs, and decreased productivity created or amplified financial problems for families, particularly those with lower incomes. Family lifestyle and routines were completely transformed overnight, as a large number of adults had to work from home with children receiving virtual instruction. Families had to juggle work and family responsibilities while negotiating time, space, and physical boundaries. For months, family members found themselves spending all time together or living in complete isolation. Lockdown measures and fear of contagion resulted in loss of social life, recreational activities, and support systems, along with disruption of medical treatments and important life events (e.g., weddings, graduations, funerals, etc.). Furthermore, for those with low digital literacy and limited access to a Wi-Fi connection and electronic devices, the isolation and inability to access services was even more dramatic. On top of family life disruptions, limited access to vaccines among adults, unavailability of vaccines for young age groups, and hypervigilance around contracting the virus have added another layer of stress, particularly for parents of young children and individuals with health conditions.
Undoubtedly, the magnitude of these transformations has been extraordinary and markedly stressful. As such, it is unsurprising that most people believe the pandemic has changed our lives forever. Indeed, it remains a major source of stress for everyone worldwide [13, 14, 15, 17]. Importantly, some populations have been disproportionately affected by the pandemic than others. Essential workers, health care providers, and first responders have been at higher risk of becoming infected and passing the virus onto others. For health care workers in particular, long work hours and the traumatic circumstances of their work (e.g., difficult medical decisions, losing patients and colleagues, high risk of infection) have led to both physical and mental exhaustion [16, 29]. Similarly, COVID-related stress and trauma have been devastating for families that have lost loved ones, had seriously ill members, and/or been battling with long COVID symptoms [17, 29].
Nonetheless, the pandemic has not been the only additional source of stress since 2020. In the U.S., the pandemic has been accompanied by episodes of police brutality (e.g., the murders of George Floyd and Breonna Taylor), which have brought increased visibility to the systemic racism and discrimination that have long plagued the country and continue to create stress for minority populations [16]. Different parts of the world have also witnessed the irreversible consequences of climate change, military interventions, and political upheaval, which have created undeniable sources of stress. These stressors and the ones created by the pandemic have piled up on top of the ones that existed before the pandemic. Results from the 2021 and 2022 APA Stress in America surveys show the long list of sources of chronic stress that affect people’s lives today [16, 17]. The majority of individuals continue to report worries about work (66%), money (61%), the economy (87%) and family responsibilities (57%), but they are also concerned about the supply chain issues created by pandemic-related disruptions (81%), global uncertainty (81%), Russian intervention of Ukraine (80%), and the potential retaliation from Russia in the form of cyberattacks and nuclear threats (80%), and [17]. Furthermore, the APA surveys also indicate that the various aforementioned stressors have created uncertainty about the future, particularly for young generations (Generation Z) who report the highest overall stress levels in the U.S. [17].
In short, the world has rarely seen a global event like the pandemic. To date, millions of individuals have died as a result of the virus, and even with measures to reduce its devastating impact, the evolution of COVID remains uncertain. Certainly, this has been an unprecedented phenomenon, the consequences of which we will fully understand in the years to come. In addition to the two-year long pandemic, political unrest, racism, and the irreversible effects of global warming have created enormous threats to our existence. Taken together, these global crises and the extraordinary rise in stress in recent years challenge both the physical and mental health of individuals and families around the world.
The Impact of Stress on Physical Health
One of the greatest concerns about the sustained levels of stress that people have been experiencing in recent decades, particularly the past two years, is its potential harmful impact on physical health. When we perceive a situation as threatening, our sympathetic nervous system (SNS), which controls involuntary body functions (e.g., breathing, blood pressure, heartbeat, dilation/constriction of blood vessels), gets activated and prepares the body for a fight-or-flight stress response [18,19]. This activation gives the body a burst of energy and prepares it for action by releasing adrenaline (epinephrine) and then cortisol. The release of adrenaline increases heartbeat, breathing, and dilation of the blood vessels of the arms and legs, while cortisol (stress hormone) elevates glucose levels in the bloodstream [18, 19]. When the threat disappears and cortisol levels drop, the parasympathetic nervous system (PNS) helps the body return to the unstressed state (known as the “rest-and-digest” response). However, when experiencing stress over a prolonged period, the continuous activation of the autonomic nervous system may exhaust our bodies and contribute to the development of various serious conditions. Ongoing elevated heart rate, blood pressure, and stress hormone levels increase the risk for hypertension, heart attack, and stroke [19]. Sustained high levels of stress may also lead to impaired communication between the immune system and the hypothalamic-pituitary-adrenal (HPA) axis, all of which have been associated with the onset of diabetes, obesity, fatigue, and immune disorders [19]. They also increase the likelihood of developing serious gastrointestinal disorders and changes in appetite, which in turn may contribute to weight loss or gain [19]. Excessive release of cortisol can also disrupt sperm production and maturation, the menstrual cycle, and reduce sexual desire [18]. In the case of children, chronic stress can also affect brain development by altering neural connections involved in thinking and learning [20].
