stress coping strategies and management

1. Stress Coping strategies
and management
Dr Wafa sheikh
Consultant Family Medicine

2. We all have experience with stress.
Why?
Because we all have Demands we are faced
with daily. There is no way for us to eliminate
Daily Hassles and Stressors and so all we
can do is learn how to cope with these
demands and the inevitable strain and stress
they will cause or wait them out.
The good news is that all demands eventually
come to an end.
Module 4: Stress and Coping by Lee William Daffin Jr.

3. be
categorized as
1-Daily
hassles
2-Stressors

4. Daily Hassles
▪ Pressure is when we feel forced to speed up, intensify, or
shift direction in our behavior. What pressures experience
in school? on job? from coach? I have felt the pressure
to be to class on time, prepare my lecture and rehearse it,
complete grading in a timely fashion, and be available for
office hours. I love it though.
▪ Frustration occurs when a person is prevented from
reaching a goal because something or someone stands in
the way. Examples of frustrations include money and
delays. Then your professors are assigning readings in the
first week but how do you complete them without a book?
▪ Conflict arises when we face two or more incompatible
demands, opportunities, needs, or goals. Whether the
conflict is with a roommate, significant other, boss,
professor, parents, etc.
4

5. Stressors
Being bullied
Working too hard
Losing a job
Marriage or relationship problems
Recent break up or divorce
Death in the family
Difficulty in school
Family problems
Busy schedule
Recent move
5

6. “
6
▪ What is stress?
Hungarian endocrinologist Hans Sesly
(1907-1973)
“The non-specific response of body to any
demands made upon it .”
▪ Stress is the “psychological,
physiological and behavioral response
by an individual when they perceive a lack
of equilibrium between the demands
placed upon them and their ability to meet
those demands, which, over a period of
time, leads to ill-health.
(Palmer 1989)

7. Stress
In order to understand how people learn to
cope with stress, it is important to first reflect
on the different conceptualizations of stress
and how the coping research has emerged
alongside distinct approaches to stress.
Stress has been viewed as a response,
a stimulus, and a transaction.
How an individual conceptualizes stress
determines his or her response, adaptation,
or coping strategies.
7

8. The General Adaptation
Syndrome
▪ Stress as a response model (Hans Sesly
1956)This model describes stress as a dependent variable and
includes three concepts:
▪ Stress is a Defensive mechanism .
▪ Stress follows the three stages of Alarum, Resistance ,
Exhaustion.
▪ If the stress is prolong or severe it results in disease of
adaptation a or even death .
▪ Stress response could result in positive and negative
outcomes based on cognitive interpretation of the physical
symptoms and psychological experience .
▪ Positive stress produces Eustress while Negative stress
response causing Distress
8

9. Alarum reaction begin that the
body recognize that it must fight
off some physical or psychological
danger
Alarum response initiate the
sympathetic nervous system to
avoid the stressor (increase heart
rate , temperature , adrenalin,
glucose) ,When confronted with
negative stimulus .
2-Resistance is the stage
when body successfully
controlling the stress –
3-Exhaustion –when person
runout of adaptation
energy and ability to
combat the stress leads to
exhaustion which leads to
adaptive disease such as
sleep deprivation , mental
illness , hypertension ,
heart disease .
9
Stress as a response model (Hans Sesly 1956)

10. “The Transactional Theory of
Stress and Coping”).
Primary
appraisal
involves determini
ng whether the
stressor poses a
threat.
Secondary
appraisal
involves the
individual’s
evaluation of the
resources or
coping
strategies at his
or her disposal
for addressing
any perceived
threats.
The process
of reappraisal is on
going and involves
continually
reappraising both
the nature of the
stressor and the
resources available
for responding to
the stressor.
10

