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Recognising and dealing with stress

Key learning points:

 - What is the purpose of stress?

- When does stress become problematic?

- Tips for patients on managing stress

Stress. We all suffer from it and know what it feels like. Walter Cannon's early research on stress in 1932 established the existence of the 'fight-or-flight response'. It is our body's primitive, automatic response that prepares the body to 'fight' or 'flee' from perceived attack or harm. Cannon showed that when an organism experiences a shock or perceives a threat, it quickly releases hormones that help it to survive.1 In humans, as in animals, these hormones help the organism to run faster and fight harder. They increase heart rate and blood pressure, delivering more oxygen and blood sugar to power important muscles. They increase sweating in an effort to cool these muscles, and help them stay efficient. They divert blood away from the skin to the core of our bodies, reducing blood loss if we are damaged. As well as this, these hormones focus our attention on the threat, to the exclusion of everything else. 

When a bridge is carrying too much weight, what is likely to happen? Common answers to these questions include ''it's going to collapse!''. Surely you would see the warning signs before this happens, wouldn't you? The answer could go either way. Similarly, we as humans could be the bridge, with many tasks and stresses on our bridge. Sure there may be a few signs here and there but it is likely that stress can creep up on some and a breakdown could be unexpected. Those who are unable to visualise their stresses should picture their bridge. For example, when taking the children to school in the morning the car breaks down and your iPhone software which has crashed because you did not get round to updating it, so you have no way of calling breakdown service. All of these things one after another loaded on your bridge can cause strain. For some, these everyday stresses could just be the straw that broke the camel's back. 

So what is the point of stress? Why do we have it? For the answer to this, we have to look at how we as a species evolved. Modern humans first surfaced in Africa approximately 200,000 years ago. One of our common ancestors, the earliest humans, was likely strolling through the jungle one day on his way back to the cave when all of a sudden a sabretooth tiger pounced out from behind a bush. Faced with the impending threat of the sabretooth tiger, the caveman would've gone into a fight-or-flight state. His body prepared itself to defend and attack. This would have been a useful response - his life was being threatened by the tiger and the stress helped him act fast. Yet it's not just life-threatening events that trigger this reaction. Even relatively minor frustrations or unexpected events can prompt it, although when the threat is small our response is small. Therefore we often may not notice it amid the many other distractions of a stressful situation.

However, we seem to be living in this fight or flight mode every day, when in actual fact this is not what are bodies are designed to cope with. Our bodies are designed to deal with stress for caveman-like situations. So why are we living in this state? More importantly, how do we avoid remaining in this state or reduce the stress in our everyday lives?

Before we can answer that question we need to be able to recognise the symptoms of stress in ourselves and our patients. The physiological symptoms include:

 - An increased heart rate. 

 - A dry mouth.

 - A tense forehead.

 - Shallow and fast breathing.

 - Strain in the eyes. 

 - Clenched jaws and teeth. 

 - Disruption of the facial complexion.

 - Feelings of anger or hostility.

 - Increased perspiration. 

 - Closing of blood vessels leading to poor circulation.

 - Tightness of the skin. 

 - Increased white blood cell count.

 - Increased blood sugar. 

 - Increased blood pressure.

 - Suspension of the digestive system and 'butterflies' in the stomach.

 - A relaxed bladder. 

What are the signs that someone is not coping with excessive stress? They can include:

 - An increase in sick leave or absenteeism (someone is not fit to work so they take the time off to recover).

 - Presenteeism - (someone is not fit to work yet they go to work anyway).

 - More accidents at home or at work.

 - Arguments, conflicts and disputes between people. 

 - A tendency to work late and not take breaks - eating lunch at their desks.

 - A loss of sense of humour, replaced by irritability. 

 - A tendency to suffer from headaches, nausea, aches and pains, tiredness and poor sleeping patterns.

 - A decrease in work standards.

 - Efficiency, productivity and output dipping. 

 - Indecisiveness and poor judgment.

 - Mistakes and quality of work dipping. 

