Stress and anxiety

What do we mean by stress and anxiety?

Everyone  feels the effects of stress at times, perhaps before exams or interviews, or during big events like moving house or changing jobs. This sort of stress has a start and a finish. But sometimes the demands stack up, and it all becomes too much: a high pressured job, having to work in order to make money and pay the bills, or not having work and not having enough money, plus dealing with the difficult bits of family life, housework, school runs, being depended on by parents, kids, partner.

Perhaps you can juggle all this until something happens that just seems like the last straw. It doesn’t have to be a big upset – divorce, bereavement or a house move. Big life-events like these certainly add to the pressures, but often what tips the balance is just the daily hassles that keep piling up, and then suddenly make us feel that we can’t cope any more.

The things that stress us may not always be obvious, especially if they are persistent and long-standing. Some examples include poor nutrition, environmental pollution and an impossible job or relationship. And things that bother one person might hardly affect someone else at all. People respond differently to stress, and some people find their stress response gets turned on very easily. Others seem to have a temperament that is much more resilient so it takes a lot more to make them feel stressed.

We hope these pages will help you understand long-term stress and why it can be a problem, and give you some ideas that might help you cope better.

What is an anxiety disorder?

When you are under pressure or faced with a stressful situation, it’s normal to feel worried or scared or tense. The body’s alarm system works automatically when we feel there’s danger around. This sort of ‘stress response’ is there to keep us on the alert and paying attention, so that we take action, and find a way of coping with threats and solving problems.

Some people feel worried most of the time. Anxiety may feel like being frightened or very nervous for no obvious reason. It can make your body react as if you were frightened, even though what you feel isn’t exactly fear. So, for instance, your heart might race, your palms sweat, your face go pale, and your mouth feels dry.

Panic attacks are sudden, overwhelming bouts of anxiety. Sometimes they come on only in certain situations: perhaps triggered by crowds, or queues, or tight spaces, or open spaces, or heights. To keep anxiety at bay, some people feel a compulsion to repeat certain actions that make them feel a bit better. All these kinds of anxiety disorder generally need specialist help. So if the anxiety you feel is constant or overpowering, and if it gets in the way of your relationships or it stops you doing things, then you have may have an anxiety disorder.

Anxiety can be so bad that it becomes a psychiatric problem. Anxiety disorders include obsessive-compulsive disorder (OCD), panic disorder, social phobia (including agoraphobia), generalised anxiety disorder (GAD), specific phobias and post- traumatic stress disorder (PTSD).

Do you have an anxiety disorder?

It is important to separate feeling stressed from generalised anxiety disorder. An over-active and persistent stress response will affect the mind, the emotions and the body. But people with an anxiety disorder experience severe symptoms every day (or nearly every day) and badly enough to make it difficult to cope with ordinary activities and relationships.

Signs and symptoms of generalised anxiety disorder (GAD) include excessive, and largely uncontrollable, worry, tenseness or restlessness, fatigue, difficulty concentrating, irritability, muscle tension and sleep disturbances, lasting for at least 6 months.

Some common symptoms of anxiety disorder?

Ask yourself the following questions. If you answer yes to some of them, you should see your doctor to find out whether you have an anxiety disorder:

• Are you tense, worried or on edge all the time?
• Is this causing you problems at work, at school or with everyday tasks?
• Are you bothered by fears that don’t come to anything but that you can’t shake off?
• Do you feel compelled to do certain things so that something bad won’t happen?
• Do some situations or activities make you so anxious that you have to avoid them?
• Do bouts of heart-racing panic sometimes come out of nowhere?
• Do you feel as if something threatening or a disaster could happen at any minute?

Anxiety and depression often go hand in hand. People who have anxiety disorders are often prone to depression, and people who get depression tend to get anxiety disorders as well.

Anxiety disorders are serious but treatable. And they need proper diagnosis and sometimes the help of a psychiatric team. If you think you might be suffering from an anxiety disorder, don’t rely on these pages. Speak to your GP straight away.

Recognising and managing stress

We can’t avoid demands and pressures; nor should we. Being alive and awake puts lots of demands on the body and mind – think about the effort involved in standing or running, or the mental strain of a job interview. Human beings are designed to cope with difficulties and learn from them, so we usually take these demands in our stride, as long as there aren’t too many of them and we feel strong enough. If there’s some pressure, we feel energetic and rise to the challenge. In fact, the right amount of the right kind of stress feels good because it’s stimulating. It makes us perform better, and we feel good about getting tasks done and solving problems.

On the other hand, if there’s not enough stimulation we may feel bored and unmotivated; the body will feel stodgy and the mind sleepy. Sometimes a challenge may go on for a long time. Perhaps the situation can’t be made any better or the problem can’t be resolved. Even if your body and mind seem to have got used to the strain, in the long-term a persistent stress response may make you feel unwell. Many diseases are triggered or made worse by long-term stress.

