Stress

Mental Health Awareness Week

Stress, the theme for Mental Health Awareness Week 2018, can be defined as the degree to which you feel overwhelmed or unable to cope as a result of pressures that are unmanageable. 

What is stress?

At the most basic level, stress is our body’s response to pressures from a situation or life event. What contributes to stress can vary hugely from person to person and differs according to our social and economic circumstances, the environment we live in and our genetic makeup. Some common features of things that can make us feel stress include experiencing something new or unexpected, something that threatens your feeling of self, or feeling you have little control over a situation.1  

When we encounter stress, our body is stimulated to produce stress hormones that trigger a ‘flight or fight’ response and activate our immune system 2. This response helps us to respond quickly to dangerous situations.

Sometimes, this stress response can be an appropriate, or even beneficial reaction. The resulting feeling of ‘pressure’ can help us to push through situations that can be nerve-wracking or intense, like running a marathon, or giving a speech to a large crowd. We can quickly return to a resting state without any negative effects on our health if what is stressing us is short-lived 3, and many people are able to deal with a certain level of stress without any lasting effects. 

However, there can be times when stress becomes excessive and too much to deal with. If our stress response is activated repeatedly, or it persists over time, the effects can result in wear and tear on the body and can cause us to feel permanently in a state of ‘fight or flight’ . Rather than helping us push through, this pressure can make us feel overwhelmed or unable to cope. 

Feeling this overwhelming stress for a long period of time is often called chronic, or long-term stress, and it can impact on both physical and mental health.

Stress is a response to a threat in a situation, whereas anxiety is a reaction to the stress.

What makes us stressed?

There are many things that can lead to stress. The death of a loved one, divorce/separation, losing a job and unexpected money problems are among the top ten causes of stress according to one recent survey 5.  But not all life events are negative and even positive life changes, such as moving to a bigger house, gaining a job promotion or going on holiday can be sources of stress. 

What are the signs of stress?

Emotional changes

When you are stressed you may experience many different feelings, including anxiety, fear, anger, sadness, or frustration. These feelings can sometimes feed on each other and produce physical symptoms, making you feel even worse. For some people, stressful life events can contribute to symptoms of depression.6 7   

Work-related stress can also have negative impacts on mental health 8.  Work-related stress accounts for an average of 23.9 days of work lost for every person affected 9

Behavioural changes

When you are stressed you may behave differently. For example, you may become withdrawn, indecisive or inflexible. You may not be able to sleep properly 10. You may be irritable or tearful. There may be a change in your sexual habits 11.Some people may resort to smoking, consuming more alcohol, or taking drugs 12.  Stress can make you feel angrier or more aggressive than normal 13. Stress may also affect the way we interact with our close family and friends.

Bodily changes

When stressed, some people start to experience headaches, nausea and indigestion. You may breathe more quickly, perspire more, have palpitations or suffer from various aches and pains. You will quickly return to normal without any negative effects if what is stressing you is short-lived, and many people are able to deal with a certain level of stress without any lasting adverse effects.

If you experience stress repeatedly over a prolonged period, you may notice your sleep and memory are affected, your eating habits may change, or you may feel less inclined to exercise. 

Some research has also linked long-term stress to gastrointestinal conditions like Irritable Bowel Syndrome (IBS), or stomach ulcers14 as well as conditions like cardiovascular disease15

Who is affected by stress?

All of us can probably recognise at least some of the feelings described above and may have felt stressed and overwhelmed at some time or another. Some people seem to be more affected by stress than others. For some people, getting out of the door on time each morning can be a very stressful experience. Whereas others may be able to cope with a great deal of pressure.

Some groups of people may be more likely to experience stressful life events and situations than others. For example, people living with high levels of debt, or financial insecurity are more likely to experience stress related to money16, 17, people from minority ethnic groups or whose who are LGBT (lesbian, gay, bisexual and transgender) may be more likely to experience stress due to prejudice, or discrimination18,19,20, and people with pre-existing or ongoing health problems may be more likely to experience stress related to their health, or stress due to stigma associated with their condition.

How can you help yourself?

There are some actions that you can take as an individual to manage the immediate, sometimes unpleasant, signs of stress and identify, reduce, and remove stressful factors that may cause you to feel overwhelmed and unable to cope. If you feel comfortable, talking to a friend or close colleague at work about your feelings can help you manage your stress.

