This leaflet gives some general tips on how to reduce stress. However, see a doctor if you develop persistent anxiety symptoms.
What is stress?
Stress is difficult to define or measure. Some people thrive on a busy lifestyle and are able to cope well with daily stresses. Other people become tense or stressed by the slightest change from their set daily routine. Most people fall somewhere in between but may have periods when levels of stress increase. Telltale signs of stress building up include:
- Not being able to sleep properly with worries going through your mind.
- Minor problems causing you to feel impatient or irritable.
- Not being able to concentrate due to many things going through your mind.
- Being unable to make decisions.
- Drinking or smoking more.
- Not enjoying food so much.
- Being unable to relax and always feeling that something needs to be done.
- Feeling tense. Sometimes 'fight or flight' hormones are released causing physical symptoms. These include:
- Feeling sick (nauseated).
- A 'knot' in the stomach.
- Feeling sweaty with a dry mouth.
- A 'thumping' heart (palpitations).
- Headaches and muscle tension in the neck and shoulders.
Sometimes stress builds up quickly - for example, the unexpected traffic jam. Sometimes it is ongoing - for example, with a difficult job. Sometimes symptoms of stress occur in response to a very upsetting and unexpected event in one's life. When this happens, the stress is referred to as 'acute". Read more about acute stress reaction.
Is stress harmful?
Ongoing stress is thought to be bad for health but this is difficult to prove. For example, stress is possibly a risk factor for developing heart problems in later life. Stress may also contribute to other physical illnesses in ways that are not well understood. For example, it is thought that irritable bowel syndrome, psoriasis, migraine, tension headaches and other conditions are made worse by an increased level of stress.
Your work performance and relationships may also be affected by stress.
How can I avoid stress?
The following is a list of suggestions that may be useful to try to combat stress. Some will be more appropriate than others for people:
You can try making a stress list. Try keeping a diary over a few weeks and list the times, places and people that aggravate your stress levels. A pattern may emerge. Is it always the traffic on the way to work that sets things off to a bad start for the day? Perhaps it's the supermarket check-out, next door's dog, a work colleague, or something similar that may occur regularly and cause you stress.
Once you have identified any typical or regular causes of stress, two things may then help:
- If you discuss this with a close friend or family member, it may help them and you to be aware of the reasons why you are feeling stressed. Simply talking it through may help.
- These situations can be used as cues to relax. You can use simple relaxation techniques (see below) when a stressful situation occurs or is anticipated. For example, try doing neck stretching exercises when you are in that traffic jam rather than getting tense and stressed.
Try simple relaxation techniques
- Deep breathing. This means taking a long, slow breath in and very slowly breathing out. If you do this a few times and concentrate fully on breathing, you may find it quite relaxing. Some people find that moving from chest breathing to tummy (abdominal) breathing can be helpful. Sitting quietly, try putting one hand on your chest and the other on your tummy. You should aim to breathe quietly by moving your tummy, with your chest moving very little. This encourages the diaphragm to work efficiently and may help you avoid over-breathing.
- Muscular tensing and stretching. Try twisting your neck around each way as far as it is comfortable and then relax. Try fully tensing your shoulder and back muscles for several seconds and then relax completely.
Try practising these simple techniques when you are relaxed; then use them routinely when you come across any stressful situation.
Set specific times aside to relax positively. Don't just let relaxation happen, or not happen, at the mercy of work, family, etc. Plan it and look forward to it. Different people prefer different things. A long bath, a quiet stroll, sitting and just listening to a piece of music, etc. These times are not wasteful and you should not feel guilty about not 'getting on with things'. They can be times of reflection and putting life back in perspective.
Some people find it useful to set time aside for a relaxation programme such as meditation or muscular exercises. You can also buy relaxation tapes to help you learn to relax.
Try to allow several times a day to 'stop' and take some time out. For example, getting up 15-20 minutes earlier than you need to is a good start. You can use this time to think about and plan the coming day and to prepare for the day's events unrushed. Take a regular and proper lunch break, preferably away from work. Don't work over lunch. If work is busy, if possible try to take 5-10 minutes away every few hours to relax.
Once or twice a week, try to plan some time just to be alone and unobtainable. For example, a gentle stroll or a sit in the park often helps to break out of life's hustle and bustle.
Many people feel that regular exercise reduces their level of stress. (It also keeps you fit and helps to prevent heart disease.) Any exercise is good but try to plan at least 30 minutes of exercise on at least five days a week. A brisk walk on most days is a good start if you are not used to exercise. In addition, if you have difficulty in sleeping this may improve if you exercise regularly.