What is the stress response?

We all know how it feels to face an emergency. Your heart starts to race, your muscles tense up, your breathing gets faster, your blood pressure rises, and your attention is totally focused on the threat. Like all animals, when confronted by danger we try to survive by tackling the threat or by escaping it. (This is known as ‘fight or flight’).

For as long as the emergency lasts, it takes up most of your attention. Your body forgets about digestion. Blood flows into muscles and away from the belly, causing the dry mouth and the ‘butterflies in the tummy’ feeling. This survival mode is part of our ‘inner caveman.’

The problem is that 21st-century human beings don’t usually face caveman challenges. But our brains and bodies are hard-wired to survive in the hostile environments where our ancestors lived. But you can’t fight a mortgage, or run away from unemployment. These situations are not physically dangerous but they can still trigger the ancient alarm system inside us.

Then, unless we know how to make the relaxation response kick in, these stress responses may begin to snowball and get out of control.

When does stress become a problem?

Some of the things that can cause stress are from outside: big life-events such as bereavement or long-term stresses due to noise, pollution or the general grind of daily life. Some stresses come from inside, such as painful memories, inappropriate expectations and feelings like guilt or insecurity. If these stresses pile up, it gets harder to cope with everthing. Sometimes the inner caveman/woman then gets into unhealthy ways of coping to find some way of quietening down the upset inside. This is how over-use of alcohol and sugary, fatty ‘comfort’ foods, and even addictions to drugs, sex, gambling and shopping get started.

There is plenty of evidence that continual stress can harm health and well-being. Long-term stress is related to some cardiovascular conditions, including high blood pressure (hypertension), heart attacks and stroke. Stress also makes some existing health conditions worse. Some long-term conditions flare up at times of stress, including irritable bowel syndrome, asthma, some skin problems and rheumatoid arthritis. People living with prolonged stress also tend to get more colds and infections because stress makes the immune system less efficient.

Stress-proofing: how to make yourself more resilient?

Often, people are not aware of just how stressed or anxious they are. Some actually rely on a constant adrenaline boost to keep going, and have forgotten what it feels like to relax. They may be irritable, sleeping badly, unable to wind down even on holiday, and perhaps find it difficult to concentrate or make decisions. Even so, they prefer to ignore the signs that they are beginning to burn out.

So the first step is to be aware of feeling stressed. You might not know why you feel this way, or what the pressures actually are. You might even be telling yourself that there’s no reason to be stressed, that life is fine. All the same, certain symptoms are linked to the stressed state and it’s important to recognise them as warning signs that your natural capacity to cope is getting stretched.

Recognising the symptoms of stress

When someone is in continually stressed state there are some typical symptoms:

FEELINGS

• Tense
• Irritable
• Overwhelmed/Helpless
• Anxious

PHYSICAL SYMPTOMS

• Feeling of ‘butterflies in the stomach’
• Being tired/exhausted
• Unexplained shortness of breath
• Feeling sick
• Poor concentration
• Disturbed and unrefreshing sleep

THOUGHT PATTERNS

• ‘This situation won’t change’
• ‘I can’t cope’
• ‘How can I manage all this?’
• ‘I’m out of control’
• ‘I never have enough time’

BEHAVIOUR PATTERNS

• Having difficulties concentrating
• Always being too busy
• Easily losing your temper
• Feeling easily distracted
• Always putting things off.

It’s important to spot these early warning signs, because prevention is better than cure. Eventually if the body can no longer regulate itself properly, health problems may follow: at first stress-linked symptoms, such as heart palpitations, dizziness, shortness of breath, and unexplained pain. If these sensations make you feel more stressed, the stressed state can become a vicious circle that undermines well-being and harms your health.

The relaxation response

Our bodies and minds are hard-wired to look out for challenges and respond to them. Then, when the danger has passed, all our revved-up preparations for action are supposed to go into reverse. So, just as we are designed for action, we are also hard-wired for the sort of calmness and self-healing that gets our bodies back into balance.

This natural set of calming-down reactions can switch off the hyped-up emergency state. As it does, your breathing and heart rate slow down, pumped up muscles loosen up and and your blood pressure drops to normal. The relaxation response draws cholesterol and inflammation chemicals out of the blood, helps your digestion to work properly, and helps your body resist infection. It can turn down the volume control on pain, and help warmth flow where it’s needed in the body. It can even make you more peaceful, creative and patient!

In the 1960s Herbert Benson, of Harvard Medical School discovered that when people learned to turn on the relaxation response and practised doing so regularly it reduced their stress levels a lot. His later research found that people had been doing this for centuries through prayer, chanting and rhythm.

