What is stress

Stress is what you feel when you react to pressure. This pressure can come from the outside world, such as work, family, friends, financial problems, relationships, school or traumatic events (such as a pandemic, natural disaster, or act of violence). Or stress can come from inside yourself, like when you want to do well at work or want to fit in. Stress is a normal reaction for people of all ages. Stress affects everyone and some people find stress helpful or even motivating. Stress is a normal psychological, physical and emotional reaction that people experience as they encounter changes in and demands of life ¹. Stress is a normal feeling – a small amount of stress can be good, motivating you to perform well ². Some stress can be caused by good things in your life, such as an interesting project, a new baby, planning a wedding or an upcoming vacation. Other times, stress is caused by difficult situations, such as losing your job, getting divorced, meeting deadlines and paying bills, can push you beyond your ability to cope. Stress is caused by your body’s instinct to protect itself from emotional or physical pressure or, in extreme situations, from danger. No matter what causes your stress, too much stress can wear you down. This makes you more likely to get sick and feel irritable or depressed. Long-term stress may contribute to or worsen a range of health problems including digestive disorders, headaches, sleep disorders, and other symptoms. Stress may worsen asthma and has been linked to depression, anxiety, and other mental illnesses.

There are at least three different types of stress:

1. Routine stress related to the pressures of work, family, and other daily responsibilities
2. Stress brought about by a sudden negative change, such as losing a job, divorce, or illness
3. Traumatic stress, which happens when you are in danger of being seriously hurt or killed. Examples include a major accident, war, assault, or a natural disaster. This type of stress can cause post-traumatic stress disorder (PTSD).

Different people may feel stress in different ways. Sometimes you might be able to tell right away when you’re feeling under stress, but other times you might keep going without recognizing the signs. Stress can affect you both emotionally and physically, and it can affect the way you behave. Some people experience digestive symptoms. Others may have headaches, sleeplessness, depressed mood, anger, and irritability. People under chronic stress get more frequent and severe viral infections, such as the flu or common cold. Vaccines, such as the flu shot, are less effective for them.

Stress may cause you develop emotional symptoms or unexplained physical symptoms that don’t seem to go away, such as:

• Anxiety
• Back pain
• Constipation or diarrhea
• Depression
• Fatigue
• Headaches
• High blood pressure
• Trouble falling asleep or staying asleep
• Shortness of breath
• Stiff neck or jaw
• Upset stomach
• Weight gain or loss
• Some people who experience severe stress can sometimes have suicidal feelings.

How stress may make you feel:

• irritable, aggressive, impatient or wound up
• over-burdened
• anxious, nervous or afraid
• like your thoughts are racing and you can’t switch off
• unable to enjoy yourself
• depressed
• uninterested in life
• like you’ve lost your sense of humor
• a sense of dread
• worried about your health
• neglected or lonely.

How stress may make you behave:

• finding it hard to make decisions
• constantly worrying
• avoiding situations that are troubling you
• snapping at people
• biting your nails
• picking at your skin
• unable to concentrate
• eating too much or too little
• smoking or drinking alcohol more than usual
• restless, like you can’t sit still
• being tearful or crying.

Although the exact role of stress in human diseases is not known, it is clear that stress can lead to particular diseases by temporarily inhibiting certain components of the immune system. Stress-related disorders include gastritis, ulcerative colitis, irritable bowel syndrome, hypertension, asthma, rheumatoid arthritis (RA), migraine headaches, anxiety, and depression. People under stress are at a greater risk of developing chronic disease or dying prematurely.

Interleukin-1 (IL-1), a substance secreted by macrophages of the immune system, is an important link between stress and immunity. One action of interleukin-1 is to stimulate secretion of adrenocorticotropic hormone (ACTH), which in turn stimulates the production of cortisol (see Figure 1 below). Cortisol, a corticosteroid hormone, is produced by the adrenal cortex and is known to be involved in the response to stress suppression in the immune system. Increased serum cortisol levels have been observed in connection with clinical depression and psychological stress involving stressors such as hypoglycemia, illness, fever, trauma, surgery, fear, pain, physical exertion or extremes of temperature. In normal release, cortisol has widespread actions that help restore homeostasis after stress. Cortisol acts as a physiological antagonist to insulin by promoting gluconeogenesis, breakdown of lipids and proteins, and mobilization of extrahepatic amino acids and ketone bodies. This leads to increased blood glucose concentrations, resulting in increased glycogen formation in the liver ³. In chronic stress, prolonged cortisol secretion causes muscle wastage, hyperglycemia, and suppresses immune/inflammatory responses. Moreover, long-term exposure to cortisol results in damage to cells of the hippocampus that may cause impaired learning.

However, short-term exposure of cortisol helps to create memory, and constitutes the proposed mechanism for the storage of flash bulb memories. Furthermore, cortisol provide resistance to stress and inflammation and it also suppresses further production of interleukin-1. Thus, the immune system turns on the stress response, and the resulting cortisol then turns off one immune system mediator. This negative feedback system keeps the immune response in check once it has accomplished its goal. Because of this activity, cortisol and other glucocorticoids are used as immunosuppressive drugs for organ transplant recipients.