 - A problem with drinking, smoking, excessive eating or drug taking. 

People looking unkempt, personal hygiene standards dipping - people not presenting themselves to their usual standards. 

How can you best advise patients to help them to lead stress-free lives?2

Step 1: Prioritise your health

Many people aren't tuned in to their body and aren't aware, until it's too late, of the effects that stress is having on them. It is important to have a comprehensive understanding of your mind, body and spirit. It is also important to know how to protect your mind and body from stress and the damage it causes. Stress is a leading cause of poor health and it is up to you to reduce and, where possible, remove any stressors in your life.

Step 2: Get a good night's sleep

Sleep is essential to maintain good mental and physical health. It is nature's healer; the opportunity for your brain and body to repair themselves from the stresses of the day and build and develop for the future. Yet more than 50% of adults have insomnia a few nights a week and 25% suffer from insomnia most nights, lasting a month or longer. What is your day like if you have had a poor night's sleep? Do you find yourself snappy and irritable, overreacting to the most minuscule challenge? What about days when you have slept well? Are you more likely to take things in your stride and stay calm under pressure? 

Step 3: Practice deep breathing 

You can go several weeks without eating, you may be able to go several days without water; however, we can only go a few minutes (at most) without oxygen. Oxygen is the most important nutrient of the body - every cell needs it to function efficiently, however, the brain is the body's largest user of oxygen. Breathing serves two purposes: it helps in ingesting oxygen to be transported to all parts of the body through the bloodstream, and it helps in the elimination of waste products. More oxygen will clear your mind, rejuvenate your skin and energise your whole body. 

On the other hand, lack of oxygen will lead to mental sluggishness, lack of focus, depression and anxiety. If you are looking for relief from stress, practicing deep breathing is one of the best services that you could be doing to yourself. Even under normal circumstances, taking a full, deep breath by itself is deeply relaxing. However, most of us are used to 'shallow breathing': using only 25-30% of our lung capacity.

Step 4: Stay hydrated

Water is the most important nutrient for our bodies after oxygen. We could only survive a few days without drinking water and it's impossible to go through your day-to-day life without being aware of water's importance. The human body is approximately 70% water. The effect that water has on our brains is probably best understood when we understand that our brains are made up of approximately 85% water. 

Clearly then, when we are not hydrated properly enough, we can experience anything from mild headaches and fatigue to seizures, which can be a symptom of severe dehydration. It has now been established that stress can cause dehydration and vice versa. The symptoms of stress and dehydration are very similar - increased heart rate, nausea, fatigue and headaches. Do also bear in mind that when suffering from stress you are far more likely to get dehydrated as your heart rate is up and you are breathing more heavily, causing you to lose fluid. 

Try advising patients to stop drinking all fizzy drinks, caffeinated drinks and juices for a week and replace them with water and see how they feel. Caffeine addicts may suffer from going cold turkey if withdrawing completely (symptoms can include headaches), however, the more water drunk, the easier it will be to manage. 

Step 5: Eat for wellbeing not for stress

Like oxygen and water, food is vital for our health and wellbeing - it is our energy source and provides our bodies with the nutrients it needs to grow, fight disease and repair itself. Food can affect our stress levels in two ways: it can either be the cause of the stress - the physical stress caused to the body and its organs as it gamely tries to assimilate and metabolise what we eat and drink; or it can simply aggravate or increase the stress from which we are already suffering. 

Many of us feed ourselves platefuls of food loaded with toxins, chemicals, fats, sugars and other nasties which are of no benefit to our bodies and we expect it to cope. There has always been a link between stress and nutrition. A balanced diet will boost our resistance against the effects that stress brings upon the body, therefore it is important to constantly top up on vital nutrients. Someone with a healthy and balanced diet is likely to be far less stressed than someone with a poor diet as their bodies are working more efficiently and they are more resilient to stress.



1. Cannon W. Wisdom of the Body. United States: WW Norton & Company; 1932.

2. Shah H. The 10-Step Stress Solution: Live More, Relax More, Re-energise. London: Vermillion; 2012.