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Physician, author and TV presenter Dr Rangan Chatterjee estimates that 80% of patient conditions he sees in his clinic are in some way related to stress.

Isn’t that incredible!? It begs the question: Do you know your stress?

As April is Stress Awareness Month, we’re taking this opportunity to talk about stress. And as always, we’re going to be looking through the three-dimensional BioPsychoSocial lens.

We all know something about stress. Many of us have often uttered: “I’m so stressed”. This could be due to deadlines at work, feeling overwhelmed by what needs doing before bedtime, or attempting something for the first time. While many see stress as primarily a mental thing, that’s just one of its three dimensions. 

As always, it’s more helpful to be curious than critical so, let’s get curious…

What is stress?

Stress is the response to perceived threats, including lack of resources like sleep and food. It’s often referred to as the Fight / Flight / Freeze response and its primary purpose is to keep us alive. When we feel threatened in any way, hormones like cortisol and adrenaline flood our body to galvanise us to fight the threat, mobilise us to run away from it, or shut us down in the hope that the threat will pass us by.

Fight – Flight – Freeze vs. Rest and Repair

Here at The Helpful Clinic, we frequently refer to the body’s stress state and maintenance state.

We are in the maintenance state when there’s little or no stress going on. This state is often referred to as Rest and Repair. This is when the body’s systems, like digestion and immune system, are ticking along quite nicely and everything is functioning alright. 

When there is a perceived threat, we shift to the stress state. The body’s focus changes from operational to survival. This means resources are directed away from systems like digestion or libido and towards everything that helps us fight or flee the perceived threat.

If neither fight or flight feels possible, we shut down or go into freeze. Once the threat has passed, we return to the maintenance state, which allows us to recover and recuperate, hence the ‘Rest and Repair’ moniker.

How do you know you’re stressed?

There are a range of indicators that let you know you’re stressed. We all share most of them, but then we may also have some that are more specific to us. What are your top three clues when you’re stressed? 

Here are some indicators to prompt your thinking:

  • Physical: increased heart rate, sweating, tunnel vision, urge to speed up, loss of libido, headaches, constipation, sleep issues.
  • Mental: initial alertness which then drops into struggling to think and / or speak clearly. Losing sense of humour, struggling to make decisions. 
  • Social: avoiding or clinging onto people, being impatient, being inappropriate, oversharing, saying yes to what you don’t want.
When we exert ourselves physically like when climbing a mountain, physical stress is activated. Image courtesy of Shutterstock

Physical Stress

This is usually activated in response to us either being under some kind of physical duress, or when we don’t have enough resources to function. 

Duress could be climbing a mountain that needs extra effort. The same goes for something more everyday, like exercise. Any physically demanding activity puts your body under duress. Duress can also mean running out of a burning building or lifting a tree trunk off your leg. 

In addition to the duress of an activity, lack of resources affects the stress response. Think of it as your body’s overdraft facility. Say, you haven’t had enough sleep, your energy account is running low and the stress response kicks in to tide you over. Likewise, the stress response is activated when we are hungry until we get something to eat.  Have you heard of ‘hangry’? It combines the words hungry and angry (Fight).

Mental Stress

Mental stress occurs, for example, when we’re overwhelmed i.e. trying to do too much within the time we have. You can learn more about overwhelm, including its benefits, here.

It can also apply to fears or worries that tip us into anxiety. Any situation where we don’t feel safe or we don’t trust that we can deal with what’s going on, will do that. This can be because something is not being addressed or resolved, because of beliefs we have about our abilities to deal with what comes our way or because of rapidly changing circumstances (yup, Covid context counts). 

Then there’s the mental stress that arises because we don’t know how to do something, or we believe that we can’t do it well enough. Feeling not good enough will ramp up the stress response. Finally there’s the mental stress that comes from not having meaning or a sense of purpose in our lives, or when there isn’t a meaningful activity in our day.

Social Stress

This refers to the stress we can feel in relation to other people and in our dealings with social institutions, like the health service or tax authorities. Humans are inherently social animals and although there can often be pressure to not be affected by what other people think, there’s no denying that two thirds of our brain is wired to be affected by others. 

