Mental Health Awareness Week 2018 is focused on stress, and rightly so, as stress is in many ways health enemy number one. As well as increasing our chances of developing physical health problems such as heart disease, high blood pressure and even cancer, chronic stress also increases our chances of developing mental health issues such as depression, anxiety, and other mood disorders.
Whether at work, at home, at school, or within the confines of our inner worlds, stress affects everyone. Stress, and whether it's helpful or unhelpful to us, can be visualised in an inverted u-shape. Some stress is good for us: our stress response keeps us safe from danger, gives us mental clarity, increases performance and enables us to get things done - up to a point. These positive effects of stress go up and up (on our inverted u-shape) until they reach a critical point, beyond which all of these helpful benefits plummet and the opposite results: impaired performance, brain fog, feeling paralysed and unable to complete daily tasks.
This might all sound familiar, and is at the root of our complicated relationship with stress. We know that, at times, stress has helped us out. It might also ring true that some people simply respond differently to stress than others. And that people who seem so in control of their stress levels in some area of their life can surprise us by experiencing immense stress in another. There are various reasons why this is the case, as we explore below.
Why do some people get more stressed than others?
Goal-setting, self-worth, and stress
You might think, 'I'm only stressed about xxx, because I care so much'. This is entirely valid and goes some way to explaining why some people get more stressed than others. The value that we place on achieving our goals is central to our ability to deal with stress. It's entirely normal to feel stress generated by a work project that you care about doing well in, or passing your exams, or fighting for your relationship to survive; it's also entirely normal to want to achieve your goals. However, what might separate someone who doesn't feel unhelpfully stressed in these situations, from someone that does, is self-worth. The degree to which meeting life's goals - often that we set for ourselves - relates to our sense of self dictates how stressful we will find meeting these goals, and even more so how we deal with potential failure to reach them. If our self-worth is contingent on reaching every goal we set ourselves, then we will experience high levels of stress when we are challenged, because to fail is to mean that we aren't good enough.
Unfortunately, higher levels of stress in the face of something that we care about can actually stop us from performing optimally, thus making that utterly-dreaded failure more likely.
Circumstance and choice
Some people simply lead lives that create more opportunities for stress than others. Circumstances related to our financial stability, our relationships, whether people are dependent on us or not (whether children, partner, or an unwell relative or friend), our health, our work situation: some people's lives are more stressful than others. Key to this is the element of choice. How much autonomy a person has in their situation is central to how stressful that situation is. Consider a person who has just accepted a long-desired position at work with extra, more stressful responsibilities vs. someone who is completely overworked due to poor management; or someone who chooses to live a simplistic lifestyle with few possessions vs. someone who has that lifestyle as a result of lacking in means and opportunity. If we have chosen a certain situation for ourselves, we are more likely to benefit from it and see any stress that results as either being invigorating, or as something worth putting the effort into; when we feel that we continuously have stress put upon us by forces or people outside of our control - it's not easy to thrive in such circumstances.
Personality and stress
In the psychological field, personality is often spoken about in terms of the Big Five: agreeableness, conscientiousness, extraversion, neuroticism, and openness to experience. We all, if we adopt this framework, exhibit different levels of each of these five factors and that largely manifests as our personality. When it comes to stress, the key factor is neuroticism, and it's opposite: emotional stability. Where we fall on the spectrum between neuroticism and emotional stability will go some way to determining how we deal with stress. None of us would enjoy being called neurotic, but it's simply an affective term and doesn't necessitate any judgement. If you are high in neuroticism it just means that you are likely very sensitive to internal and external stressors. On the flip side, a person high in emotional stability will be better able to view their situation with a healthy level of detachment, process what is happening to them, and take helpful action.
Our personality is thought to be 50/50 genetics and upbringing, which brings us onto the next important point.
Childhood experiences and adult stress
Our childhood experiences have been shown to affect our adult life in various ways. A lot of focus is put on the idea of attachment between the child and primary care-giver. The nature of this attachment in many ways dictates how we form relationships in adulthood, and how we respond to stress. A secure attachment between parent and child is one characterised by warmth, attention to needs, and validating behaviours. Children who have secure attachments are more likely to grow into adults who have a good sense of self-worth, who respond to criticism in a healthy manner, and who are willing to take risks without being too afraid of failure or potential challenges. An insecure attachment (which in attachment theory falls into either avoidant, anxious, or fearful), makes it much more likely that as adults we will respond to stressful situations in unhelpful ways. How our parents responded to our errors or emotional needs as children has a lasting impact on how we view ourselves, and our own perception of our ability to cope, as adults. An insecure attachment in childhood is related to various psychological disorders, such as anxiety and depression, to poor emotional regulation, and also to a sense that we might not be able to trust others or rely on them for support. All of these factors make coping with stress much more challenging.