However, sometimes individual actions on their own are not enough to reduce long-term stress for everyone. We can often be affected by factors that are beyond our direct control. Communities, workplaces, societies, and governments all have a role to play in tackling these wider causes of stress.

1. Realise when it is causing a problem and identify the causes

An important step in tackling stress is to realise when it is a problem for you and make a connection between the physical and emotional signs you are experiencing and the pressures you are faced with. It is important not to ignore physical warning signs such as tense muscles, feeling over-tired, and experiencing headaches or migraines. 

Once you have recognised you are experiencing stress, try to identify the underlying causes. Sort the possible reasons for your stress into those with a practical solution, those that will get better anyway given time, and those you can't do anything about. Take control by taking small steps towards the things you can improve. 

Think about a plan to address the things that you can. This might involve setting yourself realistic expectations and prioritising essential commitments. If you feel overwhelmed, ask people to help with the tasks you have to do and say no to things that you cannot take on. 

2. Review your lifestyle

Are you taking on too much? Are there things you are doing which could be handed over to someone else? Can you do things in a more leisurely way? You may need to prioritise things you are trying to achieve and reorganise your life so that you are not trying to do everything at once.

3. Build supportive relationships

Finding close friends or family who can offer help and practical advice can support you in managing stress. Joining a club, enrolling on a course, or volunteering can all be good ways of expanding your social networks and encourage you to do something different. Equally, activities like volunteering can change your perspective and helping others can have a beneficial impact on your mood.  

4. Eat Healthily

A healthy diet will reduce the reisk of diet-related diseases. There is also a growing amount of evidence showing how food can affect our mood. Feelings of wellbeing can be protected by ensuring our diet provides adequate amounts of nutrients including essential vitamins and minerals, as well as water.

5. Be aware of your smoking and drinking

 If possible, try to cut right down on smoking and drinking. They may seem to reduce tension, but in fact they can make problems worse. Alcohol and caffeine can increase feelings of anxiety.

6. Exercise

Physical exercise can be an excellent initial approach to managing the effects of stress. Walking, and other physical activities can provide a natural ‘mood boost’ through the production of endorphins. Even a little bit of physical activity can make a difference, for example, walking for 15-20 minutes three times a week is a great start.21

7. Take Time Out

One of the ways you can reduce stress is by taking time to relax and practicing self-care, where you do positive things for yourself.  Striking a balance between responsibility to others and responsibility to yourself is vital in reducing stress levels. 

8. Be Mindful

Mindfulness meditation can be practiced anywhere at any time. Research has suggested it can be helpful for managing and reducing the effect of stress, anxiety, and other related problems in some people22. Our ‘Be Mindful’ website features a specifically-developed online course in mindfulness, and details of local courses in your area.

9. Get some restful sleep

Sleep problems are common when you’re experiencing stress. If you are having difficulty sleeping, you can try to reduce the amount of caffeine you consume23 and avoid too much screen time before bed24. Writing down your to do list for the next day can be useful in helping you prioritise but also put the plans aside before bed25. For more tips on getting a good night’s sleep read our guide ‘How to  sleep better’.

10. Don't be too hard on yourself

Try to keep things in perspective and don't be too hard on yourself. Look for things in your life that are positive and write down things that make you feel grateful. 

If you continue to feel overwhelmed by stress, seeking professional help can support you in managing effectively. Do not be afraid to seek professional help if you feel that you are no longer able to manage things on your own. Many people feel reluctant to seek help as they feel that it is an admission of failure. This is not the case and it is important to get help as soon as possible so you can begin to feel better.

The first person to approach is your family doctor. He or she should be able to advise about treatment and may refer you to another local professional. Cognitive Behavioural Therapy (CBT) has been shown to be helpful in reducing stress by changing the ways we think about stressful situations26, this might include focusing on more positive aspects of a situation and reassessing what their likely impact might be. Other psychosocial interventions that can be helpful include brief interpersonal counselling, which can give people the opportunity to discuss what causes them to feel stress and develop coping strategies; and mindfulness-based approaches27.

References

[1] Centre for Studies on Human Stress. Recipe for Stress: Retrieved on 4 Apr 2018 from: http://humanstress.ca/stress/understand-your-stress/sources-of-stress

[2] Segerstrom SC & Miller GE (2004) Psychological Stress and the Human Immune System: A Meta-Analytic Study of 30 Years of Inquiry. Psychological Bulletin, 130, 601-630.

