Stress and Anxiety Coping Skills: Tips for Providers to Share with Patients

Healthy coping and self-soothing strategies are often effective tools for helping providers manage the effects of stress and intense emotions on our patients. These strategies have also been shown to help moderate the relationship between stress and the development of more severe health problems (e.g., depressive symptoms¹ and physical health concerns). Instruction in healthy coping may, therefore, be considered an important preventive exercise for children and teens. Primary care providers can instruct children, adolescents, parents and caregivers about the use of healthy coping strategies.

Stress is normal

Children, adolescents, parents and caregivers face a multitude of acute and chronic life stressors, and this is normal. These stressors may include pressures related to academics, peer relationships, social media, life transitions, political climate, separation or loss of caregivers, poverty, familial conflict, exposure to violence and physical illness.

Exposure to adverse or stressful experiences during childhood occurs at high rates, and without appropriate intervention, has been linked problems in adulthood.²

What is coping?

Coping commonly refers to an individual's effort to regulate emotions, cognitions, physiology, behavior and situations in reaction to stressful events or challenging circumstances.⁴ In other words, coping can be described as anything that one does in an attempt to manage stress.

During stressful situations, coping skills can help to diffuse or "turn down the volume" of intense emotion, allowing for increased control over how an individual chooses to respond to the situation. 

Coping skills generally serve one or more of the following purposes³:

• Self-soothing: engages the body's natural calming system
• Distraction: redirect to more pleasurable activities to decrease intensity of emotion
• Opposite action: engagement in an activity that generates an emotion or experience that is counter to the distressing one
• Emotional awareness: activities that promote emotional exploration and increase clarity
• Mindfulness: focus on being grounded in the present

Not all coping efforts are helpful

Often, individuals develop unhealthy methods to deal with stress and difficult emotional experiences. Self-harm behavior, substance abuse, unhealthy eating, social withdrawal, aggression and other maladaptive behaviors can emerge as misguided attempts to manage stress. While these behaviors can be effective in the moment, they do not promote long-term health.

Teaching coping to younger children

Children first learn how to manage stress by watching their parents and caregivers manage stress. Caregivers may benefit from examining their own typical coping strategies and how they are modeling healthy coping for their children.

Families with younger children may consider developing a "family coping plan" to practice healthy coping strategies together. Using movie or book characters for examples on healthy and unhealthy coping can also be helpful in teaching younger children about coping in an age-appropriate way.

Talking to teens about coping

Tip: You don't have to call it "coping." Inquire broadly about anything the teen currently does to manage emotions, calm down or "turn it around" when struggling. Encourage teens to consider what strategies have helped them in the past, even if these strategies were not conceptualized as "coping." For example, "I usually feel better after soccer practice" suggests that exercise may be a coping skill even if soccer practice is not attended in order to manage stress or cope.

Use the teen's own language to help increase the likelihood of engagement. For example, instead of a "coping plan," teens may respond better to the idea of a "stress management plan," a "list of calming activities" or some other label of their choosing.

Sample coping strategies

Self-soothing

• Deep breathing
• Tensing and relaxing major muscle groups (progressive muscle relaxation)
• Meditation or guided imagery

Distraction

• Calming activities (listening to music, painting or drawing)
• Activities (puzzles, baking, playing a game)
• Talk to someone

Opposite action

• Enjoyable activities
• Exercise

Emotional awareness

• Cognitive strategies: coping thoughts (e.g., "This situation is really rough, but it's only temporary" or "I can ride this out")
• Self-affirmations 
• Journaling

Mindfulness

• Grounding exercises (counting your breaths, counting or subtracting by sevens, counting the colors you see)
• Five senses grounding activities (5 things you see, 4 things you hear, 3 things you feel, 2 things you smell, 1 thing you taste)

Contact us

Children's Hospital Colorado's Pediatric Mental Health Institute professionals are trained to help youth and their families collaboratively identify and create healthy coping habits. To refer a patient for consult, call 720-777-6200.

Sources:

1. Grant, K. E., Compas, B. E., Thurm, A. E., McMahon, S. D., Gipson, P. Y., Campbell, A. J., ... & Westerholm, R. I. (2006). Stressors and child and adolescent psychopathology: Evidence of moderating and mediating effects. Clinical psychology review, 26(3), 257-283.
2. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., ... & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 14(4), 245-258.
3. Linehan, M.M. (2015). DBT skills training manual: Second edition. New York: Guilford Press.
4. Modecki, K. L., Zimmer‐Gembeck, M. J., & Guerra, N. (2017). Emotion regulation, coping, and decision making: three linked skills for preventing externalizing problems in adolescence. Child Development, 88(2), 417-426.