It is also during childhood that we learn about our sense of choice and autonomy. 'Learned helplessness' is the psychological term used to describe when an individual has learnt, through early life experiences, that they do not have much control over their environment. Experiencing high levels of external stressors in childhood, such as growing up with neglectful parents, or those with substance abuse issues for example, or growing up in poverty, or moving house a lot, or experiencing a bereavement early in life: all of these are examples of situations that may teach a child that they do not have much control over their environment. This lack of sense of autonomy can continue into adulthood and make it much more difficult to respond to stress. We might respond in apathy or by shutting down.
Traumatic past experiences
One of the most clear demonstrations that people respond significantly differently to stress is PTSD - post-traumatic stress disorder. Some veterans sadly develop PTSD, and others who experienced and witnessed similar events do not. The same is true of other trauma: some people are better able to cope with it than others. What is common with individuals who have experienced a highly stressful or traumatic event, whether they develop diagnosed PTSD or not, is that it can affect their ability to cope with future, potentially much more mundane stressors. If you have suffered a traumatic bereavement, been assaulted, or experienced another kind of major trauma, it can take a really long time to recover, and you may never be fully the same. While you may feel recovered in certain or even most aspects, the ability to cope with stress can be damaged as even small stresses remind us (through alarming thoughts or memories, or physical sensations) of the major stress we experienced before.
The brain and stress
Acute stress is registered in the brain through activation of the amygdala, which, through a series of actions and hormone release, triggers the 'fight or flight' response. This is extremely helpful to us and is an adaptive survival mechanism. Exposure to chronic stress, however, can change the shape of the brain and the neural pathways that dictate much of our thoughts and behaviours. When we experience stress, even if the stressor disappears quickly, neurologically speaking something more long-term is going on. When we experience stress, the areas of our brain related to decision-making and emotional regulation fire up, as we try to work out what to do. This area of the brain is called the ventral medial pre-frontal cortex. In experiments using fMRI scans, researchers have shown that people who exhibit more activity in this area of the brain when faced with stressful stimuli report less feelings of stress. More activity in this part of the brain indicates more flexibility - or neuroplasticity - in this stress-management centre and therefore more likelihood that the individual would be able to manage their emotions and behaviours in response to stress. Less activity in this area results in more feelings of stress, as our attention is narrowed and we struggle to take in information from outside of our point of focus (i.e. we can't stop thinking about the thing causing us so much stress). When we can't distract ourselves or evaluate the spectrum of options available to us, we feel we have less choice; in this way, stress perpetuates stress, and stress-related patterns of behaviour and thinking can set in.
Chronic stress also increases the size of the amygdala, the brain's anxiety centre, and increases the number of neural pathways directed to this area, meaning that long-term stress makes future stress much more difficult to deal with. While it enlarges the amygdala, chronic stress also reduces the size of the hippocampus. This is the area of the brain that is involved in memory function. Not only can this effect short-term memory, but also our ability to access our stored long-term memories which can be so helpful to us when making decisions. The hippocampus is also essential for emotional regulation and learning, and chronic stress causes it to shut down, leading to impulsive behaviours and inability to control emotions.
Chronic stress means that we have cortisol - 'the stress hormone' - running through our bodies for long periods of time. Even after a stressful event has ended, it takes a while for cortisol levels to return to normal. If you are constantly encountering stress, your cortisol levels never get the chance to properly recalibrate. Cortisol increases the levels of free radicals which damage the brain. This damage often reveals itself through 'brain fog', forgetfulness and difficulty concentrating.
Depression is thought to be related to levels of serotonin and dopamine in the brain. Chronic stress reduces our levels of these two neurotransmitters and therefore makes it much more likely that a person with long-term stress will develop depression or another mood disorder.
