The Coping Mechanisms For Healthcare During the Conflict
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Coping can be described as an attempt to master, tolerate, or reduce internal or external stressors that an individual perceives as exceeding existing resources. Coping mechanisms are how individuals handle stress and difficult emotions. These are the patterns and behaviors people use to deal with unusually stressful situations especially post conflict or disaster phase. Most current coping measures are mainly built upon the problem and emotion-focused domains. The principle of coping mechanism could be spending mental energy in a way that can reduce stress. Whether conscious or subconscious, the ultimate goal of all coping mechanisms is to solve a problem and return to normal life. Coping strategies can be positive or negative, depending on whether they increase or reduce mental wellbeing. The experts suggest differences in coping strategies between men and women.[1]
Conflict is a complicated issue with a multidimensional consequence for community health. Its effects have a broad pattern, starting from direct war-related morbidity and mortality caused by bullets and bombs to indirect consequences due to the interruption of the delivery of preventive and curative health services. Conflict also indirectly deteriorates the health of the population by causing breakdown of the health system, shortage of medical supplies and displacement of healthcare workers, as well as disruption of food and clean water supplies. Furthermore, conflict-related insecurity and a lack of free movement also reduces the provision and utilization of health services, with patients hesitating to seek healthcare due to concerns about their safety or potential targeting when traveling to healthcare facilities. Conflict-affected communities are also highly vulnerable to enormous public health threats including, but not limited to outbreaks of various communicable diseases, non-communicable diseases, gender-based violence, mental and psycho-social problems, maternal and child health nutritional issues and mental health. [1]
Coping Mechanism
A coping mechanism is a technique individuals use to manage stress, anxiety, or negative emotions. Coping mechanisms don’t come out of nowhere. Stressors, usually external situations or circumstances, trigger them. When these challenges arise, people usually refer to one of two types of coping mechanisms which are active coping strategies: problem-focused coping or emotion-focused coping or both.
Problem-focused coping means taking some action to get help or make the situation easier to deal with in some way. Emotion-focused coping is about managing the symptoms of emotional distress that arise in response to the circumstance. Neither coping mechanism is inherently better than the other. When one faces difficult circumstances, he/she uses a blend of both types. These are proactive ways that one might try to eliminate either the source of the stress or the stress itself. Active coping strategies are adaptive, meaning one learns how to adapt rather than reacting in an unhealthy or unproductive way. [2]
Defense mechanisms are a particular type of coping mechanism. They typically only arise in response to feelings of internal stress. Defense mechanisms are the unconscious mind’s way of responding to something that is traumatic, or otherwise poses a threat to a person’s identity. One usually knows when they’re using a coping strategy to deal with stress. But with defense mechanisms, one might not recognize what they’re doing. This isn’t healthy because it doesn’t take steps to manage the stress or the situation itself, whereas active coping strategies do. Defense mechanisms may provide temporary relief but can be detrimental in the long run. Examples of defense mechanisms include repression, denial, projection, and rationalization. [2]
There are two types of coping mechanisms–adaptive (healthy) and maladaptive (unhealthy). [3]
· Adaptive Coping Mechanisms: Adaptive coping mechanisms are positive, supportive, and life-enhancing stress management tools. These actions bring joy and comfort to one’s life while reducing stressful emotions, leaving one feeling more balanced and at ease. Those with adaptive coping mechanisms tend to have positive outlooks, and dealing with challenges head-on builds self-confidence and self-esteem. Instead of avoiding their problems, they acknowledge the presenting issues and move forward with a solution in mind.
· Maladaptive Coping Mechanisms: Maladaptive coping mechanisms are harmful and can worsen stress and difficult emotions. These techniques are counterproductive because, while they may appear helpful, individuals often experience more problems than benefits. Individuals with histories of anxiety, depression, and other mental health concerns may lean toward these coping styles because their symptoms can cloud thinking, feeling, and decision-making.
