As you learned in the previous section, stress—especially if it is chronic—takes a toll on our bodies and can have enormously negative health implications. When we experience events in our lives that we appraise as stressful, it is essential that we use effective coping strategies to manage our stress.

Coping refers to mental and behavioral efforts that we use to deal with problems relating to stress, including its presumed cause and the unpleasant feelings and emotions it produces.

"Perhaps the most dramatic of stress coping interventions studies was conducted by Fawzy and his colleagues (Fawzy, Cousins, Fawzy, Kemeny, & Morton, 1990; Fawzy, Kemeny, et al., 1990; Fawzy, et al., 1993; Fawzy & Fawzy, 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 active behaviour coping than the controls, and also had more positive affect.

Differences in immune functioning were evident between the two groups at the six-month assessment. Specifically, experimental subjects had a greater percentage of large granular lymphocytes, more natural killer (NK) cells, and better NK cytotoxicity. While coping strategies were not directly associated with immune cell changes, they were correlated with affect, which in turn was associated with immune functioning.

The studies supported the hypothesis that effects of coping on biomedical outcomes may be mediated through affect. 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."

Lazarus and Folkman (1984) distinguished two fundamental kinds of coping: problem-focused coping and emotion-focused coping. In problem-focused coping, one attempts to manage or alter the problem that is causing one to experience stress (i.e., the stressor).

Problem-focused coping

Problem-focused coping is helpful when you need to change your situation, perhaps by removing a stressful thing from your life. For example, if you’re in an unhealthy relationship, your anxiety and sadness might be best resolved by ending the relationship (as opposed to soothing your emotions).

Emotion-focused coping

Emotion-focused coping is helpful when you need to take care of your feelings when you either don’t want to change your situation or when circumstances are out of your control.

For example, if you are grieving the loss of a loved one, it’d be important to take care of your feelings in a healthy way (since you can’t change the circumstance).

There isn’t always one best way to proceed. Instead, it’s up to the individual to decide which type of coping skill is likely to work best for oneself in that particular circumstance.

Here's a short video on the two types of coping:

The following are examples of stressful situations and how each approach could be used

Building strong interpersonal relationships with others helps us establish a network of close, caring individuals who can provide social support in times of distress, sorrow, and fear. Social support can be thought of as the soothing impact of friends, family, and acquaintances.

1. Demographic factors

Demographic factors including age, gender, education and socio-economic status, affect the type and availability of coping resources. Those who lack knowledge, skills, support networks or money are clearly disadvantaged when appraising and coping with many of life’s demands.

Age: As people grow older, they have a wider range of cognitive strategies they can draw on to compensate for declining physical strength.

Gender: Men and women are often exposed to different types of challenge or danger during their lifetimes, acquire different skills, and demonstrate different ways of coping, and may therefore respond differently. For example, it appears that women are more likely than men to seek and provide social support.

Education: People of different levels of educational attainment and job experience are likely to vary in the knowledge and skills they bring to different types of situation.

Socio-economic status (SES): People with very limited resources and those who experience social exclusion are among those least likely to be able to cope successfully with all the demands and challenges of life. Those who can afford to pay for good sand services when they need them are clearly advantaged those who cannot.

2. Personality factors

Hardiness (Kobasa 1979): consists of three dimensions of resilience: Commitment (active involvement in life activities), Control (belief in autonomy and the ability to influence life events) and Challenge (belief that change is normal and growth-enhancing). This concept continues to attract positive results, for example, Garossa et al. (2010) reported that it was one of a number of factors associated with a lower risk of burnout in nurses.

Optimism and pessimism: A number of studies have indicated that optimists have better psychological adjustment and immune responses, possibly because they have more effective coping strategies and more supportive social networks (Brisette et al. 2002).

Hostility and anger: General cynicism and interpersonal mistrust is robustly associated with depression (Nabi et al. 2010). Chida and Steptoe (2009) reviewed evidence that anger and hostility exert harmful effects on coronary heart disease (CHD) outcomes in healthy populations and those with CHD, particularly men.

Optimism was significantly and directly correlated with improved health outcomes, including lower levels of saturated fat, body fat, and global coronary risk, and positively associated with success in increasing aerobic capacity. Billings and colleagues (2000) showed that coping affected positive and negative affect among men who were caregiving for AIDS patients.

Social support coping predicted increases in positive affect, which in turn were related to fewer physical symptoms. Avoidant coping, however, was related to increases in negative affect, which were related to more physical symptoms.

Researchers have found that among people ages 55 to 75, those who are caregivers experience a 23 percent higher level of stress hormones, according to the American Psychological Association. That can lead to high blood pressure and elevated glucose levels, contributing factors to hypertension and diabetes. Caregivers also show a 15 percent lower level of immune response than non-caregivers, making them more vulnerable to the flu and other infections.

The effects on mental health can be damaging, too. In a 2015 survey from the AARP Public Policy Institute and the National Alliance for Caregiving, nearly 4 in 10 caregivers reported that they suffered from a high level of stress. A 2018 study found that 41 percent of caregivers experienced depression, mood swings and resentment as a result of their labours.

Over time, that physical and psychological wear and tear can lead to caregiver burnout — a condition of feeling exhausted, listless and unable to cope. It can cause caregivers to make mistakes that could endanger a loved one, such as mismanaging medication, or lead to unhealthy behaviours like smoking or alcohol abuse. There needs to be an awareness of the signs of caregiver burnout and taking proactive steps to deal with it before it spirals out of control is important.

Consider the following questions as you move on to the next section.

In what way is stress different for people across different age groups? Who are most vulnerable?

How does stress in our lives influence our perception of health and illness?

What can we do to help our patients and family members manage stress?