Different responses to stress
The following are different potentially unhelpful responses to stress, but it's important to note that we can only do the best we can in the situation we are in. There are many reasons why someone might respond to stress in the following ways, and if any of these resonate with you, you should not judge yourself too harshly.
Shutting down or detaching yourself.
This can happen emotionally, mentally and physically. Under severe stress, you may find that you emotionally close off, the original stress-induced feelings of anxiety or worry instead replaced with numbness or apathy. You may also find that you have a tendency to detach yourself from people physically, spending less time with your friends or partner. You may also find that you mentally shut down, unable to access the more abstract or creative parts of your thinking. Falling asleep, or suddenly feeling immensely tired, in the face of stress is also a coping mechanism whereby the individual chooses to disengage from what is happening around them, or inside them.
Turning to substances
If we respond to stressful situations by turning to alcohol or drugs, we can become dependent on these substances and our primary response when faced with new stress might be to self-soothe using our chosen vice.
Anger is a complicated emotion; it's also a very normal one. The problem being that often we resort to anger to mask other emotions - such as anxiety, fear, guilt or shame - as it is less painful for us to rile against the world than it is to deal with the hurt that we are feeling. Similarly with stress: if anger is our default position when our sense of self feels threatened, when we encounter a stressful situation we are more likely to lash out, with potentially longer-term consequences than the length of our flash of anger.
If we feel immensely stressed by a situation, whether work-related, our relationship, or a friendship, and we don't know how (or we simply don't want to) deal with it, we might start behaving in ways to self-sabotage. Self-sabotaging behaviours can arise in the face of stress, as a means of forcing the other people involved in the situation to make decisions on our behalf, for example, behaving in ways that pushes our partner away because we don't know how to break up with them, and we hope they might do it first.
Am I more stressed than I realise?
Many of the above responses to stress result in the same potentially dangerous issue: we don't realise how stressed we are. If we detach, push people away, turn to substances, or deflect our stress with some other short-term fix, we won't necessarily acknowledge how much stress we are under. We may manage to convince ourselves, on the conscious level at least, that we aren't in fact stressed at all. In these cases, we may stay in unhealthy relationships, or cut people off who are actually really important to us; we might continue to abuse substances or become progressively more angry and eventually depressed. In our society, being busy is sometimes seen as something of a badge of honour, and stress is seen as part and parcel. Being stressed might become comforting on some level, as we begin to associate it with being successful, with working hard for our goals and with being someone who manages to 'do it all'.
Not facing up to how stressed we are means we aren't likely to do anything about it. Chronic (long-term) stress can result, and in turn can have serious health consequences, both physical and mental. Though we can, by various means, block out mental processes and thoughts that we don't want to - or aren't ready to - listen to, our body has ways that it will let us know that we are dealing with unhealthy levels of stress.
The physical symptoms of stress
heartburn / chest pains
muscular ache in the neck or back
fatigue / insomnia
trichotillomania (hair pulling), skin-picking, or other body-focused repetitive behaviours
white spots on fingernails
teeth grinding and / or tension in the jaw
frequent common colds or flu
lacking in energy
weight gain or difficulty losing weight, particularly around the mid-section
missed or erratic menstrual cycles in women and / or severe menstrual cramps
loss of libido
How can I protect myself from stress?
A lot of what is spoken about above comes down to one thing: how we interpret the situation around us. This is, in essence, what determines who struggles with stress more deeply. Stress occurs in response to external or internal stimuli; this stimuli can either be interpreted as a threat (leading to stress), or an opportunity / manageable challenge. When we encounter a stressful situation, we typically make two appraisals: what is needed to cope with this situation? And, secondly, do I have the resources available to me to cope with this situation?
A person high in resilience and with a solid sense of self-worth might be more likely to answer yes to the second question, and this is the key to feeling less stressed: having the self-assurance that you do have the resources to cope with what life throws at you. It's important to remember of course that even the most resilient or emotionally stable person might not always have the resources. If you think about your resources as a stockpile of energy, tools and equipment that you can put out in to the world when you need to, we are all susceptible to running out of stock if we don't take care of ourselves. You literally cannot give more than what you have available to you, and if you try there are a multitude of potential consequences waiting to catch you eventually: burnout, relationship breakdown, mental and/or physical ill-health. Our resources can come from various sources: our social interactions, our physical health, the time we have, how supported we are, our emotional energy. So, how can we give ourselves the best possible chance of having the resources we need to deal with stress?
