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Stress

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Stress is the way that you feel when pressure is placed on you.
Brought to you by NHS Choices

Overview

Introduction

A little bit of pressure can be productive, give you motivation, and help you to perform better at something. However, too much pressure or prolonged pressure can lead to stress, which is unhealthy for the mind and body.

Everyone reacts differently to stress, and some people may have a higher threshold than others. Too much stress often leads to physical, mental and emotional problems.

In the UK, anxiety and depression are the most common mental health problems, and the majority of cases are caused by stress. Research by mental health charities also suggests that a quarter of the population will have a mental health problem at some point in their lives.

Stress chemicals

When faced with a situation that makes you stressed, your body releases chemicals, including cortisol, adrenaline and noradrenaline. These invoke the ‘fight or flight’ feelings that help us to deal with the situation. However, when you’re in a situation that prevents you from fighting or escaping, such as being on an overcrowded train, these chemicals are not used.

If the chemicals that are released during stressful situations accumulate from not being used, their effects are felt by the body. A build-up of adrenaline and noradrenaline increases blood pressure, heart rate, and the amount that you sweat. Cortisol prevents your immune system from functioning properly, as well as releasing fat and sugar into your blood stream.

Symptoms

Symptoms of stress

Stress affects different people in different ways, and everyone has a different method of dealing with it.

The chemicals 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

  • anger,
  • depression,
  • anxiety,
  • changes in behaviour,
  • food cravings,
  • lack of appetite,
  • frequent crying,
  • difficulty sleeping (mental),
  • feeling tired, and
  • difficulty concentrating.


Physical symptoms

  • chest pains,
  • constipation or diarrhoea,
  • cramps or muscle spasms,
  • dizziness,
  • fainting spells,
  • nail biting,
  • nervous twitches,
  • pins and needles,
  • feeling restless,
  • a tendency to sweat,
  • sexual difficulties such as erectile dysfunction or a loss of sexual desire,
  • breathlessness,
  • muscular aches, and
  • difficulty sleeping (physical).


If you have been experiencing some of these symptoms for a long period of time you are at risk of developing high blood pressure which can lead to heart attacks and stroke.

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.

Causes

Causes of stress

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 and it has different triggers. Sometimes, just the thought of something, or several small things that build up, can trigger stress.

Some common causes of stress include:

  • money matters,
  • job issues,
  • relationships,
  • bereavement,
  • family problems, and
  • 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.

Diagnosis

Diagnosing stress

Your GP will usually be able to diagnose stress based on your symptoms alone.
However, they may want to run some tests such as a blood or urine, or a health assessment.

This is so that your GP can rule out any underlying conditions that may be causing your symptoms. Your GP may also ask about your family history and your personal life.

Treatment

Treating stress

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 your feelings, particularly if they are interfering with the way that you live your life.

Identifying the cause or causes of your stress is a positive step. Speaking to someone about your feelings may help you to identify the causes of stress, or any other underlying causes.

Counselling

You should speak to your GP if you feel that you are stressed and under too much pressure. They may be able to recommend treatments, such as talking therapy or counselling.

Counselling involves talking to someone about a range of issues, such as the triggers for your stress. 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.

Medication

If stress is causing you to feel anxious or depressed your GP may prescribe medication to treat these conditions.

If you are feeling depressed as a result of stress, you may be prescribed antidepressant medicine. Antidepressants affect the neurotransmitters in your brain. Neurotransmitters pass brain signals between each other.

However, if you are depressed, some neurotransmitters do not work properly or at the correct level. Antidepressant medication boosts the activity of neurotransmitters so that brain signals are functioning effectively and your mood is stabilised.

There are several medications which can help treat the symptoms of anxiety. These include:

  • sedatives, which help you to relax and calm you down,
  • antihistamines, which help to relax your brain,
  • certain types of antidepressants, and
  • beta blockers.

Stress management

Your GP should be able to recommend various stress management techniques for you to practice when you feel yourself getting stressed. Stress management is designed to help you take control of your stress triggers before they cause any further health problems.

If stress is causing you to feel angry, there are various anger management techniques that are available, such as cognitive behaviour therapy (CBT), talking treatments or specific anger management.

There are also a number of independent support groups that are designed to help people to recognise and overcome stress. Your GP may be able to provide you with details of support groups in your local area.

Complications

Complications of stress

If you are very stressed or you experience stress over a long period of time you may develop other conditions as a result. These conditions can include:

  • depression,
  • anxiety,
  • insomnia,
  • high blood pressure (hypertension),
  • stomach and duodenal ulcers,
  • asthma,
  • rheumatoid arthritis, or
  • an over-active thyroid (hyperthyroidism).


These conditions can also lead to the development of other serious health conditions. For example, high blood pressure (hypertension) can increase your risk of developing heart disease and stroke.

