Stress
Introduction
What is stress?
Stress is the feeling of being under pressure. A little bit of pressure can:
- increase productivity
- be motivating
- improve performance
However, too much pressure or prolonged pressure, can lead to stress, which is unhealthy for both the mind and body. It can cause symptoms such as:
- difficulty sleeping
- sweating
- lack of appetite
- difficulty concentrating
How common is stress?
It is difficult to estimate how common stress is because not everyone who has stress visits their GP. However, research suggests that a quarter of all adults will have a mental health problem, such as depression or anxiety, at some point in their lives. The same issues that contribute to these conditions, such as divorce and unemployment, may also cause stress.
A recent survey estimated that during 2008 and 2009, over 400,000 people in Britain experienced work-related stress that was making them unwell. Another survey from 2009 found that around one in six workers thought that their job was stressful.
Outlook
It may be possible to manage short-term stress using relaxation techniques, such as listening to music. Making changes at work or home may also help by removing the cause of stress.
If stress is not treated, it may cause further health problems such as:
These conditions may require further treatment, including medications such as antidepressants or talking therapies such as counselling.
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Symptoms
Stress affects different people in different ways, and there is a variety of ways of dealing with it.
The hormones that are released by your body as a result of stress can build up over time and cause various mental and physical symptoms. These are listed below.
Mental symptoms of stress include:
- anger
- depression
- anxiety
- changes in behaviour
- food cravings
- lack of appetite
- frequent crying
- difficulty sleeping
- feeling tired
- difficulty concentrating
Physical symptoms of stress include:
- chest pains
- constipation
- diarrhoea
- cramps, or muscle spasms, when your muscles contract painfully
- dizziness
- fainting spells, where you temporarily lose consciousness
- biting your nails
- nervous twitches
- pins and needles
- feeling restless
- sweating more
- sexual diffuclties, such as erectile dysfunction (an inability to get or maintain an erection), or loss of sexual desire
- breathlessness
- muscular aches
- difficulty sleeping
Long-term symptoms
Experiencing even one, or two, of these symptoms can make you feel frustrated, or anxious. This can be a vicious circle - for example, you want to avoid stress, but symptoms such as frequent crying, or nervous twitching, can make you feel annoyed with yourself and even more stressed.
If you have been experiencing some of these symptoms for a long time, you are at risk of developing high blood pressure (hypertension). This can lead to:
- a heart attack: a serious medical emergency where the supply of blood to your heart is suddenly blocked, usually by a blood clot
- a stroke: a serious medical condition that occurs when the blood supply to the brain is interrupted
See the topic about High blood pressure for more information about this condition.
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Causes
When faced with a situation that makes you stressed, your body releases hormones that cause the physical symptoms of stress. However, what causes stress for you may be different to someone else.
Stress hormones
Stress hormones include:
- cortisol
- adrenaline
- noradrenaline
These hormones are all produced by the adrenal glands (two small organs that are located just above the kidneys). They invoke the 'fight or flight' feelings that help you to deal with a stressful situation.
However, when it is impossible to fight or escape a stressful situation, such as being on an overcrowded train, these chemicals are not used. If the chemicals that are released during stressful situations accumulate, you will feel their effects in your body.
A build-up of adrenaline and noradrenaline will increase:
- your blood pressure
- your heart rate
- the amount that you sweat
A build-up of cortisol will:
- increase your blood pressure
- suppress your immune system (the body’s natural defence against illness and infection), which means you may not be able to fight off an illness or recover from an injury
- release fat and sugar into your bloodstream, which may lead to weight gain
Stressful situations
Everyone reacts differently to stressful situations, and a situation that one person finds stressful may not be stressful to someone else. Therefore, almost anything can cause stress. Sometimes, just the thought of something, or several small things that build up, can lead to stress.
Some common causes of stress include:
- money matters
- job issues
- relationships
- bereavement (loss of a loved one)
- family problems
- moving house
However, sometimes there are no clear causes of stress. Some people naturally feel more frustrated, anxious, or depressed than others, which can lead to them feeling stressed more often.
Carers
If you are a carer, you are more likely to be stressed. Extra responsibilities, worrying about the person you care for and having to be around to help them at any time can all increase your stress levels. For information on caring see the topic Carers.
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Diagnosis
Your GP will usually be able to diagnose stress based on your symptoms. They may also ask you about your family history and your personal life to help determine the cause of your stress.
