CLIENT EDUCATION, STRESS AND COPING

 

PATIENT EDUCATION

Definition

Patient education involves helping patients become better informed about their condition, medical procedures, and choices they have regarding treatment. Nurses typically have opportunities to educate patients during bedside conversations or by providing prepared pamphlets or handouts. Patient education is important to enable individuals to better care for themselves and make informed decisions regarding medical care.

 

Description

Patients acquire information about their condition in a variety of ways: by discussing their condition with health professionals; by reading written materials or watching films made available in hospitals or doctors’ offices; through specific health care organizations, such as the American Cancer Association; and through drug advertisements on television and in popular magazines. With the explosion of information on the World Wide Web, patients can access a wide range of medical information, from professional medical journals to on-line support and chat groups with a health focus.

 

Viewpoints

Being informed about one’s health care options is essential to a patient’s health and well-being. Especially with the increase in managed care, in which economics and efficiency is sometimes paramount, patients may be able to obtain better health care if they are knowledgeable and assertive about their needs and wishes. Informed patients may benefit, for example, by realizing they have a choice of different medications, different treatments, or what lifestyle patterns may affect their condition.

 

Professional implications

Professional health care givers have traditionally borne the responsibility for patient education. In recent years, however, patients independently have easy access to a wide range of health information. However, many patients cannot easily obtain information, especially if they are not well educated or are not fluent in English. In addition, many patients may not understand enough about their condition to ask relevant questions. Finally, a significant amount of popular information is inaccurate or publicized for a profit motive rather then for education purposes. Patients may not be able to sort out what is true or what is relevant to their own condition.

Another relatively recent aspect of patient education centers around legal ramifications. When a patient is fully informed about the risks and benefits of a particular procedure or therapeutic approach, the likelihood of a lawsuit resulting from a complication is sharply reduced. A patient must be made aware of risks before accepting treatment.

Nurses play an important role in providing health education. They are often the best sources of information regarding caring for patients, such as learning to breast feed, soothing fussy babies, or staying comfortable in the hospital. They may be more accessible than doctors, both because they may spend more time with patients, and because patients may feel less intimidated by nurses and more comfortable asking questions and sharing fears. It is important that nurses do not provide information they are unsure about, or falsely reassure patients about their condition.

 

Through education, patients can be made aware of their disease process and potential treatment options. But, educating our patients is not as easy as one might think. Our patients come from different ethnic and socioeconomic backgrounds; and they have different treatment priorities. It’s important to have an open discussion with patients and to get to know their expectations and needs.

So, how can effective teaching be accomplished? And, how can effective teaching be done when we, as nurses, have so many other daily demands? These tips could help:

Computer-aided teaching:  Computer or other output devices allow patients to view and to hear patient education materials in the hospital and some of these materials can be reviewed at home. Manuals are often made available to accompany the computerised programs. And there is usually a test to evaluate learning once the program is completed.

 

Video education: Video education is very similar to computer-based training. But, it is more difficult to evaluate learning. A written post-test could be used after the video is reviewed. But, it is important with both of these media to consider the patients’ educational level, language, and hearing/seeing abilities.

 

Demonstration: Demonstration is another effective patient-teaching technique. Patients can be showed how to complete a task or how a process works in a one-on-one setting, and then they can do the task more effectively at home. However, in an acute care setting this might be more difficult to do. The pace is much faster, but case managers or patient care assistants can be used to assist the nurse if needed. And, demonstration does ensure that patients fully understand the teaching, and it allows them to get feedback and ask questions in a safe arena.

 

Written material:  Written material seems so easy and routine. But, it can be effective. For instance, material with pictures can offer instructions or explanations.  Written material related to prescribed medicines is also a necessity.  And, it can offer instructions in a step by step fashion. Once again, it is important to evaluate the patients’ literacy level, language, and sight before handing out routine teaching materials. 

Discharge instructions:  At the time of discharge, patients can be equipped with a set of instructions with follow-up appointments, medication teaching, and phone numbers. Many discharge instructions can easily be printed using PHR and EMR software systems. These instructions usually give phone numbers (of whom to call with questions) and follow-up appointment instructions. 

 

Discharge prescriptions:  Prescriptions for discharge medications are usually included in these instructions.  It is important to verify that the patient knows the names, the purpose, and the dosage instructions for these medications.

If needed, verify with the case manager that the patient can afford these medications; and if needed, call them into their pharmacy before discharge.

 

Other information about patient teaching can be obtained from organisations such as the Arthritis Foundation, the American Diabetes Association, and the American Cancer Society.  Another valuable resource is the Clinical Practice Guidelines developed by the Agency for Healthcare Research and Quality (AHRQ). These evidence-based interdisciplinary guidelines assist clinicians to prevent, diagnose, treat, and mange clinical conditions, with a focus on patient outcomes.

 

Effective patient teaching also requires evaluation and ocumentation.

Learning can be evaluated in the following ways:

Asking questions:

Simply ask the patient questions to see whether they is information that needs reinforcing.

Observe return demonstration:

Watch the patient perform a task (i.e. self inject insulin) to see if the technique is correct.

Assess the data:

Ask the patient to record his blood pressure, blood glucose, or weight at home.  And, review the records at the next visit. 

These records will demonstrate how effective the current treatments have been.

Talk with the patient/family: At the next visit, or before discharge, talk with the family to see how the patient has been doing, or before they leave the hospital, engage in open dialogue about barriers or concerns. This is very similar to the idea of “asking questions, “ but both methods are useful. 

 

Documenting patient teaching

There are many computerised systems out there. And some offices might still use hand-written documentation. Whatever method you use remember that the information must become a part of the patient’s permanent medical record.  You can include in the documentation:

1.     Information and skills you have taught

2.     Teaching methods used – brochures, models, videos, demonstration

3.     Patient and family response to teaching

4.     Evaluation of what the patient and family have learned and how learning outcomes were determined

Through teaching and empowering our patients, we are giving them the tools they need to manage their disease process. 

Managing the disease process results in fewer hospitalisations and in an improved quality of life. 

 

 

HOW TO MAKE A NURSING PATIENT TEACHING PLAN

INSTRUCTIONS

Patient Assessment:

1 This step requires the analysis and organization of information about the patient. Determine the patient’s level of understanding about her disease, injury or condition.

2 Use the information gathered about the patient to judge how well she will be able to understand and apply what is taught to her.

3 Be sure to factor in cultural considerations that are specific to that patient such as ethnicity and religion. It will be necessary to factor in any information you have about the patient’s level of development as well. It may be necessary for the nurse to motivate the patient in order for her to learn. Ability to learn is affected if the patient is too tired, in pain, upset or distracted.

