Are you all stressed out?

What is stress?

Health24 defines it as follows: “Stress is the physiological, psychological, emotional and behavioural response of a person seeking to adapt and adjust to internal and external pressures or demands. It is basically a physical survival response leading to a ‘flight-or-fight’ reaction. All living organisms - from plants, to animals, to humans - have a stress response. That’s why certain species have survived to this day.”

This means that the body has not only a psychological reaction to stress, but a physical one, and this can have lasting effects on our health. Stress is usually thought of as being psychological, but it also includes physical stresses such as a car accident, an attack of flu, a heart attack or an operation.

What it is not

A certain amount of stress is not a bad thing, but sadly in today’s society the pressures have become so great that many people suffer the effects of excess stress. In days of old the ‘fight or flight reaction’ of fast heart beat, dry mouth etc was  needed for survival, but the urban jungle no longer contains sabre toothed tigers; just bosses, deadlines, spouses etc.

Who gets it?

Stress affects anyone, from the tiniest newborn to the elderly. It can also affect animals, for example your dog may become very stressed when there is a thunder storm, or simply when left alone for too long. Anyone who has watched Cesar Millan’s programs will know that both humans and animals can be very sensitive to stress.

What happens?

In acute stress, there is an instant ‘flight or fight reaction’, no matter whether it is a psychological or physical shock. Think how you feel when someone appears unexpectedly, when you have a near miss in the car [or perhaps not a miss but a smash!], or when you cut yourself badly or burn yourself on the oven. In every scene you are acutely aware of what is happening, your heart pounds, you may gasp in air, your palms may sweat and you may shake. In severe cases people may even vomit and wet their pants or have an involuntary bowel movement.  So often when we ask if someone is OK, they reply “just a little shaken”.

Long term stress, which in other words is not so immediate and continues for some time, may include chronic worry about finances, job pressure, a bad relationship in the family, an unhappy marriage or physical stress such as chronic pain, recurrent headaches, even poor sleep.

What are the Causes:

In acute stress it is easy to see that the body is preparing to fight or flee; the raised heart rate, raised breathing, emptying of bowel and bladder,  are all preparation for rapid physical activity. In this situation the body 1st puts out adrenaline, then cortisol. The effects of these can be measured both directly and by looking at their effects on e.g. blood sugar. When the stress is long term, these reactions continue and the adrenal glands may become exhausted, while cortisol levels remain high, leading to abdominal obesity, hypertension [blood pressure], and raised blood sugar or even diabetes.

What is the usual Treatment ?

If you go to your GP and he diagnoses stress, he may advise you how to learn to manage it, perhaps by referring you to a psychologist or other counsellor. He may also prescribe medication. This may be tranquillisers or antidepressant medicines.

Tranquillisers such as Ativan, Valium etc do have a place, but are highly addictive even when taken for only 4-5 days, so should be treated with care. They are useful for acute situations such as the death of a loved one, but I really don’t think they should be used for long except in exceptional cases. Antidepressant medication is somewhat overused, and the effects have been questioned in the literature; how much is truly effect and how much suggestion? Certain kinds have been shown to be dangerous in teenagers, with an increase in suicides noted. The most useful medications for stress are low dose tricyclics e.g. Amitryptilene, to help with sleep. While the antidepressant dosage for these old friends is 75-100mg, they can be taken at a dose of 10-25mg at night to help sleep, and to aid the management of chronic pain. I find that helping someone to sleep well often enables them to tackle what previously seemed insurmountable when tiredness was adding to the stress.

Sulpiride is a mild antidepressant which is non sedating and can be very useful in taking the edge off stress. It is often used for post natal depressant as it can stimulate milk production, and is safe in breast feeding mothers.

What else can I do?

Today’s world is filled with pressures, both in the home and at work; pressures to conform, work harder, be better... so what to do?

A certain amount of stress is healthy, as it keeps us awake and on our toes, but individuals vary as to how much they can handle. What for one person is an exciting challenge may be a nightmare for someone else. Our individual capacity may also depend on what is going on in the background. We each have only so much capacity, so if, for instance, an individual has a stressful home life, or develops a chronic illness, a normally insignificant incident may just turn out to be the straw on a camel’s back, and result in him reaching a crisis.

One way of looking at this is via the 3 A’s: Acknowledge, Assess, Act.

Acknowledge: The first step in stress management is to recognise that you are stressed. Are you waking in the morning still tired, eating on the go, never feeling that you have achieved anything? NO, it is not normal to be constantly tense and irritable, always wishing there were 25 hours in a day. Perhaps you are smoking or drinking too much, comfort eating or alternatively skipping meals, withdrawing from your normal social life, preferring to sit at the PC or TV, sleeping too much or too little, being angry and lashing out at loved ones. These are all symptoms of excessive stress, and should be addressed.

