COPING with trials and tribulations

“When you begin to see that your enemy is suffering, that is the beginning of insight.”

-Thich Nhat Hanh

• Trials and tribulations are part of life; there is no way around it.

• At the time of writing this article, our clinic is treating post-concussion patients that also have to deal with CoVID and all its consequences.

• • It’s consequences may not be obvious to many, but they are indeed real

• • • even a change in recreational habits carries with it a score of 19 points on the Rahe and Holmes Stress Scale (a.k.a. The Social Readjustment Rating Scale [SRRS]).
    • This scale sees our annual allowance of stress as 150 points. More than that, and the model predicts an increased risk of health problems.
    • Many of our concussion patients have scores in excess of even 300! Take the test and see how you fare…

https://www.mindtools.com/pages/article/newTCS_82.htm

“Coping refers to cognitive and behavioural strategies that people use to deal with stressful situations or difficult demands, whether they are internal or external.”

-Courtney E. Ackerman

1. Cognitive strategies could be things like benefit finding or ways of thinking about something that makes it less stressful.
2. Behavioural strategies could be things like going for a run, actions you take to make yourself feel better.
3. Internal stressors could be things like depression, anxiety or post-concussion syndrome.
4. External situations could be having to put up with a disrespectful coworker, dealing with a loss of your job or coping with a child moving out.

Coping & Modern Day Life

1. Our coping skills have evolved to help us survive in environments very different from those in which most of us now live, work, and play (Cosmides & Tooby, 2013). 
2. While we have a body and mind well adapted to overcome the challenges faced by hunters running down a kudu in the African savannah, we are a poor match for the difficulties found in modern life (Li, Vugt, & Colarelli, 2017).
3. Psychological research in the fields of sports, business, and beyond has identified approaches, skills, and tools that can help us cope, overcome, and even flourish.
4. Coping is not the same thing as defense mechanisms. Defense mechanisms are usually subconscious ways of seeing things that usually have more to do with you than the other person.
   • E.g., You may not trust someone to keep their word because you recognize that you frequently don’t keep your word, so you may take extra measures to make sure they keep their word; this would be a defense mechanism.

There are over 400 strategies and multiple classifications for coping in the literature (Machado et al., 2020).

There are also many ways to categorize coping.

• Freud was categorizing coping skills back in 1926.
• Lazarus and Folkman categorized it as follows in 1984:
  1. Self-Control
  2. Confrontation
  3. Social Support
  4. Emotional Distancing
  5. Escape and avoidance
  6. Radical acceptance
  7. Positive Reappraisal
  8. Strategic problem-solving
• The coping wheel outlines 12 “coping families” (Skinner & Zimmer-Gembeck, 2007)

For the purpose of this article, we will use the following categorizations for coping strategies:

1. Perspective: 

• cognitive (problem) vs emotions (including acceptance-based strategies)

2. Goal-oriented:

• Approach vs avoidant

3. Healthy

• Healthy (positive) vs unhealthy (negative)

These 3 categories (i.e., Perspective, Goal-oriented, Healthy) overlap

• e.g., Healthy coping skills can also be cognitive, or they can be behavioural).
• We will filter our discussion to only focus Healthy coping skills.

Problem-focused

This involves using your cognition, logic, executive functioning, problem-solving, resilience strategies, behavioural activation, setting goals, etc. to change your situation.

Emotionally/Physiologically-focused

This approach focuses on making emotionally reacting to the situation rather than addressing the physical problem.

• Negative (unhealthy) emotionally-focused strategies could be things like rumination, illogical cognitions, blaming, etc.
• Positive emotionally-focused strategies could be things like seeking social support, praying, going for a run, expressive writing, meditating or practising relaxation strategies, etc.
• This is not the same thing as ignoring the problem.
• Sometimes we have to accept the situation in order to be able to leverage our attention and efforts in a way to influence the situation.

“Rock bottom became the solid foundation in which I rebuilt my life.”