 

Planning

4 Formulate patient goals. Take the patient and the family’s point of view into consideration, as their input will have an effect on their outcomes. Patient outcomes and motivation are directly associated with the amount of input they have in determining their goals. The goals must be realistic and able to be achieved by the patient.

5 Identify how the teaching plan will be carried out. Implement the plan according the patient’s learning style (audio, visual, or kinetic) as opposed to the nurse’s teaching style.

6 Develop nursing goals based on desired health outcomes. They should be patient-centered and based on health outcomes for the patient’s health status and quality of life.

 

Determine Method of Implementation

7 The method of implementation of the nursing patient teaching plan should be specific to the patient’s learning style and desired outcomes that were identified.

8 Prepare to document patient responses and level of understanding as the nurse perceives them while the teaching plan is implemented.

9 Prepare to document any other relevant information that will assist with the evaluation of learning.

 

Formulate Evaluation Process

10 An evaluation process will need to be formed in order to assess patient outcomes. The following specific elements of patient learning will need to be evaluated: patient knowledge, behavior, attitude, and skills. The evaluation should include a review of the documentation that details patient responses and level of understanding that were recorded during the implementation steps.

11 The evaluation plan should include observations of the family’s understanding of what will be required of them for the patient to achieve desired outcomes.

12 The last key element of the evaluation plan is the nurse’s recommendation for follow-up procedures to be used in the event that the patient’s learning was not sufficient to produce desired outcomes.

In order to teach, the nurse must first have an understanding of the patient education

The following is a list of strategies that promote the incorporation of teaching into daily nursing practice:

• Emphasize what is necessary. In the inpatient setting, many patients fear losing their independence (Jones, 2002). Patients will be motivated to learn what is necessary for them to care for themselves; therefore nurses should emphasize these strategies.

• Choose the right time. Remember that when teaching, timing is crucial. For instance, if the patient has just been informed of a diagnosis, he or she will need time to cope with this information. There might be associated feelings of grief, powerlessness, fear, and vulnerability (Jones, 2002). These will cloud the ability to learn.  
   

• Look for teaching moments. Like choosing the right time for teaching, it is equally important to “look for teaching moments.” Imagine caring for a patient with end-stage renal disease. A teaching moment would be when the patient receives his tray and there is only a small amount of fluid. In this situation the nurse could ask, “Why is it important for you to monitor your fluid intake?”  
   

• Plan teaching during an uninterrupted time. When teaching the patient, timing is crucial. It is not appropriate to fit everything into the day of discharge. Similarly, it would not be appropriate to provide complex lessons during meal time or visiting hours.
   

• Use basic principles. It is important to consider the educational level of the patient when teaching. After all, not everyone has had a nursing education. Some patients might not be able to understand complex medical jargon. They may even be illiterate and are unable to read handouts.
   

• Evaluate the senses. Nurses must evaluate the patient’s ability to see and to hear. For example, if a patient has difficulty seeing, it might not be practical to give her a handout on disease management. If the patient has difficulty hearing, it might not be appropriate to guide her with verbal instructions.
   

• Keep expenses in mind. Many patients, especially elders, live on a fixed income. Therefore, it might not be practical to recommend that they join a fitness center as a means of weight reduction. When recommending a glucometer for the diabetic patient or a scale for the dialysis patient, it is important to consider the cost of each one.  
   

• Clearly define goals and objectives. Before beginning, it is important to have a list of goals and objectives that are formulated by the patient and the nurse. The significance of these should be understood by each person, and they should be evaluated on a continuous basis.  
   

• Remember to document. When teaching a new skill, documentation is important. This allows the incoming nurse or a nursing assistant to see what has been done and where she should start. Likewise, if the patient has difficulty with a certain skill or needs certain assistance, this should be recorded so that accommodations or further instruction can be provided.

Patient education requires that the nurse think critically. No longer are we simply responsible for administering medications and communicating with physicians. We also play a dynamic role in assuring that the patient is able to be independent in managing his disease.

In essence, we are nurse educators. After all, teaching is a vital component of the nursing process. However, the process is not uniform iature. In order to promote learning, it is valuable to keep these proposed strategies in mind. And as part of our nursing education about the values of patient teaching, we have to remember that the patient population is indeed heterogeneous.

 

Choosing effective patient education materials

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Once you have assessed your patient’s needs, concerns, readiness to learn, preferences, support, and possible barriers to learning, you will need to:

• Make a plan with your patient and their support person

• Agree with the patient on realistic learning objectives

• Select resources that fit the patient

Be aware of what the patient knows about their conditioow. Some patients need time to adjust to new information, master new skills, or make short- or long-term lifestyle changes.

Getting Started

Assessing your patient’s preferences will likely have a direct impact on the patient education materials you select and the methods you use.

• Find out how your patient likes to learn.

• Be realistic. Focus on what your patient needs to know, not on what’s nice to know.

• Pay attention to the patient’s concerns. There may be a fear to overcome before a skill can be taught.

• Respect their limits. Figure out how to give the patient the right amount of information, including how you organize the information and how much the patient can handle at one time.

• Be aware that you may need to adjust your plan, according to situations that could range from changes in your patient’s health status to an environmental factor like their lack of privacy.

Basic Priorities

With any type of patient education you will likely need to cover these basics:

• What your patient needs to do and why

• When your patient can expect results (if applicable)

• Warning signs (if any) your patient should watch for

• What your patient should do if a problem occurs

• Who your patient should contact for questions or concerns

Patient Education Resource Options

There are so many ways to deliver patient education, such as one-on-one teaching, often with a demonstration. Try using analogies or “word pictures” to explain concepts.

You can also use one or more of the following examples:

• Brochures or other printed materials

• Podcasts

• YouTube videos

• Videos or DVDs

• PowerPoint presentations

• Posters or charts

• Models or props

• Group classes

• Trained peer educators

Selecting Materials

Using a mixed media approach works best. The type of resources that a patient or support person responds to varies from person to person.

Keep your assessment in mind. Are there literacy, cultural, or other factors to consider when you select education materials and develop a plan?

Avoid fear tactics. Focus instead on the benefits of education. Tell your patient what to pay special attention to.

Be sure to review any materials you plan to share with a patient before using them. Keep in mind that no resource is a substitute for one-on-one patient teaching.

Sometimes, despite a thorough search, it is impossible to find patient education information or the right materials that fit your patient. For example, it may be hard to find materials oew treatments, in certain languages, or on sensitive topics. Bring up those sensitive or difficult topics. And, when high quality materials are not available, consider creating the patient teaching tool your patients need.

 

 

 

 

 

Feeling like there are too many pressures and demands on you? Losing sleep worrying about tests and schoolwork? Eating on the run because your schedule is just too busy? You’re not alone. Everyone experiences stress at times — adults, teens, and even kids. But there are ways to minimize stress and manage the stress that’s unavoidable.