In addition to these direct effects, chronic stress can also affect our physical health indirectly. Stress can change one’s eating, activity levels (e.g., exercise), and sleep habits and lead to unhealthy behaviors (e.g., smoking, drinking, drug use), all of which can have well-known negative impacts on our health. Even though the development of any health conditions varies across individuals depending on various biological factors, chronic stress can definitely increase this risk dramatically [18].
The Impact of Stress on Mental Health
The impact of stress on individual mental health has been studied extensively. In general, stress in adults has been associated with depression, anxiety, post-traumatic stress disorder (PTSD), increase in smoking, accidents, substance use, sleep difficulties, eating disorders, higher alcohol consumption, and self-medication [18, 24]. Importantly, the deterioration of mental health due to chronic stress has been observed across different types of stressors. For example, in my own research, economic stress was found to be associated with anxiety and depression [23] and immigration stress with problematic drinking in Latin American adults living in the U.S. [24]. Perceived discrimination has been associated with depression, low-self-esteem, and traumatic stress symptoms [26]. In children, chronic stress has been linked to academic, emotional and behavioral problems, including but not limited to school readiness, academic achievement, depression, anxiety, self-regulation, emotion regulation, among others. [20, 21, 25]. For example, children and adolescents experiencing stress from natural disasters or war have reported anxiety, depression, and PTSD [18].
As noted earlier, in the years prior to the pandemic, individuals and families have long reported experiencing increasingly stressful lives. As such, mental health disorders were on the rise during this time, with one in five U.S. adults reporting a mental illness or related symptoms [27,28]. The COVID-19 pandemic has only exacerbated these mental health challenges over time. In fact, the situation has become so critical that in the U.S., the 2020 APA “Stress in America” report spoke of “a national mental health crisis that could yield serious health and social consequences for years to come” [13]. More specifically, in 2020 75% of respondents reported sitting around and doing nothing, 74% felt very restless, 73% found it hard to think properly or concentrate, 73% felt lonely, and 71% felt miserable or unhappy [13]. Reports from 2021 in the U.S. indicated that one in three adults were so stressed about the coronavirus pandemic that they struggled to make basic decisions (e.g., what to wear or what to eat) as well as major life decisions [16]. A recent meta-analysis from studies on 68 samples across the world paints the same mental health picture related to the pandemic: Increases in anxiety and depressive disorders, insomnia, post-traumatic stress disorder, substance use, suicidal ideation, suicide, and drug overdose deaths [27].
Regarding the mental health effects of the pandemic on children, a national survey in the U.S. found that 71% of parents said the pandemic had taken a toll on their child’s mental health, with 69% indicating that the pandemic was the worst thing to happen to their child. Data from the Center for Disease Control (CDC) in the U.S. showed that from March 2020 to October 2020, mental health-related emergency department visits increased 24% for children ages 5 to 11 and 31% for those ages 12 to 17 compared with 2019 emergency department visits. [28]. The situation in the U.S. is comparable with studies from other countries that also found an increase in various mental health disorders in children during the pandemic (e.g., attention deficit hyperactivity disorder, oppositional defiant disorder, depression, anxiety) [29].
It is important to note that even though the pandemic may have negatively affected mental health for a large majority of the population, this impact has been stronger for particular groups. First, adolescents and young adults (Generation Z) in the U.S. have reported worse overall mental health (including depression symptoms), more substance use, and more suicidal ideation than any other age group [16, 30], all of which has been attributed to an increase in uncertainty and hopelessness for the future [16]. Second, women with children report greater symptoms of anxiety and/or depression than men with children [30], which may be attributed to increased stress associated with school closures and lack of childcare. Third, Latinos and African Americans in the U.S., who have been disproportionately affected by the pandemic, are also more likely to report symptoms of anxiety and depression than other populations [30]. Finally, essential workers have reported increased substance use, suicidal ideation, and burnout [30] and have been more likely to be diagnosed with a mental health disorder during the pandemic [16].
Chronic Stress and Relationships
Chronic stressors can have a detrimental impact on family relationships (spouses/partners, children, and other significant family members). Chronic stressors external to a relationship can often negatively impact partners’ relationship functioning and parent-child relationships, a phenomenon referred to as stress spillover [31]. In particular, chronic stress may render individuals less likely to respond to and interact with one another in adaptive, relationship-enhancing ways, in part due to the negative changes that stress has on our emotional well-being. When stressed, we become preoccupied with the stressor and the resources required to cope with it. We may spend a considerable amount of time ruminating about the problem, which is associated with an increase in negative thinking (e.g., self-blame cognitions, catastrophizing). As stress persists, our self-esteem, sense of self-worth, and confidence in our ability to address challenges may deteriorate notably. As a result, we may experience negative emotions (e.g., frustration, anger, fear, guilt) with more intensity and struggle to manage these emotions effectively (i.e., emotional dysregulation). Put together, all of these changes – the psychological distress, emotional dysregulation, and associated consequences (e.g., concentration and sleep disturbances, depression, anxiety) – may make it challenging to engage in positive relationship behaviors with our spouses/partners and children because our cognitive and emotional resources are divided among several effortful acts [32]. Consequently, we may become more irritable, impatient, and hostile in our interactions with others. We may be more prone to engage in conflict and find it difficult to de-escalate heated arguments. Furthermore, the preoccupation with the stressor may turn our attention away from others and more to our internal world. As we become more self-oriented rather than other-oriented, we are less likely to be present in our interactions and may withdraw from others. We become less empathic and understanding with our spouses/partners and children, which in turn may create conflict and/or distance, and eventually, dissatisfaction in relationships and parenting. In sum, stress leaves individuals in a state of resource depletion that simultaneously increases the likelihood of destructive behaviors and decreases overall satisfaction with our relationships and parenting (see Figure 1).
