Coping Strategies Research Articles

The impact of stress on sleep quality: a mediation analysis based on longitudinal data.

This study evaluates the potential mechanisms through which stress affects sleep quality and examines the mediating roles of rumination, social anxiety, emotion-focused coping strategies, and smartphone dependence in the relationship between stress and sleep quality. From October 2023 to April 2024, we conducted three surveys with 426 university students and utilized structural equation modeling to explore the mechanisms by which stress impacts sleep quality. Stress not only significantly predicts sleep quality but also significantly affects sleep quality through rumination, emotion-focused coping strategies, and smartphone dependence as independent mediators. Additionally, stress influences sleep quality through both dual-mediation and triple-mediation paths. Stress has a significant direct and indirect impact on sleep quality. This study reveals the complex mechanisms through which stress affects sleep quality. Improving individuals' sleep quality requires not only considering the influence of real-life stressors but also examining the intersecting effects between stress and factors such as ruminative thinking, social anxiety, smartphone dependency, and emotion-focused coping strategies. The intense social competition in Chinese society exacerbates the decline in sleep quality, highlighting the need for the government to implement more policies aimed at maintaining the physical and mental health of the population to alleviate the increasingly severe sleep issues and mental health crisis.

Impact of Academic Progress on the Mental Health of Young People in Nigeria: A Case Study of Undergraduate Students in South-Western Nigeria

Background: Education is important in forging a pathway to economic opportunity and social mobility. It is widely regarded as a fundamental human right and a cornerstone of personal and social development. Method: This descriptive cross-sectional study employs a quantitative data collection approach. Four hundred individuals were interviewed using semi-structured, interviewer-administered questions through a multi-stage sampling technique. After data analysis with SPSS version 26, a chi-square test statistic was employed to determine whether there was a significant relationship between the categorical variables, with a p-value of less than 0.05. Results: Out of 400 respondents, 211 (52.8%) male and 189 (47.2%) female were questioned. Nearly half of the respondents (49.0%) were between the ages of 19 and 21 years old. According to the survey, most of the respondents (70.0%) asserted that their current academic workload is heavy, while (18.0%) and (9.0%) described their workload as moderate and light, respectively. Additionally, (60.0%) of the respondents rated their overall academic performance as good. However, only (13.0%) acknowledged that academic pressure contributes to stress and anxiety in life and (79.0%) occasionally expressed stress related to academic demands. About (11.8%) and (8.8%) of the respondents reported having been diagnosed with a mental health disorder before and experienced symptoms of depression in the past month respectively. An additional (20.0%) of respondents reported having experienced depression, while (24.5%) and (23.5%) claimed to have experienced anxiety and stress, respectively. Moreover, (11.8%) reported experiencing panic attacks, and (5.3%) mentioned having had suicidal thoughts. More than half of the respondents used to exercise (59.0%) and engaged in hobbies or interests (56.5%) as coping mechanisms for academic stress. Additionally, (45.5%) practiced mindfulness or relaxation techniques, and (25.5%) sought social support to manage their academic stress. About (32.5%) of respondents claimed they were aware of mental health support services available at their institutions, compared to (67.5%) who were unaware of these services. Of those aware, (33.1%) had utilized mental health support services. Additionally, (44.2%) of respondents were satisfied with the mental health support services on campus, while (39.5%) were very satisfied. The study also reveals that there’s no statistically significant association between the age, gender, monthly upkeep of the respondents and utilization of mental health support services. Conclusion: There is a complex connection between academic performance, psychological well-being, and the use of coping strategies and mental health support services among university students. This underscores the importance of addressing students' mental health needs alongside providing academic assistance. Keywords: Mental health, Academic performance, Mental health support services, Stress, Anxiety, Depression, Mental health coping mechanisms

Effects of personal cancer history and genomic risk information on mothers' psychological adaptation to inherited breast/ovarian cancer syndrome.