Exercise and diet
Exercise is a great stress-buster; it floods your brain with feel-good endorphins and ensures your brain and body are getting the oxygen they need. Taking time away from a stressful situation to exercise also serves as a distraction and may enable you to make better decisions when you return to tackle whatever needs your attention. On a sunny day, try to exercise outside (this can just be a stroll around the park or block), to get a dose of much needed vitamin D.
Anti-oxidant rich foods can protect against the damage caused by free radicals created by stress and taking the time to prepare nutrient-dense food that your body and brain needs is a great part of any self-care routine. Periods of stress also deplete our nutrient stores (leading to some of the physical symptoms listed above such as cracked lips, spots, and white spots on fingernails), so it's really important to give your body the fuel it needs to perform.
Friendship and social support
With a solid social support network in place, you will be better able to deal with stress. This happens for a number of reasons. Firstly, having healthy, fulfilling friendships is good for our sense of self-worth and self-esteem. Secondly, knowing that we have people who care about us and support us makes taking risks, failing, and facing challenges much more doable. In times of stress, we might be worried about reaching out, or may not feel we have the energy. Try to nurture your friendships by staying in touch with people and trying new or well-liked activities together.
The first part of being more mentally flexible is to accept that stress is a part of life. Energy can be wasted fighting with thoughts of 'I shouldn't have to deal with this'. Dealing with stressful situations is hard and can be taxing, but it's unhelpful to think that you shouldn't 'have to' be dealing with stress in the first place. Things come up, people behave in unexpected ways, and this will inevitably manifest in stressful situations. Truly accepting stress as a normal part of life frees you to dedicate your energies towards moving yourself forward and beyond the stressful situation. You will become more flexible in your thinking, better able to come up with a Plan B and to let go of any resentment related to 'having to deal with it' in the first place.
Being flexible also involves accepting the things you cannot change.
Give yourself more choice
This is related to flexibility of mind in some ways: sometimes life can really throw us a curveball that makes being flexible in your thinking really, really challenging. In these circumstances, you might find that you freeze, or fall back on responding some way that you have done in the past. This isn't necessarily the best option, and might - in the long-term - compound unhelpful patterns of behaviour. Try to treat each situation with fresh eyes and a fresh mind - give yourself the choice to respond differently than you have done in the past.
Giving yourself choice might also include allowing yourself some extra time before making a decision, saying no to a social or work opportunity when you feel that you don't have the time or resources, setting boundaries in your relationships so that the domestic and emotional labour of the household and partnership is fairly shared, making sure you draw a line between work and life. Whatever your circumstances, you can make choices to improve your situation. They may be very small choices, but they have the potential for significant change.
Mindfulness meditation can help with stress management in a multitude of ways. Meditation has been shown to increase neuroplasticity, specifically in the prefrontal cortex, the area that is so important in decision-making, emotion regulation and therefore in stress management. Mindfulness also reduces levels of the stress hormone cortisol. It also focuses on breathing, particularly the kind of belly-breathing that activates the parasympathetic nervous system. When we are stressed, our breathing becomes more shallow and tends to be focused in the chest; this breathing pattern perpetuates our stress, and one way to calm our minds down and reassure our bodies that we aren't under threat is to focus on breathing into the belly, rather than the chest. This breathing calms us down. With a regular mindfulness practice, you might find you can deploy this as a technique to deal with stressful times as an when they arise.
Practicing mindfulness meditation can also help us cultivate more gratitude for the things that we have in our present situation. This stops us from thinking back regretfully for the things we perceive we have lost, and gives us pause when we are consumed by what we think we need to get / achieve / do in order to be happy and less stressed. By focusing on and nurturing how you are in this exact moment, you will find that more options come available to you. You can only start from where you are.
Talk to someone
Beyond leaning on friends and family in times of stress, talking to a professional can also help immensely. Often the stress we are experiencing involves those closest to us (such as our partners, children, friends and colleagues) and therefore it can be hard to express yourself honestly and without fear of consequence to the people in your life. Talking to a therapist can help you unpack why you respond to stress the way you do, and help you build healthier, more effective long-term coping strategies. Particularly cognitive behavioural therapy (CBT) might help in terms of learning to challenge the harmful thought patterns that keep you stuck in a state of stress, unable to move forward.