The Importance Of Coping Mechanisms For Well-Being
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When circumstances feel overwhelming, the coping mechanisms help bring them back under control. People do this by either managing the emotions or trying to fix the problem. The magic of healthy coping mechanisms is that they bring one from stress and frustration back into normal state of mind. When one uses coping strategies, he/she unconsciously goes into “problem-solving” mode. People belief in their ability to positively affect the circumstances is called internal locus of control. People with a strong internal locus are often physically healthier, feel happier, and are many times more likely to be resilient. On the other hand, people with an external locus of control rely on external forces to drive actions or make decisions, which prevents them from taking personal initiative. Although this isn’t automatically negative — and there may be circumstances that people truly can’t control — it can lead to feelings of hopelessness and unhealthy coping mechanisms. [4]
Individuals Who Possess A Strong Internal Locus Of Control:
· Are more likely to take responsibility for their actions
· Tend to be less influenced by the opinions of other people
· Usually have a strong sense of self-efficacy
· Tend to work hard to achieve the things they want and often achieve greater success in the workplace
· Feel confident in the face of challenges
Individuals With An External Locus Of Control:
· Blame outside forces for their circumstances
· Often credit luck or chance for any successes
· Don’t believe that they can change their situation through their own efforts
· Frequently feel hopeless or powerless in the face of difficult situations
· Are more prone to experiencing learned helplessness
Mechanisms Through Which Communities Cope Conflict’s Affects
The conflict gives rise to various health challenges, which profoundly affect the health of individuals and the community. In response to these challenges, people utilize different coping mechanisms to navigate through the difficulties they face. These coping mechanisms are diverse and varied depending on the individuals involved which may be described as coping mechanisms utilized by patients; community cooperation and religious leader’s roles in coping mechanisms; and coping mechanisms utilized by health care providers.
· Coping Mechanisms Utilized By Patients: The breakdown in the health system due to conflict becomes a big challenge for patients, as they are unable to access necessary treatment and medications for their illnesses. To mitigate this challenge, patients may employ various coping mechanisms, with the most commonly reported strategies being the use of traditional medicine and home remedies, followed by traveling to areas unaffected by the conflict in search of treatment and medication.
· Roles of Community Cooperation Religious Leaders In Coping Mechanisms: The local community tries to alleviate challenges and problems, using different mechanisms and platforms. The main mechanism could be the cooperation and support of community members with each other. The formation of peace committees consisting of elders and members of the community is an example of community cooperation which plays a crucial role in fostering unity, helping those in need, protecting health facilities, and promoting overall well-being. People voluntarily share the limited food, shelter, medicines etc they have with those in need.
The other main buffer for alleviating the health consequences could be the role of religious leaders in conflict areas where they matter by stabilizing the community and organizing health facilities. Moreover, the active involvement and support of religious leaders serves to inspire the community and individuals, fostering a strong sense of hope and faith in their religion. This enables them to cope with feelings of despair and stress, while simultaneously encouraging mutual support in difficult situations. Religious leaders’ encouragement also becomes important source of motivation for health workers. It encourages the health workers to leverage religious beliefs and feelings of duty to provide services. Religious leaders may also play a major role in protecting the health facilities.
