The Use of Coping Skills as A Psychological Tools for The Management of Covid-19 And Other Chronic Diseases Among Nigerian Workers

Dr. Suleiman T. Folorunsho

Head, Clinical Psychology
Lagos University Teaching Hospital
Idi-Araba, Lagos, Nigeria

INTRODUCTION

Coronaviruses are zoonotic, as they are normally transmitted between animals and humans. The disease (COVID-19) is caused by a new strain of coronavirus (SARS-Cov-2) that has been previously identified in humans. The disease (COVID-19) was first reported to W.H.O. on the 31^st of December, 2019, in Wuhan, China, and since then it has become a serious health issue globally. As of April 4^th, 2020, the disease has spread to more than 60 countries around the world, with more than 1 million cases of infected patients.

The symptoms of coronavirus disease could include pneumonia, fever, dry cough, sore throat, headache, shortness of breath, and loss of smell. In severe cases, it could lead to difficulty breathing, and death can occur if not adequately treated.

CHRONIC HEALTH CONDITIONS

Chronic diseases are defined broadly as conditions that last 1 year or more and require ongoing medical attention or limit the activities of daily living or both of the individual concerned. Chronic diseases such as heart disease, cancer, asthma, back pain, diabetes, and mental health conditions are the leading causes of death and disability globally. Chronic diseases are the leading cause of death worldwide and are largely associated with millions of deaths that occurred over the years.

The majority of these deaths are attributed to COVID-19, cardiovascular diseases, cancer, chronic respiratory disease, and diabetes, and the burden associated with the management of chronic illnesses is well documented.

Generally, the treatment of chronic illness comes in many forms, including physical therapy, psychological therapies like cognitive-behavioral therapy, interpersonal therapy stress management to enable people with chronic illness conditions to cope perfectly with their disease condition, and radiotherapy can also be a standard in the management of some of these chronic disease conditions.

Coping skills are the use of an individual’s conscious effort to solve personal and interpersonal problems to master his/her stressful life condition.

Generally, coping skills refer to adaptive coping strategies, that is, strategies to reduce stressful life conditions among people. Some coping strategies might be tagged as maladaptive coping because of their inability to reduce stressors among the general population, e.g., the use of substances to suppress stressful life conditions.

The most influential theory of stress and coping was developed by Lazarus and Folkman (1984), who defined stress as resulting from an imbalance between perceived external or internal demands and the perceived personal and social resources to deal with the psychological stressors.

NECESSARY PRECAUTIONARY MEASURES FOR COVID-19

You can reduce your chances of being infected or spreading COVID-19 by taking some simple precautions as a Nigerian worker:

• Regularly and thoroughly sanitize your hands with an alcohol-based hand rub or wash them with soap and water.
• Maintain at least 1 meter (3 feet) of distance between yourself and others.
• Avoid going to crowded places.
• Avoid touching your eyes, nose, and mouth.
• Make sure you and the people around you follow good respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze.
• Stay home and self-isolate, even with minor symptoms such as a cough, headache, or mild fever, until you recover.
• If you have a fever, cough, or difficulty breathing, seek medical attention, but call by telephone in advance if possible and follow the directions of your local health authority. Like the NCDC in Nigeria.
• Keep up-to-date on the latest information from trusted sources, such as the WHO or your local and national health authorities like the NCDC.
• As Nigerian workers, you should take necessary precautionary measures before going home so as not to infect your family members.

NECESSARY PRECAUTIONARY MEASURES FOR CHRONIC DISEASES

• Eat healthy: eating healthy helps to prevent any form of disease.
• Get regular physical activity.
• Avoid the use of alcohol and other substances
• Do regular screening to ascertain your health status.
• Get enough sleep
• Take care of physical and environmental hygiene
• Maintaining a normal body weight
• Manage heart disease and other chronic diseases perfectly
• Get vaccinated
• Handle and prepare food for safety
• Avoid touching your eyes, nose, and mouth when you are sick
• Cover your mouth when you cough and sneeze, so that you do not spread the disease.