This study aimed to understand long-term coping responses of mothers (N = 287) receiving genetic counseling and testing (GCT) for hereditary breast/ovarian cancer (HBOC) syndrome. Psychological characteristics, including cancer-specific distress (Impact of Events Scale-Revised, α = .85) and coping (Brief COPE, α = .93) were assessed via structured personal communication, along with epidemiologic items assessing personal and family history of cancer. Genetic risk was determined by BRCA1/2 carriage. A principal component analysis was conducted on the coping measure to reduce its summary score to active coping (α = .91) with nine approach-oriented strategies responsive to stress. A multivariable regression model examined the main and interacting effects of clinical and psychological characteristics on maternal coping. Personal cancer history (F = 4.99, df = 1, p = .026), BRCA test result (F = 22.20, df = 1, p < .001), and cancer-specific distress (F = 17.80, df = 1, p < .001) were associated with greater engagement in active coping strategies. When controlling for cancer-specific distress, the interaction between personal cancer history and genetic test results was significant, such that women previously unaffected by cancer who received positive BRCA results reported the greatest levels of active coping (F = 7.92, p < .001). These findings indicate that previous cancer history, genetic risk, and psychological distress independently and jointly impact how women adapt to the threat of cancer over time.

Digital diaspora

In this paper, we examined the relationship between social networking sites (SNSs) and the coping strategies international students adopt amidst cultural shocks in India, particularly in the vibrant locale of Chandigarh. The study scrutinizes pivotal factors that influence international students' SNS use and creates and validates an instrument that measures this relationship. Grounded in the uses and gratifications theory (UGT), this research introduces an instrument—the Social Capital Assessment Scale and Inventory (SCASI), which was developed via exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The research concludes that SNSs play a pivotal role in the globalization of information, encompassing education, knowledge dissemination, interactivity, and cultural exchange in geographically diverse countries such as India.

The Daydream Spectrum: The Role of Emotional Dysregulation, Internalized Stigma and Self-Esteem in Maladaptive Daydreaming Among Adults With ADHD, ASD, and Double Diagnosis.

Maladaptive daydreaming (MD) is characterized by vivid, excessive fantasy activity that becomes prioritized over other activities and may result in avoidant coping strategies. Little is known about the relationship between MD and internalized stigma in the neurodivergent sample. The current study aimed to examine emotional dysregulation, escapism and self-perception (self-esteem and internalized stigma) as potential determinants of MD in three groups: adults on the autism spectrum, with ADHD, and both diagnoses ("AuDHD"), including their neurodivergent symptoms (autistic traits, empathizing, ADHD symptoms). A sample of 293 persons (139 with ADHD, 74 on the autism spectrum, and 80 with both diagnoses) completed self-report scales concerning ADHD symptoms, autism spectrum symptoms, empathizing, self-esteem, daydreaming as escapism, emotional dysregulation, maladaptive daydreaming, and internalized stigma. A correlation analysis was implemented. Additionally, a group comparison and quantile regression for the 25th, 50th, and 75th percentile of maladaptive daydreaming in the three groups were executed. The results showed that internalized stigma, emotional dysregulation, escapism, and self-esteem have significant associations with MD in the neurodiverse sample. The ADHD group achieved the lowest scores in emotional dysregulation, discrimination experience, and social withdrawal. The groups did not vary in MD rates, stereotype endorsement, stigma resistance, nonacceptance of emotional responses, and impulse control difficulties. The AuDHD group achieved higher results than the ASD group only in the ADHD symptoms. Quantile regression revealed differences in the predictors of maladaptive daydreaming in the three groups. ADHD symptoms and self-suppression escapism were significant predictors for the higher levels of MD in persons with singular autism or ADHD diagnosis. The results showed no differences in MD rates, although there were significant variations in predictive features among the three samples. The role of internalized stigma and self-esteem was highlighted in the results as significant associates of MD prevalence. These outcomes expand the current knowledge in the context of maladaptive daydreaming, internalized stigma, self-esteem and emotional dysregulation in a neurodiverse sample and allow for proposing clinical applications and further research directions.