In addition to spillover, a family member’s stress may affect their relationships with others through cross-over [33]. The defining feature of a family is interdependence, or the idea that one person’s experiences have the capacity to influence the outcomes of other family members. Thus, stress cross-over suggests that stress experienced by one family member affects not only that individual, but also others within the family unit. This has been shown consistently across studies of couple functioning examining a variety of external stressors, including racial discrimination [34], immigration-related stress [35], illness, work-related stress, and job loss, among others [32]. Additionally, and most importantly, many of the stressors that family members experience affect more than one family member directly. This may be the case especially when both parents struggle to meet their full-time work and family responsibilities, when a child has a serious academic, social or neuro-developmental disorder (e.g., autism, learning disability), when there are financial, legal, or housing problems, when a family member has a serious medical condition, or when facing pandemic related stressors.
When several family members become stressed either through crossover or spillover, the quality of their relationships are at risk of deteriorating [31, 32]. Findings from (a) my studies on the impact of economic stress on couple relationships during the 2001-2002 economic crisis in Argentina [23, 36] and (b) a meta-analysis from international studies of financial stress and [37] provide an excellent example of the process through which common stressors affect family relationships. Collectively, these studies indicate that partners’ economic stress is associated with increased depression, anxiety, and irritability, which in turn are linked to increased negative interactions between partners (e.g., psychological aggression, hostility, conflict, demand/withdraw patterns) and eventually lead to declines in relationship satisfaction and stability [34]. In addition to the deterioration of couple satisfaction and stability, studies on parenting behavior and children’s adjustment have demonstrated when economic stress affects the spouses’ psychological well-being and increases conflict, the quality of the parenting declines (e.g., harsh parenting) and children develop emotional and behavioral problems [38, 39].
Studies of other chronic stressors, such as stress related to family and work responsibilities, discrimination, and immigration, have also shown that such stressors are associated with negative relationship functioning [32, 34, 35]. For example, in the U.S., racial discrimination experienced by African Americans and immigrant related stress (e.g., language barriers, feeling at a loss in the U.S., missing family) in Latin American couples have been linked to lower relationship satisfaction [35, 40]. Similarly, the pandemic has been reported to deteriorate the quality of parenting (e.g., more authoritarian, less autonomy support), increase parental conflict, and reduce family cohesion [41] along with the quality of couple relationships [42, 53] for many families.
In addition to deteriorating the quality of family interactions, chronic stressors can reduce the amount of time family members spend together. This may happen for two reasons. On the one hand, as noted above, stressed individuals may find it difficult to behave in a relationship- promoting manner if they do not possess the resources or energy to engage in those behaviors. As such, they may isolate themselves and withdraw from others, given that they have reduced capacity to manage relationship issues or engage in positive behavior (e.g., emotional support, physical affection) [43]. On the other hand, stressors often require time and attention to be resolved; thus, family members may simply have limited opportunities to spend time as a unit [44]. Certainly, these patterns can be seen among families reporting greater stress within the past few years. For example, a report by the Pew Research Center in the U.S. noted that among those working full time, 86% of mothers and 81% of fathers said they felt “rushed” sometimes or all the time; 39% of mothers and 50% of fathers also said they spent too little time with their kids [8]. These reports are concerning considering that research shows that less parent-child time affects the parenting quality and children’s health [45]. Furthermore, previous work has found that couples experiencing external stressors are less likely to participate in end-of-the-day reunions (e.g., intimate exchanges of thoughts and feelings), spend less time engaging in leisure activities together, and engage in fewer expressions of affection or sexual intimacy [46, 47]. This deficit in shared positive experiences is noteworthy, as these are crucial to strengthen and maintain family bonds and individual well-being [46].