This is why social stress gets triggered by anything that could risk our social relationships or affect whether we feel fairly treated by the social institutions and mechanisms in our society. It’s when we feel we’re being judged by others, for example being looked at disapprovingly.

The curious thing is that regardless of whether the stress response is activated physically, mentally or socially, it’s the same response, so it’s not like these are separate strands, but rather the same experience viewed through all three dimensions each with their own activation mechanism. 

What are you believing about stress?

Nothing is good or bad – ask rather is it helpful?

There’s a quote from Shakespeare’s Hamlet that reads:

‘There is nothing either good or bad, but thinking makes it so’.

Research shows that what we make our stress response mean will either amplify it or reduce it. When we interpret our own stress response as alarming, we’re likely to get stuck in it and it ramps up. When we interpret our stress response as healthy or helpful, we’re more likely to be able to channel the power of those chemicals to move through what’s going. 

We often refer to how we all have thoughts and feelings about our thoughts and feelings. This is the internal conversation about our experience (like a running commentary). When we keep assessing whether something is good or bad, true or false, right or wrong, we can get stuck in judgement. It’s like getting stuck on the roundabout of unhelpful thoughts, just going around in circles. 

When we check our thoughts and feelings about the thoughts and feelings of the stress response, we can shift to being more curious about what’s going on and ask ‘is it helpful?’.

Training and confidence matter

Our stress response is wired to assume everything is life threatening until proven otherwise. We talk about the animal risk model of cats, dogs, wolves, and tigers. This refers to likelihood on the one hand and impact on the other — you can read more about that here.

So if we don’t develop the critical thinking skills to triage the risk — much like a doctor would — when we believe everything is a tiger, we will always be flooded with stress hormones. This reduces our ability to deal with what’s going on. The other component is when you believe that you can handle a stressful situation. When you do, it will reduce the additional stress hormones that will be kicking in at that point. When you don’t, stress increases.

So it boils down to two things: 1) what is the actual size of the threat? Or is it actually not a threat but a challenge? And 2) what am I believing about my ability to deal with that situation? Or to be able to access the resources to deal with that situation? 

The research showed that by changing the meaning of whatever triggered the stress response, our physical responses improved, as well as our thinking towards the source of stress. 

This is important because it highlights that not all stress is bad.

Think about people who deliberately place themselves in stressful situations, like athletes, explorers and doctors. They don’t necessarily experience an adverse effect of being in those situations. That’s because of the training they’ve had and their belief in their ability to handle situations.

In her TED talk, How to make stress your friend, Kelly McGonigal talks about not just the stress response being triggered, but what we then make it mean.

What to do when you are stressed?

First and foremost, it’s important to recognise that you are stressed. Get curious. Map your indicators (if you want to take it to the next level, map your early indicators). This is the A in the ABC and the A stands for Awareness (the ABC is the Helpful First Aid for Feelings technique – you can learn more about it here).

Next do some breathing exercises. Try for example the 5/7 breathing (breathing in to the count of 5 and out to the count of 7), shift your focus into your body, shuffle your shoulders, wriggle your toes, move about. This is the B part in the ABC which stands for Breath and Body.

Finally, check out your choices. This is the C part of the ABC and stands for Choice. Get curious about what you are making your response to the stress mean. Ask yourself, is it helpful? What might be more helpful instead? 

What helps physically, mentally and socially? 

When we look after our stress response in all three dimensions of physical, mental and social, we are better at lowering it i.e. not see everything as a tiger, built our confidence and training in dealing with it better as well as access resources that helps us do that.  

This month get curious about how you do stress and the situations that stress you out. Consider how your stress shows up in terms of the physical, mental and social. What do you do when you are stressed? Do you reach out to others for help? Or do you retreat to behind a metaphorical rock? 

What do you turn to when you’re stressed? Food, alcohol, rescuing others, working more, binge TV? Whatever it is, practice being genuinely curious and ask yourself, is what I’m making it mean helpful? Is a glass of wine / cheesecake / boxset / working more / rescuing helpful? If your answer is yes then great, keep doing that. If it’s not helpful, ask yourself: ‘what might be more helpful?’. Remember it’s more helpful to be curious than critical.

Look out for our next blog which will be about the intensity of stress, how to track it and what happens when the body gets stuck in the stress response.

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Go gently, hold steady, stay the course.
All the best, Thor