Prevalence of urinary incontinence in postpartum women and physiotherapy interventions applied: An integrative review.

This integrative review identified studies that reported the prevalence of physiotherapeutic interventions for urinary incontinence among postpartum women. This is an integrative literature review study. We used the integrative literature review framework proposed by Whittemore and Knafl to search for relevant literature. The search strategy for electronic databases was developed from the research question and definitions of key concepts, assisted by the librarian. Databases that were searched include Google Scholar, Medline (PubMed), CINAHL, and the Joanna Briggs Institute databases. Both qualitative and quantitative studies that met the inclusion criteria were included. We used the CASP tool to assess the quality of selected papers. The included articles were thematically analyzed. Thirty-six papers met the inclusion criteria for the review. Six themes emerged from the analysis: prevalence of postpartum UI; risk factors for postpartum UI; antenatal pelvic floor muscle training; conservative treatment and quality of life; experiences of postpartum women with UI; and possible coping strategies adopted by women. Most of the articles were quantitative studies (80.5%); 16.6% were qualitative and 2.7% adopted mixed methods. Urinary incontinence is common in postpartum women. Antenatal pelvic floor muscle training is protective against postpartum UI and should be the first-line treatment option.

A Qualitative Exploration on Psychological Stressors and Coping Mechanisms in Medical Laboratory Personnel

Healthcare professionals, particularly those working in high-stress environments like hospitals, are frequently exposed to significant psychological challenges. This study explores the psychological stressors and coping mechanisms of medical laboratory personnel at the People's Hospital of Keyouqianqi, Inner Mongolia, China. Using a qualitative research design, data was collected through semi-structured interviews with 10 participants, focusing on their experiences of stress and the strategies they use to manage it. The findings reveal that the most significant stressors include high workloads, time pressure, the responsibility for diagnostic accuracy, and interpersonal conflicts within the workplace. Additionally, personal and social stressors, such as balancing work with family responsibilities, further compounded their stress levels. Participants employed a variety of coping mechanisms, both problem-focused and emotion-focused, with effective strategies including building strong professional relationships, engaging in physical activities, and practicing mindfulness. However, some participants resorted to ineffective coping strategies, such as avoidance behaviors and unhealthy habits, which often exacerbated their stress. This study highlights the complex interplay between individual coping strategies and the cultural and institutional context in which these professionals operate. The findings have important implications for practice and policy, offering insights into how healthcare institutions can better support the mental health and well-being of their staff.

Social anxiety in culturally diverse young people: An insight into lived experiences

AbstractObjectivesThere is little research exploring the subthreshold social anxiety (SSA) in culturally diverse young people. This study addresses this gap and provides an insight into the vivid world of this ‘hidden’ population.DesignFour participants from England were interviewed using semi‐structured interviews. Four superordinate themes and their corresponding subordinate themes emerged from the transcripts: Excessive self‐consciousness—The inner critic and Feeling judged by others; Influences of social and cultural norms—The impact of dress‐code rules and The pressure of high expectations; Embracing a false reality—Patterns of avoidance and The public self; and Coping strategies—Breaking the wall of cultural norms, Pushing the bubble out and Know that you are not alone. Due to the vastness of the data, this study presents only the first two superordinate themes and their corresponding subordinate themes.MethodsThe author chose interpretative phenomenological analysis (IPA). This allowed the participants to describe thoroughly their lived experiences and enabled the researcher to adopt a scientific approach.ResultsThe results revealed that the socio‐cultural background of this population played a pivotal role in the prevalence and expression of SSA.ConclusionsThe participants' experiences were significantly influenced by the social and cultural norms of their country of origin as well as the characteristics of modern society in England. The predominant factors were the pressure of high expectations from family and society, transgenerational trauma, socio‐cultural norms, uncertainty about the future and lack of opportunities to secure employment. Future research could examine the socio‐cultural influences shaping contemporary British society and their impact on youth's mental health.