20 tips for controlling your stress levels

1. When faced with a situation that winds you up, use ‘first-aid diaphragmatic breathing’ to diffuse tension. Take long, slow in-breaths and longer, slower out-breaths, using your belly. This needs practice.
2. In a situation you can’t do anything about (for instance, when you’re stuck in a traffic jam or late for an appointment), give a mental shrug, sigh, drop your shoulders and tell yourself ‘this will pass’. This also requires practice! Your body and mind need to rehearse these methods so that they are available when you need them.
3. Eat a healthy, balanced diet. Good nutrition fuels your body systems so that you have more energy to deal with events and are less prone to exhaustion.
4. Don’t skip or rush meals or live on snacks and junk food. Don’t skip breakfast (you need it to jump-start your metabolism) and make sure you take a lunch break. Don’t rely on alcohol, cigarettes or other drugs to help you keep going.
5. Exercise for at least 20 minutes, four times a week, to release the body’s ‘feel good’ chemicals, known as endorphins and channel adrenaline where it was designed to go: into activity.
6. Take regular short breaks for a stretch, and do a little physical activity every day, even if it’s only a short walk.
7. Organise your day to avoid rushing and arrive at your workplace early enough to plan and allocate time for the day’s tasks.
8. Be appropriately assertive: decide what it is you want or feel and say so specifically and directly, then stick to your statement.
9. Learn to say no to unnecessary requests so that you don’t take on too much.
10. Delegate: hand over jobs that other people can do so that you are not over-committed.
11. Prioritise tasks to make the most efficient use of your time. Make daily lists: urgent, and not so urgent.
12. Close the door and put the telephone on hold if there is something that must be finished and you can’t afford to have interruptions.
13. Make your workplace as comfortable as possible. if you’re an office worker, ensure your chair, desk and workstation are ergonomically correct (good for your posture). Personalise your work area with a pot-plant or photograph.
14. Avoid working late. Long working hours have been linked to mental and physical health problems.
15. Spend a few quiet minutes alone, as a buffer zone between work and home.
16. Keep the hour before bedtime free from daily hassles and aim for 6-8 hours sleep every night.
17. Allow at least 20 minutes a day for your choice of relaxation, even if you have to mark it in your schedule.
18. Find time in the week for pleasure and creativity. It doesn’t have to cost. Seek out the little pleasures of life and try to appreciate them.
19. If you go away on holiday, leave your work behind. Short breaks can be more restful than long holidays. Even if you can’t afford a holiday away, try to get a change of scene.
20. Get help when you need it. Open up to friends, family, and professionals. Being able to make use of social support at times of stress is good for everyone’s mental and physical well-being.

Stress management – doing it yourself or getting help?

Later in this section you will learn about several methods of reducing stress, from relaxation techniques to cognitive-behavioural therapy (CBT). Relaxation techniques are very helpful but they are not always the solution. For example, you may be getting stressed because you aren’t working efficiently, in which case time management techniques could help you organise your internal (and external) clutter, and prioritise the things you have to do. Or it might be that you are feeling overloaded because you find it hard to tell people what you do or don’t want. In that case, assertiveness and social skills training could help you deal with people, take more control, and gain self-confidence and self-esteem. There again, if your mind is buzzing with worries, conflicts and confused emotions, you may need to consider counselling or psychotherapy. And if you feel you need to start changing how you think and feel about the pressures you are under, then CBT may be very helpful.

Some problems appear too overwhelming until they are broken down into bite-sized challenges that seem more do-able. It’s important to get a sense of proportion and think clearly enough to find some positive possibilities. If the ways you think and feel about a problem are partly what caused it, then using the same thoughts and feelings won’t solve the problem. Often what’s needed is an attitude change. CBT can help shift stuck and unhelpful attitudes and behaviours.

But some problems really are too big to solve alone. When that’s the case, you may need some help, because major changes always require support, the right information and, most importantly, energy. It takes energy to change things for the better. If (as is likely at such times) you feel exhausted, do whatever you must to get the rest and recuperation you need so that you can begin to make sense of your situation.

Considering different types of treatment

If you feel very anxious or if tension is making everyday work difficult you should get expert advice. Stress levels are easier to handle if you learn the relaxation response, and get enough sleep. You might also need to put yourself under less pressure; take time off or get some help at home. Exercise and healthy eating are likely to help as well. In addition there may be some natural medicines, or treatments or classes that could reduce tension.

Other information that might be helpful

• If you are feeling ‘low’ (particularly if you’re waking early), or if you’re feeling very down about yourself, you might find our DEPRESSION pages helpful.
• If you think your anxiety might be linked to lack of sleep, try our SLEEP PROBLEMS section.
• If are feeling generally exhausted, see the pages on FATIGUE.

For further information see:

• NHS Website information on Stress
• NHS Website information on Anxiety
• MIND
• Samaritans UK or telephone free in the UK: 116 123