What is the problem with ‘stress’ ?
The word ‘stress’ is often used in a variety of contexts and can come to mean a plethora of things, but here it will be used in a professional mental health sense.
1. Stress is a hormonal reaction to a situation that signals there is a perception of risk or threat.
2. Stress is a biological and psychological response to the need to act.
3. Stress is part of a normal regulated person’s life balanced between action and relaxation.
One and two in the list are essentially the same but involve a cognitive reframing and two and three are the types of stress that are useful and healthy. One is the stress that leads to problems such as burnout. When one happens our body secretes two hormones that produce physical changes, they are adrenaline and cortisol. Adrenaline as most folk know increases heartrate, it makes us sweat and gives us a dry mouth, our hearing improves, and our field of vision narrows. Cortisol tenses our muscles, affects our stomach and appetite, and changes our immune response. Adrenaline is pretty short lived, but cortisol can build up in the body and is often the hormonal response that can produce health problems if not regulated, it also has a significant effect on mood if again not regulated.
Work stress management
In mental health, work stress management is understood as key in the development of severe conditions such as psychosis. Identical twins where one develops psychosis show the other has a 50/50 chance of developing it because external factors play a significant part*. This genetic and environmental combination runs true for all mental illnesses, though the actual percentage vary.
One of the biggest environmental factors is the presence of stressors that cannot be managed either because they are too great or because the person experiencing them has limited or ineffective tools to cope. Too great to manage is either a one-off event that is overwhelming (e.g., a near death car crash) or an event happening repeatedly over a longer period that wears you down. Stressors are things that produced this biological response or stress hormones being released.
The classic signs of being stressed out are:
- Fatigue from tense muscles
- Problems or changes in sleep
- Changes in outlook
- Irritability and anger
- Avoidance of people places or things (including work)
- Intrusive thoughts, or too many thoughts of different worries, or obsessive rumination on one thought
- The use of alcohol, drugs, sex, or food to manage feelings
- Concentration issues
- Drop off in performance
- Multiple small illnesses
- Multiple small absences from work (unexplained by prior knowledge of for example issues of childcare etc.)
All these issues can be mitigated against significantly by effective stress management techniques even if there exist significant environmental stressors. Though repeated and long-term exposure to risk for example will inevitably produce negative effects on an individual.
Things that work to help the individual fall into a few categories:
- Cognitive work
- Healthy living tools
- Behavioural tools
Principally under cognitive work we are looking at knowledge base and thinking tools. Learning about stress and one’s own coping mechanisms is crucial as a defence against overwhelm. Psychoeducation (learning about mental health and mental ill health) is one of the four pillars of cognitive behavioural health. Learning about and normalising our situation means we are less afraid, and less fear means reduced stress hormones. The second element of cognitive work is tools such as reframing (I’m not afraid of flying I’m excited), balanced thinking to challenge hot thoughts (I’m not a failure facing ruin if I don’t meet the deadlines, I am a person doing my best to achieve my goals).
Healthy living is key, sleep properly, exercise regularly and eat a healthy diet. Focusing on your physical health is the same as focusing on your psychological health and vice versa. If you can do one thing on this list and nothing else start taking regular exercise. It is the single most important change you can make to your health.
Good relationships as a social animal are your get out of free jail card. It doesn’t matter what is happening in your life if there are people around you who love about you and care about you and who you love and care about, things will be fine. Talk to everyone who will listen about your struggles and to those who won’t listen! Loving supportive relationships are deeply valued biologically because it’s a main species level survival tool (the herd) and as such social bonds produce loads of reward hormone which have the impact of reducing stress hormones.
For behavioural tools it’s partly covered by exercise which will reduce anxiety and depression, but there is also exposure work which might need to be led by a professional. Exposure work was developed in CBT to help reduce anxiety expressed via avoidance. Effective exposure work helps us learn we can manage that which triggers us to isolate and hide much better. It sits alongside work around distress tolerance from work in DBT. Both CBT and DBT are forms of evidence based psychological therapies that will need qualified professionals.
One of the big stressors at the moment is the move into the “festive season”. It is what’s called a known stressor as it happens at the same time every year. Somehow though people seem to forget that actually it is quite stressful and imagine that it’s going to be just lots of fun and it will be fun. However, if you don’t predict and plan for the actual difficulties that are known to exist during this time of year, you will experience those stresses much more strongly. Again, thinking about all the tools that are at one’s disposal and having a realistic appraisal of just exactly what is going to be happening will help us frame it correctly. We are still struggling with the cost-of-living crisis even though the rates at which things are increasing in cost has reduced. So, the first thing is to be aware of what is going to be a challenge and accepting that can mean that you will get through the challenge much more effectively. So, it’s really important during the build-up to the festive season and during it that you think about self-care needs in particular, making sure that you are resting and sleeping, that you are exercising, that you are meeting with your friends, that you are doing special things for yourself when you can. It’s the non-flying equivalent of being told to put the oxygen mask on yourself first. Ask yourself the question what celebration do you actually want? It’s also crucial to be thinking at this time of year on reducing not increasing your use of alcohol. Alcohol has a profoundly complex and difficult relationship to stress. It is, during times of stress that alcohol can become more of a prop than anything and a prop that’s going to break.