Physical Symptoms and Coping Strategies With Earthquake Stress Among Adults Living in Tent Cities: A Cross-Sectional Study.

This study aimed to examine the physical symptoms, coping strategies for earthquake stress and factors predicting coping strategies among adults staying in tent cities after an earthquake. A cross-sectional design was conducted. The study sample consisted of 706 adults residing in tent cities in three cities of earthquake-affected regions. Data were collected through face-to-face surveys and the Earthquake Coping Strategies Scale, starting from the 16th day after the earthquake in February-March 2023. Independent samples t-test, one-way analysis of variance, McNemar test and multiple linear regression analysis used for data analysis. The first three physical symptoms with the highest frequency after the earthquake were insomnia, frequent waking and difficulty falling asleep, respectively. Individuals with chronic illnesses, lower education levels, no previous experience with earthquakes and having undamaged homes more frequently used religious coping strategies. Individuals with higher incomes, employed individuals, non-smokers and those with having undamaged homes more frequently used positive reappraisal strategies. The present study concluded that physical symptoms were common among individuals in the post-earthquake period and that many individuals adopted religious coping strategies. Nurses can develop effective interventions for preventing physical and mental health problems in the post-earthquake period. They can contribute significantly as caregivers, leaders, researchers and advisors in health monitoring and improvement practices for individuals after earthquakes. The results of the study are instructive for designing prevention and improvement practices to minimise future destructive effects of earthquakes. Individuals mostly experienced sleep problems and preferred different coping styles in the early post-earthquake period. The physical and mental health of individuals can be improved by early intervention and encouraging effective coping methods after an earthquake. STROBE checklist. No patient or public involvement.

Communication Apprehension and Coping Strategies of the English Language Learners: Basis for Interactive Activities Enrichment

Communication apprehension is an uneasiness experienced by all individuals, especially when speaking. Meanwhile, coping strategies are approaches people use in dealing with anxiety. This study determined the level of communication apprehension and coping strategies of the BSED-English major students of the College of Education (CED), Jose Rizal Memorial State University-Tampilisan Campus. The researchers used the descriptive survey method utilizing the survey-questionnaire checklists. The first instrument was adopted from McCroskey's (1981) cited in Diane (2015) Personal Report of Communication Apprehension 24 (PRCA-24). The other one is the validated researchers-made survey statements comprising 30-item statements categorized as strategies for overcoming communication apprehension in group discussions, meetings, interpersonal conversation, and public speaking, with a Cronbach's alpha value of &gt;0.70. The researchers also adopted McCroskey and Richmond's coding and scoring system, weighted mean, and frequency count. Results show that most of the English major students in JRMSU-TC have a moderate level of communication apprehension. Further, there is a difference in the level of communication apprehension when grouped according to group discussion, meetings, interpersonal communication, and public speaking, as well as in the overall weighted mean. Therefore, there is a difference in the level of communication apprehension of the BSED English major students when grouped according to year level. In terms of coping strategies, students used the following strategies: accepting cultural differences, paying attention when talking to others and considering their cultural views, thoroughly preparing before the speech, and thinking of intrinsic and extrinsic motivation as a reward. In this connection, there are proposed interactive activities that may help overcome the students' communication apprehension.

Strategies for Confronting the COVID-19 Pandemic in the State of Piauí-Brazil: Contributions to Nursing.

To analyze the influence of the strategies to cope with the COVID-19 pandemic, implemented by the Public Health Network of the State of Piauí, Brazil, as contributions to nursing, on the outcome of cases and deaths. This is a descriptive and documentary study with a qualitative approach, carried out in the state of Piauí-Brazil, whose data were processed at IRAMUTEC and analyzed by the Descending Hierarchical Classification (DHC). Ninety-two normative acts were instituted as coping strategies, distributed in three classes: technical-operational protocols for preventing and combating COVID-19 in Piauí; Piauí strategic bases for social distancing against COVID-19; and management of services and economic activities in Piauí in the fight against COVID-19. The actions determined by and implemented in the normative acts were conducted according to the behavior of the epidemiological curve regarding the number of cases and deaths. The normative acts, which defined the technical-operational protocols for the prevention and control of COVID-19, were directly related to social distancing strategies and the use of protective equipment in the quality of life of the population.

