Journal of Preventive Medicine

Introduction
The outbreak of COVID-19 disease caused many problems in the field of emotional, behavioral and social adaptation, especially in teenagers and young people. The impact of COVID-19 on people's mental health was more than the impact on their physical health. Awareness of warning signs such as imbalance in feelings and emotions is necessary for the wellness and maintaining the health of people. At the time of such crises, people use different coping strategies (adaptive or maladaptive). The cognitive-behavioral responses affect the well-being of the individuals and society and can continue for a long time after the outbreak of the disease. The coping strategies during the pandemic included the infection control measures such as cleaning house with sanitary materials, changing decision-making processes regarding health care, obtaining information about the pandemic, and self-quarantine. Some people quarantined themselves in case of suspected contact with infected patients to prevent the spread of the disease to others or because of worry about social stigma. These coping strategies allow them to take better control of their health by taking proactive steps towards self-empowerment and reducing doubts. This study aims to investigate the effect of teaching adaptive coping skills on the development of individual and social adaptability in Iranian college students during the COVID-19 pandemic.

Methods
This is a quasi-experimental study. The study population consists of the students of Shahrekord University of Medical Sciences in 2022. Based on Morgan's table, the sample size was determined 40 per group. Among all medical students, 80 students were randomly selected from different fields of study and randomly divided into control and intervention groups. The entry criteria were willingness to participate in the study and access to the Internet and social networks, while the exit criteria were a history of neurological disorders, mental illness, or other serious systemic disorders, and having substance abuse based on medical records. The data collection tool was the California individual-Social Adjustment Scale. The questionnaire was sent on WhatsApp and completed by two groups.
The training program was the cognitive-behavioral coping-skills training provided to the intervention group at 10 training sessions, each for 30 minutes, using PowerPoint and audio slides, and a training booklet. Immediately and one month after the training program, the questionnaires were completed again. The collected data was analyzed in SPSS v.18 software, using descriptive statistics and statistical tests including independent t-test and repeated measures analysis of variance (ANOVA).

Results
The results showed no significant difference in the mean score of social adjustment and its subscales of social patterns, social skills, family relations, educational relations and social relations in the two groups before the intervention (P>0.05). However, this difference was significant in the post-test and one-month follow-up phases based on independent t-test results (P<0.05). The repeated measures ANOVA showed a significant difference in these scores among three phases (P<0.001). However, this test did not show a significant difference in the mean score of the subscale of antisocial tendencies among three evaluation phases (P>0.05).

Conclusion
The results of this study showed that the coping skills training with a positive cognitive-behavioral approach increases the personal and social adjustment of college students in dealing with the stressful conditions during the COVID-19 pandemic. This training can be used as a selective method in people suffering from corona anxiety. The findings can help planners and policy makers in Iran to adopt effective intervention programs that can increase mental health, coping skills and consequently the quality of life of college students. There is a need for more psychosocial interventions to address the negative consequences of the COVID-19 pandemic and quarantine on the mental health of college students. It is recommended that future studies use interviews to obtain deeper and more accurate information along with self-report tools. Further studies are recommended to compare the results of this intervention program with other metacognitive programs based on coping skills or use combined approaches.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by Shahrekord University of Medical Sciences, Shahrekord, Iran (Code: MED.REC.1400.005).

Funding
This article was financially supported by the Research Vice-Chancellor of Shahrekord University of Medical Sciences, Shahrekord, Iran.

Authors' contributions
All authors equally contribute to preparing all parts of the research.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors would like to thank and appreciate  the Research Vice-Chancellor of the Shahrekord University of Medical Sciences, Shahrekord, Iran.