 

                              What Is Stress?

Stress is a feeling that’s created when we react to particular events. It’s the body’s way of rising to a challenge and preparing to meet a tough situation with focus, strength, stamina, and heightened alertness.

The events that provoke stress are called stressors, and they cover a whole range of situations — everything from outright physical danger to making a class presentation or taking a semester’s worth of your toughest subject.

 

The human body responds to stressors by activating the nervous system and specific hormones. The hypothalamus signals the adrenal glands to produce more of the hormones adrenaline and cortisol and release them into the bloodstream. These hormones speed up heart rate, breathing rate, blood pressure, and metabolism. Blood vessels open wider to let more blood flow to large muscle groups, putting our muscles on alert. Pupils dilate to improve vision. The liver releases some of its stored glucose to increase the body’s energy. And sweat is produced to cool the body. All of these physical changes prepare a person to react quickly and effectively to handle the pressure of the moment.

 

This natural reaction is known as the stress response. Working properly, the body’s stress response enhances a person’s ability to perform well under pressure. But the stress response can also cause problems when it overreacts or fails to turn off and reset itself properly.

 

Good Stress and Bad Stress

The stress response (also called the fight or flight response) is critical during emergency situations, such as when a driver has to slam on the brakes to avoid an accident. It can also be activated in a milder form at a time when the pressure’s on but there’s no actual danger — like stepping up to take the foul shot that could win the game, getting ready to go to a big dance, or sitting down for a final exam. A little of this stress can help keep you on your toes, ready to rise to a challenge. And the nervous system quickly returns to its normal state, standing by to respond again wheeeded.

 

But stress doesn’t always happen in response to things that are immediate or that are over quickly. Ongoing or long-term events, like coping with a divorce or moving to a new neighborhood or school, can cause stress, too.

Long-term stressful situations can produce a lasting, low-level stress that’s hard on people. The nervous system senses continued pressure and may remain slightly activated and continue to pump out extra stress hormones over an extended period. This can wear out the body’s reserves, leave a person feeling depleted or overwhelmed, weaken the body’s immune system, and cause other problems.

 

What Causes Stress Overload?

Although just enough stress can be a good thing, stress overload is a different story — too much stress isn’t good for anyone. For example, feeling a little stress about a test that’s coming up can motivate you to study hard. But stressing out too much over the test can make it hard to concentrate on the material you need to learn.

Pressures that are too intense or last too long, or troubles that are shouldered alone, can cause people to feel stress overload. Here are some of the things that can overwhelm the body’s ability to cope if they continue for a long time:

being bullied or exposed to violence or injury relationship stress, family conflicts, or the heavy emotions that can accompany a broken heart or the death of a loved one ongoing problems with schoolwork related to a learning disability or other problems, such as ADHD (usually once the problem is recognized and the person is given the right learning support the stress disappears) crammed schedules, not having enough time to rest and relax, and always being on the go Some stressful situations can be extreme and may require special attention and care.

 

Posttraumatic stress disorder is a very strong stress reaction that can develop in people who have lived through an extremely traumatic event, such as a serious car accident, a natural disaster like an earthquake, or an assault like rape.

Some people have anxiety problems that can cause them to overreact to stress, making even small difficulties seem like crises. If a person frequently feels tense, upset, worried, or stressed, it may be a sign of anxiety. Anxiety problems usually need attention, and many people turn to professional counselors for help in overcoming them.

 

Signs of Stress Overload

People who are experiencing stress overload may notice some of the following signs:

·        anxiety or panic attacks

·        a feeling of being constantly pressured, hassled, and hurried

·        irritability and moodiness

·        physical symptoms, such as stomach problems, headaches, or even chest pain

·        allergic reactions, such as eczema or asthma

·        problems sleeping

·        drinking too much, smoking, overeating, or doing drugs

·        sadness or depression

 

Everyone experiences stress a little differently. Some people become angry and act out their stress or take it out on others. Some people internalize it and develop eating disorders or substance abuse problems. And some people who have a chronic illness may find that the symptoms of their illness flare up under an overload of stress.

 

Keep Stress Under Control

What can you do to deal with stress overload or, better yet, to avoid it in the first place? The most helpful method of dealing with stress is learning how to manage the stress that comes along with any new challenge, good or bad. Stress-management skills work best when they’re used regularly, not just when the pressure’s on. Knowing how to “de-stress” and doing it when things are relatively calm can help you get through challenging circumstances that may arise.

 

Here are some things that can help keep stress under control:

Take a stand against overscheduling. If you’re feeling stretched, consider cutting out an activity or two, opting for just the ones that are most important to you.

 

Be realistic. Don’t try to be perfect — no one is. And expecting others to be perfect can add to your stress level, too (not to mention put a lot of pressure on them!). If you need help on something, like schoolwork, ask for it.

 

Get a good night’s sleep. Getting enough sleep helps keep your body and mind in top shape, making you better equipped to deal with any negative stressors. Because the biological “sleep clock” shifts during adolescence, many teens prefer staying up a little later at night and sleeping a little later in the morning. But if you stay up late and still need to get up early for school, you may not get all the hours of sleep you need.

 

Learn to relax. The body’s natural antidote to stress is called the relaxation response. It’s your body’s opposite of stress, and it creates a sense of well-being and calm. The chemical benefits of the relaxation response can be activated simply by relaxing. You can help trigger the relaxation response by learning simple breathing exercises and then using them when you’re caught up in stressful situations. And ensure you stay relaxed by building time into your schedule for activities that are calming and pleasurable: reading a good book or making time for a hobby, spending time with your pet, or just taking a relaxing bath.

 

Treat your body well. Experts agree that getting regular exercise helps people manage stress. (Excessive or compulsive exercise can contribute to stress, though, so as in all things, use moderation.) And eat well to help your body get the right fuel to function at its best. It’s easy when you’re stressed out to eat on the run or eat junk food or fast food. But under stressful conditions, the body needs its vitamins and minerals more than ever. Some people may turn to substance abuse as a way to ease tension. Although alcohol or drugs may seem to lift the stress temporarily, relying on them to cope with stress actually promotes more stress because it wears down the body’s ability to bounce back.

Watch what you’re thinking. Your outlook, attitude, and thoughts influence the way you see things. Is your cup half full or half empty? A healthy dose of optimism can help you make the best of stressful circumstances. Even if you’re out of practice, or tend to be a bit of a pessimist, everyone can learn to think more optimistically and reap the benefits.

Solve the little problems. Learning to solve everyday problems can give you a sense of control. But avoiding them can leave you feeling like you have little control and that just adds to stress. Develop skills to calmly look at a problem, figure out options, and take some action toward a solution. Feeling capable of solving little problems builds the inner confidence to move on to life’s bigger ones — and it and can serve you well in times of stress.