A longitudinal study of the psychological predictors of mental health and stress among university students during the COVID-19 pandemic in Germany

AbstractRepeated nationwide lockdowns and contact restrictions during the COVID-19 pandemic in Germany massively affected students’ life.There is a lack of longitudinal studies on the change in students’ mental health problems and the influencing factors across the pandemic phases. The aims of the longitudinal study were to investigate the change in students’ depression, anxiety and stress across a one-and-a-half-year study period of the pandemic in Germany and the association between protective (mindfulness, coping strategies, self-efficacy) and risk factors (financial and academic worries) and students’ mental health issues and stress. A subsample of 911 university students was included in the longitudinal analyses. Students were surveyed at four points during the first and second years of the pandemic. Linear mixed-effects modelling was used to investigate our research questions. The models investigated the protective and risk factors as time-invariant and time-varying covariates. The results showed that depression, anxiety and stress decreased slightly over the pandemic. Further, mindfulness and active coping remained equally important over time for reducing depression, anxiety and stress. However, self-efficacy and acceptance became more critical for reducing mental health issues or stress over time. Although financial worries remained equally important for depression, anxiety and stress throughout the pandemic, academic worries became more important for mental health issues over time.The study provides insights into protective and risk factors throughout the pandemic. The results highlight the importance of investigating time-invariant and time-varying predictors of mental health issues.

Digital Narratives: The Impact of Instagram® on Mothers of Children with Congenital Toxoplasmosis.

Congenital toxoplasmosis leads to severe complications in childhood and presents significant global health challenges. In Brazil, the prevalence of toxoplasmosis during pregnancy and congenital cases ranges from 0.3 to 8 per 1000 live births. The clinical manifestations of congenital toxoplasmosis can include neurological and ocular damage, among other health issues, which place significant burdens on affected families. This study aims to investigate the experiences and motivations of mothers of children with congenital toxoplasmosis who share their journeys on social media, particularly Instagram. A qualitative virtual ethnography was used that explored the content shared by mothers of children diagnosed with congenital toxoplasmosis, aiming to understand how social media aids in their coping strategies and the support networks they create. Fifteen Instagram accounts were analyzed, and twelve mothers participated in in-depth interviews. Thematic analysis revealed three main themes: the initial search for information and support, the evolving role of social media in advocacy and education, and the creation of a supportive online community. This study highlights the potential of social media to provide emotional support, disseminate information, and foster communities among mothers facing similar challenges, ultimately contributing to better care strategies and professional awareness for supporting families dealing with congenital toxoplasmosis.

Validity, test-retest reliability, and responsiveness of the Indonesian version of FACIT-COST measure for subjective financial toxicity.