Figure 1. Hypthothalamus-Pituitary-Adreno Axis and Sympatho-Adreno-Medullary Axis

Footnote: Responses to stressors during the stress response. Red arrows (hormonal responses) and green arrows (neural responses) in (a) indicate immediate fight-or-flight reactions; black arrows in (b) indicate long-term resistance reactions.

5 things you should know about stress

Everyone feels stressed from time to time. Stress is how your brain and body respond to any demand. Any type of challenge—such as performance at work or school, a significant life change, or a traumatic event—can be stressful.

1. Stress affects everyone

Everyone experiences stress from time to time. There are different types of stress—all of which carry physical and mental health risks. A stressor may be a one-time or short-term occurrence, or it can happen repeatedly over a long time. Some people may cope with stress more effectively and recover from stressful events more quickly than others.

Examples of stress include:

• Routine stress related to the pressures of school, work, family, and other daily responsibilities.
• Stress brought about by a sudden negative change, such as losing a job, divorce, or illness.
• Traumatic stress experienced during an event such as a major accident, war, assault, or natural disaster where people may be in danger of being seriously hurt or killed. People who experience traumatic stress may have very distressing temporary emotional and physical symptoms, but most recover naturally soon after.

2. Not all stress is bad

In a dangerous situation, stress signals the body to prepare to face a threat or flee to safety. In these situations, your pulse quickens, you breathe faster, your muscles tense, and your brain uses more oxygen and increases activity—all functions aimed at survival and in response to stress. In non-life-threatening situations, stress can motivate people, such as when they need to take a test or interview for a new job.

3. Long-term stress can harm your health

Coping with the impact of chronic stress can be challenging. Because the source of long-term stress is more constant than acute stress, the body never receives a clear signal to return to normal functioning. With chronic stress, those same lifesaving reactions in the body can disturb the immune, digestive, cardiovascular, sleep, and reproductive systems. Some people may experience mainly digestive symptoms, while others may have headaches, sleeplessness, sadness, anger, or irritability.

Over time, continued strain on your body from stress may contribute to serious health problems, such as heart disease, high blood pressure, diabetes, and other illnesses, including mental disorders such as depression or anxiety.

4. There are ways to manage stress

If you take practical steps to manage your stress, you may reduce the risk of negative health effects. Here are some tips that may help you to cope with stress:

• Be observant. Recognize the signs of your body’s response to stress, such as difficulty sleeping, increased alcohol and other substance use, being easily angered, feeling depressed, and having low energy.
• Talk to your health care provider or a healthcare professional. Don’t wait for your health care provider to ask about your stress. Start the conversation and get proper health care for existing or new health problems. Effective treatments can help if your stress is affecting your relationships or ability to work.
• Get regular exercise. Just 30 minutes per day of walking can help boost your mood and improve your health.
• Try a relaxing activity. Explore relaxation or wellness programs, which may incorporate meditation, muscle relaxation, or breathing exercises. Schedule regular times for these and other healthy and relaxing activities.
• Set goals and priorities. Decide what must get done now and what can wait. Learn to say “no” to new tasks if you start to feel like you’re taking on too much. Try to be mindful of what you have accomplished at the end of the day, not what you have been unable to do.
• Stay connected. You are not alone. Keep in touch with people who can provide emotional support and practical help. To reduce stress, ask for help from friends, family, and community or religious organizations.

5. If you’re overwhelmed by stress, ask for help from a health professional

You should seek help right away if you have suicidal thoughts, are overwhelmed, feel you cannot cope, or are using drugs or alcohol more frequently as a result of stress. Your doctor may be able to provide a recommendation. Resources are available to help you find a mental health provider (https://www.nimh.nih.gov/health/find-help).

Is stress always bad?

No, stress isn’t always bad. In fact, a little bit of stress is good. Most of us need to feel the pressure of wanting to do well. This is how you push yourself, whether it’s in sports, music, dance, work, or school. Also, many people need the stress caused by a deadline. Without it, you wouldn’t be able to finish projects or get to work or school on time.

If stress is so normal, why do I feel so bad?

With all the things that could happen to you in life, sometimes it’s easy to feel overwhelmed. Things that you can’t control are often the most frustrating. Maybe your parents are fighting. Maybe you’re having trouble with your social life. You can also feel bad when you put pressure on yourself. This could be pressure to get good grades or to get promoted at your job. A common reaction to stress is to criticize yourself. You may even get so upset that things don’t seem fun anymore. Life might look pretty grim. When this happens, it’s easy to think there’s nothing you can do to change things. But you can!

While you can’t always control the things that are stressing you out. But you can control how you react to them. The way you feel about things results from the way you think about things. If you change how you think, you can change the way you feel. Try some of these tips to cope with your stress:

• Take care of yourself. Eat well-balanced meals on a regular basis. Drink less caffeine. Get enough sleep, and exercise on a regular basis.
• Make a list of the things that are causing your stress. Think about your friends, family, school, and other activities. Accept that you can’t control everything on your list.
• Take control of what you can. For example, you may need to cut back your work hours. Or you might have to drop one of your activities after school.
• Give yourself a break. Remember that you can’t make everyone in your life happy all the time. And it’s okay to make mistakes now and then.
• Don’t over-commit yourself. If you’re already too busy, don’t promise to decorate for the school dance. If you’re tired and don’t want to go out, tell your friends you’ll go another night.
• Find someone to talk to. Talking to your friends or family can help. Talking about your feelings is the first step in learning to deal with them and starting to feel better. It gives you a chance to express your feelings. However, problems in your social life or family can be the hardest to talk about. If you feel like you can’t talk to your family or a friend, talk to someone outside the situation. This could be a religious leader, a school counselor, or your family doctor.