– J.K. Rowling

We have previously discussed the difference between Approach and Avoidance Behaviours in our article “Behaviours Associated with a Longer Recovery“.

To summarize the difference between the two approaches:

Active: conscious attempts to either reduce the resulting stress, eliminate the source of the stress, or both.

Avoidant: avoiding or ignoring the problem. This doesn’t have to be a conscious decision, e.g., some people are in denial about a problem.

Healthy

• This approach reduces stress, increases well-being and resolves the issue.
• Cognitively, this could involve changing the way you view the situation (e.g., benefit-finding)
• The ability to see your thoughts as theories, as things that do not define you or your situation (i.e., Metacognition) helps a great deal with this process.
• The ability to accept your faults without criticizing yourself or committing logical fallacies helps with this
• Leveraging your strengths & resources or using many resilience skills like flexible optimism helps with this
• Examples:
  • Having a good cry
  • Making sure to take care and enjoy the good things in your life
  • Helping others in similar situations
  • Playing to your strengths

Unhealthy

• Unhealthy coping creates stress or anxiety and damages self-confidence (Boyes, 2013).
• Examples:
  • Emotional eating (Scott, 2017)
  • Drinking
  • Isolating yourself from parts of your life
  • Punishing yourself
  • Pretending like something is small when it’s really a big deal
  • Avoiding things that are uncomfortable

“You put water into a bottle, it becomes the bottle. You put water in a teapot, it becomes the teapot. Now water can flow or it can crash. Be water my friend.”

– Bruce Lee

There are many ways to surf the waves of trials and tribulations.

• You can activate internal attitudes and “rise to the challenge”; or you can use external techniques that help you cope.

The mindfulness philosophy reminds us that we are not our suffering (i.e.,  the teapot or the bottle).

Below we have included an overview of commonly used techniques.

• In no way is this list exhaustive, and you may have techniques that work better for you than anything on this list.
• But we wanted to share with you the following for your considerations.
• Many of our patients keep a list of “go to” strategies when they feel the waves of life crashing down on them, and this helps them catch the wave and surf it.

1. Asking trusted friends/family for support
2. Prioritizing self-care
3. Taking timeouts from situations that make you stressed
4. Positive self-talk
5. Reducing what’s on your plate
6. Visualization
7. Practising Gratitude & Altruism
8. Distraction
9. Psychotherapy

1. Cognitive Behavioural Therapy
2. Positive self-talk & flexible optimism
3. Responsibility Pie
4. Forgiveness
   • There is a book on this by McCullough, “Forgiveness: Theory, Research, Practice”
   • What is forgiveness? It is finally giving up on a better past
   • It is not mean: approval, forgetting, reconciling, giving up on justice
   • “You forgive for you”, to move on, better for health, focus on the future
5. Assertive communication
6. Flexible optimism
7. Practising Gratitude
8. Expressive Writing
9. Mindfulness
10. Benefit finding
11. Relaxation
12. Heart Rate Variability Training
13. Solution-Focused Brief Therapy

1. Meditating
2. Stretching
3. Engaging in progressive muscle relaxation
4. Listening to music
5. Aerobic exercise
6. Watching television
7. Going to the movies
8. Reading
9. Working on puzzles or playing games
10. Going for a leisurely walk
11. Going to a health club
12. Relaxing in a steam room or sauna
13. Spending time alone

Markaway describes 7 categories of self-care coping skills and Ackerman gives examples:

1. Sensory self-care

• Getting a breath of fresh air
• Snuggling under a cozy blanket
• Listening to running water
• Sitting outdoors by a fire pit
• Taking a hot shower or a warm bath
• Getting a massage
• Cuddling with a pet
• Paying attention to your breathing (practicing mindfulness/meditation)
• Burning a scented candle
• Walking through tall grass in bare feet
• Staring up at the sky
• Lying down where the afternoon sun streams in through a window
• Listening to music

