Publication Date

Winter 3-6-2024

Item Type


Executive Summary

Healthy Coping Mechanisms Within the Recovery Setting


Nineteen percent of the Seattle-Tacoma Metropolitan Statistical Area (MSA) population ages 12 and older are using illicit drugs (Brief, 2012). And twenty-two percent have an excessive alcohol use disorder (Brief, 2012). Six Seattle Pacific University nursing students (the team) were assigned a leadership project at a recovery center in downtown Seattle. The recovery center is a non-profit organization that aims to provide hope, healing, and community to those within the recovery community. Members have experienced anything from homelessness to addiction, trauma, and mental health struggles and the center provides a way to manage mental health, maintain sobriety, and find community all while giving back. The center provides lunches/dinners, talk circles, and referrals to community resources.

While at the center, the team found that no matter what members were recovering from, there was consistently a need for increased healthy coping mechanisms. The team's focus was to teach the members three different healthy coping mechanisms and provide education on what is healthy and what is not.


The recovery center allows members to register with the community and access its services. In return, members are expected to “give back” to the community through helping do chores around the facility and being exposed to volunteer opportunities around the area. Around 50% of the community also experiences homelessness alongside being in recovery for addiction. This also often intersects with traumatic experiences, and these populations “often experience barriers to accessing and following treatment recommendations for substance use disorders” (Magwood et. al 2020).

Stress is also correlated to substance use and notably for this population, relapse. Sinha (2008) states that “the drug-craving state marked by increasing distress and compulsive motivation for drug (craving) along with poor stress regulatory responses (altered glucocorticoid feedback or increased noradrenergic arousal) results in an enhanced susceptibility to addiction relapse”. Prevention and addressing stress and coping were identified as a target of interest for interventions given the vulnerability of this population. The team focused on the diagnosis of ineffective coping related to the instability of recovery, secondary to stress, as evidenced by client statements of loss of control, drug use, high blood pressure and client statements of feeling stuck or lonely.

Activities with Rationale

To address this issue, the team implemented group art activities, education on healthy coping mechanisms, box breathing, and journaling. The group conducted these three sessions over the course of three weeks. For art therapy, the team decided to specifically use coloring books to engage with the clients. This is because coloring books/pages are cost effective and accessible to anyone even if they have zero art experience. Art therapy has been shown to be a very effective form of coping. Like mediation, art requires participants to focus on the present moment, distracting them from intrusive thoughts and stressors (Holly, 2018). Art therapy aids individuals in managing intense emotions, fostering self-awareness and self-worth, and decreasing anxiety (Holly, 2018).

Art therapy also allowed the group to provide the clients with education on other healthy coping mechanisms and how to reduce stress. Their education included things like box breathing, engaging in hobbies that they enjoy, and staying connected with friends, family, or support groups (Center for Disease Control and Prevention, 2021).

The last intervention the team implemented was journaling. Similar to coloring, journaling is easily accessible to anyone with access to a pen and paper. Journaling provides a private outlet for emotional expression and self-reflection (Intermountain Health, 2023). The team provided members with three writing prompts to help guide their thought process: What is one thing you are proud of yourself for? Write about a negative thought that won't leave your mind. When you are finished, tear out the page and throw it away. What is your favorite memory associated with a holiday?

These prompts were specifically chosen as they encourage enough self-reflection to promote a therapeutic response, but aren’t so intrusive that it turns away clients who are not used to writing their feelings on paper (Intermountain health, 2023).