What are some things that don’t help you deal with stress?

There are safe and unsafe ways to deal with stress. It’s dangerous to try to escape your problems by using drugs and alcohol. Both can be very tempting, and your friends may offer them to you. Drugs and alcohol may seem like easy answers, but they’re not. Using drugs and alcohol to deal with stress just adds new problems, such as addiction, or family and health problems.

How can other people help with stress?

If someone you’re close to is feeling stressed there are lots of practical things you can do to support them – even though you probably can’t change the situation they’re in.

• Help them reflect on whether they are stressed. Often, people don’t notice that some physical symptoms and behavior (such as not being able to get to sleep, or drinking more than usual) are actually signs of stress. Sometimes you may be able to see it before they recognize it themselves. If you’ve noticed that someone seems particularly busy, anxious or unwell, you could gently let them know, and ask how you can help.
• Listen to how they are feeling. Having a chance to talk openly could help someone to feel calmer and more able to move forward. Just being there for them will probably help lots.
• Reassure them that stressful situations can pass. For someone who is in the middle of a stressful time, it can be hard to see an end point. Let them know that situations change and can get better.
• Help them identify their triggers. You can be specific about things you’ve observed, but try to stay open-minded and non-judgemental. Your perspective might be valuable, but your friend or family member could find this conversation stressful, and being patient will help.
• Help them address some causes of stress, if you can. You might be able to help your friend or family member look for support around issues like debt, housing problems or difficulties at work.
• Help them learn and practise relaxation techniques. You could help them research good relaxation techniques and find ways to practise them, such as a weekly yoga class, or setting aside time for breathing exercises at home. This might become something that you could do together.
• Support them to seek professional help. For example, you could help them contact their doctor, go with them to an appointment or do some research on mental health and wellbeing.
• Look after yourself. If someone around you is very stressed, you might become stressed too. If this happens, try to take a step back and look after your own wellbeing. Being calm and relaxed will make you more able to help someone else.

What’s the difference between normal stress and anxiety?

Stress is the physical or mental response to an external cause, such as having a lot of homework or having an illness. A stressor may be a one-time or short-term occurrence, or it can happen repeatedly over a long time. Stress is a normal psychological and physical reaction to positive or negative situations in your life, such as a new job or the death of a loved one. Stress itself isn’t abnormal or bad. What’s important is how you deal with stress.

Anxiety is your body’s reaction to stress and can occur even if there is no current threat. Anxiety is part of stress. You may feel anxious before you take a test or walk down a dark street. This kind of anxiety is useful – it can make you more alert or careful. It usually ends soon after you are out of the situation that caused it. If that anxiety doesn’t go away and begins to interfere with your life, it could affect your health. For millions of people in the United States, the anxiety does not go away, and gets worse over time. You may have experience problems with sleeping, with your immune, digestive, cardiovascular, and reproductive systems, chest pains or nightmares. You may even be afraid to leave home. You also may be at higher risk for developing a mental illness such as an anxiety disorder or depression.

You may be at risk for an anxiety disorder if it feels like you can’t manage the stress and if the symptoms of your stress:

• Interfere with your everyday life.
• Cause you to avoid doing things.
• Seem to be always present.

Types of anxiety disorder include:

• Panic disorder
• Obsessive-compulsive disorder
• Post-traumatic stress disorder
• Phobias
• Generalized anxiety disorder

Treatment can involve medicines, therapy or both.

Common anxiety signs and symptoms include:

• Feeling nervous, restless or tense
• Having a sense of impending danger, panic or doom
• Having an increased heart rate
• Breathing rapidly (hyperventilation)
• Sweating
• Trembling
• Feeling weak or tired
• Trouble concentrating or thinking about anything other than the present worry
• Having trouble sleeping
• Experiencing gastrointestinal problems
• Having difficulty controlling worry
• Having the urge to avoid things that trigger anxiety

Table 1. Stress vs. Anxiety

Stress	Both Stress and Anxiety	Anxiety
Generally is a response to an external cause, such as taking a big test or arguing with a friend. Goes away once the situation is resolved. Can be positive or negative. For example, it may inspire you to meet a deadline, or it may cause you to lose sleep.	Both stress and anxiety can affect your mind and body. You may experience symptoms such as: Excessive worry Uneasiness Tension Headaches or body pain High blood pressure Loss of sleep	Generally is internal, meaning it’s your reaction to stress. Usually involves a persistent feeling of apprehension or dread that doesn’t go away, and that interferes with how you live your life. Is constant, even if there is no immediate threat.

Types of stress

Stress is your body’s reaction to the demands of the world. Stressors are events or conditions in your surroundings that may trigger stress. We all experience stress differently in different situations. Your body responds to stressors differently depending on whether the stressor is new or short term often called acute stress or whether the stressor has been around for a longer time also called chronic stress ¹². Effective stress management involves identifying and managing both acute and chronic stress.

