Stress and anxiety

Summary
It is always important to have a healthy diet. This means a diet that includes enough vitamins and minerals, and plenty of fruit, vegetables and whole grains. Improving your diet could help with your mood.  

The NHS Eatwell Guide shows that to have a healthy, balanced diet, people should try to:

• eat at least 5 portions of a variety of fruit and vegetables every day (see 5 A Day)
• base meals on higher fibre starchy foods like potatoes, bread, rice or pasta
• have some dairy or dairy alternatives (such as soya drinks)
• eat some beans, pulses, fish, eggs, meat and other protein
• choose unsaturated oils and spreads, and eat them in small amounts
• drink plenty of fluids (at least 6 to 8 glasses a day)

If you’re having foods and drinks that are high in fat, salt and sugar, have these less often and in small amounts.

Try to choose a variety of different foods from the 5 main food groups to get a wide range of nutrients.

Overview
Your way of life will obviously affect your well-being for better or worse. There is a lot of evidence showing that so-called therapeutic lifestyle changes (TLCs) can improve mental wellbeing as effectively as psychotherapy or medication. So what are these healthy lifestyle factors? Among the widely researched TLCs are exercise, improving diet, spending time in nature, attention to relationships and recreation, learning relaxation and stress management skills, religious or spiritual involvement, and voluntary service to others.

Summary
Could what you’re eating make you feel more stressed or anxious? Some people do say they think certain foods trigger odd symptoms. Others say they get irritable and anxious if they haven’t eaten for three to four hours, and that eating makes them feel better within 15 minutes. If you think food(s) make a difference, it would be good to keep a food diary and record when you get your symptoms. If you are sure there is a link between food and your symptoms, consider carefully if you can safely leave off that food. Then try a rigorous elimination experiment where you stop the food completely for a few days, then reintroduce it (the ‘rechallenge’) and check again. Repeat if necessary to rule out other factors. Be careful though: if you are anxiety-prone you may be hyper-alert to associations with foods, and then giving up items may set you down a slippery slope of giving up more and more, and you could end up with a diet that is too restricted.

One common observation is that refined carbohydrates and sugars can send blood sugar up and down, and this can add to anxiety. It is always a healthy option to reduce your sugar intake and instead eat more complex carbohydrates (such as baked potatoes, wholemeal bread and wholemeal pasta) and good proteins (like fish, eggs and free-range meat – these generally the best fat profiles). Your body won’t burn them up as fast as highly processed junk foods, sweets and biscuits. Eating ‘slow-burn foods’, and having smaller meals more often (breakfast, lunch, dinner and three in-between protein snacks), will help you avoid big blood-sugar swings.

There is also growing evidence of the links between health of the gut and the mind (‘the gut-brain axis’) and in particular of the healthy gut bacteria (the ‘microbiome’). The implication is that a diet that is good for the microbiome – high in vegetables, cereals and other plant sources for example – will be good for the mind. The common western high-fat and high-sugar diet has also been shown to add various markers that could increase anxiety and depression.

Evidence
Although the science is building on the links between eating well and psychological wellbeing there is very little direct research evidence as to how changing diets affects people with stress or anxiety.

Safety
If you want to make big changes to what you eat, do check to make sure you are still eating a broad healthy diet and getting all the nutrients you need. Either do your homework online or see a dietician or other specialist. Avoid those who sell fad diet regimes – most do not stand up to scrutiny and may leave you deficient in key nutrients. In general our digestive systems are designed to eat everything – we are omnivores, not carnivores, nor herbivores – and the healthiest digestion and metabolism is often the one with the greatest variety.

Cost
Eating a healthy diet need not cost you anything. For example some of the cheapest food in the world is that eaten in India and elsewhere in Asia. But if you consult a professional there will be a charge, unless there is a dietician service provided by your family practice. Do avoid paying for fad diets.

Summary
Many people find that an alcoholic drink relieves that stressed-out feeling for a short time. So people who are dealing with financial stress, job stress, marital problems and other types of stress tend to drink more – especially if they don’t have much social support. According to the research, the worse and more long-standing the stress, the greater the alcohol consumption. Anxiety disorders are more common among people with an alcohol problem, so giving up alcohol can reduce anxiety in the long run.