Before implementing the interventions, the team asked pre-survey questions to gauge where the clients were in regard to coping mechanisms. The team asked three questions to a total of 17 clients: how stressed are you on a scale of 1-10? What are the /l/’’main stressors in your life? And do you have healthy coping mechanisms in place to deal with those stressors? The data the team collected found that before the interventions, 64.7% of clients stated that they did not have healthy coping mechanisms that they used in their life. This excluded their recovery circles. The team then implemented three weeks of art therapy and journaling therapy. There were a total of 32 participants over the three weeks of intervention. Forty-seven percent stated that they enjoyed coloring and journaling and wanted to implement this healthy coping mechanism from now on when they felt stressed out. The team then asked the same three questions from above at the end of the intervention weeks and got a response from 15 clients. Of those 15 clients, it was found that 40% were implementing one of the interventions as a healthy coping mechanism in their daily life now.

At the box breathing station, the team had a total of 6 members participate. The team took participants' blood pressure as soon as they sat down and then walked them through a box breathing exercise. After the box breathing, blood pressure was taken again and compared to the pre-intervention measurement. The team found that 83% of the participants had a lower blood pressure after implementing box breathing in comparison to before. One hundred percent of participants were surprised by the effectiveness of this intervention and stated that they would be using this exercise in their daily lives from now on.

The team also took a generalized post-intervention survey and asked clients to rate the interventions on a scale of 1-10, taking into consideration how much they enjoyed them and their effectiveness. In the first week of interventions 10 participants and the average rating was 7.5/10. The second week, there were 12 participants, and the average rating was 8/10. For the third week, there were 10 participants and averaged a 9/10. This data is shown in the bar chart to the right and reflects the client’s views of helpfulness towards the team’s interventions.


The group faced a few limitations that influenced the ability to implement interventions and evaluate longer term effects that clients were experiencing. One of the main limitations was that group talk sessions and lunch are scheduled at the same time as the scheduled clinical hours to be at the site, which in turn limits interaction with clients. The group found that clients were less inclined to interact with us and engage in the interventions during this time. In addition to the time conflict, there are different clients every week, so it is difficult to evaluate the implementation of interventions. The group was able to evaluate the effectiveness of interventions with some clients who saw multiple times throughout the weeks of intervention and evaluation.


With the team's time spent at the recovery center, they were able to identify challenges across this underserved population. One of the main needs identified was a need for healthy coping mechanisms. Discussions with members revealed that they experience high levels of stress and resort to unhealthy coping mechanisms such as isolation and substance abuse. The team’s goal was to introduce healthy coping mechanisms they could resort to in place of the ones that’ll take a toll on their health. In an effort to address the need for healthy coping mechanisms, three interventions were implemented: art therapy, box breathing, and journaling with prompts. These interventions were effective in educating and empowering individuals with healthy coping mechanisms that will help them relieve stress without harming their overall well-being. They believe their interventions laid the foundation for resorting to positive coping mechanisms and lasting resilience.


Brief, M. (2012). Substance use and mental disorders in the Seattle-Tacoma-Bellevue MSA. National Survey on Drug Use and Health.

Coping with Stress. (2021). Center for Disease Control and Prevention.

Holly, T. (2023). The benefits of art therapy can have on mental and physical health. Michigan State University.

Magwood, O., Salvalaggio, G., Beder, M., Kendall, C., Kpade, V., Daghmach, W., Habonimana, G., Marshall, Z., Snyder, E., O'Shea, T., Lennox, R., Hsu, H., Tugwell, P., & Pottie, K. (2020). The effectiveness of substance use interventions for homeless and vulnerably housed persons: A systematic review of systematic reviews on supervised consumption facilities, managed alcohol programs, and pharmacological agents for opioid use disorder. PloS one, 15(1), e0227298.

Sinha R. (2008). Chronic stress, drug use, and vulnerability to addiction. Annals of the New York Academy of Sciences, 1141, 105–130.

Smyth, J. M., Johnson, J. A., Auer, B. J., Lehman, E., Talamo, G., & Sciamanna, C. N. (2018). Online positive affect journaling in the improvement of mental distress and well-being in general medical patients with elevated anxiety symptoms: A preliminary randomized controlled trial. JMIR Mental Health, 5(4).

How journaling can relieve stress. (2023). Intermountain Health.

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