STRESS-RELATED SYMPTOMS AMONG NIGERIAN WORKERS DURING COVID AND OTHER CHRONIC DISEASES

• Nervousness
• Fear of isolation
• Depression
• Anxiety
• Lack of routine
• Poor Salary and other remuneration
• Workers are exposed to infection
• Lack of protective equipment
• Work overload
• Poor infection control
• Job burn out
• Excessive workload
• Inadequate social support

TIPS ON STRESS MANAGEMENT

The maintenance of health through stress management strategies requires the practice of effective lifestyles, which are necessary conditions for people irrespective of their age or level of authority and responsibility.

1. Form the habit of frequent medical check-ups
2. Recognize early warning signs of stress
3. Take one thing at a time
4. Avoid working under pressure
5. Talk about your worries
6. Appraise luck and misfortune objectively
7. Learn to accept things that you can not change
8. Cognitive and behavioral approaches: People can learn how to perceive life in a positive way rather than the negative perception that causes stress.
9. Cognitive restructuring: stress-provoking thoughts or beliefs are replaced with more constructive or realistic ones that reduce the person’s appraisal of the problem.
10. Social support from relatives.
11. Physical exercise, pursue a regular programme of physical exercises
12. Expose your problem to those that can be of help
13. Good, healthy living habits
14. Avoid the use of psychostimulants to reduce stress

TYPES OF COPING STRATEGIES

ADAPTIVE COPING STRATEGIES

• Adaptive coping helps the person deal effectively with stressful events and minimizes the distress associated with them.
• Effective coping  results in adaptation

MALADAPTIVE COPING STRATEGIES

• Maladaptive coping can result in unnecessary distress for the person and others associated with the person during the stressful event.
• Ineffective coping results in maladaptation.

Problem-focused coping: This is aimed at changing or eliminating the source of the stress.

• makes adverse circumstances less stressful.
• Obtaining information or advice
• Solving problems and implementing plans to deal with the problem.
• Confrontation-defending one’s rights and persuading other people to change their behaviour.

Emotion-focused coping focuses on alleviating the emotions associated with a stressful situation, even if the situation itself cannot be changed.

• Cognitive strategies (often involve a reappraisal of the situation).
• Behavioural strategies (e.g., exercise, seeking support, use of drugs).

Avoidance coping: denying any negative emotions and pushing them out of conscious awareness.

MALADAPTIVE COPING STRATEGIES

• Use of alcohol or prescribed drugs to reduce emotional response or to reduce awareness of stressful events.
• Deliberate self-harm, either by drug overdose or by self-injury.
• Unrestrained display of feelings can reduce tension, and in some societies, such behaviour is sanctioned in particular circumstances (e.g., grieving).
• Aggressive behaviour is the immediate release of feelings of anger.

RELAXATION TECHNIQUE

A relaxation technique (also known as relaxation training) is any method, process, procedure, or activity that helps a person to relax, attain a state of increased calmness; or otherwise reduce levels of pain, anxiety, stress, or anger.

Relaxation therapy refers to several techniques designed to teach someone to be able to relax voluntarily. These techniques can include special breathing practices and progressive muscle relaxation exercises, which are designed to reduce physical and mental tension.

TYPES OF RELAXATION TECHNIQUES:

• Autogenic training. This technique uses both visual imagery and body awareness to move a person into a deep state of relaxation. The person imagines a peaceful place and then focuses on different physical sensations, moving from the feet to the head. For example, one might focus on warmth and heaviness in the limbs, easy, natural breathing, or a calm heartbeat.
• Breathing Exercise. In breathing techniques, you place one hand on your chest and the other on your belly. Take a slow, deep breath, sucking in as much air as you can. As you are doing this, your belly should push against your hand. Hold your breath, and then slowly exhale.
• Progressive muscle relaxation. This technique involves slowly tensing and then releasing each muscle group individually, starting with the muscles in the toes and finishing with those in the head.