Moderate drinking means no more than two drinks a day for men and one drink a day for women. A unit of alcohol is half a pint of ordinary strength beer, lager or cider or a small pub measure (25 ml) of spirits or a standard pub measure (50 ml) of fortified wine such as sherry or port (20% alcohol by volume). A small (125ml) glass of basic wine is 1 and a 1/2 units.

Evidence
Some research has found that alcohol increases anxiety levels. People who are heavy drinkers are most likely to suffer from worse anxiety. Suddenly stopping smoking can increase anxiety for a short period. But research shows that, after stopping smoking, people eventually have fewer anxiety symptoms.

Safety
There are unlikely to be side-effects if you are cutting down from a moderate alcohol intake. If you are cutting down from heavy drinking you may experience side-effects, including loss of appetite and difficulty sleeping. If you are a very heavy drinker, it is a good idea to see your GP and ask for some help while you’re cutting down.

Cost
There are no costs. In fact you will save money.

Further information
For more information, see the NHS information sensible drinking.

If you are giving up or cutting down on smoking you can order a Quit Kit from SmokefreeNHS. You can also phone the NHS Free Smoking Helpline on 0800 022 4332.

Summary
Caffeine is the stimulant in coffee, tea, cola and some energy drinks. It can disturb your sleep, upset your hormone balance, make you feel moody and boost your stress response. In particular one of caffeine’s effects in the tissues is to reduce the breakdown of adrenaline – in other words to extend the anxiety-inducing effects of that hormone. Some people feel jittery after only two or three cups of coffee. If you have a caffeine habit you may feel you need caffeine just to get going. But once the ‘caffeine hit’ has worn off, you’re still tired and feel you need another one.

Evidence
Some surveys suggest that caffeine makes anxious people more anxious and prone to panic.

Safety
Reducing your caffeine intake is safe. But if you are cutting down from large amounts of caffeine, headaches might be a problem for two or three days. It’s better to reduce the amount of caffeine gradually, over a few days.

Cost
There are no extra costs.

Summary
Stress and anxiety is caused by too much of the hormone adrenaline – our best survival tool when we lived in the wild. Look at how alert animals are in nature documentaries! What with predators and hunger we had much more stress in the past than most of us have now. One difference is that in the wild we were constantly active – adrenaline is linked to the ‘fight-flight response’ –  and we know that exercise does much to dispel the negative impact of adrenaline on the body. Nowadays we tend to take our stress sitting down! Getting up and moving may be our best first step to reducing anxiety.

While you are at it try to make your exercise something that builds health. Exercise can be a healthy distraction; so can gardening or working on an allotment, or voluntary work. It’s good to get outdoors. One study found that people were much less depressed after taking a walk in the country than if they spent the same time walking round a shopping centre. So it seems that where you get active is almost as important as how active you get. Green spaces are good for your mood!

Being more active does more than keep you fit. It definitely makes a difference to all sorts of health problems. It makes your heart and lungs work better, tones your muscles, and strengthens your bones and joints. It also stimulates circulation to your brain and internal organs and boosts the immune system. It helps protect against osteoporosis, triggers brain chemicals that lift your mood and can generate a glowing sensation of well-being. Exercising with others can also be a very good way of meeting people.

If you decide to take up more strenuous exercise, you might want to get some support and advice. Exercise classes include aerobics such as stepping and walking; strengthening exercises such as lifting weights or using resistance machines; and stretching for flexibility. There are classes in tai chi, qigong and yoga too. These supervised programmes are safe for most people, though at first you might feel more tired. It’s best to increase your exercise slowly.

Evidence
Research has shown that exercise helps people deal better with stress and anxiety.

Safety
If you’re not used to doing much exercise, you should gradually increase your activity until you can manage a moderate level. If you feel worse, cut back and build up more slowly. If you think it isn’t helping or that you’re getting worse in any way, check with your doctor. Anyone with severe osteoporosis, joint problems, acute back pain or recent injuries should avoid strenuous exercise and get advice from a healthcare professional.

Cost
You can exercise at home for nothing – walking and gardening is all exercise – although you should get advice on the best exercises to do from a trainer first. There will probably be a small cost (usually £5-£8 a class), if you join an organised programme.

Further information
Natural England is one of several organisations that organise walking schemes designed to help people improve their health. Walk4Life Programme has about 600 local groups, and around 40,000 people take part in short local walks every week. Find out about Green Gyms where volunteers take on voluntary projects outdoors. Many local councils organise Health Walks for people who want to get active in company.

Check your local leisure centre for exercise classes. See also the Classes section for more information.