Acute stress

Also known as the fight-or-flight response, acute stress is your body’s immediate reaction to a perceived threat, challenge or scare. The acute-stress response is immediate and intense, and in certain circumstances it can be thrilling. Examples of acute stressors include having a job interview or getting a speeding ticket.

A single episode of acute stress generally doesn’t cause problems for healthy people. However, severe acute stress can cause mental health problems — such as post-traumatic stress disorder (PTSD). It can also cause physical difficulties such as tension headaches, stomach problems or serious health issues — such as a heart attack.

Chronic stress

Mild acute stress can actually be beneficial — it can spur you into action, motivate and energize you. The problem occurs when stressors pile up and stick around. This persistent stress can lead to health problems, such as headaches and insomnia. The chronic-stress response is more subtle than is the acute-stress response, but the effects may be longer lasting and more problematic.

What happens in your body during stress

Biochemical Changes

The responses to stressors may be pleasant or unpleasant, and they vary among people and even within the same person at different times.

Your body’s homeostatic mechanisms attempt to counteract stress. When they are successful, the internal environment remains within normal physiological limits. If stress is extreme, unusual, or long lasting, the normal mechanisms may not be enough. In 1936, Hans Selye, a pioneer in stress research, showed that a variety of stressful conditions or noxious agents elicit a similar sequence of bodily changes. These changes, called the stress response or general adaptation syndrome, are controlled mainly by the hypothalamus.

The stress response occurs in three stages:

1. Stage 1: an initial Fight-or-Flight Response,
2. Stage 2: a Slower Resistance reaction, and eventually
3. Stage 3: Exhaustion.

Research on the stress response has shown that many of the physiological alterations associated with stress are brought about by centrally controlled biochemical changes – stressors stimulate the hypothalamus to initiate the stress response through the fight-or-flight response and the resistance reaction. During situations perceived as being acutely stressful, the 2 main pathways activated are:

1. The Hypthothalamus-Pituitary-Adreno Axis and
   
2. The Sympatho-Adreno-Medullary Axis.

Both axes are activated by the hypothalamus secreting corticotrophin-releasing hormone (CRH), which causes the pituitary gland to release adrenocorticotropic hormone (ACTH). In the more rapidly acting of these pathways, the Sympatho-Adreno-Medullary axis, ACTH stimulates the adrenal medulla to release the catecholamines epinephrine and norepinephrine ¹³. These stress-induced alterations are directly linked to a number of the physiological changes that take place in the body including increases in blood pressure, heart rate, respiration, and oxygen consumption.8 In the slower-acting HPA axis, blood-borne ACTH acts on the adrenal cortex to release cortisol. Once in the bloodstream, cortisol induces metabolic changes in the liver, resulting in increased glucose concentrations in blood and tissues. The increased glucose produces adenosine triphosphate (ATP) to repair damaged cells and enables metabolically active cells throughout the body to respond to the stressor ¹³.

The Fight-or-Flight Response (Stage 1 of Stress)

The fight-or-flight response, initiated by nerve impulses from the hypothalamus to the sympathetic division of the autonomic nervous system (ANS), including the adrenal medulla, quickly mobilizes the body’s resources for immediate physical activity (see Figure 1 above). It brings huge amounts of glucose and oxygen to the organs that are most active in warding off danger: the brain, which must become highly alert; the skeletal muscles, which may have to fight off an attacker or flee; and the heart, which must work vigorously to pump enough blood to the brain and muscles. During the fight-or-flight response, nonessential body functions such as digestive, urinary, and reproductive activities are inhibited. Reduction of blood flow to the kidneys promotes release of renin, which sets into motion the renin–angiotensin–aldosterone pathway. Aldosterone causes the kidneys to retain Na+, which leads to water retention and elevated blood pressure. Water retention also helps preserve body fluid volume in the case of severe bleeding.

The Resistance Reaction (Stage 2 of Stress)

The second stage in the stress response is the resistance reaction (Figure 1b). Unlike the short-lived fight-or-flight response, which is initiated by nerve impulses from the hypothalamus, the resistance reaction is initiated in large part by hypothalamic releasing hormones and is a longer-lasting response. The hormones involved are corticotropin-releasing hormone (CRH), growth hormone–releasing hormone (GHRH), and thyrotropin-releasing hormone (TRH).

Corticotropin-releasing hormone (CRH) stimulates the anterior pituitary to secrete adrenocorticotropic hormone (ACTH), which in turn stimulates the adrenal cortex to increase release of cortisol. Cortisol then stimulates gluconeogenesis by liver cells, breakdown of triglycerides into fatty acids (lipolysis), and catabolism of proteins into amino acids. Tissues throughout the body can use the resulting glucose, fatty acids, and amino acids to produce ATP (adenosine triphosphate is the energy packets necessary for cells to function) or to repair damaged cells. Cortisol also reduces inflammation.

A second hypothalamic releasing hormone, growth hormone–releasing hormone (GHRH), causes the anterior pituitary to secrete growth hormone (GH). Acting  via insulin like growth factors (ILGF), GH stimulates lipolysis and glycogenolysis, the breakdown of glycogen to glucose, in the liver. A third hypothalamic releasing hormone, thyrotropin-releasing hormone (TRH), stimulates the anterior pituitary to secrete thyroid-stimulating hormone (TSH). TSH promotes secretion of thyroid hormones, which stimulate the increased use of glucose for ATP production. The combined actions of GH and TSH supply additional ATP for metabolically active cells throughout the body.

