Dr Chris Moore
Managing Stress - Calming our Actions
Our actions are greatly affected by chronic stress. We may try to avoid situations, become preoccupied with the means of quickly escaping an activity or behave in ways which provide quick comfort at the expense of long-term well-being. Here are some ways in which we act as a response to stress:
· Avoid going to places.
· Reduce our time socialising with others.
· Withdraw from situations.
· Become disorganised.
· Spend time procrastinating.
· Delay making decisions.
· Take on too many tasks at once.
· React emotionally, such as becoming angry or tearful.
Some of these actions provide a short-term gain, in that we put off an anxiety-provoking situation or eliminate it completely. However, the problem underlying these actions continues to grow in the background. These actions can merely reinforce and maintain our anxiety. We can start to feel paralysed and resist taking responsibility for important decisions. As we can engage in these actions more often, we become over-sensitive to perceived threats to our well-being. They can put strains on our relationships with others, especially if we take out our anger on others or keep them at arm’s length by isolating ourselves.
These actions ultimately undermine our self-esteem and confidence. We start to focus on what we aren’t doing or what we feel is impossible, thereby reducing our awareness of the skills we do possess and how we have coped well with situations in the past. This leaves us vulnerable to both anxiety and depression.
If you feel that problems are insurmountable, the best advice is to seek help by talking to a family member or a friend, contacting your GP or seeking advice through a helpline. The NHS website has a list of supportive organisations which can be found here - https://www.nhs.uk/conditions/stress-anxiety-depression/mental-health-helplines/ During the current coronavirus pandemic, it may be more difficult to quickly obtain professional support. The following are some general ideas for calming our actions.
Identify when the stress is at its worst
Try tracking your feelings over time. Make a list of everything you did in the day and at what time – break it down to fine details such as getting out of bed, having a shower, having breakfast, etc. If you can label a specific feeling that is affecting you (such as worried, tired, distracted, etc), give yourself a score out of 10 for how strong that feeling is during each activity – 10 being very strong and 1 being very weak.
This can help to identify times of the day when you are most susceptible to stress and therefore times when you need to apply coping strategies. If you wake up feeling bad, this may be the time to do a quick exercise or breathing routine as suggested in my “Calming our Bodies” blog. If you start to worry as you go to bed, you might need to practise challenging your thoughts or reframing them with the “3 Good Things” exercise referenced in the “Calming our Thoughts” blog.
Set achievable goals
When you’re in a rut, what you really want is for the problems to magically disappear. We can pretend this is the case by putting something off or avoiding it altogether, as these actions give us a few hours or days of respite before the problems become an obstacle once again. The healthier option is to set goals that we can achieve. It might be three things to get done in a day or there may be days when even achieving one thing is enough to reduce our worries.
It’s important to set very explicit goals, so that we have something precise to aim towards. Let’s take the example of someone who is feeling very down and has become unproductive at home. “Do some housework” is a very vague goal – the person may be watching the clock and become more and more worried by the fact that they know they wanted to do some housework but haven’t found the motivation. By the evening, they can feel guilty about their inaction and engage in unhealthy habits like eating snacks. Setting a clearer goal, such as “I’m going to vacuum all the rooms downstairs”, provides a more specific objective and provides a sense of accomplishment when it is completed. Even if the person did “some” housework, there can be guilt over the amount that was done or how long it took. We can feel better when we focus on results, rather than how many things we do or how much time we spent on them.
Slow down and Prioritise
Stress can be so overwhelming that it’s hard to know where to start in tackling it. It’s easy to act impulsively and try to get something out of the way, in order to quickly reduce our worries or our level of pain. We see this in someone who is socially anxious. They may feel very uncomfortable in a crowded bar and only go there for a short time or sit at the door so that they can have breaks from the social demands. But when that person realises that they can eliminate the stress completely by not even going to a place, this reduces their capacity to tolerate any uncomfortable feelings and may lead to them withdrawing from more important activities in their lives.