Individual Coping Strategies
Individuals cope with stress by trying to either resolve the situation causing their stress (also known as problem-focused coping strategies) or reduce the negative feelings associated with the situation (commonly referred to as emotion-focused coping strategies) [4, 48]. Problem- focused coping involves accepting the existence of the stressful situation and becoming actively involved in solving it by analyzing, planning, gathering information, consulting and/or seeking instrumental support from others, brainstorming and finding solutions, and/or gaining skills and abilities to better assess and address the situation [4, 48]. Problem-focused coping strategies are particularly effective when the person has direct or some indirect control over the source of stress. For example, in coping with financial stress, an individual may try to generate more income, reduce expenses, or ask for a loan. When stressed about meeting work and family life demands, a parent may try to find child care assistance, reduce their work hours, or prioritize tasks. If stressed about violence and crime rates in the neighborhood, a person may make some practical decisions, such as restricting times to go out, finding resources in the community to increase safety (e.g., police assistance), or becoming involved in initiatives to reduce gang and criminal activities. When stressed about becoming infected with the coronavirus, a person can take actions to reduce such a risk by getting vaccinated, using hand sanitizer, social distancing, and wearing masks. Individuals may also cope with stress related to discrimination, climate change, or military interventions with problem-focused strategies by becoming involved in actions to reduce their occurrence (e.g., increasing environmentally friendly behaviors; engaging in organizations that promote social justice; protection of the environment, or peaceful conflict resolution; relocate to another geographic region). Although problem-focused strategies are viewed as effective, adaptive ways of coping with stress, they may not be possible for situations that are beyond the individual’s control (e.g. death of a loved one), contextual restrictions (e.g., prohibition for women to participate in family, community, religious, and political decisions), personal circumstances and conditions (medical and mental health conditions, physical and/or cognitive disabilities), or being a dependent (e.g., children and adolescents that have no control over situations that generate stress such as inter-parental conflict).
In contrast, emotion-focused strategies are not geared toward reducing or eliminating the source of stress, but rather at feeling differently about it [4, 48]. This type of coping may involve reframing the situation in a way that looks more favorable and less threatening, which is referred to as cognitive restructuring or reframing. Cognitive restructuring can involve creating some positive meaning out of the stressor or putting the stressful experience into perspective to decrease its magnitude. Emotion-focused coping strategies may also include venting (letting out feelings), using humor, relying on religion and spiritual resources, and seeking emotional support, wishful thinking, and distraction [48]. Because emotion-focused strategies seek to reduce emotional distress, they are particularly beneficial when we need to adapt rather than resolve a stressful situation that is beyond our control or cannot be eliminated (e.g., death, pandemic). Nonetheless, individuals sometimes try to reduce the negative emotions associated with a stressor through denial, cognitive avoidance, or numbing. This is when individuals cope with a stressful situation in maladaptive ways by overeating, drinking excessively, oversleeping, using drugs, playing long hours of video-games, or binge-watching TV. In addition to the harmful consequences for our health, these coping mechanisms create relationship problems, impair our ability to share quality time with others, and do not often decrease or eliminate the negative feelings associated with the stressor.
As noted earlier, the adaptive function of individual coping strategies may vary depending on the type of stressor, the intensity, the controllability and other environmental factors. This is why coping flexibility may be critical in the coping process [49]. Coping flexibility refers to “being sensitive to contextual demands, drawing on a wide variety of coping strategies, and monitoring and modifying strategies as needed” [49]. Research has found that coping flexibility is associated with fewer illnesses, greater longevity, and better quality of life [49]. The concept of coping flexibility also suggests that there are no universal ways of coping. In fact, the coping strategies that people use also depend on their personality traits, cultural background, and social identities. For example, requesting instrumental assistance may be an acceptable way of coping with a chronic stressor in some Western cultures but not in some Asian ones [50].
In addition to emotion- and problem-focused coping, individuals use a variety of psycho- physiological stress reduction strategies such as mindfulness, contemplation, meditation, progressive muscle relaxation, and deep breathing techniques [51]. These stress management tools aim at restoring the psycho-physiological balance that is upset in the stress response [51]. They are also considered to enhance overall mental and physical health by improving emotion regulation, preventing the development of negative thoughts and feelings, and allowing us to be more emotionally present to connect with ourselves and with others. These techniques have also been found to increase coping flexibility [46] and optimize the use of individual coping strategies. Other activities that have been recommended to reduce the negative effects and that can strengthen our physical, mental, and spiritual well-being include exercising, sleeping well, and engaging in recreational, pleasant activities (e.g., walking, painting, coloring, listening to music, praying, cooking, reading, dancing, etc.) and spiritual moments that connect us with ourselves in meaningful and fulfilling ways [52].
The Limitations of an Individual Focused Approach During Times of Crisis
The increase in chronic stressors for individuals and families has been accompanied by a proliferation of guidelines for coping and stress management available through websites, blogs, social media, books, and other printed and virtual outlets. However, these guidelines tend to focus primarily on the individual, that is, on their individual health, their needs, and well-being [53]. Despite the importance of promoting individual well-being, the relative absence of relationship-focused approaches to manage the effects of stress is concerning, considering the vital role of healthy, stable family relationships in general and during times of crisis in particular [54, 55].