The resistance stage helps the body continue fighting a stressor long after the fight-or-flight response dissipates. This is why your heart continues to pound for several minutes even after the stressor is removed. Generally, it is successful in seeing you through a stressful episode, and your bodies then return to normal. Occasionally, however, the resistance stage fails to combat the stressor, and the body moves into the state of exhaustion.

Stage of Exhaustion (Stage 3 of Stress)

The resources of the body may eventually become so depleted that they cannot sustain the resistance stage, and exhaustion ensues. Prolonged exposure to high levels of cortisol and other hormones involved in the resistance reaction causes wasting of muscle, suppression of the immune system, ulceration of the  gastrointestinal tract, and failure of pancreatic beta cells. In addition, pathological changes may occur because resistance reactions persist after the stressor has been removed.

This puts you at increased risk of numerous health problems, including:

• Anxiety
• Depression
• Digestive problems
• Headaches
• Heart disease
• Sleep problems
• Weight gain
• Memory and concentration impairment

That’s why it’s so important to learn healthy ways to cope with the stressors in your life.

Figure 2. Comparative Impact of the Acute Stress and Relaxation Responses

Footnote: Central and Peripheral Nervous System Activities

Using blood pressure as an example, scientists show how acute stress and relaxation responses alter hypothalamus-pituitary-adrenal (HPA) and sympatho-adreno-medullary (SAM) axis activities. These responses introduce contrasting hormonal and signal molecule changes that in turn influence clinically significant conditions such as high blood pressure. Epi = epinephrine or adrenaline /  Ne = norepinephrine or noradrenaline / Sympatho-Adreno-Medullary (SAM) axis is the adrenal medulla to norepinephrine (noradrenaline) and epinephrine (adrenaline) / Cort = cortisol / NO = nitric oxide / HPA (hypothalamus-pituitary-adrenal) axis is the adrenal cortex to cortisol

Causes of stress

Everyone experiences stress, and sometimes that stress can feel overwhelming. Stress is usually a reaction to mental or emotional pressure. It’s often related to feeling like you’re losing control over something, but sometimes there’s no obvious cause. When you’re feeling anxious or scared, your body releases stress hormones such as epinephrine (adrenaline) and cortisol. This can be helpful for some people and stress might help you get things done or feel more motivated. But it might also cause physical symptoms such as a faster heartbeat or sweating. If you’re stressed all the time it can become a problem.

Feelings of stress are normally triggered by things happening in your life. If you know what’s causing your stress it might be easier to find ways to manage it.

Some examples of sources of stress include:

• Work – feeling pressure at work, unemployment or retirement
• Family – relationship difficulties, divorce or caring for someone
• Financial problems – unexpected bills or borrowing money
• Health – illness, injury or losing someone (bereavement)

Types of stressors in your life which involve:

• being under lots of pressure
• facing big changes
• worrying about something
• not having much or any control over the outcome of a situation
• having responsibilities that you’re finding overwhelming
• not having enough work, activities or change in your life
• times of uncertainty

Even significant life events such as buying a house, having a baby or planning a wedding could lead to feelings of stress.

There might be one big thing causing you stress, but stress can also be caused by a build-up of small pressures. This might make it harder for you to identify what’s making you feel stressed, or to explain it to other people.

You might find it hard to explain to people why you feel this way, but talking to someone could help you find a solution.

Why do certain things make me feel stressed?

The amount of stress you feel in different situations may depend on many factors such as:

• your perception of the situation – this might be connected to your past experiences, your self-esteem, and how your thought processes work (for example, if you tend to interpret things positively or negatively)
• how experienced you are at dealing with that particular type of pressure
• your emotional resilience to stressful situations
• the amount of other pressures on you at the time
• the amount of support you are receiving.

We’re all different, so a situation that doesn’t bother you at all might cause someone else a lot of stress. For example, if you’re feeling confident or usually enjoy public speaking, you might find that giving a speech in front of people feels comfortable and fun. But if you’re feeling low or usually prefer not to be the center of attention, this situation might cause you to experience signs of stress.

What kind of situations can cause stress?

Stress can be caused by a variety of different common life events, many of which are difficult to avoid. For example:

Personal

• illness or injury
• pregnancy and becoming a parent
• bereavement
• long-term health problems
• organizing a complicated event, like a wedding or group holiday
• everyday tasks such as travel or household chores.

Friends and family

• getting married or civil partnered
• going through a break-up or getting divorced
• difficult relationships with parents, siblings, friends or children
• being a carer for a friend or relative who needs lots of support.

Employment and study

• losing your job
• long-term unemployment
• retiring
• exams and deadlines
• difficult issues at work
• starting a new job.

Housing

• housing problems such as poor living conditions, lack of security or homelessness
• moving house
• problems with neighbors.

Money

• worries about money or benefits
• poverty
• debt.

Can happy events cause stress?

