Stress

The everyday meaning of "stress" is being under too much pressure, usually from work or other commitments. It can have psychological and physical symptoms such as poor sleep, irritability and feeling anxious.

Some stress may help your body to prepare for certain challenges, so it's probably impossible to live without any stress. But too much stress, especially if it's day in, day out, can cause physical and emotional problems.

So that your body can respond almost instantly to challenges, many of its control mechanisms happen without you having to think about them. This involuntary control of things such as how fast your heart beats, is achieved by a network of nerves called the autonomic nervous system. This is an essential part of the "fight or flight" response.

As well as triggering responses in muscles, such as your heart, your autonomic nervous system sends signals to your hormonal system, triggering the release of chemical messengers such as adrenaline. These are released into your bloodstream and travel all around your body contributing to the "fight or flight" response by, for example, making you more alert, boosting your blood pressure and releasing sugars into your bloodstream. This results in a heightened - or stressed - state that prepares your body for optimum performance in dealing with the situation.

The modern stresses we face in our everyday lives - such as deadlines at work or money troubles - don't really trigger a fight or flight response. However, they do release the same stress hormones, and this natural reaction can damage health and reduce the ability to cope.

Stress and illnesses

The exact role of stress in causing illnesses isn't known. However, it's clear that stress can temporarily weaken the immune system. And put under too much stress, the body becomes exhausted.

If you are stressed, you may also be more exposed to risk factors for diseases. For example, smokers may smoke more if they are stressed, and people who drink alcohol to relieve stress may become dependent on it. In the long term this will push up your risk of having a heart attack or stroke, and of developing certain cancers. Overall, if you are under long-term stress you are at greater risk of developing disease or dying prematurely.

Causes

Many things (or the anticipation of them) can lead to stress. These include:

• pressure to perform at work or at school
• threats of physical violence
• money worries
• arguments
• family conflicts
• divorce
• bereavement
• unemployment
• moving house
• marriage

Often there is no particular reason for developing stress, and it's caused by a build-up of a number of small things.

Stress can be caused by a range of common situations. However, people have very different responses to stress. For some people, stress can be useful, helping motivate them to achieve more. In others, particularly if it goes on for a long period of time, it causes a sense of not being able to cope.

It's important to differentiate between temporary stress that you know will go away when a situation is resolved, and long-term or chronic stress. Most people can cope with short periods of stress. Chronic (long-term or continuous) stress is much harder to deal with, and can be psychologically and emotionally damaging, both for you and your friends and family.

Symptoms

Everyone reacts to stress differently, but there are some common effects to look out for. In times of extreme stress, people may tremble, hyperventilate (breathe faster and deeper than normal) or even vomit. For people with asthma, stress can trigger an asthma attack. People who are chronically stressed may have:

• periods of irritability or anger
• apathy or depression
• constant anxiety
• irrational behaviour
• loss of appetite
• comfort eating
• lack of concentration
• loss of sex drive
• increased smoking, drinking, or taking recreational drugs
• There can also be physical effects, which may include the following:
• excessive tiredness
• skin problems, such as eczema
• aches and pains resulting from tense muscles, including neck ache, backache and tension headaches
• increased pain from arthritis and other conditions
• heart palpitations
• feeling sick
• stomach problems
• for women, missed periods

Post-traumatic stress

Post-traumatic stress can affect anyone who has been through an extremely difficult or violent experience, such as witnessing a violent death or disaster, being involved in a serious car crash, or surviving a fire.

People suffering from post-traumatic stress may experience any of the symptoms listed. They may also feel a mixture of emotions such as fear, shame, depression, guilt or anger, and recurrent memories or images that may be haunting or lead to nightmares. These feelings can last for weeks, months or even years after the traumatic event that triggered them. Specialist treatment, possibly with medicines and psychological therapies, is available.

Treatment

Self-help

Here are some ways you can help yourself to deal better with stress:

• take regular exercise - even if you are not sporty, brisk walking for 30 minutes every day can be a very effective stress buster
• delegate or share your responsibilities at work - making yourself indispensable can be a major source of problems
• learn to be more assertive - for example, not agreeing to things you know you can't do well or know shouldn't be your responsibility
• don't drink too much alcohol or take drugs - these will not help you to cope better and may make you ill
• don't drink too much caffeine
• try to eat a healthy, balanced diet, rich in fruit and vegetables
• set aside some time to organise yourself
• find some quiet time to listen to music or relaxation tapes
• learn breathing techniques - this can help you to "centre" yourself and slow down

A good way to tackle stress is to talk to your friends or family - sharing your thoughts and worries can help It's important to talk directly to your manager if you are suffering from work-related stress. Your manager has a duty to take reasonable steps to try to resolve the problem.

If stress is causing physical symptoms, severe distress or making it difficult for you to function as normal, it's worth seeing your doctor. It's important to remember that although stress is a usual part of life, extreme or prolonged stress can be harmful and needs treatment.

Your doctor will be able to spot the physical symptoms of stress. In case there are physical reasons for your symptoms, the doctor may also want to do some tests to exclude certain conditions. He or she may also help you identify the things that are causing your stress and give advice on learning techniques to help you relax.

Stress management

There are four basic approaches to dealing with stress:

• removal or alteration of the source of stress
• learning to change how you see the stressful event
• reducing the effect on your body that stress has
• learning alternative ways of coping
• Stress management techniques aim to promote one or more of these approaches. You can learn these techniques from self-help books, attending a stress management course, or personal development or therapy sessions run by a counsellor or psychotherapist.

Complementary approaches include aromatherapy and reflexology, and these may provide a quiet, relaxed environment in which to wind down. Learning relaxation techniques, breathing exercises and meditation can help you to relax. Practising yoga or the Alexander technique may help relieve muscle pains and help you control your breathing in stressful situations.

Medicines

Only in exceptional circumstances is your doctor likely to prescribe medication to help you cope with stress, although some types of anxiety can be treated with antidepressants.

Anti-anxiety drugs such as diazepam (eg Valium) aren't suitable for treating stress. They won't help you learn to cope better with the stresses you face, just make you less aware of them. You may also become dependent on this type of drug.

Rather than relying on medicine, it's usually far better to try and identify the things in your life that are causing stress and try to deal with them.

Further information

Anxiety Care (020 8262 8891) www.anxietycare.org.uk
International Stress Management Association (07000 780 430) www.isma.org.uk
Mental Health Foundation (020 7803 1101) www.mhf.org.uk