In some cases, your GP may also want to run some tests to rule out any underlying conditions.This could include:
- a blood test, when a sample of your blood is tested for abnormalities
- a urine test, when a sample of your urine is tested for abnormalities
- an assessment of your overall health, for example by listening to your breathing and measuring your blood pressure
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Treatment
Some people are often unwilling to ask for help if they feel stressed. They may feel embarrassed, or that they should be able to deal with stress on their own. However, if you are stressed, it is important to speak to someone about how you feel, particularly if it is interfering with your daily life.
Speak to your GP if you are stressed and under too much pressure. Speaking to someone about your feelings may help you to identify what is causing your stress, which is a positive step.
Your GP may suggest that you try some self-help techniques, such as exercise (see Stress - prevention and the paragraph below on self help), or they may recommend other treatments, such as a talking therapy.
Your treatment may depend on:
- the underlying cause of your stress
- the symptoms you are experiencing
- whether or not you have been diagnosed with any other conditions
Self help
If you are feeling stressed, the tips below may be useful.
- Work out what situations make you feel stressed and how you behave in those situations. See if there is a way of managing those pressures so that you can face them in a different way.
- Make a list of all the things that make life stressful and a list of things that would help make life less stressful. This can help you sort out how you feel about certain situations.
- If you feel that problems keep on building up and are making you more stressed, tell someone about it.
Counselling
Counselling involves talking to someone about a range of issues, such as what causes you to feel stressed. A counsellor will encourage you to discuss your feelings, and they can help you to find solutions to your problems. They can also help you to discover ways to deal with stress and its effects.
See the topic about Counselling for more information about this type of treatment.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) describes a number of therapies that are designed to solve problems. CBT starts with the idea that your problems are often created by you. It is not the situation itself that is making you unhappy, but how you think about it and react to it.
CBT aims to change the way that you think about a situation, as well as influencing your behaviour. See the topic about CBT for more information.
Anger management
Stress can cause you to feel angry. Anger management is a form of counselling that encourages you to deal with anger in a healthy way. It includes:
- recognising when you get angry
- taking time to cool down
- reducing your general stress levels in life
See the topic about Anger management for more information about this type of treatment.
Support groups
There are a number of independent support groups that help people recognise and overcome stress. Your GP may be able to give you details of support groups in your area.
For example, the mental health charity Mind has a network of local associations. No Panic, a charity for people who have panic attacks, phobias or anxiety, also has a network of local support groups, although there is a membership charge.
Medication
Medication may be used if your stress leads to further problems and you are diagnosed with:
- depression: when you have feelings of extreme sadness, despair or inadequacy that last for a long time
- anxiety: constant feelings of unease, such as worry or fear, that affect your daily life
Depression
If you have depression, you may be prescribed antidepressant medicines. The neurotransmitters (chemicals that carry messages between brain cells) do not work properly in people with depression.
Antidepressant medication boosts the activity of neurotransmitters so that brain signals function effectively and your mood is stabilised.
See the topic about Antidepressants for more information.
Anxiety
There are several medications which may be used to treat anxiety. These include:
- sedatives, which help you to relax, and calm you down
- antihistamines, which have a calming effect on your brain
- certain types of antidepressants
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Complications
If you experience stress over a long period, or you have severe stress, you may develop other conditions as a result. These conditions can include:
- depression: feelings of extreme sadness, despair or inadequacy that last for a long time
- anxiety: constant feelings of unease, such as worry or fear, that affect your daily life
- insomnia: difficulty getting to sleep or staying asleep
- high blood pressure (hypertension)
- stomach and duodenal ulcers (open sores that develop in the stomach or small intestine)
- asthma: a condition that causes inflammation (swelling) of the airways in the lungs
- rheumatoid arthritis, or: a condition that causes pain and swelling in the joints, initially in the hands and feet but any joint may later become affected
- an over-active thyroid gland (hyperthyroidism)
Cardiovascular disease
If it is not treated, high blood pressure can cause many different types of cardiovascular disease (conditions that affect your heart and circulation), including:
- stroke: a serious condition where the blood supply to the brain is interrupted
- heart attack: a serious condition where the blood supply to the heart is blocked
- blood clot (thrombosis): a serious condition that is caused by blood clots within the blood vessels
- aneurysm: a serious condition that is caused by a weakness in the blood vessel wall, which forms a bulge in the blood vessel
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Prevention
Being able to identify what leads to stress is an important step in preventing it. Identifying the causes of your stress will enable you to take steps to avoid them and will help you to recognise when you are becoming stressed again.
There are several ways that stress can be prevented. You may find some of the methods that are outlined below useful.