Prevention

Preventing stress

Being able to identify what is causing stress is an important step in preventing it. Identifying the triggers 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 in their tracks by relaxing your muscles and taking deep breaths. Start by inhaling for three seconds, then exhale for a little longer. This will help to remove the older oxygen from your lungs and replace it with fresh oxygen that will improve 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

It is important to eat a healthy, balanced diet when you are stressed because food and drink can have am big impact on the way that you feel and act.

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. However, 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 help improve your concentration and mood.

A balanced diet consists of food from the five main food groups. These are;

  • protein (from food like meat, fish, cheese, tofu, eggs and nuts),
  • carbohydrates (from bread, pasta, rice and potatoes),
  • dairy (from cheese, milk and yoghurts),
  • fruit and vegetables (aim for five portions a day), and
  • fats and sugars (from oils and sweet food).


You should also try to reduce the amount of caffeine and alcohol that you drink because they can have similar effects on your body as stress and anxiety.

Department of Health guidelines state that men can drink between 3-4 units of alcohol a day, and women can drink between 2-3 units a day without there being any significant risk to health.

Drinking too much caffeine - found in tea, coffee and cola drinks - can leave you feeling anxious, irritable and restless. Try to drink more caffeine-free varieties, or opt for squash or water instead. Ideally, you should drink between 6-8 glasses (1.2litres) of water a day.

Exercise

The benefits of exercise are numerous. Not only does it release a chemical called serotonin, which makes you feel happier and less stressed, it also improves circulation and prevents conditions such as stroke and heart attack. Exercise also allows you to take out your frustration and anger in a constructive way.

You should aim to do a minimum 30 minutes of exercise five times a week. Any exercise that increases your heart rate and leaves you slightly out of breath afterwards is beneficial. Examples of these type of activities include running, swimming and cycling.

In particular, running has been found to be very beneficial for relieving stress, as well as being an effective method of weight control. However, if you decide to take up running you should ensure that you take it slowly to begin with and build up gradually over several months. Also, 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 period of time, you should visit your GP for a health check-up before starting an exercise programme.

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 getting to sleep or you may wake up a few times during the night. This can also make you tired and groggy the next day, which can make you feel even more stressed.

If you are having difficulty sleeping, you should contact your GP to discuss your sleep pattern and any potential causes of stress. Your GP may prescribe medication to help you sleep or they may suggest counselling to identify any underlying causes of stress. Your GP will also know some relaxation methods that could help you get a good rest.

Quit smoking

Contrary to popular belief, smoking does not help to combat stress. In fact, it can make stress worse and it causes 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, you should remember that the irritability and craving is a sign that your body is trying to repair itself.

If you would like more information, or advice, about quitting smoking, you can call the NHS Stop Smoking Helpline on 08000 224 332.

Relaxation

When you are stressed, your muscles often tense, which can cause muscular aches to develop later on. When 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 it helps them to relax if they imagine a peaceful place, such as a desert island or a tranquil lake. 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 help relieve tension by getting some ‘me time’. Spend some time doing whatever you enjoy - for example, having a warm bath, reading your favourite book or doing some gardening.

Expert view

Stress expert Dr Alan Cohen on the questions to ask

We asked Dr Alan Cohen, a GP and primary care advisor for the National Institute for Mental Health in England (NIMHE), what he would want to know about stress.

What is stress?
Stress can occur when the demands put upon someone by certain situations or thoughts, can make them feel angry, frustrated or anxious. However, the things that cause stress can vary from person to person, and what is stressful to one person isn’t always stressful to another.

So stress is bad for you.
Not always. Stress is a normal part of life and small quantities of stress can motivate you and help you be more productive. It’s when there is too much stress or you’ve a strong reaction to stress, that it can be harmful to your health.

How do I know I’m stressed?
Everyone has different reactions to stress, however it is common to suffer from anxiety as well as a number of physical reactions. These physical reactions can include:

  • Muscle tension, aches and pains.
  • Sweating.
  • Abdominal pain.
  • A rapid or irregular heart beat.
  • Nausea.
  • Sleeping difficulties and nightmares.
  • Irritability.
  • Decreased concentration.
  • A lack of sex drive.

What causes stress?
Stress is caused by a combination of external events (or the anticipation of them) and how we see our own ability to manage them. Sources of stress can vary from work-related performance, money worries or family problems to unemployment, moving house, bereavement and divorce. Alternatively, it can be a combination of minor problems, which all grow into one big problem.

What happens if my symptoms aren’t caused by stress?
If the root cause of your symptoms isn’t clear-cut, physical tests and investigations will be made in order to rule out any other possible reasons.

Does feeling stressed mean I can’t cope?
No, it just means you’re human. Because we’re all different, we all react in different ways to different situations. And admitting you feel stressed can go part way to helping you find a solution to it.