References

1. Dhungana HN. Comments on "Preliminary estimation of the basic reproduction number of novel Coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven Analysis in the early phase of the outbreak". Int J Infect Dis. 2020; 94:72-3. [PMID]
2. Wei J, Xu H, Xiong J, Shen Q, Fan B, Ye C, et al. 2019 Novel Coronavirus (COVID-19) Pneumonia: Serial Computed Tomography Findings. Korean J Radiol. 2020; 21(4):501-4. [DOI:10.3348/kjr.2020.0112] [PMID]
3. Kannan S, Shaik Syed Ali P, Sheeza A, Hemalatha K. COVID-19 (Novel Coronavirus 2019) - recent trends. Eur Rev Med Pharmacol Sci. 2020; 24(4):2006-11. [DOI:10.26355/eurrev_202002_20378] [PMID]
4. Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle. J Med Virol. 2020; 92(4):401-2. [DOI:10.1002/jmv.25678] [PMID]
5. Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents. 2020; 55(3):105924. [PMID]
6. Jiloha R. COVID-۱۹ and mental health. Epidemiol Int. 2020; 5(1):7-9. [Link]
7. Park CL, Russell BS, Fendrich M, Finkelstein-Fox L, Hutchison M, Becker J. Americans' COVID-19 stress, coping, and adherence to CDC guidelines. J Gen Intern Med. 2020; 35(8):2296-303. [PMID]
8. James PB, Wardle J, Steel A, Adams J. Post-Ebola psychosocial experiences and coping mechanisms among Ebola survivors: A systematic review. Trop Med Int Health. 2019; 24(6):671-91. [PMID]
9. Kamara S, Walder A, Duncan J, Kabbedijk A, Hughes P, Muana A. Mental health care during the Ebola virus disease outbreak in Sierra Leone. Bull World Health Organ. 2017; 95(12):842-7. [DOI:10.2471/BLT.16.190470] [PMID]
10. Chew QH, Wei KC, Vasoo S, Chua HC, Sim K. Narrative synthesis of psychological and coping responses towards emerging infectious disease outbreaks in the general population: Practical considerations for the COVID-19 pandemic. Singapore Med J. 2020; 61(7):350-6. [DOI:10.11622/smedj.2020046] [PMID]
11. Schwerdtle PM, De Clerck V, Plummer V. Experiences of Ebola Survivors: Causes of distress and sources of resilience. Prehosp Disaster Med. 2017; 32(3):234-9. [PMID]
12. Surujlal J, Van Zyl Y, Nolan VT. Perceived stress and coping skills of university student-athletes and the relationship with life satisfaction. Afr J  Phys Health Educ Recreat Dance.2013; 19(42):1047-59. [Link]
13. Smith RE. Effects of coping skills training on generalized self-efficacy and locus of control. J Personal Soc Psychol. 1989; 56(2):228-33. [DOI:10.1037/0022-3514.56.2.228]
14. Esmaeilimotlagh M, Oveisi K, Alizadeh F, Asadollahi Kheirabadi M. An investigation on coping skills training effects on mental health status of University students. J Humanit Insights. 2018; 2(01):37-42. [Link]
15. Sadeghi Movahed F, Narimani M, Rajabi S. [The effect of teaching coping skills in students' mental health (Persian)]. J Ardabil Univ Med Sci. 2008; 8(3):261-9. [Link]
16. Maykrantz SA, Houghton JD. Self-leadership and stress among college students: Examining the moderating role of coping skills. J Am Coll Health. 2020; 68(1):89-96. [DOI:10.1080/07448481.2018.1515759] [PMID]
17. Touzandeh Jani H, Sadighi K, Najat H, Kamalpour N. [An investigation of relative effectiveness of cognitive-behavioral trainings of self-esteem on social adjustment of male juniors of high school (Persian)]. Curriculum Plan Knowl Res Educ Sci. 2008; 21(16):41-56.
18. Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, et al. Psychological impact and coping strategies of frontline medical staff in Hunan between January and March 2020 during the outbreak of Coronavirus Disease 2019 (COVID-19) in Hubei, China. Med Sci Monit. 2020; 26:e924171. [DOI:10.12659/MSM.924171] [PMID]
19. Álvarez-García HB, Lugo-González IV, Correa UJ. The effect of cognitive-behavioral therapy and coping strategies on sleep disturbances during the covid-19 pandemic. In: BaHammam A, Pandi-Perumal SR, Jahrami H, editors. COVID-19 and sleep: A global outlook. Progress in sleep research. Singapore: Springer; 2023. [DOI:10.1007/978-981-99-0240-8_11]
20. Hanani A, Badrasawi M, Zidan S, Hunjul M. “Effect of cognitive behavioral therapy program on mental health status among medical student in Palestine during COVID pandemic.” BMC Psychiatry. 2022; 22(1):310.[DOI:10.1186/s12888-022-03915-1] [PMID]
21. Solgi Z. [The effect of metacognitive skills training on symptoms of social anxiety and demoralization symptoms in girls with high levels of coronary anxiety (Persian)]. Soc Psychol Res. 2022; 11(44):1-22. [Link]