 

Build Your Resilience

Ever notice that certain people seem to adapt quickly to stressful circumstances and take things in stride? They’re cool under pressure and able to handle problems as they come up. Researchers have identified the qualities that make some people seem naturally resilient even when faced with high levels of stress.

 

If you want to build your resilience, work on developing these attitudes and behaviors:

1.     Think of change as a challenging and normal part of life.

2.     See setbacks and problems as temporary and solvable.

3.     Believe that you will succeed if you keep working toward your goals.

4.     Take action to solve problems that crop up.

5.     Build strong relationships and keep commitments to family and friends.

6.     Have a support system and ask for help.

7.     Participate regularly in activities for relaxation and fun.

Learn to think of challenges as opportunities and stressors as temporary problems, not disasters. Practice solving problems and asking others for help and guidance rather than complaining and letting stress build. Make goals and keep track of your progress. Make time for relaxation. Be optimistic. Believe in yourself. Be sure to breathe. And let a little stress motivate you into positive action to reach your goals.

 

Stress Management

A lot of research has been conducted into stress over the last hundred years. Some of the theories behind it are now settled and accepted; others are still being researched and debated. During this time, there seems to have been something approaching open warfare between competing theories and definitions: Views have been passionately held and aggressively defended.

What complicates this is that intuitively we all feel that we know what stress is, as it is something we have all experienced. A definition should therefore be obvious… except that it is not.

 

STRESS is a condition or feeling experienced when a person perceives that “demands exceed the personal and social resources the individual is able to mobilize.” In short, it’s what we feel when we think we’ve lost control of events.

This is the main definition used by this section of Mind Tools, although we also recognize that there is an intertwined instinctive stress response to unexpected events. The stress response inside us is therefore part instinct and part to do with the way we think.

Fight-or-Flight

Some of the early research on stress (conducted by Walter Cannon in 1932) established the existence of the well-known “fight-or-flight” response. His work showed that when an organism experiences a shock orperceives a threat, it quickly releases hormones that help it to survive.

In humans, as in other animals, these hormones help us to run faster and fight harder. They increase heart rate and blood pressure, delivering more oxygen and blood sugar to power important muscles. They increase sweating in an effort to cool these muscles, and help them stay efficient. They divert blood away from the skin to the core of our bodies, reducing blood loss if we are damaged. As well as this, these hormones focus our attention on the threat, to the exclusion of everything else. All of this significantly improves our ability to survive life-threatening events.

Not only life-threatening events trigger this reaction: We experience it almost any time we come across something unexpected or something that frustrates our goals. When the threat is small, our response is small and we often do not notice it among the many other distractions of a stressful situation.

Unfortunately, this mobilization of the body for survival also has negative consequences. In this state, we are excitable, anxious, jumpy and irritable. This actually reduces our ability to work effectively with other people. With trembling and a pounding heart, we can find it difficult to execute precise, controlled skills. The intensity of our focus on survival interferes with our ability to make fine judgments by drawing information from many sources. We find ourselves more accident-prone and less able to make good decisions.

There are very few situations in modern working life where this response is useful. Most situations benefit from a calm, rational, controlled and socially sensitive approach.

In the short term, we need to keep this fight-or-flight response under control to be effective in our jobs. In the long term we need to keep it under control to avoid problems of poor health and burnout.

 

Coping With Stress

Stress affects your mind, body, and overall health. When you are feeling stressed, changes may occur in your body:

1.     Your blood pressure may increase.

2.     Your heart rate rises.

3.     Your immune system does not function as well.

4.     Your body’s response to stress could lead to illness.

5.     You can control your stress level by practicing simple relaxation techniques to train your mind to lower your response to the tension.

 

By using relaxation techniques regularly, you can lower the amount of stress hormones in your blood. This will help you protect yourself from the harmful mental and physical effects of stress.

 

Breathing

Breathing provides oxygen to your bloodstream and body. When you breathe in, you inhale oxygen. When you breathe out, you exhale carbon dioxide. Your diaphragm (DIEeh-fram) is a sheet-like muscle that separates your stomach (abdomen) and your chest. Your diaphragm works to help you breathe in and out. When you inhale, the diaphragm lowers, your stomach pushes out, and your chest cavity swells. This gives the lungs more space to expand into and  increases the amount of air that you can inhale.

 

Chest Breathing vs. Abdominal Breathing

As we get older, our breathing gets shallower, and most of us use only the upper parts of our chest to breathe. When you breathe from your chest, you inhale about a teacup of oxygen. Instead, you should breathe from your abdomen. When you breathe from your abdomen, you inhale about a quart of oxygen. The more oxygen you inhale, the better.

How you breathe also affects your nervous system. Chest breathing makes your brain create shorter, more restless brain waves. Abdominal breathing makes your brain create longer, slower brain waves. These longer and slower brain waves are similar to the ones your brain makes when you are relaxed and calm. So, breathing from the abdomen helps you relax quickly.

 

Practice Abdominal Breathing

It may be easier to practice abdominal breathing when you’re lying down. With practice, you should be able to do abdominal breathing anywhere.

Put your right hand on your abdomen, at the navel (belly button), and put your left hand on the center of your chest. You may find it helpful to close your eyes.

 Inhale through your mouth more deeply than usual, and pay attention to your abdomen. If you are breathing from your abdomen, you should feel your abdomen rise as your lungs fill with air. The hand on your chest should move only slightly. If your chest rises more than your abdomen, then you are breathing from your chest.

To change from chest to abdominal breathing, exhale all of the air in your lungs. Keep pushing the air out. When you feel like you can’t exhale any more air, pause. Then inhale slowly. When you breathe this way, you push the air out from the bottom of your lungs, and create a vacuum that will pull in an abdominal breath when you inhale.

Do steps 2 and 3 again, but this time, breathe in through your nose. Breathing through your nose is better than breathing through your mouth because your nose:

warms the air .

1.     filters the air

2.     adds moisture to the air

3.     lets you breathe in more air

 

Mini Relaxation Exercise

A mini relaxation exercise can help you reduce stress and tension immediately. The important part of these exercises is to focus on your breathing. During the exercises, try to breathe from your abdomen. You should feel your stomach rising about an inch as you breathe in, and falling about an inch as you breathe out. Remember, it is impossible to breathe from your abdomen if you are holding your stomach in. Relax your stomach muscles. You can do these exercises with your eyes open or closed. There are a variety of mini relaxation exercises. Choose the one that works best for you.

The following mini relaxation exercises were adapted from the Mind/Body Medical Institute in Boston, Massachusetts.