Assess: Are you a ‘glass ½ full’ person or a ‘glass ½ empty’ one? Try to see what you regard as a problem in perspective. Is it going to change the weather? Will it matter in 12 months time? At the same time try to regard difficulties as challenges, and see what good you can turn each one to. For instance having to sit in a Dr’s waiting room for hours due to a health problem could be an opportunity to catch up on some reading.

Act: Take stock of your life and try to identify the unnecessary stressors. Take a look at your average day; can you delegate some household chores or duties, or perhaps do things more efficiently such as only shopping once a week instead of having to go every day?  Differentiate the ‘musts’ from the ‘shoulds’, and learn to say no; don’t feel guilty for refusing someone’s request that you feel is beyond you, learn to be considerate to yourself!

Make a list of the things [or people] that worry you, then alongside, write the solution and action needed. If there really is nothing you can do then try to put that worry away. However if there is an answer, no matter how difficult it may seem, formulate a step wise plan to address it. It may be as simple as phoning a friend instead of wondering why she hasn’t phoned you, or as difficult as getting a teenager some counselling. If there is a major problem in your life, try to break it into small pieces and then set about tackling it piece by piece; for instance with a major debt: first talk to the bank or a debt counsellor, then remove any temptation to spend more, then draw up a practical budget that includes repayments.

Once you have pared down the necessities and decided to act on the problems, have a look at your attitude. Make yourself a ‘gratitude list’ and write down all the things that you are grateful for. It need not be anything big, simply things that you can appreciate. At the end of each day think about what was nice that day, perhaps the sun shone, your child gave you a hug; learn to appreciate life’s smaller joys!

Make time to relax and do something enjoyable every day, perhaps by taking ½ hour to walk the dog or going for a walk you can combine it with some time to meditate. Even if it is just sitting down with a cup of coffee, do take the time, you will be more productive afterwards. Remember that simply stroking a pet is known to reduce blood pressure, so pat the dog instead of kicking him! This is not luxury time, it is essential ‘you time’, and it should be an important part of your daily schedule. Also try to be aware of your body. Many people tighten their shoulders when anxious, and this leads to tension headaches. Practice relaxing your jaw, neck and shoulders and do some deep breathing.- If you smile you must relax your jaw!

Learn from your mistakes. If you are stressing over a badly handled situation, consider what you could have done differently, and learn from it! We cannot change the world, so at times we must accept imperfection. Don’t be too critical of yourself or others; perhaps the shop assistant who was so rude has her own difficulties to deal with! Try to forgive as you would wish to be forgiven, and accept and enjoy life’s strange quirks! Live a healthy lifestyle, ensure that you are eating properly, getting enough sleep, and try to reduce your consumption of alcohol, cigarettes and sugars.

If your problem is health related, there may be a support group for that problem. To share a stress is often a great relief, and you will be with like minded people who are experiencing similar troubles to yours. You can Google the subject, or try LifeLine: http://www.lifeline.org.za or 0861322322

EFT or emotional freedom technique is an auto suggestion technique which has proven very useful in helping people overcome chronic stress, including post traumatic stress syndrome. It is easily learned and can be done by anyone at any time. learn more about it here: http://www.eft-sa.co.za/

Other treatments include prayer, yoga and meditation, all of which help people learn to relax.

What other treatments are available?

There are times, of course, when no matter how hard you try, you feel overwhelmed, and need some extra help. This is when many make the mistake of turning to readily available comforters such as food [usually carbohydrates], alcohol and cigarettes. Please try to avoid these as they simply create more problems without solving any! There are several over the counter herbal medications that are very effective:

Kava kava is a root from the Pacific Islands which has been shown to have anti anxiety effects equivalent to valium. It is non addictive and not sedating, but there are concerns about liver toxicity, so it should not be used long term or by anyone with liver problems or who drinks too much alcohol. Combining passionflower with kava can help some worriers get some much needed sleep.

St. John's wort is known to be an effective anti depressant. It may cause some sun sensitivity, and can react with some prescription medicines, so please check with your pharmacist.

Valerian root is a natural sedative, and very helpful for insomnia. It has very few side effects.

Rescue Remedy is a well known ‘emergency’ treatment for acute anxiety and shock.

Vitamin B co and vitamin B12 injections can be helpful to give you a boost.

Stressvite made by nrf is an effective supplement containing calcium, magnesium, and B vitamins.

When to worry

If you find yourself unable to contemplate any of the above suggestions, and feel overwhelmed, please go and get help; talk to your GP, a sympathetic friend, a church leader, or phone Lifeline at 0861322322. Remember that no matter how alone you feel, you are not alone and help is available.


 
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