I think I’m stressed. What’s the next step?
This depends on your symptoms and how you react to stress. You may find that just addressing your problems and recognising them as the source of stress, will help you find ways of managing them. It can be a good idea to write down the things that worry you or make you feel miserable. Talking to other members of your family, friends or close members of your community, such as religious leaders, can also help. If you’re still feeling very stressed, you should talk to your GP, who may be able to refer you for further support.

Will my GP give me medication?
Only a very small proportion of people will be prescribed medication for stress.

If you’re stressed:

  • Try to work out what situations make you feel stressed and how you behave in those situations. Is there a way of managing those pressures so 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 make life less stressful. Doing this can help you sort out how you feel about certain situations.
  • If you feel that problems keep on building up and they’re making you more stressed, tell someone about it.

If somebody you know is stressed:

  • Give them support. Let them know you’re there if they want to talk about it. Talking about your problems can help you find ways of dealing with them.
  • Encourage them to eat a healthy diet and not drink or smoke too much. Regular exercise can help get rid of stress. Running, swimming, yoga or tai chi are all good exercises and can all be done with an exercise partner.
  • If stress is adversely affecting their health, encourage them to see their GP or a stress counselor to find ways of dealing with it.

Real stories

Liz’s story

‘The physical symptoms were bad, but the mental fog was awful’

Today, Liz Tucker is a health and wellbeing counsellor who specialises in stress management. Fourteen years ago, at the age of 30, she burned out from too much work-related stress

“I had a building company at the time and was working incredibly hard. It wasn’t unusual for me to drive from Taunton, up to York and down to Norfolk in the space of 24 hours. I’d start work at 7am and often not finish until 8pm the following day, 36 hours later. In fact, the year I burned out, I drove over 100,000 miles.

“I loved the buzz of it. There was a lot of stress involved, but I really enjoyed the adrenaline kick of having something turn out right in the end. It was very satisfying.

“At first the work was manageable. Then, during the year before I became ill, I started working on weekends. I had no social life at all, which didn’t bother me at the time.

“Then I met my partner and because of the pressures of trying to see him, and keep on top of the work, it all began to fall apart. I started feeling really tired and very lethargic and one Sunday night I went to bed early because I felt like I was getting a bit of a cold.

“When I woke on Monday, I simply couldn’t get out of bed. I could move my fingers, head and feet, but I had no energy in my arms and legs.

“When the doctor told me that I’d burned myself out from too much stress, I found it difficult to believe. To me stress was about being unhappy, whereas I was really enjoying my life. But it was true, there was no work-life balance and I was living a high-stress life. In addition, my diet was appalling. I lived on food that I bought in petrol stations, and I hadn’t been getting nearly enough sleep. My body had shut itself down in protest.

“The first three months, I couldn’t get out of bed. All I did was sleep. Very slowly, I began to improve but then, after a few months, the doctor diagnosed ME. I was housebound. The physical symptoms were bad but the mental ‘fog’ was awful. It was like someone had drilled a hole in my head and filled it with concrete.

“I was like this for four years, and I was declining. My partner was beginning to wonder whether I was going to die, and when he asked the doctor, the answer was, ‘I simply don’t know. She has the body of an 80-year-old’. It was very shocking to hear.

“I think up until that point, I’d believed the doctors knew what was right for me, so hearing that they didn’t know what to do made me start thinking about my own destiny. With my partner, I began thinking about what was right for me to do.

“I decided I needed some pleasure in life. I’d been so worried for so long. So I began having a weekly massage and hypnotherapy to help me relax. I also decided not to watch anything on TV that was violent or miserable.

“The biggest turning point was when I began to pace myself. Up until then I’d compare myself to how I was before and if I was feeling a bit better, I try to do lots of things and then feel ill with exhaustion again. I began to realise I was setting myself unrealistic goals so I decided to take things gradually.

“After I’d started this regime of proper relaxing, it was remarkable how quickly I began to feel better. I was eating a healthy diet with lots of fruit and vegetables and I’d stopped having caffeine and alcohol. I began to notice the changes within a few weeks. After three months, I was feeling so much better, but because I’d spent so much time in bed, I was very weak physically. By six months, I was back to normal. I had lots of energy, my skin was better and I didn’t have to stay in bed the whole time. It was amazing.

“I’ve now been working as a health and wellbeing counsellor for 10 years. I went back to university and studied human health and biology, really just to find out what had happened to me. I found it so interesting it’s turned into my career. I’m working really hard again and get a lot of satisfaction out of it, but the difference is that now I have a work-life balance and know what to do when things get too stressed.”

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This article was originally published by NHS Choices

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Readers' comments (1)

  • could somone tell me is it legal to be left in charge of an acute medical ward with just a healthcare assistant?
    my managers is now leving one nurse and one auxillary on a ward for a shift as you can imagine myself and colleagues are not happy

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