During times of crisis, emotional support from spouses and extended family is critical to cope with external stressors, such as unemployment, medical and/or mental health conditions, discrimination, and COVID-19 related stressors, among others [54, 56, 57]. Emotional support (e.g., understanding, validation, acceptance, encouragement) from parents and extended family members is important also for children and adolescents to cope with expected and unexpected developmental and life challenges (e.g., adjustment to a new school, making friends, academic, behavioral, social) [54]. Extended family can also provide fundamental instrumental support to cope with stressful situations by providing financial resources, shelter, caring for children and members with medical and mental health conditions, or assisting with family tasks (e.g., doing the groceries, making appointments, preparing meals, taking children to school, helping children with schoolwork, etc.), among others. On top of providing support, family relationships can be a source of strength and meaning for people, even at times when society does not give time and space to strengthen family relationships [53]. Families give transcendence and meaning to our existence, as part of something greater than oneself. This may be the reason why today people still view family as the top source of meaning in life. A survey conducted in 2021 by the Pew Research Center showed that in 14 out of 17 industrialized nations [57] people considered family to be the top source of meaning and before occupation, friends, material well-being, society, hobbies, and health. Furthermore, respondents emphasized the meaning derived from relationships with parents, siblings, children, and grandchildren, the quality time spent with family members, and feeling proud of other family members’ accomplishments. Also, and in support of the critically protective role of family relationships during stressful times, studies have shown that healthy, positive family relationships can reduce the risk of mental health issues when experiencing stress. A recent study in the early stages of the pandemic showed that positive family functioning was associated with lower stress and greater feelings of meaning in life attenuating the effects of stress on psychological distress whereas social support from friends and social participation did not [59]. Studies with children show that positive family functioning is a protective factor for coping with stressful situations such as natural disasters (e.g., hurricane, tsunami), the pandemic lockdown, and unexpected changes [51, 52, 60].
As earlier discussed, stress can take a toll on significant close relationships by reducing the time families spend together and negatively affecting the quality of their interactions. If strengthened, such relationships can offer a significant protective factor for all members’ physical and emotional well-being. Approaches that only promote individual coping strategies for chronic stress are important but not enough to protect and strengthen family relationships during times of crisis. The next section will discuss the way in which family-focused coping strategies that encourage family members to support one another, cope with stress conjointly, and share time together, especially in meaningful ways, can help relationships strengthen and thrive during times of crisis.
Relational Coping: A Family-Focused Approach to Coping with Stress
Facing stressors in the context of family relationships means seeing ourselves as part of a network of relationships that, on the one hand, can give us meaning, love, care, and protection during stressful times but, on the other hand, we are responsible for nurturing and strengthening, particularly when all family members are experiencing stress. Crises related to financial problems, housing and food challenges, natural disasters, immigration issues, medical conditions, climate change, neighborhood safety, and the pandemic, among others, offer opportunities for family members to strengthen their bonds by helping each other cope with stress. I refer to this approach of coping with others as relational coping. This family-oriented type of coping can involve two or more family members. Coping relationally means being mindful of the impact of our own stress and individual coping strategies on others, counting on other family members for support to cope, appreciating the support given to us, being able to identify when other family members are stressed and provide support to them, and engaging in conjoint efforts to cope with stressors that affect all family members or that have become a shared concern. Above all, relational coping is about focusing on and strengthening relationships.
Most of what will be described about relational coping in this section is an extension of the concept of dyadic coping advanced by Bodenmann’s systemic transactional model (STM) [61]. Dyadic coping refers to the process through which spouses/partners cope with stress in the context of their couple relationship. It is the most comprehensive model to understand relational coping between two individuals. However, the principles of dyadic coping can be extended to understand stress and coping processes in relationships of two or more family members that are not necessarily romantic partners.
The first step in relational coping is for family members to be able to identify signs of stress in others [62]. These may include changes in behaviors (e.g., withdrawing, isolating, increases in crying, watching TV, sleeping staying in bed, eating, biting nails, smoking, playing and video-games, etc.), topics of conversation (e.g., excessive focus on a particular issue such as finances, climate change, possibility of getting the virus, etc.), and the emotions conveyed verbally and non-verbally during interactions (e.g., exasperation, irritation, anger, annoyance, frustration, etc.) [62]. The identification of signs of stress is particularly important to understand young children that may not be able to understand and communicate explicitly about their state of stress.
When family members are able to identify signs of stress in each other, they can explore each other’s experiences of stress (stressor, emotions, etc.) through conversations in which listening is validating, empathic, and non-judgmental. Being purposeful about observing and understanding the experience of stress in each other, is already a first step toward strengthening family bonds and being able to assist each other. It is a step that shows compassion and care, both of which are critical for the development of positive family relationships.
Equally important is for family members to be able to communicate their stress to each other [62]. In the case of children, they should also be encouraged to express, in verbal and/or non-verbal ways, when they are stressed and when they require assistance to cope. Various studies have demonstrated the importance of stress communication in activating positive relational coping mechanisms and strengthening family relationships [64, 65]. For example, stress communication between romantic partners has been associated with better relationship satisfaction in Japanese, Latin American, and Western European and American couples [56, 63]. Furthermore, in a study across 24 different countries during the pandemic stress communication in couples predicted higher relationship quality [42].
