YOUR MENTAL HEALTH MASTERCLASS Dr Sarah Jarvis on coping with stress

Pressure can be a good thing, but too much can cause anxiety and depression. It’s about striking the right balance, says Dr Sarah Jarvis

What is stress? It means different things to different people. It can be defined as the degree to which you feel overwhelmed or unable to cope as a result of pressures that exceed your personal or psychological reserves. Some of us have greater reserves than others, due to a combination of psychological resilience and personal circumstances, and this determines our reaction to stress.

We may respond to the same stress differently at different times. If you’re unhappy in your job, for instance, and are made redundant, you might view it as a blessing in disguise; the motivation you need to take that first step in re-evaluating your career. But if you go through the same event when someone close to you is diagnosed with a terminal illness, your perceptions – and the stress caused by the redundancy – are likely to be different.

Causes and symptoms

When I explore the sources of stress for patients, the causes may vary, but they often arise from the common theme of loss of control. Stress can manifest as…

• Physical symptoms: headaches, palpitations, insomnia, muscle tension.

• Emotional symptoms: agitation, moodiness, irritability, depression.

• Cognitive symptoms: racing thoughts, loss of objectivity, indecisiveness, inability to concentrate, memory lapses.

• Behavioural symptoms: teeth grinding, isolating yourself from others, unhealthy eating habits or excessive alcohol.

Recognising that you are stressed is the first step to taking control.

How to cope

Mental health practitioners often advocate a three-pronged approach: action-orientated, emotion-orientated and acceptance-orientated. If you can take action, do; if not, move on to the next measure. Sometimes, a combination works best.

The action-orientated approach is about identifying the source of stress, confronting it and changing the situation. If, for instance, your sibling assumes you’ll do all the running around after

your elderly mother and this is keeping you awake at night, call a family meeting and calmly set out your rationale for sharing the responsibilities. Or if your teenagers are failing to help at home, give them an option of taking on defined roles or risk having their allowance cut. It might concentrate their minds. But do think about the possible repercussions before you take action, and approach any confrontation feeling calm and prepared.

The emotion-orientated approach is useful when you recognise that you may not have the power to change a situation, but you can manage stress by changing your interpretation of it. I give patients my own simple example: I keep my favourite CD in the car and I’m not allowed to play it unless I’ve been stuck in traffic for at least 15 minutes. So, 10 minutes into any jam, my attitude to the traffic changes as my ‘reward’ comes into sight.

The acceptance-orientated approach is useful, regardless of whether you can help your stress with action. Focus on putting yourself in the best physical and mental position to survive stress you can’t change – practise relaxation exercises or mindfulness, eat healthily, avoid alcohol (see right) and take regular exercise.

Mind your stress

At its simplest, mindfulness is the art of paying moment-by-moment attention to what’s happening inside your body, and what’s going on around you.

Just a few months ago, we bemoaned the pace of our lives and the challenge of finding time for ourselves. The coronavirus pandemic changed that, but the worrying cause of our enforced isolation has hardly been conducive to serene thinking. Instead, some of us may have started to dwell on elements in our lives we can’t control. Mindfulness can help you switch off from a negative spiral, start taking pleasure in elements in your surroundings that you’ve taken for granted, and challenge patterns of unhelpful thought.

If you’re new to mindfulness, start small – just a few minutes of shutting off the outside world can be a challenge at first. Follow these simple steps…

• Set aside 10 to 15 minutes each day, increasing as you become more adept.

• Download the Headspace, Calm or Portal app (App Store and Google Play).

• Sit in a quiet, comfortable environment where you won’t be interrupted.

• Turn off technology – apart from your mindfulness app!

• Focus on one part of your body at a time; be present in the here and now.

• If outside thoughts start encroaching, bring your mind back to the present.

Why alcohol doesn’t help

Many of my patients have reported using alcohol to cope with anxiety, especially in recent months. ‘It helps me unwind and get to sleep,’ is a common refrain. While alcohol might help you sleep, it interferes with the quality of your sleep. You’ll spend more time in deep sleep and less in the restorative sleep phase of REM. In addition, since alcohol is a diuretic, you’re likely to wake up early needing the loo and find trouble drifting off again. And while alcohol might make you feel more relaxed by lowering inhibitions in the short term, it is a depressant and can make you more prone to depression. If you’re cooped up at home in a high-octane environment, it makes arguments more likely.

Women and men should limit their alcohol intake to 14 units a week, spread over several days. Many find increasing the number of alcohol-free days they have in a week an easy way to stick to the limits. Alternatively, swap alcoholic drinks for non-alcoholic options sometimes, and use a drinks measure and the Drinkaware app to keep a tally of your intake.

Online solutions

The coronavirus has fundamentally shifted the way health services are delivered. Almost overnight, GPS moved to triaging every patient with telephone and video consultations. As a result, all of us in the NHS have discovered that we don’t need to see patients as often as we thought. There are many effective online tools to help with anxiety and depression. Among those I recommend most often to my patients are…

• Living Life To The Full For ways to help with anxiety and depression (llttf.com).

• Overcoming Find self-help books and downloadable material by psychologists and therapists (overcoming.co.uk).

• NHS Apps This has mental health apps for everything from anxiety, self-harm and low mood to relaxation techniques and online CBT (nhs.uk/apps-library).