Some of the situations listed above are often thought of as happy events – for example, you might feel expected to be happy or excited about getting married or having a baby. But because they can bring big changes or make unusual demands on you, they can still be very stressful. This can be particularly difficult to deal with, because you might feel there’s additional pressure on you to be positive.

Stress signs and symptoms

Stress can cause many different symptoms. It might affect how you feel physically, mentally and also how you behave. It’s not always easy to recognize when stress is the reason you’re feeling or acting differently.

Stress may cause you develop emotional symptoms or unexplained physical symptoms that don’t seem to go away, such as:

• Anxiety
• Back pain
• Constipation or diarrhea
• Depression
• Fatigue
• Headaches
• High blood pressure
• Trouble falling asleep or staying asleep
• Shortness of breath
• Shallow breathing or hyperventilating
• Stiff neck or jaw
• Upset stomach
• Weight gain or loss

Physical symptoms of stress:

• headaches or dizziness
• muscle tension or pain
• stomach problems
• chest pain or a faster heartbeat
• sexual problems, such as losing interest in sex or being unable to enjoy sex
• you might have a panic attack
• blurred eyesight or sore eyes
• problems getting to sleep, staying asleep or having nightmares
• tired all the time
• grinding your teeth or clenching your jaw
• chest pains
• high blood pressure
• indigestion or heartburn
• constipation or diarrhea
• feeling sick, dizzy or fainting

Psychological effects of stress:

• difficulty concentrating
• struggling to make decisions
• feeling overwhelmed
• constantly worrying
• being forgetful

Changes in your behavior:

• being irritable and snappy
• sleeping too much or too little
• eating too much or too little
• avoiding certain places or people
• drinking or smoking more

There are warning signs that could mean you have too much stress. These include:

• Feeling depressed, edgy, guilty, or tired a lot
• Having headaches, stomachaches, or trouble sleeping
• Laughing or crying for no reason
• Blaming other people for bad things that happen to you
• Only seeing the downside of a situation
• Feeling like things that you used to enjoy aren’t fun anymore or are a burden
• Resenting other people or your responsibilities
• Feeling like giving up

Sometimes you try dealing with your stress, but you still feel like giving up. This is a danger sign. Stress can become too much to deal with. It can lead to such awful feelings that you may think about hurting—or even killing—yourself. When you feel like giving up, it may seem like things will never get better. Talk to someone right away. Talking about your feelings is the first step in learning to deal with them and starting to feel better.

Stress management

Learning what causes or triggers your stress and what coping techniques work for you can help reduce your anxiety and improve your daily life. There are ways to cope with stress, but it’s important to remember that different things work for different people. It may take trial and error to discover what works best for you. Only try what you feel comfortable with.

Managing stress

Everyone encounters stressful situations at times, and learning about managing stress can involve different strategies.

It may not be possible to remove the stress from your life; however, managing your stress may help you to get things done. Below are some ideas for managing stress:

• Be aware – monitor your levels of stress and ask whether they are helpful or getting you down.
• Take stock – think about things in your life or pressures you place on yourself that may be increasing your stress.
• Take charge – deal with unhelpful sources of stress before they build up and become a bigger problem.
• Make choices – look at areas in your life where you could manage your situation better or change the way you respond.

Some examples of good ways to deal with stress:

• Take some deep breaths.
• Talk to someone you trust.
• Create a stress diary, note down when you feel stressed and why.
• Have a health check with your doctor.
• Exercise.
• Eat a healthy, balanced diet.
• Try to avoid smoking, alcohol and caffeine.
• Make time for things you enjoy.

These are ways to help you bounce back and become more resilient to stress.

Recognizing the signs and symptoms of stress will help you figure out ways of coping and save you from adopting unhealthy methods such as drinking or smoking.

You can talk to your doctor about ways to help you bounce back and become more resilient to stress.

Identify the sources of stress in your life

Stress management starts with identifying the sources of stress in your life. Working out what triggers stress for you can help you anticipate problems and think of ways to solve them. This isn’t as straightforward as it sounds.

The first step is to identify your triggers, or what makes you feel stressed. Notice the warning signs that you are becoming stressed; these may include muscle tension, being irritable or tired.

Take some time to reflect on events and feelings that could be contributing to your stress (you could do this on your own or with someone you trust).

Until you accept responsibility for the role you play in creating or maintaining it, your stress level will remain outside your control.

You could consider:

• Issues that come up regularly, and that you worry about, for example paying a bill or attending an appointment.
• One-off events that are on your mind a lot, such as moving house or taking an exam.
• Ongoing stressful events, like being a carer or having problems at work.

You might be surprised to find out just how much you’re coping with at once. Remember that not having enough work, activities or change in your life can be just as stressful a situation as having too much to deal with.

Changing the stressor

Some stressors can be changed while others may be beyond your control. For example if work is causing your stress you may be able to make changes to your work hours or job duties.

Postpone major life changes such as moving house if you are already stressed.