Smoking and alcohol
Many people find that a hobby which has no deadlines and no pressures and which can be picked up or left easily, takes the mind off stresses. Such hobbies include, for example: sports, knitting, music, model-making, puzzles and reading for pleasure.
Some people find they have times in their lives when stress or anxiety becomes severe or difficult to cope with. See a doctor if stress or anxiety becomes worse. Further treatments such as anxiety management counselling - for example, cognitive behavioural therapy (CBT) - or medication may be appropriate.
What is an acute stress reaction?
An acute stress reaction occurs when symptoms develop due to a particularly stressful event. The word 'acute' means the symptoms develop quickly but do not usually last long. The events are usually very severe and an acute stress reaction typically occurs after an unexpected life crisis. This might be, for example, a serious accident, sudden bereavement, or other traumatic events. Road traffic accidents cause many casualties each year and you may be directly or indirectly affected by this kind of exceptionally stressful event. Acute stress reactions may also occur as a consequence of sexual assaults or domestic violence.
Acute stress reactions have been seen in people who experience terrorist incidents or major disasters. They may also occur in people who experience war in their countries. Military personnel are at more risk as a result of extreme experiences during conflicts.
What are the symptoms of an acute stress reaction?
Symptoms usually develop quickly over minutes or hours - reacting to the stressful event. They usually settle fairly quickly but can sometimes last for several days or weeks. Symptoms of acute stress reactions may include the following:
- Psychological symptoms such as anxiety, low mood, irritability, emotional ups and downs, poor sleep, poor concentration, wanting to be alone.
- Recurrent dreams or flashbacks, which can be intrusive and unpleasant.
- Avoidance of anything that will trigger memories. This may mean avoiding people, conversations, or other situations, as they cause distress and anxiety.
- Reckless or aggressive behaviour that may be self-destructive.
- Feeling emotionally numb and detached from others.
- Physical symptoms such as:
- A 'thumping heart' (palpitations).
- A feeling of sickness (nausea).
- Chest pain.
- Tummy (abdominal) pains.
- Breathing difficulties.
The physical symptoms are caused by stress hormones, such as adrenaline (epinephrine), which are released into the bloodstream, and by overactivity of nervous impulses to various parts of the body.
What are the treatments for acute stress disorder?
No treatment may be needed, as symptoms usually go once the stressful event is over and you deal with it. Understanding the cause of symptoms and talking things over with a friend or family member, may help. However, some people have more severe or prolonged symptoms. One or more of the following may then help:
Cognitive behavioural therapy (CBT)
CBT is a talking therapy and is based on the idea that certain ways of thinking can trigger or fuel certain mental health problems. The therapist helps you to understand your current thought patterns. In particular, to identify any harmful, unhelpful and false ideas or thoughts. The aim is then to change your ways of thinking in order to avoid these ideas and help your thought patterns to be more realistic and helpful. When it is used for acute stress reactions it is known as trauma-focused CBT.
This may be an option if symptoms are persistent or severe. Counselling helps you to explore ways of dealing with stress and stress symptoms. This may be available locally but some charities also offer online resources and helplines that may be useful.
Taking a medicine may be an option:
- A beta-blocker is one medicine that can help relieve some physical symptoms that are caused by the release of stress hormones. Beta-blockers are not addictive, are not tranquillisers and do not cause drowsiness or affect performance. You can take them as required.
- Diazepam is a benzodiazepine tranquilliser. These are very rarely used and are reserved for exceptional cases for very short periods. It is addictive and will quickly lose its effect when taken for more than a few days.
What if my symptoms persist?
Some people who have an acute stress reaction will find their symptoms persist for longer than one month. It may be necessary to discuss these symptoms with your doctor. There may be another explanation for your symptoms. Some people with long-term symptoms may need to be assessed to see if post-traumatic stress disorder is a possibility.
Although alcohol may apparently give short-term relief of symptoms it can be damaging. Drinking alcohol to 'calm nerves' may lead to problems with low mood, worse anxiety and problem drinking and is not recommended.
Further reading & references
- Anxiety disorders; NICE Quality Standards, Feb 2014
- Computerised cognitive behaviour therapy for depression and anxiety; NICE Technology Appraisal Guidance, February 2006 (last updated May 2013)
- Rahnama M, Shahdadi H, Bagheri S, et al; The Relationship between Anxiety and Coping Strategies in Family Caregivers of Patients with Trauma. J Clin Diagn Res. 2017 Apr;11(4):IC06-IC09. doi: 10.7860/JCDR/2017/25951.9673. Epub 2017 Apr 1.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Laurence Knott
Dr John Cox