Sometimes family members respond to each other’s communication of stress in various ways: Choosing to ignore the implicit or explicit request for assistance or offering a negative or positive coping response [66]. Negative relational coping responses include criticizing, ridiculing, mocking, blaming, or hostile responses or providing support insincerely, superficially, or in an ambivalent way. Ignoring the implicit or explicit request for assistance or offering a negative dyadic coping response are likely to occur when people are more individual than others and/or when their commitment, and therefore, protection for the relationship is not a primary goal. Negative relational coping responses may also happen in relationships in which there has been a long period of unidirectional support with no rewarding feedback or when the support is demanded or coerced [66]. Negative relational coping is also likely when the family member has personal traits of egoism, dominance, or intolerance or when they are emotionally depleted and burnt out. Negative relational coping is harmful for relationships as it is associated with lower levels of marital quality, romance, constructive conflict resolution, and marital satisfaction in couples in different parts of the world [56]. Furthermore, parents’ use of negative relational coping also has an undesirable outcome in children. It increases their likelihood of using this form of coping in their adult romantic relationships [67].
Positive relational coping responses to other family members’ communication of stress can be of three types: Supportive, delegated, and common [66]. Supportive relational coping can be emotion- or problem-focused, depending on whether the support provided to the family member(s) is aimed at helping them reduce the negative feelings related to the stressor (e.g., anger, frustration, sadness, etc.) or resolve the stressful situation. Showing empathy, understanding, and solidarity to the stressed family member(s) and helping them reframe the situation, calm down, believe in themselves, or relax (e.g., giving massages, holding hands) are all examples of emotion-focused supportive relational coping. Helping the stressed family member(s) seek information, search for a practical solution, or giving helpful advice are all problem-focused supportive relational coping strategies. However, family members can also respond to each other’s communication of stress by taking tasks and duties that the stressed family member(s) would normally do in order to reduce their burden. This way of responding is known as delegated relational coping. Finally, and most importantly, family member(s) can respond to each other’s stress by engaging in conjoint strategies to cope, which is referred to as common relational coping. This is a coping response unique to relationships as it happens only when two or more individuals consider that the stressor affects all of them. In other words, common relational coping is an option when there is a stressor that affects more than one person in the family, even if the stressor initially concerned one family member and has become a “we” problem. This type of relational coping can also be emotion-focused aiming at reducing all individuals’ negative emotions (e.g., joint relaxation, joint reframing of the situation, joint spiritual coping, joint mindfulness, mutual self-disclosure and sharing of negative emotions, mutual massages and physical contact, etc.) or problem-focused aiming at resolving the common stressor (e.g., joint search for information, brainstorming solutions jointly, joint engagement in problem solving, etc.). When engaged in common relational coping, family members can use symmetrical (e.g., both provide solutions) or complementary (e.g., one/some brainstorm(s) solutions and other(s) evaluate them) coping strategies.
Strong, healthy family relationships in which members are emotionally connected to one another increase the chances of relying on relational coping during stressful times and protecting such relationships. For example, research shows that unhappy partners are less likely than partners satisfied with their relationship to communicate their stress, provide support to one another, and engage in conjoint coping strategies [68]. Developing and maintaining strong family bonds involves nurturing such relationships by spending quality time together, showing appreciation, love and care for each other, communicating constructively, trusting and respecting one another, being emotionally available and responsive to each other’s needs, prioritizing shared goals and values, and providing a place of safety and comfort for all members [57]. The fast pace and increasing demands of modern life are a major threat for families to spend meaningful moments together. Nonetheless, the importance of such times to develop positive, strong family connections and protect people from the negative effects of stress could not be more emphasized. Sharing everyday routines (e.g., cooking, dining, walking the dog, doing groceries), celebrations, and spiritual moments, practicing mindfulness, meditation, or relaxation together, and/or engaging in recreational, stress-free activities conjointly (e.g., reading, singing, walking, writing, painting, visiting a museum, coloring, painting, playing sports and instruments, etc.) are all examples of ways in which families can connect and strengthen their relationships [53, 69]. Crises may also bring family members together to reflect on the purpose and meaning of their lives and reassess priorities and decisions. It has been emphasized that “in the face of an unpredictable, largely uncontrollable, existential, and pervasive crisis like COVID-19 ... couples and families need to reflect on their higher and broader values” [53]. These reflections may bring about significant changes in the family.
In summary, this section has described how families can support each other, cope conjointly, and increase the time they spend together during moments of stress and crisis. The next section discusses the way in which relational coping and meaningful shared times can help families turn stressful periods into opportunities to strengthen their bonds.