Financial toxicity describes the impairment of financial wellbeing in patients due to the burden of cancer diagnosis and care. The COST: A Functional Assessment of Chronic Illness Therapy Measure of Financial Toxicity (FACIT-COST) is the most widely used cancer-specific measure of subjective financial toxicity, having been validated in multiple languages, but not in Indonesian. This study aimed to validate the Indonesian version of FACIT-COST in a breast cancer sample. A single-center prospective cohort study was performed in Indonesia. Female breast cancer patients aged ≥ 18 undergoing treatment at baseline were invited to participate and followed for up to six months. The survey included the official Indonesian version of FACIT-COST (v2) which was administered to the patients by interviewers. Clinical information (e.g., metastasis status, disease duration) was provided based on medical records. The following measurement properties of FACIT-COST were tested: distributional characteristics, structural validity (principal component [PCA] and confirmatory factor analyses [CFA]), internal consistency reliability (Cronbach's alpha and McDonald's omega), known-groups validity (Mann-Whitney U or Kruskal-Wallis H test), test-retest reliability, and responsiveness to change. Overall, 300 female patients participated at baseline. No patients reported the best or worst possible FACIT-COST total scores. The PCA proposed a two-factor model structure for the instrument, which was confirmed by the CFA (RMSEA = 0.042, SRMR = 0.049, CFI = 0.99, TLI = 0.99). The internal consistency reliability of the two factors was considered adequate (Cronbach's alpha = 0.774-0.882, McDonald's omega = 0.786-0.888). The FACIT-COST total score significantly discriminated across the following known-groups: age, education, residential setting, income, employment, metastasis status, number of symptoms, and financial coping strategies. The FACIT-COST demonstrated excellent test-retest reliability (intraclass correlation coefficient = 0.96) and satisfactory responsiveness to change (standardized response mean and effect size ranges=|0.39| to |0.92|). This is the first study to validate the FACIT-COST in patients with breast cancer and to present the measurement properties of the Indonesian version of FACIT-COST. The Indonesian FACIT-COST demonstrates acceptable psychometric performance and shows potential as a valid measure of subjective financial toxicity. The instrument may serve as a valuable tool for informing health policies that focus on providing resource support to improve cancer care in Indonesia.

Impacts of Closed Season on Operations, Livelihood and Coping Strategies of Fishers

Impacts of Closed Season on Operations, Livelihood and Coping Strategies of Fishers

Assessing smallholder farmers’ flood risk behavior and their willingness to pay for crop insurance as a risk coping strategy in northern Bangladesh

Assessing smallholder farmers’ flood risk behavior and their willingness to pay for crop insurance as a risk coping strategy in northern Bangladesh

Addiction to analgesics in patients with chronic migraine and medication-overuse headache

Patients with medication-overuse headache (MOH) and chronic migraine (CM) have varying degrees of addiction to painkillers (PK), which complicates treatment and leads to relapses. Development of addiction to PK is associated with various clinical and psychological characteristics and disorders in patients with MOH.Objective: to investigate the relationship between PK addiction and individual clinical and psychological characteristics in patients with CM and MOH.Material and methods. The study included 156 patients with CM and MOH (61 men and 95 women, mean age 34.1±8.9 years). Clinical and psychological characteristics were assessed in all patients using a clinical interview, tests and headache diaries. The relationship between PK addiction (according to the Leeds Dependence Questionnaire – LDQ) and clinical and psychological characteristics (duration of migraine and CM, frequency and intensity of headaches, duration of MOH, frequency of PK use, number of PK doses, personal and situational anxiety, depression, pain catastrophizing, beliefs about the body and health, coping strategies for stressful situations, daily activities during headache, insomnia) was investigated using regression analysis.Results. All patients had misconceptions and wrong behavior regarding PK. The majority (59%) of patients had moderate degree of PK addiction according to the LDQ. Twenty six percent of patients had other forms of addictive behavior (smoking, excessive alcohol consumption, overeating, excessive use of sleeping pills), and 52.6% of patients had relatives with addictive behavior. There was a statistically significantly positive correlation (R≥0.45; p&lt;0.05) between PK addiction and smoking, alcohol consumption, use of sleeping pills, body mass index (BMI), frequency of PK use, attitudes towards pain, body and health (pain catastrophizing, hopelessness about pain, intolerance of body sensations, overestimation of symptom severity, catastrophizing in the interpretation of body symptoms), depression, personal anxiety and avoidance (maladaptive coping behavior). Adequate treatment of CM and MOH was provided in only 7.7% of patients.Conclusion: A positive association was found between PK addiction and smoking, alcohol consumption, use of sleeping pills, BMI, frequency of PK usage, attitudes towards pain, body and health, depression, personal anxiety and avoidance behavior.