Practice the 4 A’s (avoid, alter, adapt, or accept) of stress management:

• Avoid unnecessary stress: It’s not healthy to avoid a stressful situation that needs to be addressed, but you may be surprised by the number of stressors in your life that you can eliminate.
• Alter the situation: If you can’t avoid a stressful situation, try to alter it. Often, this involves changing the way you communicate and operate in your daily life.
• Adapt to the stressor: If you can’t change the stressor, change yourself. You can adapt to stressful situations and regain your sense of control by changing your expectations and attitude.
• Accept the things you can’t change: Some sources of stress are unavoidable. You can’t prevent or change stressors such as the death of a loved one, a serious illness, or a national recession. In such cases, the best way to cope with stress is to accept things as they are. Acceptance may be difficult, but in the long run, it’s easier than railing against a situation you can’t change.

Address some of the causes of your stress

Although there will probably lots of things in your life that you can’t do anything about, there might still be some practical ways you could to resolve or improve some of the issues that are putting pressure on you.

Housing and finances

• Housing and mental health: Housing and mental health are often linked. Poor mental health can make it harder to cope with housing problems, while being homeless or having problems in your home can make your mental health worse.
• Money and mental health: Poor mental health can make earning and managing money harder. And worrying about money can make your mental health worse. It can start to feel like a vicious cycle.
• Finding local help and support. It is important to get specific advice about your particular circumstances from a welfare benefit specialist. Go to the National Institutes of Health (https://hr.nih.gov/benefits)
• Insurance cover: Unfortunately, if you have a mental health problem you might sometimes find that you have a hard time getting suitable insurance cover. There are lots of different types of insurance to cover a wide range of situations. Most are optional (meaning it’s up to you to decide whether you need them or not), but many people find that buying insurance provides financial security and peace of mind.

Work and student life

• Wellbeing at work: Many people find that working is good for their mental health. A job can help you look after your mental health by providing you a source of income, a sense of identity, contact and friendship with others, a steady routine and structure including opportunities to contribute and gain skills.
• Discrimination at work: Sometimes people who have mental health problems are treated worse at work because of their mental health condition. This is called discrimination and, if you experience discrimination at work, you may have a legal right to challenge it.
• Coping with student life: Adjusting to student life can be tough. You might be getting used to a new living situation, or moving away from home for the first time. Maybe you’re nervous about starting your course, or you’re worried about making new friends.

Family and personal life

• Coping when supporting someone else: If you care for another person, it can feel difficult to take time to look after yourself. But it’s important to look after your own wellbeing when you can.
• Coping as a parent with a mental health problem: Many people worry that it will be difficult to cope with parenting if they have a mental health problem. It is natural to be concerned about the impact this will have on you and your children. With the right support and resources though, it is perfectly possible to be a good parent while managing a mental health problem, and to care for and support your children in a positive way.
• Abuse: Taking the first step in seeking help for abuse can feel difficult. You may especially feel this way if you have tried to talk to friends, family or professionals and have not had a response that helped you. These organizations support people who are experiencing, or have experienced, any type of abuse.
  • Domestic Violence Resources (https://hr.nih.gov/working-nih/civil/domestic-violence-resources)
  • National Domestic Violence Hotline 1-800-799-7233 (https://www.thehotline.org)
  • National Center for Victims of Crime 1-855-484-2846 (https://victimconnect.org)
• Addiction and dependency: Addiction is often linked to mental health problems. Your addiction may have started as a way to cope with feelings that you felt unable to deal with in other ways. Some of the following organizations may be able to help you understand and manage your addiction (https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction).

Exercising

Being physically active is important for both your physical and mental health. Regular exercise can relieve tension, relax the mind and reduce anxiety. When you’re stressed, the last thing you probably feel like doing is getting up and exercising. But physical activity is a huge stress reliever—and you don’t have to be an athlete or spend hours in a gym to experience the benefits. Exercise releases endorphins that make you feel good, and it can also serve as a valuable distraction from your daily worries.

While just about any form of physical activity can help burn away tension and stress, rhythmic activities are especially effective. Good choices include walking, running, swimming, dancing, cycling, tai chi, and aerobics. But whatever you choose, make sure it’s something you enjoy so you’re more likely to stick with it.

While you’re exercising, make a conscious effort to pay attention to your body and the physical (and sometimes emotional) sensations you experience as you’re moving. Focus on coordinating your breathing with your movements, for example, or notice how the air or sunlight feels on your skin. Adding this mindfulness element will help you break out of the cycle of negative thoughts that often accompanies overwhelming stress.

While you’ll get the most benefit from regularly exercising for 30 minutes or more, it’s okay to build up your fitness level gradually. Even very small activities can add up over the course of a day. The first step is to get yourself up and moving. Here are some easy ways to incorporate exercise into your daily schedule:

• Put on some music and dance around
• Take your dog for a walk
• Walk or cycle to the grocery store
• Use the stairs at home or work rather than an elevator
• Park your car in the farthest spot in the lot and walk the rest of the way
• Pair up with an exercise partner and encourage each other as you work out
• Play ping-pong or an activity-based video game with your kids

Relaxing

Deep breathing exercises, muscle relaxation exercises, yoga and meditation are some techniques that can relax the body and reduce stress.

Spending time with family for friends

Being with people you find uplifting, resolving personal conflicts, and talking about your feelings can help.

There is nothing more calming than spending quality time with another human being who makes you feel safe and understood. In fact, face-to-face interaction triggers a cascade of hormones that counteracts the body’s defensive “fight-or-flight” response. It’s nature’s natural stress reliever (as an added bonus, it also helps stave off depression and anxiety). So make it a point to connect regularly—and in person—with family and friends.