Deep breathing
If you feel yourself getting stressed, try to halt those feelings by relaxing your muscles and taking deep breaths. Start by breathing in for three seconds before breathing out for a little longer. This will remove the older oxygen from your lungs and replace it with fresh oxygen improving your circulation and alertness.
Continue these deep breathing exercises until you feel calmer and ready to continue what you were doing. It might be better to do something else rather than continue with the stressful task.
Healthy eating
Food and drink can have a big impact on the way you feel and act. It is therefore important to eat a healthy, balanced diet.
Some people find that stress causes them to snack on sugary, unhealthy foods, such as crisps and biscuits. This gives your body a sugar rush followed by a sharp drop in your sugar and energy levels. This can make you feel tired or irritable, as well as making it harder for you to concentrate.
Eating at regular times and not skipping meals can make a big difference. This will allow your body to release a steady stream of energy throughout the day which will improve your concentration and mood.
A balanced diet consists of food from the five main food groups:
- protein (from food like meat, fish, cheese, tofu, and eggs)
- carbohydrates (from bread, pasta, rice, and potatoes)
- dairy (from cheese, milk, and yoghurts)
- fruit and vegetables (aim for at least five portions a day)
- fats and sugars (from nuts, avacados and sweet food).
See the topic about Diet for more information and advice about eating healthily.
Fluids
Try to reduce the amount of caffeine (found in coffee, tea and cola) and alcohol that you drink. These can have a similar effect on your body as stress and anxiety.
If you drink alcohol, do not exceed the maximum recommended daily intake of:
- 3-4 units of alcohol for men
- 2-3 units of alcohol for women
One unit of alcohol is a single (25ml) measure of spirit, a small glass (125ml) of wine or half a pint of standard-strength lager, cider or bitter. Drinking more than the recommended amount can have a negative effect on your health.
Drinking too much caffeine can leave you feeling anxious, irritable, and restless. Try to drink more caffeine-free varieties, or opt for squash or water instead. Drink 6-8 glasses (1.2litres) of fluids a day.
Exercise
Exercise has numerous benefits and is known to:
- release a chemical called serotonin, which makes you feel happier, and less stressed
- improve circulation and prevents conditions, such as stroke and heart attack
- allow you to take out your frustration and anger in a constructive way
You should aim to do at least 30 minutes of exercise, five times a week. The exercise should increase your heart rate and leave you slightly out of breath. Examples of these type of activities include:
If you decide to take up running, take it slowly to begin with, and build up gradually over several months. Make sure that your footwear is suitable for your running style. If you are unsure about this, the staff at your local running store will be able to advise you.
If you have not exercised in the past, or if you have been inactive for a long time, visit your GP for a health check-up before starting an exercise programme. See the topic about Exercise for more information.
Sleep
It is common for your sleep pattern to be disturbed when you are feeling stressed. If you are worried about something it can often be on your mind even when you try to forget about it. This may cause sleepless nights, or bad dreams.
You may find it difficult to get to sleep, or you may wake up a few times during the night (insomnia). If you feel tired the next day, it can make you feel even more stressed.
If you are having difficulty sleeping, contact your GP. They will be able to discuss your sleep pattern with you and any potential causes of stress. Your GP may:
- prescribe medication to help you sleep
- recommend cognitive and behavioural treatments to change any unhelpful thoughts and behaviours that are contributing to your insomnia
See the topic about Insomnia for more information about this condition.
Quit smoking
Contrary to popular belief, smoking does not help to combat stress. In fact, it can make stress worse as well as causing damage to your body.
Giving up smoking is not easy and, in the short term, may lead to you feeling more stressed, or annoyed. However, irritability and craving is a sign that your body is trying to repair itself.
See the topic about Quitting smoking for more information and advice or speak to your GP or pharmacist.
If you would like more information, or advice, about quitting smoking, you can call the NHS Smokers Helpline Wales on 0800 169 0 169 or visit the NHS Smokefree website.
Relaxation
When you are stressed, your muscles often tense, which can cause muscular aches to develop later on. If you feel yourself getting stressed, shrug your shoulders a few times and shake out your arms and legs. This will help to loosen your muscles.
Some people find that imagining a peaceful place, such as a desert island, or a tranquil lake, can help them relax. Imagine yourself being there and the scenery around you. Diverting your mind to a calming environment will help to distract you from the stress and relax your body.
You can also relieve tension by having some time to yourself. Spend some time doing whatever you enjoy, such as:
- having a warm bath
- reading your favourite book
- doing some gardening
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