Instead of making quick decisions, we can slow down and take our time. “To do” lists are a great way of breaking up stress into smaller and more manageable chunks – especially as they can be written on paper or kept in an app on our phones or an online calendar. Try putting the jobs or activities in order. You may want to start with the worst thing, so that it doesn’t play on your mind over the course of the day and you get the biggest positive emotion early on after achieving it. As outlined in my “Self-Care” blog, you can divide the list into “Must do” and “Should do”. The former is what you have to get done, while the latter are bonus items. This is about putting things into perspective. If we think about work-based stress, some of us may have workloads which will never be cleared. But we can manage the guilt or anxiety about how much you achieve by prioritising the most important things and showing ourselves that we are making progress over time.
Constructing a Positive Daily Routine
When we feel depressed, we tend to stop doing the things we enjoy and find rewarding. Did you used to read more often? Did you previously go for a walk in the evenings? Have you stopped listening to music as often as you used to? These are the types of things we need to bring back into our daily schedule. When thinking about our routine and the times of the day that make us stressed, we can try to incorporate these activities to increase positive emotion and distract us from unhealthy urges.
When I’m stressed, I’m very susceptible to snacking between 10pm and 11pm - even if I’m not particularly hungry – and I become more prone to watching things on my iPad instead of reading in bed. I now try to play a game or listen to music on an iPod – something which occupies my hands until the urge subsides, which then makes me more likely to read and therefore relax into sleep. It’s important to be realistic about these activities – it may take time for them to become as enjoyable as they once were. We can balance these with time in the day to worry about what is on our minds. Consider scheduling time in the evening to think about what is making us anxious. We can write them down or make a “To do” list for the following day so that we clear our minds. We may even forget about what we were going to worry about later on, by the time those 10 or 15 minutes for worrying come around in the evening.
Face your fears with a Plan
Facing your fears is a key component of any Cognitive Behavioural approach to anxiety and stress. Dr Jim White, Consultant Clinical Psychologist and creator of the “Stress Control” programme (https://stresscontrol.org/home), talks about how this makes us feel worse in the short-term but better in the long-term. This is because stress-based actions, such as avoidance, externalising behaviour or risk-taking, have the exact opposite effect – they make us feel better in the short-term but worse in the long-term because unhealthy habits start to impair our daily functioning. Facing our fears is not something we can just jump into – it will take time for our confidence to grow and we are very likely to have setbacks along the way. This is why a plan is so important. The first step is to create a clear problem statement and what you do (inadvertently or deliberately) to maintain the problem.
Let’s take the example of the current coronavirus pandemic – someone who is so afraid of catching the virus that they do not want to leave their house. The statement would be “I am afraid to go outside” and the maintaining behaviour is “I stay in the house all day”. The person could come up with different solutions and weigh up the pros and cons. Dr Paul Stallard, author of “Think Good, Feel Good”, talks about the concept of a ladder and tackling problems in small steps. Going to the supermarket might be a step too far at such an early stage, but simply being out in the back garden would be a smaller step with less chance of overwhelming anxiety. The steps can be very precise, such as standing out in the garden for 1 minute and then gradually moving on to 2 minutes, 5 minutes, etc. Bigger steps might be going for a walk up and down the street, going for a short drive to a familiar location and finally going to a place with other people. This achieves the goal of leaving the house with increasing levels of success.
It will be important to review the plan and think about whether it was better or worse than expected, what worked well, what didn’t work well and how it can be changed for next time. As outlined in my other blogs, use relaxation strategies to keep your body calm and apply mantras or positive self-talk to help keep negative thoughts at bay. The most important thing to remember is that it is a plan – plans may be effective on some days, but less so on other occasions. They are a work in progress.
This was the take-home message from my own training on stress management, after going through a period where I had to take time off work to look after my mental health. Stress is something we must constantly work on. We will always have stress in our lives and a moderate amount has many benefits. I would be lying if I said that I have fully recovered from my own stress – if anything, it has taught me that there is no silver bullet. We can know about an endless amount of strategies, but ultimately we must have the courage to know when we need them, put them into practice when stress is getting on top of us and not be too harsh on ourselves when we do not achieve success right away.