**5. Conclusions**

The study of coping strategies adopted by individuals in response to stressful situations is a crucially important topic due to its association with mental health and psychological well-being. Mental health problems are a matter of significant social concern and lead to high economic costs for public health [48]. This study has advanced our understanding of coping strategies and shown that a stressful situation such as lockdown prompts students with existing health problems to adopt an unhealthy coping response based largely on cognitive avoidance strategies (cognitive avoidance and acceptance or resignation). The clinical group experienced a dual spiral of distress and anxiety due to their psychopathological issues and the stress of the lockdown, as well as their ineffective coping responses. In this case, rather than acting as a protective factor, coping strategies became a risk factor that increased levels of distress and anxiety.

In conclusion, it is important to design interventions to ensure that this clinical group develops active, effective coping strategies in response to stressful situations and learns to manage the anxiety caused by the pandemic. Urgent action must be taken to provide this group with medical and social support.

**Author Contributions:** V.-M.L.-R., B.L.-d.-B., S.M.-L., and M.-I.P.-d.-R. designed the study and had full access to all the data in the study, performed all statistical analyses and the interpretation of the data and contributed to manuscript preparation. All authors have read and agreed to the published version of the manuscript.

**Funding:** This work has been funded by the support to Research Groups of the Junta de Extremadura (SEJO14 GR15079).

**Institutional Review Board Statement:** The study was conducted according to the guidelines of the Declaration of Helsinki and was approved by the Bioethics and Biosafety Committee of the University of Extremadura.

**Informed Consent Statement:** Informed consent was obtained from all individuals involved in the study.

**Data Availability Statement:** Data is contained within the article.

**Conflicts of Interest:** The authors declare no conflict of interest.

#### **References**