Coping strategies associated with art adherence among older adults living with HIV, South Carolina

ABSTRACT People living with HIV/AIDS (PLWH) are living longer due to improvements in HIV care including antiretroviral therapy (ART). Even though ART improves HIV prognosis and life expectancy, its adherence is hindered by many factors. As the population of older adults living with HIV (OALH) continues to increase, it is important to understand the psychosocial factors that are associated with living with HIV to improve ART adherence. The aim of this study was to determine the association between coping strategies and ART adherence. Data were obtained from 91 OALH at an immunology clinic in Columbia, South Carolina via purposive sampling. The participants were at least 50 years or older and living with HIV. Coping was assessed using the Brief COPE Inventory. Crude and adjusted linear regression models, controlling for age, race, gender, and were used to determine the association between coping strategies and ART adherence. Subgroup analyses were done to determine if the association between coping and ART adherence varied by gender. The analyses were conducted in SAS version 9.4. The mean difference in ART adherence was statistically significant for race (p = 0.0292). There was a statistically significant association between religion and ART adherence (β = −0.718, p = 0.024). Males who use venting as a coping mechanism had higher ART adherence (β = 1.227, p = 0.048), and males who use behavioral disengagement had lower ART adherence (β = -1.624, p = 0.003) after adjusting for age and race. OALH who use religion as a coping strategy were less likely to adhere to ART treatment. Venting and behavioral disengagement tend to be associated with ART adherence among men. Qualitative research is needed to delve deeper into the relationship between religious coping and ART adherence, especially among OALH.

Promoting resilience among medical students using the Wadi framework: a clinical teacher's perspective.

Resilience is essential for medical students to navigate the challenges of their education and future careers. Defined as the ability to adapt well in the face of adversity, resilience can be learned and is critical for maintaining mental health. Medical educators play a pivotal role in fostering resilience by integrating it into both formal and informal curricula, including the hidden curriculum, which can significantly influence students' coping strategies. Research highlights the importance of resilience training in reducing depression and anxiety among students, underscoring its necessity as a core component of medical education. This essay presents the Systematic Assessment for Resilience (SAR) framework, which provides a comprehensive approach to promoting resilience through four key constructs: self-control, management, engagement, and growth. Practical strategies for each construct are discussed, including assessment mapping, time management, and the use of formative assessments to enhance students' preparedness and self-control. Engagement is fostered through collaborative assessments, open book exams, and regular formative feedback, while growth is encouraged via self-reflection and faculty development. Implementing the SAR framework has shown positive outcomes, with students reporting reduced anxiety and improved performance. However, further exploration and institutional support are needed to fully integrate these strategies into medical education. The SAR framework offers a feasible and effective method for cultivating resilience, contributing to students' mental well-being and equipping them to face future challenges in their medical careers. Continued refinement and broader institutional adoption will be crucial to sustaining the impact of resilience training in medical education.

Responding to location-based triggers of cravings to return to substance use: A qualitative study

IntroductionIndividuals with substance use disorders face many challenges in establishing and maintaining recovery, most notably from contextual factors such as people, locations, events, emotions, and other triggers of cravings that could spark return to use. We sought to understand how individuals experience and cope with locations as triggers. MethodsWe conducted 31 semi-structured in-depth interviews with individuals who had recently been in substance use treatment and reported problem levels of alcohol and opioid use according to screening instruments. Interviews were designed to explore how individuals experience location-based triggers. We coded these interviews according to concepts outlined in Marlatt and Gordon's cognitive behavioral model and used thematic analysis to generate themes in participant experiences. ResultsWe found that participants described triggers as interrelated and associated with multiple people, locations, events, or emotions. Participants commonly identified ‘home’ as a trigger, one that is particularly difficult to cope with. Participants most commonly employed avoidance as a coping strategy. Finally, participants described an expectation that substance use was associated with more time spent outside of ‘home’ while recovery was associated with limited travel and more time spent at home. ConclusionsLocation-based triggers represent a particularly challenging barrier to sustained substance use disorder recovery, partly due to the amorphous and interrelated nature of such triggers. The identification of ‘home’ as a primary trigger and common use of avoidance as a coping strategy suggest the need for additional recovery support and interventions. We plan to use these findings to develop and test an intervention promoting coping strategies.