Individual and Relational Benefits of Positive Relational Coping and Family Time
Viewing relational coping during times of crises as critical for strengthening family bonds comes from the accumulated knowledge on the benefits of dyadic coping for couples and families around the world. Research findings indicate that supportive, delegated, and common relational coping have positive effects for family relationships across a wide range of stressful situations (e.g., immigration stressors, medical conditions, loss of a child, children’s neurodevelopmental disorders, post-traumatic stress disorder, financial stressors, discrimination, and pandemic-related challenges) [65] and that such effects are even stronger than the benefits of individual coping [69]. Studies across different continents, races, ages, and socio-economic groups provide evidence that all forms of positive relational coping predict greater relationship quality [56] and can also buffer the effects of stress on relationship functioning [58, 70]. Specific relationship benefits include increased intimacy, positive conflict management, improvement in communication and problem-solving skills, lower verbal aggression, higher shared meaning, and relationship stability [56, 71, 72]. As an example, a recent global study involving 24 countries showed that supportive coping provided by a spouse/partner improved relationship quality and attenuated the negative effects of COVID-19 related psychological distress on relationship quality [42]. One interesting aspect of the research on dyadic coping is the finding that even though there are cultural variations regarding how individuals communicate their stress, relational coping is still beneficial for all relationships across different cultures [72]. Parents’ relational coping is also positive for children as it reduces co-parenting conflict [73], which in turn increases warmer parenting and reduces children’s externalizing behaviors [74].
Interestingly, and important for its implications for families, is the fact that among all forms of positive relational coping, conjoint strategies (common relational coping) are the ones providing the strongest and largest benefits for adult relationships [56, 71, 72]. In other words, when adult family members view the stressful situation as affecting them all and try to solve it together and engage in mutual emotional support, the quality of their relationship improves more than when they view the situation as affecting only one member and unidirectional support from one member to another is provided. Considering that during a crisis stressors are perceived as affecting every family member, there is an increased likelihood of using common relational coping during such times.
In addition to benefits for family relationships, positive relational coping is also associated with greater individual well-being across a wide range of stressors. It predicts the use of adaptive individual coping strategies, experiencing less depression and distress when coping with medical conditions (e.g., cancer) and financial stressors, alcohol abstinence during treatment, and smoking abstinence after quitting, among others [56, 75]. These individual benefits have also been observed in relation to pandemic stressors. For example, a study in Italy found that individuals with COVID-19 related concerns that communicated their stress and received support from their partners reported greater psychological well-being [68]. Studies have also found that relational coping attenuates the negative effects of immigration, medical, discrimination, and financial stressors on individual’s health [56].
As noted earlier, during times of crisis families can strengthen their bonds not only through relational coping but also by sharing time together. Family time has a positive impact on children and adults’ emotional well-being, particularly during stressful times [53, 76]. Furthermore, the benefits of family time were seen during the pandemic. Family members were forced to be with each other during quarantines and strict lockdown mandates. Even though accommodation to those situations was initially stressful, for many people spending more time with spouses and children helped them feel more connected with them, improving their life satisfaction and reducing their stress [77, 78].
Considering the benefits that relational coping and sharing time together offer for family and individual well-being, the following section addresses recommendations to help families use such resources when coping with stress during crisis.
Recommendations to Help Families Strengthen their Bonds When Coping with Stress During Crisis
It is important to assist families to cope with stress during crises in ways that strengthen their bonds and emotional connection. However, reducing stress and protecting family bonds does not depend only on families but also on changing social structures, policies, practices, and political decisions that contribute to the development and maintenance of chronic stressors for families, particularly disadvantaged ones, in the first place (financial necessity, job insecurity and instability, difficulties in accessing housing, food, and health care, displacement, natural disasters, war, discrimination, etc.). It is beyond the scope of this presentation to address such changes and the resources that families need to thrive but their importance cannot be overlooked. Having acknowledged the role of governments and institutions in reducing chronic stressors, below are a set of recommendations to encourage healthy family relationships and positive relational coping processes to strengthen family bonds during stressful times:
1. Emphasize the value of healthy family relationships, the importance of nurturing family bonds, and their vital, protective role during crises
Governments and organizations in which family members participate (e.g., schools, community centers, churches, etc.) should educate individuals about the value of healthy family relationships and promote policies and initiatives that support the development of healthy family bonds. If individuals value and focus on family relationships, they will be more likely to cope with stress in relational ways that protect such relationships during times of crises. Institutions should always include a family impact analysis of all of their activities and policies to prevent any unintended negative effects on family relationships.
2. Encourage families to spend time together, especially meaningful time together, to strengthen their bonds in general and during times of crisis as well
If family members are emotionally connected, they will be more likely to prioritize and protect family relationships during times of crisis. One important way in which emotional connection develops and grows is when family members share time together. Regular rituals that bring family members together such as meals, taking children to school, cooking together, a phone or zoom call to a parent, exercising together, attending church services, doing laundry or groceries together, talking about the school/work day, and/or sharing a prayer among others should be valued and preserved, particularly when coping with stressful times. Sharing moments that show love, affection, and appreciation for one another or that engage the family in deep reflections about life purpose and meaning should be especially encouraged. Additionally, governments and organizations can provide programs and events that are especially designed for family members to participate together. An excellent example is the program Padres Preparados, Jóvenes Saludables [Prepared Parents, Healthy Youth] in the U.S. that brings immigrant Latin American fathers and adolescents together to learn about the value of good nutrition and physical activity and help them prepare meals and exercise together [79]
3. Help families strengthen their communication, conflict resolution, and emotion regulation skills
Communication, conflict resolution, and emotion regulation skills are important for family members to engage in positive interactions and address challenges and disagreements, all of which are associated with positive family functioning and use of relational coping. These skills should be introduced to families in all institutions and systems that they interact with (schools, churches, hospitals, etc.). Currently, they are mostly disseminated through psycho-educational programs (e.g., PREP program [80]), social media, websites, and public campaigns. Family therapy should be encouraged when the family struggles with these skills.