2. Pleasure

• Taking yourself out to eat
• Being a tourist in your own city
• Gardening
• Watching a movie
• Making art, or doing a craft project
• Journaling
• Walking your dogs (or going to a shelter to walk dogs without a family)
• Going for a photo walk (taking photos on your walk)

3. Mental / Mastery

• Cleaning out a junk drawer or a closet
• Taking action (one small step) on something you’ve been avoiding
• Trying a new activity
• Driving to a new place
• Making a list
• Immersing yourself in a crossword puzzle
• Doing a word search
• Reading something on a topic you normally wouldn’t

4. Spiritual

• Attending church
• Reading poetry or inspiring quotes
• Lighting a candle
• Meditating
• Writing in a journal
• Spending time in nature
• Praying
• Listing five things you’re grateful for

5. Emotional

• Accepting your feelings / being okay with your feelings
• Writing your feelings down
• Crying when you need to
• Laughing when you can (laughter yoga may help!)
• Practicing self-compassion

6. Physical

• Trying yoga
• Going for a walk or a run
• Dancing
• Stretching
• Going for a bike ride
• Ensuring you get enough sleep
• Taking a nap

7. Social

• Going on a lunch date with a good friend
• Calling a friend on the phone
• Participating in a book club
• Joining a support group

1. Wise Mind “ACCEPTS”
2. Self-soothe the five senses
3. Improve the moment
4. Radical acceptance (a term from Dialectical Behaviour Therapy [DBT])

Activities: This could be anything – exercise, gardening, watching a movie, candy crush, painting, etc.

Contributing: Believe it or not, making more money or buying things doesn’t make people happier (Yu et al., 2016; Kumar et al., 2015). I feel the spirit of this technique well illustrated in Drake’s song “God’s plan”.

Comparisons: Are you comparing yourself to the crème de la crème? Or that lucky ol’ son? If you look down, you often you will see many less well off. 6/10 of people have a chronic medical condition. Sometimes seeing where we are on the scale helps puts things in perspective.

Emotions: Do things that stimulate different emotions. Often people say to laugh. No doubt, that’s enjoyable. But, many psychologists even recommend stimulating emotions, even if negative. I’m reminded of a patient who was dealing with cancer and at that time he kept his spirits high and and his energy strong; he credited the then prime minister who he could not stand!

Pushing away: Leaving the situation, mentally or physically for a while. This could involve distraction or just doing something that resonates more with your values. When angry, it often is a good idea to leave until you cool down.

Thoughts: Focusing your attention elsewhere, like expressive writing/journaling, or doing an activity, or working, can help make you feel more accomplished.

Sensations: This may sound strange, but squeezing a ball, or holding ice, can have a way of calming your limbic system.

Imagery: relaxing scenes

Meaning: find meaning or purpose in your plight. Many successes were born of hardship, and even failure…Is there a silver lining?

Prayer: open your mind to the Universe, does not necessarily have to be attached to any specific Diety.

Relaxation: diaphragmatic breathing, Progressive muscle relaxation, imagery, heart rate variability training

One thing in the moment: entire attention on what you are doing in the moment (comes from mindfulness).

Vacation: get “away”, local or distant; or just mixing it up a bit

Encouragement: give yourself a “pat on the back”. Many of us discount our strengths and accomplishments. It’s not your fault and you’re still trying to make the world a better place…good for you!

This can be a tough pill to swallow. But sometimes it’s helpful.

Take a look at this movie clip from the movie “Ray” that tells the story of Ray Charles as a child going blind. Given Ray’s condition and the times he lived in, his mother decided it was in Ray’s best interest to face Radical Acceptance.

Sometimes there is another way to look at it…Maybe it’s a blessing in disguise.

Check out this humorous video…

We usually have to accept situations that are beyond our control, especially when it affects us. This serves as a foundation on which one can move forward in a way that gives personal meaning to unhappy circumstances.