 

Exercise #1:

Count very slowly to yourself. Count from 10 down to 0. With the first abdominal breath, say 10 to yourself; with the next breathe, say 9, and so on. If you start feeling light-headed or dizzy, slow down the counting. When you get to 0, see how you are feeling. If you are feeling better, great! If not, try doing it again.

 

Exercise #2:

 As you inhale, count to 4 very slowly and say to yourself “1,2,3,4.” As you exhale, count backwards very slowly and say to yourself “4,3,2,1.” Do this several times.

 

Exercise #3:

After each time you inhale, pause for a few seconds. After you exhale, pause again for a few seconds. Do this for several breaths.

 

When to Practice

You can practice the mini relaxation exercises almost anywhere, in any situation, including when you are:

1.     waiting in line or stuck in traffic

2.     put on hold during an important phone call

3.     bothered by something someone has said

4.     overwhelmed by what you need to accomplish

5.     in pain

 

It may seem that there’s nothing you can do about stress. The bills won’t stop coming, there will never be more hours in the day, and your career and family responsibilities will always be demanding. But you have more control than you might think. In fact, the simple realization that you’re in control of your life is the foundation of stress management. Managing stress is all about taking charge: of your thoughts, emotions, schedule, and the way you deal with problems

 

Identify the sources of stress in your life

Stress management starts with identifying the sources of stress in your life. This isn’t as easy as it sounds. Your true sources of stress aren’t always obvious, and it’s all too easy to overlook your own stress-inducing thoughts, feelings, and behaviors. Sure, you may know that you’re constantly worried about work deadlines. But maybe it’s your procrastination, rather than the actual job demands, that leads to deadline stress.

To identify your true sources of stress, look closely at your habits, attitude, and excuses:

1.     Do you explain away stress as temporary (“I just have a million things going on right now”) even though you can’t remember the last time you took a breather?

2.     Do you define stress as an integral part of your work or home life (“Things are always crazy around here”) or as a part of your personality (“I have a lot of nervous energy, that’s all”).

3.     Do you blame your stress on other people or outside events, or view it as entirely normal and unexceptional?

4.     Until you accept responsibility for the role you play in creating or maintaining it, your stress level will remain outside your control.

 

Start a Stress Journal

A stress journal can help you identify the regular stressors in your life and the way you deal with them. Each time you feel stressed, keep track of it in your journal. As you keep a daily log, you will begin to see patterns and common themes. Write down:

1.     What caused your stress (make a guess if you’re unsure)

2.     How you felt, both physically and emotionally

3.     How you acted in response

4.     What you did to make yourself feel better

5.     Look at how you currently cope with stress

 

Think about the ways you currently manage and cope with stress in your life. Your stress journal can help you identify them. Are your coping strategies healthy or unhealthy, helpful or unproductive? Unfortunately, many people cope with stress in ways that compound the problem.

Unhealthy ways of coping with stress

These coping strategies may temporarily reduce stress, but they cause more damage in the long run:

Smoking Drinking too much Overeating or undereating Zoning out for hours in front of the TV or computer Withdrawing from friends, family, and activities

Using pills or drugs to relax Sleeping too much Procrastinating Filling up every minute of the day to avoid facing problems Taking out your stress on others (lashing out, angry outbursts, physical violence)

 

Learning healthier ways to manage stress

 

If your methods of coping with stress aren’t contributing to your greater emotional and physical health, it’s time to find healthier ones. There are many healthy ways to manage and cope with stress, but they all require change. You can either change the situation or change your reaction. When deciding which option to choose, it’s helpful to think of the four As: avoid, alter, adapt, or accept.

Since everyone has a unique response to stress, there is no “one size fits all” solution to managing it. No single method works for everyone or in every situation, so experiment with different techniques and strategies. Focus on what makes you feel calm and in control.

 

Dealing with Stressful Situations: The Four A’s

Change the situation: Avoid the stressor Alter the stressor

Change your reaction: Adapt to the stressor Accept the stressor

Stress management strategy #1: Avoid unnecessary stress

Not all stress can be avoided, and it’s not healthy to avoid a situation that needs to be addressed. You may be surprised, however, by the number of stressors in your life that you can eliminate.

Learn how to say “no” – Know your limits and stick to them. Whether in your personal or professional life, refuse to accept added responsibilities when you’re close to reaching them. Taking on more than you can handle is a surefire recipe for stress.

Avoid people who stress you out – If someone consistently causes stress in your life and you can’t turn the relationship around, limit the amount of time you spend with that person or end the relationship entirely.

Take control of your environment – If the evening news makes you anxious, turn the TV off. If traffic’s got you tense, take a longer but less-traveled route. If going to the market is an unpleasant chore, do your grocery shopping online.

Avoid hot-button topics – If you get upset over religion or politics, cross them off your conversation list. If you repeatedly argue about the same subject with the same people, stop bringing it up or excuse yourself when it’s the topic of discussion.

Pare down your to-do list – Analyze your schedule, responsibilities, and daily tasks. If you’ve got too much on your plate, distinguish between the “shoulds” and the “musts.” Drop tasks that aren’t truly necessary to the bottom of the list or eliminate them entirely.

 

Stress management strategy #2: Alter the situation

If you can’t avoid a stressful situation, try to alter it. Figure out what you can do to change things so the problem doesn’t present itself in the future. Often, this involves changing the way you communicate and operate in your daily life.

Express your feelings instead of bottling them up. If something or someone is bothering you, communicate your concerns in an open and respectful way. If you don’t voice your feelings, resentment will build and the situation will likely remain the same.

Be willing to compromise. When you ask someone to change their behavior, be willing to do the same. If you both are willing to bend at least a little, you’ll have a good chance of finding a happy middle ground.

Be more assertive. Don’t take a backseat in your own life. Deal with problems head on, doing your best to anticipate and prevent them. If you’ve got an exam to study for and your chatty roommate just got home, say up front that you only have five minutes to talk.

Manage your time better. Poor time management can cause a lot of stress. When you’re stretched too thin and running behind, it’s hard to stay calm and focused. But if you plan ahead and make sure you don’t overextend yourself, you can alter the amount of stress you’re under.

 

Stress management strategy #3: Adapt to the stressor

If you can’t change the stressor, change yourself. You can adapt to stressful situations and regain your sense of control by changing your expectations and attitude.

Reframe problems. Try to view stressful situations from a more positive perspective. Rather than fuming about a traffic jam, look at it as an opportunity to pause and regroup, listen to your favorite radio station, or enjoy some alone time.

Look at the big picture. Take perspective of the stressful situation. Ask yourself how important it will be in the long run. Will it matter in a month? A year? Is it really worth getting upset over? If the answer is no, focus your time and energy elsewhere.

Adjust your standards. Perfectionism is a major source of avoidable stress. Stop setting yourself up for failure by demanding perfection. Set reasonable standards for yourself and others, and learn to be okay with “good enough.”