11. 11

12. The effects of stress
Stress can manifest itself as:
▪ Tension or vascular
headache
▪ Getting cold and flu
▪ High blood pressure
▪ Cardiovascular
disease
▪ Ulcers
▪ Chest pain
▪ Losing
motivation
▪ Depression
▪ Anxiety
▪ Dec.
concentration
▪ Feeling restless
▪ Diabetes
▪ Feeling
overwhelmed
▪ Over under
eating
▪ Social Isolation
12

13. Stress and burnout
▪ What’s the difference between stress and burnout? Stress is
inevitable. Burnout isn’t.
▪ While stress is our response, burnout is the accumulation of
excessive stressors over time, which results in
unmanageable stress levels.
▪ American psychologist Herbert Freudenberger first
termed the word “burnout” in the 1970s, referring to the
effect of extreme stress and high ideals placed on “helping”
professionals, such as doctors and nurses (“Depression:
What is burnout?”, 2018).
13

14. 14

15. “
▪ Coping, a basic process integral to
adaptation and survival, depicts how people
detect, appraise, deal with, and learn from
stressful encounters.
Coping strategies are psychological
patterns that individuals use to manage
thoughts, feelings, and actions encountered
during various stages of ill health and
treatments.
E.A. Skinner, M. Zimmer-Gembeck, in Encyclopedia of Mental Health
(Second Edition), 2016
15

16. Richard Lazarus was one of the
first psychologists to discuss coping
as an ongoing, dynamic process.
Folkman and Lazarus (1984) split
the coping strategies into four groups,
Problem-focused coping
Emotion-focused coping
Support-seeking coping
Meaning-making coping.[7][8]
Weiten has Added emotion-focused,
and occupation-focused coping.
Billings and Moos added avoidance
coping as one of the emotion-focused
coping.
16

17. 17

18. 18

19. 19

20. ▪ In addition, Epping-Jordan et al. (1994)
found that patients with cancer who
used avoidance strategies, e.g. denying
they were very ill, deteriorated more
quickly then those who faced up to
their problems. The same pattern exists
in relation to dental health and
financial problems.
20

21. Problem –focus
strategies

22. Problem –focus
strategies
▪ Problem-focused strategies try to deal with
the cause of their problem. They do this by
finding out information on the problem and
learning new skills to manage the problem.
▪ Problem-focused coping is aimed at
changing or eliminating the source of the
stress.
▪ The three problem-focused coping strategies
identified by Folkman and Lazarus are:
taking control, information seeking, and
evaluating the pros and cons.
22

23. Problem –focus
strategies
▪ Problem focused strategies aim to remove
or reduce the cause of the stressor,
including:
▪ Problem-solving.
▪ Time-management.
▪ Obtaining instrumental social support.
23

24. 24
Problem-focused strategies
Problem solving skills

25. 25

26. 26

27. Problem focus strategies
▪ Problem-focused strategies are successful in
dealing with Stressors such as
▪ Discrimination (Pascoe & Richman, 2009),
▪ HIV infections (Moskowitz, Hult, Bussolari, & Acree, 2009)
and
▪ Diabetes (Duangdao & Roesch, 2008).
▪ However, it is not always possible to use problem-
focused strategies. For example, when someone
dies, problem-focused strategies may not be very
helpful for the bereaved. Dealing with the feeling of
loss requires emotion-focused coping
27

28. Problem focus strategies
▪ Problem focus strategies work best when the person
can control the source of stress (e.g. exams, work
based stressors etc.).
▪ For example, optimistic people who tend to have
positive expectations of the future are more likely to
use problem-focused strategies,
▪ whereas pessimistic individuals are more inclined
to use emotion-focused strategies (Nes &
Segerstrom, 2006).
28

29. 29

30. Emotion focus coping
strategies

31. Emotion focus coping strategies
▪ Emotion-focused coping deals with emotional
response is a type of stress management that
attempts to reduce Negative emotional responses
associated with stress.
▪ Negative emotions such as embarrassment,
fear, anxiety, depression, excitement and
frustration are reduced or removed by the
individual by various methods of coping.
▪ Emotion-focused techniques might be the only
realistic option when the source of stress is
outside the person’s control.
31