Progressive muscle relaxation involves a two-step process in which you systematically tense and relax different muscle groups in the body.

• PRACTICING PROGRESSIVE MUSCLE RELAXATION

Before practicing Progressive  Muscle Relaxation, consult with your doctor if you have a history of muscle spasms, back problems, or other serious injuries that may be aggravated by tensing muscles.

Most progressive muscle relaxation practitioners start at the feet and work their way up to the face for a sequence of muscle groups as follows:.

• Loosen your clothing, take off your shoes, and get comfortable.
• Take a few minutes to relax, breathing in and out in slow, deep breaths.
• When you’re relaxed and ready to start, shift your attention to your right foot. Take a moment to focus on the way it feels.
• Slowly tense the muscles in your right foot, squeezing as tightly as you can. Hold for a count of 10
• Relax your right foot. Focus on the tension flowing away and the way your foot feels as it becomes loose limp and loose
• Stay in this relaxed state for a moment, breathing deeply and slowly.
• When you’re ready, shift your attention to your left foot. Follow the same sequence of muscle tension and release
• Move slowly up through your body, contracting and relaxing the muscle group as you go.
• It may take some practice at first but try not to tense muscles other than those intended.

• Mindfulness for Stress Relief: Mindfulness is the ability to remain aware of how you’re feeling right now, your “moment-to-moment” experience – both internal and external. Thinking about the past-blaming and judging yourself, or worrying about the future can often lead to a degree of stress that is overwhelming. But by staying calm and focused in the present moment, you can bring your nervous system back into balance. Mindfulness can be applied to activities such as walking exercising, eating, or

PRACTICING MINDFULNESS MEDITATION

Key points in mindfulness meditation are:

• A quiet environment. Choose a secluded place in your home, office, garden, place of worship, or in the great outdoors where you can relax without distractions or interruptions.
• A comfortable position. Get comfortable, but avoid lying down, as this may lead to you falling asleep. Sit up with your spine straight, either in a chair or on the floor. You can also try a cross-legged or lotus position.
• A point of focus. This point can be internal—a feeling or imaginary scene—or something external—a flame or meaningful word or phrase that you repeat throughout your session. You may meditate with your eyes open or closed. Also, choose to focus on an object in your surroundings to enhance your concentration, or alternately, you can close your eyes.
• An observant, non-critical attitude. Don’t worry about distracting thoughts that go through your mind or about how well you’re doing. If thoughts intrude during your relaxation session, don’t fight them. Instead, gently turn your attention back to your point of focus  

Guided Imagery. Similar to autogenic training, guided imagery involves listening to a trained therapist or a guided imagery CD to move into a state of deep relaxation. Once in a relaxed state, the images that come up in your mind can help you uncover important realizations about your emotional, spiritual, and physical health.

CONCLUSION

Stress cannot be avoided in the workplace during COVID-19 and other chronic disease conditions, but the ability of the workers to cope with their numerous stressors at work is better for them during that period. Workers should remain safe and adhere to the preventive measures and coping skills highlighted in this article.

REFERENCES

Coping Strategies Centre for Studies in Human stress (2020) https://humanstress.ca>trick-your stress. Accessed 16^th  of July, 2020.   

Folkman, S (1984) “personal control and stress and coping processes. A theoretical analysis.” Journal of  personal  and social psychology 46: 839-852  

Shorter Oxford Textbook of Psychiatry,7^th edition pg 252-255.

World Health Organization. Preventing Chronic Diseases: A Vital Investment. WHO global report. Geneva: 2015. https://www.who.int/chp/chronicdisease-report(Access 20^th of February, 2024).

Centre for Disease Control and Prevention. Chronic Diseases in America. Available from: https://www.cdc.gov/chronicdisease/about/index htm(accessed 22th February 2024.

Wikipedia.chronic condition. Available from https://en.wikipedia.org/wiki/chronic-condition(accessed 25^th February 2024.

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