· Coping Mechanisms Utilized By Health Workers: The health workers are also at the forefront of effort to cope with the devastating health consequences of the conflict. They exert maximum effort to mitigate the health challenges faced by the community. Even disregarding their own safety, prevailing insecurity and limited freedom of movement, which hinders the community’s access to health facilities, the health workers divide themselves in multiple teams and serve their respective neighborhoods by conducting house-to-house visits. Their dedication and commitment to providing healthcare in challenging circumstances play a crucial role in supporting community well-being. Additionally, when facing shortage of materials and supplies, the health professionals work with the available materials they could obtain. Furthermore, to prevent the onset and spread of sporadic diseases resulting from the usage of unclean and surface water; health professionals take the initiative to provide health education. They emphasize the importance of boiling water before use and maintaining personal hygiene practices. By raising awareness about these preventive measures, they attempt to minimize the risk of waterborne disease. Likewise, health workers also employ innovative measures to cope with the conflict-associated closure of health facilities and the dearth of supplies. This includes; the provision of health services at the community level and uses of available materials such as; plastics as surgical gloves and cloth stitches as suturing materials. [5]
Impact Of Conflicts On Health Care Work Force
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Every conflict/war imposes enormous harm to human resources. Workforce and its maintenance are very important in operational areas. Wars will lead to defeat if workforces are not properly protected. Healthcare providers, including physicians, nurses, and rescuers have key roles in handling critical conditions and provide the highest quality care. Caring, and management of health care establishments (HCEs) are important roles of this group in conflict. Care during the war is a multidimensional concept affecting physical, emotional, and psychological aspects of patients and care providers too. The nature of care during the war is very unique and is different from stable situations. Medical staff do try to treat the wounded during the war and are themselves not secure from injuries, and a huge number of doctors, nurses, paramedics, and rescue workers, get killed during the conflicts. They also suffer physical and psychological trauma due to heavy work load, disturbances in sleep pattern, long working hours, anxiety, exhaustion, stress, depression, post-traumatic stress disorder (PTSD), emotional tensions and adjustment problems after returning home if engaged in some remote places. [6]
The governments should develop some prevention program of mental disorders resulting from war, focusing on reduction of the effects of political, economic, cultural, social, emotional, and psychological diseases caused by war trauma. These programs could also prevent the progress of mental disorders and reduce social problems and their economic burden with special and immediate attention to mental health, access to accurate information, timely feedback, and recognition of people in need of psychological support.
Coping Mechanism/Techniques/Skills
Managing one’s anxiety, stress, or depression well can help feel better physically and psychologically and it can impact one’s ability to perform his/her best. [7]
Unhealthy Coping Skills
When people are unsure if they are coping in a productive, healthy way, they might resort to including:
· Increased substance use, including drugs, alcohol, and prescription medications
· Dramatic changes in spending or eating habits, sleeping patterns, or exercise routine
· Pretending or acting as if the problem doesn’t exist
· Indulging in escapism through partying, games, or other pleasure-seeking activities
· Downplaying or trivializing the severity of the problem
· Constantly complaining about the situation, or asking for help but then not accepting it
· Withdrawing from friends, hobbies, and relationships
Healthy Coping Skills
When experiencing anxiety, stress, or depression, people may have difficulty emotionally regulating or staying focused. If so, people have to approach those emotions in a healthy, intentional way. Positive coping mechanisms help one bolster his/her capabilities to promote a genuine improvement in individual wellness. [7]
· Coping Mechanisms For Anxiety/Stress/Depression: Anxiety feels like worry or fear, and it can be temporary or chronic. An anxious person might be worried about a future event. After the event, the anxiety often diminishes. But in chronic cases, one may feel intense fear of future events that aren’t pending or are completely out of one’s control. The anxious person may have increased heartbeat and even muscle tension. Chronic stress can lead to health problems like heart disease and digestive issues, so it’s important to recognize and treat. In an ideal scenario, take a step back from the situation. Try to remove oneself, break free from the stress and focus on centering one’s mind and relaxing body, which can control uncomfortable feelings. One may practice healthy coping mechanisms techniques in day-to-day life. Individuals often employ a combination of strategies based on the nature of the stressor, their personality, and available resources. In that case, contact a mental health professional. Finding effective coping mechanisms can help individuals reduce stress, enhance resilience, and improve overall well-being. One may try the following effective coping skills at home:
· Keep A Magazine/Book/Newspaper : It is a productive coping technique while essentially venting to the page, one can lessen anxiety as it helps clear one’s mind, stop overthinking, and find solutions to the problems that may contribute to the fears. Mental health professionals consider this practice as cognitive behavioral therapy (CBT) method and as a result, one feels like having control.
· Keep Up With Essential Self-Care Needs: Anxiety strategy includes taking care of physiological needs like restful sleep, excellent nutrition, and sufficient hydration, taking a relaxing bath, or watching a funny movie.