32. Emotion focus coping
strategies
▪ There are six type of Emotion focus coping strategies
▪ If the individual does not believe he or she has the capacity to
respond to the challenge or feels a lack of control, he or she is most
likely to turn to an emotion-focused coping response such as
▪ 1- Wishful thinking: when a person hopes that a bad situation
goes away or solution magically presents itself . (e.g., I wish that I
could change what is happening or how I feel),
▪ 2-Distancing: when a person chooses not to deal with the
situation for sometimes (e.g., I’ll try to forget the whole thing),
▪ 3-Emphasizing the positive : when we focus on the good things
related to problem and downplay negative ones . (e.g., I’ll just look
for the silver lining) (Lazarus & Folkman, 1987).
32

33. Emotion focus coping strategies
▪ 4-Self blame: when we blame ourselves for the
demand and subsequent stress experiencing .
▪ 5-Tension reduction: when a person engage in a
behaviors to reduce the stress caused by demand .
▪ 6-Self isolation: when a person intentionally
removes himself from social situation to avoid
having to face a demand .
33

34. Emotion focus coping strategies
Behavioral interventions
▪ Stress inoculation : this is a form of CBT in which a
therapist works with an individual to identify the problem
learn and practice new coping strategies and finally put
these newly acquired skills to use.
▪ Emotional disclosure : occurs when a therapist has a
client talk and write about negative events that lead to the
expression of strong emotions .
▪ Mindfulness : ask the individual to redirect their past and
future –directed thought to present and the problem at
hand .
▪ Relaxation training : focus on the use of deep muscles
relaxation exercise
34

35. ▪ In addition, Epping-Jordan et al. (1994)
found that patients with cancer who used
avoidance strategies, e.g. denying they
were very ill, deteriorated more quickly then
those who faced up to their problems.
▪ The same pattern exists in relation to dental
health and financial problems.
35

36. ▪ Emotion-focused coping does not provide a
long term solution and may have negative side
effects as it delays the person dealing with the
problem. However, they can be a good choice if the
source of stress is outside the person’s control (e.g.
a dental procedure).
▪ Gender differences have also been reported: women
tend to use more emotion-focused strategies than
men (Billings & Moos, 1981).
36

37. ▪ A meta-analysis revealed emotion-focused
strategies are often less effective than using
problem-focused methods in relation to health
outcomes (Penley, Tomaka, & Weibe, 2012).
▪ In general people who used emotion-focused
strategies such as eating, drinking and taking
drugs reported poorer health outcomes.
37

38. 38

39. 39

40. case 1
coping strategies
exam/test
40

41. A forth year medical
student came to you
under severe stress next
month he has his final
year exam .
▪ What stress coping
strategies can help
him to cope with exam
stress ?
41

42. 42
▪ Remember to breath
▪ Eat ,exercise and sleep
well
▪ Set the realistic goal
▪ Don’t do it alone
▪ If you feel struggle talk
▪ Believe in your self
▪ Pace yourself from panic
▪

43. 43

45. Coping strategies exam/test
▪ Students can use several coping mechanisms to deal
with the stress and anxiety that come with taking
tests /exam . People tend to cope with stress and
anxiety in one of the three ways.
▪ Problem-focused coping refers to efforts to alter
the stressful situation itself. For instance, the stress
and anxiety of an upcoming test/exam can be
minimized by studying for the test/exam, thus
eliminating the stress-inducing power of the test.
Franklin M. Zaromb, ... Richard D. Roberts, in Reference Module in
Neuroscience
and Biobehavioral Psychology, 2017
45