What are your core values?

Attitudes we hold while we are doing unpleasant activities have a big influence on how we feel.

Bob Marley, left Jamaica at a time when it was at civil war, and after there was an attempt on his life. Bob Marley was shot in his chest and arm. He left to England for his safety. However, he felt obligated to go back to Jamaica and serve his country, even at the risk of losing his life. His values, which were the inspiration for many of his songs, allowed him to do it with fervor and zeal. He accepted the risk because his values were more important to him than his discomfort and risk he ran by returning to Jamaica.

He held the “One Love Peace Concert” in an effort to unite the country.

See how he united the prime minister and his opposition, on stage, in front of the whole country (start at 1:37 min):

This is a practice that our patients find very helpful. We have written a few articles on the topic for our patients.

Please read them to get an introduction to mindfulness.

MINDFULNESS: defined

MINDFULNESS: implemented

MINDFULNESS: nine foundational attitudes

MINDFULNESS: neuroscience

Read our article on Worrying: Strategies to check it.

It is a container that contains uplifting things that can provide you with healthy (positive) coping skill options at the helm when you reach for the kit.

These items can trigger cognitive coping skills:

e.g., They can be momentos of a certain strengths you have, awards you one, people you helped, items that commemorate successes, motivations quotes, heroic stories, role models, etc.

These items can trigger emotional coping skills:

e.g., pictures of loved ones/heroes, nice scents, motivating song, uplifting book/magazine, reminders to practice relaxation strategies

So, now that you have read this article and given some thought to what coping skills appeal to you, why don’t you start building a coping kit.

A beta version coping kit can always be continually upgraded (e.g., coping kit 1.0, coping kit 2.0, etc.)

Ackerman, C. E. (Mar 4, 2021). Coping Mechanisms: Dealing with Life’s Disappointments in a Healthy Way. Positive Psychology. https://positivepsychology.com/coping/

Boyes, A. (2013, May 5). Avoidance coping. Psychology Today. Retrieved from https://www.psychologytoday.com/blog/in-practice/201305/avoidance-coping

Cosmides, L., & Tooby, J. (2013). Evolutionary psychology: New perspectives on cognition and motivation. Annual Review of Psychology, 64(1), 201–229.

Kumar, Amit & Gilovich, Thomas. (2015). Some “Thing” to Talk About? Differential Story Utility From Experiential and Material Purchases. Personality & social psychology bulletin. 41. 10.1177/0146167215594591.

Lazarus and Folkman (1984): Stress, Appraisal, and Coping.

Li, N. P., Vugt, M. V., & Colarelli, S. M. (2017). The evolutionary mismatch hypothesis: Implications for psychological science. Current Directions in Psychological Science, 27(1), 38–44.

Machado, A. V., Volchan, E., Figueira, I., Aguiar, C., Xavier, M., Souza, G. G., … Mocaiber, I. (2020). Association between habitual use of coping strategies and posttraumatic stress symptoms in a non-clinical sample of college students: A Bayesian approach. PloS One, 15(2).

Markaway, B. (2014, March 16). Seven types of self-care activities for coping with stress. Psychology Today. Retrieved from https://www.psychologytoday.com/blog/shyness-is-nice/201403/seven-types-self-care-activities-coping-stress
Skinner, E. A., & Zimmer-Gembeck, M. J. (2007). The development of coping. Annual Review of Psychology, 58, 119–144.

Sutton, J. (Mar 10, 2021). Coping Mechanisms: Dealing with Life’s Disappointments in a Healthy Way. Positive Psychology. https://positivepsychology.com/coping/

Yu, Ying & Jing, Fengjie & Su, Chenting & Zhou, Nan & Nguyen, Bang. (2016). Impact of Material vs. Experiential Purchase Types on Happiness: The Moderating Role of Self-Discrepancy. Journal of Consumer Behaviour. 15. 571-579. 10.1002/cb.1598.