Summary
In a constantly wound-up state we forget what deep relaxation and calm awareness feel like. Being able to switch on the relaxation response at will is a very valuable skill. It should be in everyone’s mental toolkit because it helps break the vicious cycle of stress responses that send you on a downward spiral into the stressed state.

Stress raises your blood pressure, speeds up your heart, makes your muscles tense and increases your sensitivity to pain. It also affects the way your stomach and intestines work. Relaxation training can make you more aware of how your body reacts to situations that make you feel stressed. It can help you control your stress response and improve your mood. Useful relaxation methods include slow breathing and muscle relaxation, self-hypnosis and imagery techniques. Each of these methods can be used on its own, or in combination with one or more of the others.

Breathing calmly and relaxing the mind and body are vital parts of many relaxation techniques, like tai chi, yoga, meditation, autogenic training, visualisation and self-hypnosis. Which one you try is very much an individual choice and you may have to sample several before you find one that suits you. If you don’t feel you can sit still, a moving technique, such as tai chi, may be the best option. And some people find they only get a relaxation response after strenuous exercise. Research has shown that exercise boosts brain chemicals, called endorphins that trigger relaxation. These endorphins provide part of the ‘exercise high’.

Learning to switch on the relaxation response at will could help you cope better with stress and feel less anxious. Why not buy a relaxation CD or download some relaxation tracks to talk you through the steps? Don’t wait until you’re too stressed to learn and practise the relaxation response.

Evidence
Scientists have shown that relaxation response practices can slow the heart rate, lower the blood pressure and reduce oxygen consumption. What’s more they improve symptoms of many health problems, including hypertension, arthritis, insomnia, depression, infertility, cancer, anxiety, even aging!

Safety
Practising the relaxation response is safe unless you have a severe or long-standing mental health problem.

Cost
Once you have learned the relaxation techniques, there are no costs.

Further information
There are many books and audio aids available online. Look for one with independent positive reviews as there are some that overclaim or even exploit.

Summary
Music affects the body and mind in many powerful ways. It can change brain waves, heart rate and breathing. So it’s no surprise that losing yourself in your favourite music can help you relax.

Evidence
There is some research that suggests that music reduces anxiety, and it could work as well as other forms of relaxation.

Safety
Listening to soft music is safe!

Summary
Meditation is a state of mind, not a religion, though it features in most major religions, especially Eastern ones. Meditation seems to harmonise the activity between the two sides of the frontal brain, and encourages a ‘relaxation response’. The relaxation response happens when the body and mind do the opposite of what they do when you feel stressed. In meditation the body is relaxed while the mind is alert. You don’t need an experienced teacher or a spiritual faith in order to take up meditation. You can learn the basics from a book or a podcast. Meditation is easily accessible, and it is remarkably effective, both for rapid stress reduction and as a way of promoting long-term health.

Evidence
Meditation can be an effective way of reducing stress. It may also help people who are naturally anxious and some people who have generalised anxiety disorder. Its effectiveness for other forms of anxiety disorder has not been established.

Safety
Meditation is safe for healthy people. Rarely it may trigger or worsen certain psychiatric problems. If you have an existing mental or physical health problem let your meditation instructor know and ask them about their training and experience.

Cost
Meditation involves certain (simple) techniques, which can be easily practised at home. There are many books and audio aids available and some people find it useful to join a class initially. Once you have learned how to meditate, there are no ongoing costs.

Summary
Progressive muscular relaxation works by tensing and relaxing various muscle groups in your body, starting from your feet and working your way up. At each level, try to notice how it feels when your muscles are tense, and how it feels when you let go and relax. Gradually you will get used to the feeling of relaxation and learn how to make it happen at will. As with most relaxation methods, you need to start by finding a quiet, relaxing place to practise. Put yourself in a comfortable position, whether standing, sitting or lying, and start by allowing your out-breath to get softer, longer and deeper.

Evidence
Techniques such as progressive relaxation are useful when you’re feeling stressed. They seem to lower anxiety levels in some types of anxiety disorder too. For other types of anxiety, treatments such as cognitive-behavioural therapy (CBT) may work better.

Safety
Progressive relaxation is generally safe but should be used cautiously in people with musculoskeletal injury or a long-standing or severe mental health problem.

Cost
Once you have learned the relaxation techniques, there are no costs. There are many books and audio aids available and some people find it useful to join a class initially.