46. Coping strategies with
exam /test
▪ Emotion-focused coping refers to efforts to reduce one's
response to the stressful situation. In this case, the stress of
an upcoming test can be reduced by imagining all the
positives that will come from successfully
completing the test – thus, the meaning of the test is
reframed from a negative one to a positive one.
▪ Avoidance-oriented coping, in which the stressor is
avoided altogether. Thus, the stress of an upcoming test
can be avoided by doing something that takes attention
away from the test, such as going out with friends or
watching television instead of studying.
Franklin M. Zaromb, ... Richard D. Roberts, in Reference Module in
Neuroscience
and Biobehavioral Psychology, 2017
46

47. “ Case 2
▪ 35 years old male came with
complaint of low mood and loss of
interest in his usual activities he is
feeling hopeless and help less .. He
has a financial and social crises
because he recently loss his job
after Covid -19
▪ What coping strategies you will offer
him to get or reduce his stress and
solve his problems ?
47

48. 48
1-Active coping (taking action to try to get rid of or decrease the
stressor or its consequences)
2. Planning (deliberations how handle the problem)
3. Seeking social support for instrumental reasons (asking for
advice, help or information)
4. Seeking social support for emotional reasons (seeking for
emotional support, sympathy or understanding).
Depression and ways of coping with stress International Medical Journal of Experimental and
Clinical Research, 25 Nov 2013, 19:1050-1056
Depression and ways of coping with stress

49. 49
Depression and ways of coping with stress
5. Suppression of competing activities (putting
aside other activities not connected to the problem
in order to better deal with it).
6. Turning to religion (as a source of emotional
support or signpost to positive reinterpretation and
development);
7. Positive reinterpretation and growth
(growing as a person as a result of the experience,
seeing events in a positive light);
8. Restraint coping (waiting for the right time to

50. 50
Depression and ways of coping
with stress
9. Acceptance (accepting situation as something
irreversible, trying to get used to it and learn to live
with it);
10. Focus on and venting of emotions (concern
about own emotions and tendency to express
them);
11. Denial (ignoring, refusal to acknowledge the
problems);
12. Mental disengagement (avoiding of

51. “
Case 3
22 years old female came for her Obesity
counseling she is feeling so depressed
despite schedule exercise program and
restrictive diet plan she has failure to lose
the weight with this body image she thinks
that is unable to cope with friends family
and society and during the consultation
you found her in distress she is asking for
help .
so what coping strategies might help
her ?
51

52. Simply changing a person’s diet or increasing one’s physical
activity is not enough.
one must change how to cope with stress and negative emotions.
Instead of obsessing over failure to stick to a diet or workout
schedule, consider what underlying thoughts and feelings may
have caused a relapse. Then, talk to a professional (such as a
counselor or psychiatrist) to formulate a plan for coping with the
bad feeling or negative thoughts .
Coping strategies with
obesity/stress

53. Coping strategies with obesity /stress
▪ Consult with a
psychiatrist,
psychologist and/or a
counselor to address
depression, anxiety, and
other emotional issues.
▪ emotion coping
strategy/Support
seeking behavior
▪ Hiring a professional
weight loss coach help
to set realistic goals and
work on behavioral
issues.
Join a support
group such as those at a
local community center,
hospital, or school, or one
like Weight Watchers.
▪ Support seeking
/problem focus strategy
Keep a journal to track
eating habits by writing
down feelings linked to
eating habits, including the
amount of food, what is
eaten, and the time of day,
to give perspective on
eating triggers.

54. “
Coping with melanoma
▪ Perhaps the most dramatic of stress coping
interventions studies was conducted by Fawzy
and his colleagues 1990-1994 (who did
specific coping skills interventions with
melanoma patients.
▪ During a six-week structured program,
participants experienced multiple program
components including health education,
psychological support, problem-solving,
and stress management training.
▪ In the short term, the experimental subjects
were more likely to use by active behavior
coping than the controls, and also had more
54

55. “
▪ Coping with
melanoma
▪ Differences in immune functioning
were evident between the two groups
at the six-month assessment.
▪ At a five-year follow-up, a third of the
control group had died, compared
with less than 10% of the experimental
group. Longer survival was associated
with more active coping at baseline.
55

57. THANKS!
Any questions?
57