· Do Physical Activity: Physical exercise like jogging, attending a yoga class, or working out on stationary bike, release happy hormones like dopamine and endorphins which support emotional health. These hormones can help people feel better and cope positively. Getting adequate physical exercise can also improve sleep.
· Do Breathing Exercises: Deep breathing exercises help control stress. When experiencing a high-stress situation, the body goes into a fight-or-flight response, thus increasing respiratory rate. When one takes deep breathe, repertory rate drops.
· Relax The Muscles: Stress can cause muscle tension, so releasing it can help returning the body to a more relaxed state. Progressive muscle relaxation techniques by working each set of muscles from toes to forehead calm muscle groups one by one until one releases all the tension one can. Take help from an expert and follow the guide the first time when practicing the technique to perform it correctly.
· Practice Mindfulness: Mindfulness is about becoming aware of one’s surroundings and the present moment, not sitting and focusing on impending thoughts. Disregard to wherever one is and whatever he/she is doing, pay attention to breath, make an observation about the world, or concentrate on the task at hand.
· Prioritize: While feeling depressed, people might not find the motivation to do anything at all. In that case, prioritize self-care and plan one or two tasks that seem more manageable. Ticking items off one’s to-do list can fuel motivation and a sense of accomplishment, which can brighten the mood.
· Affirm Oneself: Affirming oneself can reduce the effects of depression. Practicing positive self-talk, like “I can do it” or “I am worth respecting” can be a positive coping technique when one’s self-esteem is low.
· Seek Social Support: People might take help of caregiver, trust worthy friends or family members to seek support. People with strong social support suffer less depression than their counterparts who feel alone. It might be hard to reach out and ask for help, but it’s worth it to let others know how one is feeling and get the support he/she needs.
Choosing The Best Coping Style-Strategy
Understanding how coping mechanisms work can help create a strategy that suits one. Calm oneself down and brainstorm ideas for what to do. If a strategy is particularly effective (or ineffective), make note of it for next time. Take a look at the situation, whether in control or not. The amount of control one has will determine how best to react. If one hasno control, use problem-focused coping skills. One might talk to someone involved with the situation or talk to an expert to start brainstorming coping methods. one can’t directly change the situation use emotion-focused coping strategies. One always has some control over a situation, even if it’s just how one feels about it. If the situation feels unchangeable, like the loss of a family member. Try saying, “I can’t change this, but I can manage…”Face the feelings instead of repressing them. [6]
The conflict-affected persons in various countries can use a number of coping strategies associated with poorer mental health. These strategies may be useful to local authorities, NGOs and community organisations who work with the conflict-affected persons to design interventions that support coping strategies associated with good mental health. Such strategies may be particularly pertinent given the barriers faced by conflict-affected persons in using mental health services in affected countries. Such interventions should be culturally appropriate, gender-sensitive, effective and feasible.
References
1. Folkman S, Moskowitz JT. Coping: pitfalls and promise. Annu Rev Psychol. 2004;55:745-74.
2. Venner M. [Adjustment, coping and defense mechanisms--deciding factors in the therapeutic process]. Z Gesamte Inn Med. 1988 Jan 15;43(2):40-3.
3. Coppens CM, de Boer SF, Koolhaas JM. Coping styles and behavioural flexibility: towards underlying mechanisms. Philos Trans R Soc Lond B Biol Sci. 2010 Dec 27;365(1560):4021-8.
4. Kato T. Frequently Used Coping Scales: A Meta-Analysis. Stress Health. 2015 Oct;31(4):315-23.
5. Compas BE, Jaser SS, Bettis AH, Watson KH, Gruhn MA, Dunbar JP, Williams E, Thigpen JC. Coping, emotion regulation, and psychopathology in childhood and adolescence: A meta-analysis and narrative review. Psychol Bull. 2017 Sep;143(9):939-991.
6. Koolhaas JM, de Boer SF, Coppens CM, Buwalda B. Neuroendocrinology of coping styles: towards understanding the biology of individual variation. Front Neuroendocrinol. 2010 Jul;31(3):307-21.