Coping with Stress

“The greatest weapon against stress is our ability to choose one thought over another.” -William James, American philosopher and psychologist

What is Coping?images

There is no doubt that medical school is stressful, but how you handle the stress is essential to your success and well-being.

Coping is defined as “a process of constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands or conflicts appraised as taxing or exceeding one’s resources” (Lazarus & Folkman, 1984, p. 141). Coping is a dynamic process involving cognitive and behavioral modifications to manage stress.

There are two major categories in coping: problem-focused and emotion-focused coping. In problem-focused coping the individual puts forth effort to manage or alter the stressor or the situation (e.g., positive-self talk, goal setting, and time management). Emotion-focused coping, on the other hand, revolves around regulating the emotional responses due to the problem (e.g., meditation and relaxation), but there are detrimental emotion-focused strategies, including self-blame, wishful thinking, and behavioral withdrawal.

The Coping ReserveCopingreserve

Dunn, Iglewicz & Moutier (2008) describe coping through an illustration. As depicted in the picture to the right, you have a coping reserve.
Stress and time demands are negative input. They pull from your reserve. Positive input, like social support and mentorship, can refill the reserve. If the coping reserve is drained for too long, burnout may occur. However, the opposite is true when one learns how to deal with the stress and replenish the reserve. This is resilience. As a whole, the reserve represents the competing demands placed on a student and the way the students handle those demands.

A series of questions can be asked regarding your own coping reserve:

How is your coping reserve currently? Is it full? Nearly empty? How strong is it? How quickly is it depleted? How likely is it to spring a leak? Are you aware when it is low? How do you handle a depleted coping reserve?

Answering these questions can give you some insight into your ability to cope, as well as your coping tendencies. We each have our own unique strengths as a student and as a person. We vary in our coping styles and personality. Learning to leverage those characteristics, along with identifying and increasing support inputs can help foster greater resilience.

Common Sources of Stress in Medical Students

  • Transition- Going from the top of an academic class to being surrounded by other bright individuals can be challenging
    • Black-or-white thinking may be a result in some students. “I am not the top of my class anymore so I am not a good student” is an example
    • Panic mode may ensue if students do not meet high standards of excellence
  • Curricular stress
    • Disorganized lectures or poorly prepared curriculum can be a source of stress for students
  • Extremely high academic demand and time commitment
  • Less time spent exercising and socializing
  • Sleep deprivation
  • Family and life events outside of school
  • Ambivalence towards career choice- some students question whether becoming a doctor is really what they want to pursue

Replenishing Factors

  • Psychosocial support
  • Social and health-related activities
  • Mentorship
  • Intellectual stimulation

Common Strategies to Cope with Stress

  • Thought control- blocking out distractions
  • Task focus- narrowing in on the most important details
  • Rational thinking- gain perspective on the situation
  • Positive self-talk– encourage yourself
  • Positive focus and orientation- focus on belief in your ability
  • Social support
  • Anxiety management & pretest mental preparation- mental practice, pretest routines, and relaxation strategies (see below)
  • Time management
  • Study hard and study smart

Relaxation Techniques Lotus

Taking time to purposefully engage in relaxation is a perfect example of a healthy coping strategy.
All of the relaxation techniques described will use diaphragmatic breathing or deep belly breathing. Begin by taking long, slow, and deep inhalations through the nose and out the mouth. Feel the tension leave your body as you exhale. Try to concentrate only on your breathing. If your mind wanders, redirect it to your inhalation and expiration pattern.

  • Rhythmic breathing- inhale for a count of 4 seconds, hold for 4, and exhale for 4.
    • Try a 1:2 ratio. Breathe in for 4 counts and exhale for 8 counts, emphasizing full inspiration and expiration.
  • Progressive muscle relaxation- this type of relaxation involves the contraction of a specific muscle group, holding the contraction for 5-7 seconds, followed by relaxation. This exercise progresses from one muscle group to another until the whole body is relaxed. The contraction phase helps the individual understand what tension feels like in the body, while the relaxation phase teaches what the absence of tension feels like.
  • Below is a guided PMR video

Learn more about successful coping

Coping Literature

Progressive Muscle Relaxation Video