Focus on the positive. When stress is getting you down, take a moment to reflect on all the things you appreciate in your life, including your own positive qualities and gifts. This simple strategy can help you keep things in perspective.

 

Adjusting Your Attitude

How you think can have a profound effect on your emotional and physical well-being. Each time you think a negative thought about yourself, your body reacts as if it were in the throes of a tension-filled situation. If you see good things about yourself, you are more likely to feel good; the reverse is also true. Eliminate words such as “always,” “never,” “should,” and “must.” These are telltale marks of self-defeating thoughts.

 

Stress management strategy #4: Accept the things you can’t change

Some sources of stress are unavoidable. You can’t prevent or change stressors such as the death of a loved one, a serious illness, or a national recession. In such cases, the best way to cope with stress is to accept things as they are. Acceptance may be difficult, but in the long run, it’s easier than railing against a situation you can’t change.

Don’t try to control the uncontrollable. Many things in life are beyond our control— particularly the behavior of other people. Rather than stressing out over them, focus on the things you can control such as the way you choose to react to problems.

Look for the upside. As the saying goes, “What doesn’t kill us makes us stronger.” When facing major challenges, try to look at them as opportunities for personal growth. If your own poor choices contributed to a stressful situation, reflect on them and learn from your mistakes.

Share your feelings. Talk to a trusted friend or make an appointment with a therapist. Expressing what you’re going through can be very cathartic, even if there’s nothing you can do to alter the stressful situation.

Learn to forgive. Accept the fact that we live in an imperfect world and that people make mistakes. Let go of anger and resentments. Free yourself from negative energy by forgiving and moving on.

 

Stress management strategy #5: Make time for fun and relaxation

Beyond a take-charge approach and a positive attitude, you can reduce stress in your life by nurturing yourself. If you regularly make time for fun and relaxation, you’ll be in a better place to handle life’s stressors when they inevitably come.

 

Healthy ways to relax and recharge

Go for a walk. Spend time iature. Call a good friend. Sweat out tension with a good workout. Write in your journal. Take a long bath. Light scented candles.

Savor a warm cup of coffee or tea. Play with a pet. Work in your garden. Get a massage. Curl up with a good book. Listen to music. Watch a comedy.

 

Don’t get so caught up in the hustle and bustle of life that you forget to take care of your oweeds. Nurturing yourself is a necessity, not a luxury.

Set aside relaxation time. Include rest and relaxation in your daily schedule. Don’t allow other obligations to encroach. This is your time to take a break from all responsibilities and recharge your batteries.

Connect with others. Spend time with positive people who enhance your life. A strong support system will buffer you from the negative effects of stress.

Do something you enjoy every day. Make time for leisure activities that bring you joy, whether it be stargazing, playing the piano, or working on your bike.

Keep your sense of humor. This includes the ability to laugh at yourself. The act of laughing helps your body fight stress in a number of ways.

 

Stress management strategy #6: Adopt a healthy lifestyle

You can increase your resistance to stress by strengthening your physical health.

Exercise regularly. Physical activity plays a key role in reducing and preventing the effects of stress. Make time for at least 30 minutes of exercise, three times per week. Nothing beats aerobic exercise for releasing pent-up stress and tension.

Eat a healthy diet. Well-nourished bodies are better prepared to cope with stress, so be mindful of what you eat. Start your day right with breakfast, and keep your energy up and your mind clear with balanced, nutritious meals throughout the day.

Reduce caffeine and sugar. The temporary “highs” caffeine and sugar provide often end in with a crash in mood and energy. By reducing the amount of coffee, soft drinks, chocolate, and sugar snacks in your diet, you’ll feel more relaxed and you’ll sleep better.

Avoid alcohol, cigarettes, and drugs. Self-medicating with alcohol or drugs may provide an easy escape from stress, but the relief is only temporary. Don’t avoid or mask the issue at hand; deal with problems head on and with a clear mind.

Get enough sleep. Adequate sleep fuels your mind, as well as your body. Feeling tired will increase your stress because it may cause you to think irrationally.

 

Stress Coping Strategies

Stress may be inevitable, but how you deal with it is largely up to you. Here are some ideas to help you create your own stress defense.

• Use your support system – You may feel better sharing your feelings with a caring friend or family member. It can help to know that you’re not the only one who has disagreements with a spouse, problems with parenting or other worries.

• Talk it over with yourself – We often have no control over the unpleasant events that happen in our lives, but we can change what we say to ourselves about these events. All our feelings are greatly affected by what we say to ourselves.
  Avoid:

• Catastrophizing (“This is the worst thing that ever happened to me.”)

• Generalizing (“My dog doesn’t like me therefore, no one will.”)

• Projecting (“I’m sure this isn’t going to work out.”)

Instead, try telling yourself “I am loved and safe” Practice talking nicely to yourself.

• Don’t demand perfection – Ease up on yourself and those around you – accept that everyone has both strengths and shortcomings.

• Just say no – Sometimes, we take on too much. You can avoid feeling overburdened by setting realistic goals and priorities. Remember, it’s OK to say no to requests that push you beyond your limits.

• Take one thing at a time – Instead of thinking of other things you should be doing, focus on the task at hand and do it well. You’ll enjoy the sense of accomplishment and regain a sense of control.

• Strive for balance in your life – Make time for activities and people you enjoy. Taking your mind off stressful matters for a while can help you keep a healthy perspective.

• Be active – Walk your dog, go dancing or join a gym. If you’re generally healthy, aim to get at least 2.5 hours a week of moderate-intensity aerobic activity. At least two days a week, work in some muscle-strengthening activity at a moderate intensity or higher. Just be sure to check with your doctor before significantly increasing your level of physical activity.

• Eat healthfully – Some people reach for junk food or turn to other unhealthful eating habits when they are under stress. Reduce consumption of caffeine and refined sugar, and increase your consumption of whole grains, nuts, fruits and vegetables.

• Avoid unhealthy behaviors – Some people drink too much alcohol or over-eat to cope with stress. Talk with your doctor if you need help.

• Get in touch – Hug someone, hold hands or stroke a pet. Physical contact is a great way to relieve stress.

• Practice rest and relaxation – Take six deep breaths. Breathe slowly and deeply in through your nose, and out through your mouth. Use your imagination to place yourself on the beach, or in some other pleasant place from the past. Close your eyes and imagine the scene in detail, including all your senses. In just a couple of minutes you can re-experience the pleasure of actually being there. Get at least seven hours of sleep nightly. And, if your health permits, meditation, yoga or even tai chi can help you feel calm. Look for these types of classes in your community or try a video. Even losing yourself in a good book or taking a quiet walk can help you unwind.