4. Educate families about (a) the negative effects of chronic stress on relationships and individual physical and mental health and (b) the value of using relational coping to strengthen family bonds during times of crisis.
Educating families about the negative effects of chronic stress encourages them to take a proactive approach when experiencing stress during times of crisis. Providing information about the benefits of having a family focus and of coping relationally can help families turn crises into opportunities for family growth and connection. This information as well as guidance to practice relational coping skills can be disseminated through social media, psycho-educational programs, or any type of public campaign. Therapy should be recommended when family members struggle when coping with stress relationally.
5. Encourage families to share activities that reduce the negative effects of stress on the mind and body.
Abundant information has been disseminated through public printed and digital media outlets about the use of stress reduction activities to reduce the negative effects of stress on the mind and body (e.g., mindfulness, meditation, contemplation, breathing exercises, praying, etc.). However, this information should also include the value of practicing these stress reduction activities with other family members.
TOGETHER: A program for Strengthening Couple Relationships when Coping with Stress
Psycho-educational programs have been advocated as a way to help families cope with stress [81]. In this section I provide an example of a program that I developed with financial counseling experts after studying the negative effects of economic stress on couple relationships in Argentina in the early 2000s. This program, named TOGETHER, aims at helping couples improve their communication, problem-solving, individual and relational coping, and financial management skills [82]. The curriculum is an adaptation of a general stress management program for couples called Couples Coping Enhancement Training [81] to financial stress. The program has enrolled over a 1,000 couples, primarily low-income, African-American and White. More recently, it began serving Latin American immigrant couples under the name of JUNTOS EN PAREJA [Together as a Couple] after a linguistic and cultural adaptation of the curriculum. Groups of up to 10 couples come to 6 weekly sessions facilitated by a couples’ expert and a financial expert (total = 14 hours). In these sessions both spouses/partners together learn first about the value of healthy, stable couple relationships and the benefits for all family members and then go through nine different modules focused on the following topics: (a) The negative effects of financial stress and non-financial stress on the individual’s physical and emotional health and family relationships; (b) Identification of financial and non-financial stress in oneself and spouse/partner; (c) Individual and relational coping strategies for financial stress and non-financial stress; (d) Individual and couples stress reduction and recreational activities; (e) Communication about financial matters and de-escalation strategies including emotion regulation skills; (f) Understanding each spouse/partner’s relationship with money; (g) Financial roles and tasks; (h) Financial management and credit; and (i) Problem-solving financial problems with the spouse/partner. Because the program is not only content but also skill-oriented, couples have a chance to practice skills in the session under supervision of the facilitators and then they are provided guided homework to keep practicing the skills learned in the sessions in their homes. The program also has case managers that evaluate each spouse/partner’s and their family’s needs and connect them to affordable or no cost services in the community.
Generous funding from the U.S. Department of Health and Human Services has allowed me to provide this program for seven years and evaluate it with a randomized control trial, the most rigorous form of evaluation to test the effectiveness of an intervention. The evaluation showed that the program was effective in decreasing partners’ stress levels and negative ways of managing conflict and in improving their conflict management skills, relationship commitment, and relationship satisfaction [83]. The program was also effective in improving the use of budgeting and of individual and relational strategies to cope not only with financial stressors but also with non-financial stressors. Compared to other types of more personalized interventions (e.g., financial relational therapy), this is a more cost-effective approach as it reaches several couples at the same time. Nonetheless, one of the greatest benefits of the program is that even though it focuses on financial stress and coping, the communication, individual and relation coping, and problem-solving skills learned in the program help couples with other types of stressors. Also importantly, the program is equally beneficial for men and women and different racial, ethnic, and religious populations. The TOGETHER program is an example of how couples in crisis due to their financial difficulties can learn communication, stress reduction, and relational coping skills that strengthen their bond and protect their relationship and individual health from the detrimental effects of stress.
Conclusion
In the last decades, families have been dealing with an increasing number of stressors in their everyday lives. The chronic stress created by this pile-up of stressors has been exacerbated by the challenges added by the COVID-19 pandemic. Years of research reveal the devastating effects that chronic stress can have on the individual’s physical and mental health and their relationships. Nonetheless, healthy family relationships can protect individuals from such negative effects by providing instrumental and emotional support, meaning, and connection. Furthermore, during times of crises, coping with stress in ways that place value in relationships and caring for other family members becomes an opportunity for strengthening family bonds. This is possible when family members cope with stress not only individually but also relationally and spend time together. Governments and organizations can disseminate information and provide programs that educate families about their critical role during times of crisis and the benefits of relational coping and shared time for individual and family health.
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