Stress and Coping

Dear Ashley,
I know you feel like you have so much to deal with and to balance on a day-to-day basis, and you do. You not only have to manage the exhausting process of adolescence, you have to do it while constantly feeling poorly and worrying about if you will ever recover.  Just know that you have friends and family who are there for you, as am I.  Dealing with stress in a healthy way is a battle sometimes, but here are some suggestions based on research that I have done.  You know what works for you to manage stress, but it's something we are all constantly growing in.  Make it a priority to understand when and why you are stressed, because neglecting this may lead to panic levels of anxiety.  As always, let me know of any way I can be there for you. 
-Amanda

Risk for ineffective coping related to constant stress secondary to multiple diagnoses and everyday health challenges.

• Assess Ashley’s stress levels.  Sometimes stress is not expressed outright, but displayed through other emotional reactions or with changes in eating or sleeping patterns.  Her family and healthcare providers should become familiar with how she experiences and expresses stress (Carpenito-Moyet, 2010). 
• Assess sources of stress (Carpenito-Moyet, 2010).  Any changes in situation, health, or even in her personal life can be compounding sources of stress.  It is important to recognize that what may not seem significant to family or friends can be devastating for individuals.  
• Assess the coping and stress of her family.  Parents of adolescents with chronic illness can affect how their child handles stress by modeling effective or ineffective coping strategies.  Teaching effective coping to her family can also help relieve stress on Ashley (Compas, Jaser, Dunn, & Rodriguez, 2012). 
• Assess how Ashley views stress.  Some individuals focus on controlling the situation they are in (task-oriented coping), some focus on managing their feelings about their situation (emotion-oriented coping), and some like to avoid dealing with the experience altogether (avoidance-oriented coping) (Janowski, Kurpas, Kusz, Mroczek, & Jedynak, 2013).  Presenting coping strategies can be ineffective if she does not feel comfortable using them, but her ability to manage her emotions in challenging situations can be grown with teaching. 
• Assess for worsening symptoms when stress levels are high, as the body’s resources to fight illness is compromised when emotional stress is also involved (Janowski et al., 2013). 
• Educate about the importance of leisure and relaxation in managing stress.  Taking time for these enjoyable activities facilitates coping and helps to prevent stress from increasing to harmful levels (Nimrod, Kleiber, & Berdychevsky, 2012).  The positive emotions of joy generated from these experiences have a significant effect on symptoms. 
• Teach coping skills such positive thinking, assertive communication, and stress management.  These skills are important for coping with the stress of chronic illness as well as the stress of everyday life that can build up and overwhelm her (Compas et al., 2012).  It is important to not avoid the sources of stress or hope illness will resolve itself, but to focus on the positives of her situation (Peres & Lucchetti, 2010).
• Encourage regular exercise, to the extent her joint and mobility problems allow.  This is important in helping her live a healthy and fulfilled life, as well as helping with pain (Peres & Lucchetti, 2010).  Exercise is a widely recognized healthy coping strategy. 
• Refer to support groups for adolescents facing similar challenges.  Social support has been shown through research to reduce distress, depression, and anxiety during times of stress and significantly helps coping (Taylor & Stanton, 2007).  Perceiving that others are there for her and going through the same things may help Ashley avoid becoming overwhelmed. 
• Refer to a therapist for cognitive-behavioral therapy for symptoms of depression.  Adolescents experiencing chronic illness have a higher risk for depression, and cognitive-behavioral therapy can help strengthen coping and reduce this risk (Compas et al., 2012).