• Learn to laugh – Rent a comedy video and watch it with others (you’ll laugh more).

• Stretch – Stand up. Raise your arms above your head. Stretch left and hold 1-2-3-4. Stretch right and hold. Repeat the stretch several times.

• Stop smoking – Nicotine is a stimulant, and it can increase anxiety.

• Seek professional help – If your stress your level becomes severe, seek help from a mental health professional who can help determine the best course of treatment for you.

Unfortunately there is no magic wand that will remove the impact of stress on your life. Controlling stress is an active process which means that you will have to take steps to limit its impact. However, there are some very simple steps that you can take to do this which may help your stress levels work for you instead of against you.

Step One: Be careful about what you eat and drink

Try to eat a well balanced diet, eating at least three regular meals a day. Eat foods which will release energy slowly and are likely to have a calming effect. Food or drink high in sugar may give you instant energy, but in the long term may wind you up leaving you feeling more nervy and edgy than you did before.

Limit your consumption of caffeine particularly found in tea, coffee, fizzy soft drinks and “Proplus” tablets. Excess caffeine tends to heighten arousal and increases “jittery” feelings; it can also impair your concentration and may keep you awake at night.

Try to also limit your use of alcohol and to avoid all use of non-prescribed drugs. These may make you feel better in the short term, but can prevent you from sleeping properly; they can also impair your ability to remember the work that you are trying to revise. Some people drink alcohol and / or smoke more to control their stress levels, but it would be a good decision to try to develop more healthy ways of controlling your stress.

Step Two: Get enough sleep

Make sure that you get plenty of rest; six to eight hours a night are recommended. If getting to sleep is a problem, ensure that you have at least a half an hour break from your revision before going to bed. Use this break to do anything relaxing which will take your mind off your work such as:

1.     having a soak in the bath;

2.     chatting to your friends;

3.     writing a letter;

4.     listening to some music.

(image)

Step Three: Take regular exercise

Exercising regularly will not only help to keep you physically healthy, but also uses up the hormones and nervous energy produced when you are stressed. Exercise will also help to relax the muscles which become tense when you are stressed, and, as exercise increases the blood flow around the body, it can help you to think more clearly.

You do not have to take up a strenuous sport: try swimming, walking, cycling or dancing. Anything that gets you moving around and is enjoyable is beneficial, especially if it involves spending at least half an hour in the fresh air every day.

Step Four: Control your breathing

If you notice that you are starting to feel very stressed, for example as you wait for the examination to start, try to regulate your breathing by concentrating on breathing out to a slow count of four; the breathing in will take care of itself. It will be helpful if you practise this exercise when you are not stressed so that you are very familiar with the technique when you need actually need it.

Step Five: Make time for fun

Build leisure time into your revision days and the days that you sit your exams. Get involved in a non-academic activity, such as sports, crafts, hobbies or music. Anything that you find relaxing or enjoyable which will give you a break from thinking or worrying about your exams will be beneficial.

Step Six: Improve your study skills

Effective study skills can reduce stress by making you feel more in control of your work and more confident that you will succeed. Check out the Student Learning Centre’s guide to Revision & Exam Skills; attend one of the Centre’s exam skills workshops or review your approach in an individual consultation with the Centre’s adviser. (Details of how to contact the Centre are provided in the resources section at the end of this guide.) It may also be useful to talk to your course tutor to get subject specific advice to help make your revision more focused.

Remember that most of your fellow students will be feeling the same way as you do. Tell your friends and family how you feel and find ways of relaxing with them which will help to support you.

The Concept of Coping

Organisms resist change and react to external challenges by mounting responses that maintain their equilibrium. There are equivalents at many levels: at the cellular level, maintaining homeostasis is the role of the immune system; at the organ level the endocrine and limbic systems are involved; at the psychological and behavioural levels various coping processes are involved, while at the social level norms and social sanctions maintain order.

Coping may be defined as thoughts or actions designed to resolve or mitigate a problematic situation. Coping is not a fixed attribute, but is the dynamic capacity to apply suitable methods to control, avoid or prevent distress. It is also a process that involves appraisal and reaction: we do not use identical responses in every situation. Coping refers to the management of responses, not mastery over stimuli. It normally refers to managing unusual demands that tax, even exceed, a person’s resources; we do not generally speak of coping with making our bed or brushing our teeth.

Within the context of social epidemiology, our interest lies in assessing how far the use of coping strategies may protect the person, explaining the mis-match between stressful circumstances and the resulting level of distress a person feels. A second goal is to assess whether different coping responses vary in their effectiveness in reducing distress. A third would be to assess whether we can teach people more effective coping strategies.

Morbidity is as much due to our emotional reactions to a situation as to the actual threat itself; cognitive coping styles focus on reducing the emotional threat. Consider the situation in which I learn I am suffering from an incurable disease. Cognitive coping strategies may include collecting factual information about the disease, its prognosis, cause and so forth. This may allow me to explain to myself why I got the condition, perhaps thereby removing guilt or self-blame. In effect, this argues that dealing with reality is easier than dealing with the uncertainty of speculation. Obtaining and analysing technical information is easier for people with some education, so a rational, cognitive coping style may be more accessible to people with more education; they may also have more informal contacts among experts who can give them the required information.

Models of Coping
There are many models of the coping process and psychologists agree that it involves a series of stages. These begin with identifying a threat, for one cannot cope with something that is not recognized, except serendipitously. Next, most models of coping refer to a process of appraisal: an assessment of the severity of the threat, and of our resources available to handle it. There are different ways of appraising threats, and experience plays a major role here. Next, a response is implemented and the effects are evaluated by returning to the appraisal process in a circular loop. This is illustrated in Figure 1.

The time frame is very varied. Coping with an insult may be extremely rapid and automatic (even if later regretted!) Coping with marital discord may take months or even years, and involve numerous attempts to apply different strategies. The process often begins unconsciously and may only become conscious if the threat is not readily resolved. Typically a person feels tense or uneasy but may not be able to describe what is wrong. If initial coping attempts do not resolve the tension, however, and if there are successive circuits around the coping loop, the person becomes more conscious of the process as their concern mounts. This is similar to immune reactions: symptoms reflect failed attempts to cope with an infection.