[3] American Psychological Association. Stress: Retrieved on 20 April 2018 from: http://www.apa.org/helpcenter/stress-kinds.aspx

[4] Adamo SA (2014) The effects of stress hormones on immune function may be vital for the adaptive reconfiguration of the immune system during fight-or-flight behaviour. Integrative and Comparative Biology, 54, 419-426.

[5] The Physiological Society (2017) Stress in Modern Britain. Retrieved on 28 March, 2018 from: https://www.physoc.org/sites/default/files/press-release/4042-stress-mod...

[6] Hammen C (2005) Stress and Depression . Annual Review of Clinical Psychology, 1, 293-319.

[7] Stroud, CB, Davila J & Moyer A (2008) Journal of Abnormal Psychology, 117, 206-213.

[8] Bonde JO (2008) Psychosocial factors at work and risk of depression: a systematic review of the epidemiological evidence. Occupational and Environmental Medicine, 65, 438-445.

[9] Health Executive Agency (2017) Work-related stress, depression or anxiety statistics in Great Britain 2017.

[10] Âkerstedt T (2006) Psychosocial stress and impaired sleep. Scandinavian journal of work, environment and health, 32, 493-501.

[11] Bodenmann G, Atkins DC, Schär M & Poffet V (2010) The Association between Daily Stress and Sexual Activity. Journal of Family Psychology, 24, 3, 271-279.

[12] Sudraba V, Millere A, Deklava L, Millere E, Zumente Z, Circenis K & Millere I (2015) Stress Coping Strategies of Drug and Alcohol Addicted Patients in Latvia. Procedia – Social and Behavioural Sciences, 205, 632-636.

[13] Adelson R (2004) Hormones, stress and aggression – a vicious cycle. Retrieved on 20 April 2018 from: http://www.apa.org/monitor/nov04/hormones.aspx

[14] Konturek, P.C., Brzozowski, T., & Konturek, S.J. (2011). Stress and the gut: pathophysiology, clinical conasequences, diagnostic approach and treatment options. Journal of Physiology and Pharmacology, 62(6), 591-599.

[15] Yusuf S, Hawken S, Ounpun S, et al. (2004) Effect of potentially modificable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet, 364, 937-952.

[16] Meltzer H, Bebbington P, Brugha T, Farrell M et al. (2012) The relationship between personal debt and common mental disorders. European Journal of Public Health, 23, 108-113.

[17] McEwen, B.S., & Gianaros, P.J. (2010) Central role of the brain in stress and adaptation: Links to socioeconomic status, health, and disease. Ann NY Acad Sci. 1186, 190-222.

[18] Hajat, A., Diez Roux, A., Franklin, T.G., Teresa, S., Shrager, S., Ranjit, N…. Kirschbaum, C. (2010). Socioeconimic and race/ethnic differences in daily salivary cortisol profiles: The Multi-Ethnic Study of Atherosclerosis. Psychoneuroendocrinology. 35(6), 932-943.

[19] Berger, M., & Sarnyai, Z. (2015). “More than skin deep”: stress neurobiology and mental health consequences of racial discrimination. Stress. 18(1), 1-10.

[20] Meyer, I.H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 129(5), 647-697.

[21] Ströhle A (2009) Physical activity, exercise, depression and anxiety disorders. Journal of Neural Transmission, 116, 777-784.

[22] Weinstein N, Brown KW & Ryan RM (2008) A multi-method examination of the effects of mindfulness on stress attribution, coping, and emotional well-being. Journal of Research in Personality, 43, 374-385.

[23] Smith A (2002) Effects of caffeine on human behaviour. Food and Chemical Toxicology, 40, 1243-1255.

[24] Chang A, Aeschbach D, Duffy JF & Czeisler CA (2015) Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. PNAS, 112 (4), 1232-1237.

[25] Scullin, M.K., Kreuger, M.L., Ballard, H.K., Pruett, N., & Bliwise, D.L. (2018). The effects of bedtime writing on difficulty falling asleep: A polysomnographic study comparing to-do lists and completed activitiy lists. Journal of Experimental Psychology: General, 147(1), 139-146.

[26] Varvogli L & Darviri C (2011) Stress Management Techniques: evidence-based procedures that reduce stress and promote health. Health Science Journal, 5 (2), 74-89.

[27] Palmer A & Rodger S (2009) Mindfulness, Stress and Coping Among University Students. Canadian Journal of Counselling, 43 (3) 198-212.