Antonovsky brought a sociologist’s perspective in Health, stress and coping. (Jossey-Bass, 1980). He observed that many people are exposed to pathogens but but few get sick. He proposed a model of resistance & susceptibility that depends on “generalised resistance resources”. These seek to resolve problems (rather then Selye’s holding process). GRRs may refer to a person or a group of people. They include: physical factors (cf. Dubos), material resources (wealth), information (knowledge is power), emotional flexibility (cf. emotional intelligence),

Coping Responses
There is immense variety in the coping responses of humans; indeed, one of our endearing characteristics is our ability to invent bizarre and even self-destructive coping styles.   Each person’s style of coping reflects their personality and describes their enduring approach to handling life experiences. A typical contrast would be between the person who copes with challenges passively by avoiding situations or denying them, and coping based on more active confrontation and tackling of situations. Within general styles of coping, particular tactics are as varied as people themselves. Not only do we each have a characteristic approach to handling challenging situations, but the size and diversity of our repertories of coping responses also varies. Some people seem able to handle virtually any circumstance, while most are comfortable with a much narrower range of situations. Some perennially use the same type of approach; others can be remarkably resourceful in finding different ways to handle situations.

Figure 2 illustrates a hypothetical model in which a person draws on successively deeper levels of experience in inventing a way to cope with a situation that does not go away. We can debate this model in class. In a first phase (which could represent several loops around the circuit in Figure 1), the person applies familiar, “tried and true” coping strategies. Their level of concern and distress rises with each failure; there is an exaggeration of emotions which begins to appear uncomfortable; aspects of “nervousness.” If and when these fail to resolve the situation, the person is forced to resort to rarely used strategies; this increases the level of apprehension and therefore of distress. Should these coping strategies also fail, they must dig deeper and resort to tactics they have not tried, although may have heard of others using in similar situation. This is new territory, and the level of apprehension rises further. The ego responds with a second order of regulating devices, characterized by a partial detachment from the world of reality: withdrawal, fantasies, etc. These may be followed by outbursts of violence, anger, etc. If even this is unsuccessful, the person must innovate, and invent a totally new coping approach. The level of stress is high, and the likelihood of success smaller.

 Now, a crucial theme of this model is that the height of the bars illustrates the size of the person’s coping repertoire at each stage. The hypothesis is that a person who has had varied life experiences (e.g., has travelled, held many jobs, met many people) will tend to have accumulated a broader repertoire of coping styles than a person with less experience. This may contribute to explaining the association of socioeconomic status and health if, indeed, higher SES is associated with a broader range of coping strategies.

 

Evaluating Coping
While we may judge that a person does not cope well with difficult situations, no coping strategy seems wholly good or bad; following evolutionary principles, perennially useless styles should die out with their users. (Note the humorous annual “Darwin Awards” on the internet, awarded to the most idiotic people whose removal from the gene pool is held to benefit everyone). Active or passive styles may suit different circumstances; each may also work well in the short term but not on a long term basis.

There are many possible taxonomies of coping strategies, but a common distinction is between practical strategies which seek to deal with the situation, and cognitive strategies which seek to handle the symptoms of emotional distress that arise. Alternative terms are behavioural and emotional coping. Intuitively, there seems to be a gender difference in predominant coping styles, and the discovery that “Men are from Mars, women are from Venus” may reflect this (although we may wish to debate the fuller implication of links with Zodiac signs!) Both behavioural and emotional coping may be classified along the dimension of confrontation versus avoidance which is also commonly called active or passive coping or even control versus helplessness (the terms differ).

Some examples of coping strategies are given in the following table; you may wish to discuss this and fill in the blanks

	Active		Passive
	Behavioural	Emotional	Behavioural	Emotional
Exam	study hard; ensure adequate rest	express your concern to friends; (take medications?)	sleep a lot; watch movies to take your mind off it	complain to friends
Lousy teacher	make suggestions; contribute to improving course	discuss with counsellor how important the *&*# course is anyway	wait until end of term and give teacher a lousy rating	look glum in class
Personal conflicts	leave the person (giving no forwarding address)	talk to friends; seek counselling
Insufficient income
Chronic health problem

 

Many authors delight in taxonomies of coping responses. I am less impressed by this, but here are a few examples:

– use of alcohol, drugs

– daydreaming, escapism

– trying to see the humorous side of the situation

– sleeping more (the teenage response to school)

– use of food or food substitutes (chewing gum, smoking)

– getting prepared to expect worst

– curse & carry on bad

– get busy with other activities to take mind off the situation

– crying

– talk it out with friends; seek social support

– work feelings off by physical exercise

– information seeking: find out more about situation; make alternative plans for handling situation

– take some definite action on basis of your understanding, drawing on past experiences

 

Cognitive coping: mind games

– make positive comparisons (“We were worse off under the previous government”)

– selective ignoring; denial.  There’s a hierarchy:

first order denial = denial of facts, avoiding speaking about or seeking facts;

second order denial = denial of feelings and refusal to perceive oneself as sick. Orr found first order denial to be associated with poor adjustment following a diagnosis of breast cancer; second order denial was associated with positive adjustment. There have been similar findings in the cardiac rehabilitation literature  (Orr E. Open communication as an effective stress management method for breast cancer patients. J Hum Stress 1986;12:175-185.)

– optimistic faith;  belief in supernatural power who cares about you

– rejection (feel yourself the victim of an unjust situation)

– try to exert control (become an agent facing a challenge)

– resignation (feeling powerless and events externally determined by fate)

– avoidance and postponing confrontation

– minimization or negation (view yourself as secure and the situation as non-threatening)

 

Humour

A sense of humour is notoriously valuable in coping with adversity. Perhaps self-deprecating humour is most effective, for it reduces the need to protect the ego from reality. Personal humour deflects self-pity, which is a corrosive emotion. Consider this letter to the Ottawa Citizen, written by a man suffering from Tourette’s syndrome. He illustrates the use of a factual understanding of his condition, laced with a good dose of humour:

“Most people know nothing about Tourette’s syndrome, and I was one of them until three years ago.  Tourette’s makes the body and mind do and say things you don’t want them to do. It is caused by your body producing too much dopamine, which blocks your nerve network to your brain.

In my case, Tourette’s consists of cursing out loud, head shaking, hand trembling and severe panic attacks.  It isolates you; it’s very hard to go to restaurants or get on a bus. I have often been asked to leave some of these premises. (…)  Job interviews are terrible, if you manage to even get there. Sometimes you are just too panic-stricken to leave your apartment. And if you do get there, you don’t make a great first impression.

Sometimes I cannot even get to my mail box, which is only 20 feet away. At least you have a good reason for not getting your bills paid on time and doctors to back you up.  I never go to quiet movies; if I do go, I see a loud action one in which the actors swear as much as I do. It helps me blend in. And first dates are no pleasure either…

My head shaking is painful; it gives me headaches and affects my neck. I shake my head to the left most often, so I had my barber part my hair in that direction, hoping people will think I’m just shaking the hair from my face.  And I now wear hats in winter; I prefer ear muffs, but they end up wandering all over your head and you end up looking like you have Brillo pads over your eyes.

I don’t mean to make light of this disease, but I have found that keeping a sense of humour, as in other diseases, helps me get through the rough times and accept my lot.”