Keep in mind that the people you talk to don’t have to be able to fix your stress. They simply need to be good listeners. And try not to let worries about looking weak or being a burden keep you from opening up. The people who care about you will be flattered by your trust. It will only strengthen your bond.

Of course, it’s not always realistic to have a pal close by to lean on when you feel overwhelmed by stress, but by building and maintaining a network of close friends you can improve your resiliency to life’s stressors.

Looking after your health

In addition to regular exercise, there are other healthy lifestyle choices that can increase your resistance to stress.

• Eat a healthy diet. When you’re stressed, it can be tempting to skip meals or eat too much of the wrong kinds of food. But what you eat, and when you eat, can make a big difference to how well you feel. Well-nourished bodies are better prepared to cope with stress, so be mindful of what you eat. Start your day right with breakfast, and keep your energy up and your mind clear with balanced, nutritious meals throughout the day.
• Reduce caffeine and sugar. The temporary “highs” caffeine and sugar provide often end in with a crash in mood and energy. By reducing the amount of coffee, soft drinks, chocolate, and sugar snacks in your diet, you’ll feel more relaxed and you’ll sleep better.
• Avoid alcohol, cigarettes, and drugs. Self-medicating with alcohol or drugs may provide an easy escape from stress, but the relief is only temporary. Don’t avoid or mask the issue at hand; deal with problems head on and with a clear mind.
• Get enough sleep. Stress can often make it difficult to sleep, and can cause sleep problems. Getting enough sleep can help you feel more able to deal with difficult situations.
  Adequate sleep fuels your mind, as well as your body. Feeling tired will increase your stress because it may cause you to think irrationally.

Recommended Amount of Sleep

Age	Recommended Amount of Sleep
Infants aged 4-12 months	12-16 hours a day (including naps)
Children aged 1-2 years	11-14 hours a day (including naps)
Children aged 3-5 years	10-13 hours a day (including naps)
Children aged 6-12 years	9-12 hours a day
Teens aged 13-18 years	8-10 hours a day
Adults aged 18 years or older	7–8 hours a day

[Source ¹⁴]

Do things you enjoy

If you feel unable to manage your stress alone or with support from loved ones, seek help from a counselor or health professional.

• Set aside leisure time. Include rest and relaxation in your daily schedule. Don’t allow other obligations to encroach. This is your time to take a break from all responsibilities and recharge your batteries.
• Do something you enjoy every day. Make time for leisure activities that bring you joy, whether it be stargazing, playing the piano, or working on your bike.
• Keep your sense of humor. This includes the ability to laugh at yourself. The act of laughing helps your body fight stress in a number of ways.
• Take up a relaxation practice. Relaxation techniques such as yoga, meditation, and deep breathing activate the body’s relaxation response, a state of restfulness that is the opposite of the fight or flight or mobilization stress response. As you learn and practice these techniques, your stress levels will decrease and your mind and body will become calm and centered.

Give yourself a break

Learning to be kinder to yourself in general can help you control the amount of pressure you feel in different situations, which can help you feel less stressed.

• Reward yourself for achievements – even small things like finishing a piece of work or making a decision. You could take a walk, read a book, treat yourself to food you enjoy, or simply tell yourself “well done”.
• Get a change of scenery. You might want to go outside, go to a friend’s house or go to a café for a break – even if it’s just for a short time.
• Take a break or holiday. Time away from your normal routine can help you relax and feel refreshed. Even spending a day in a different place can help you feel more able to face stress.
• Resolve conflicts, if you can. Although this can sometimes be hard, speaking to a manager, colleague or family member about problems in your relationship with them can help you find ways to move forward.
• Forgive yourself when you feel you have made a mistake, or don’t achieve something you hoped for. Try to remember that nobody’s perfect, and putting extra pressure on yourself doesn’t help.

Make lifestyle changes

There are some general changes that you can make to your lifestyle that could help you feel more able to cope with pressure and stressful situations.

• Practise being straightforward and assertive in communicating with others. If people are making unreasonable or unrealistic demands on you, be prepared to tell them how you feel and say no.
• Use relaxation techniques. You may already know what helps you relax, like having a bath, listening to music or taking your dog for a walk. If you know that a certain activity helps you feel more relaxed, make sure you set aside time to do it. See our pages on relaxation for lots more ideas.
• Develop your interests and hobbies. Finding an activity that’s completely different from the things causing you stress is a great way to get away from everyday pressures. If stress is making you feel lonely or isolated, shared hobbies can also be a good way to meet new people.
• Make time for your friends. When you’ve got a lot on this might seem hard, but it can help you feel more positive and less isolated. Chatting to friends about the things you find difficult can help you keep things in perspective – and you can do the same for them. Laughing and smiling with them will also produce hormones that help you to relax.
• Find balance in your life. You may find that one part of your life, such as your job or taking care of young children, is taking up almost all of your time and energy. Try making a decision to focus some of your energy on other parts of your life, like family, friends or hobbies. It’s not easy, but this can help spread the weight of pressures in your life, and make everything feel lighter.

Organize your time

Making some adjustments to the way you organize your time could help you feel more in control of any tasks you’re facing, and more able to handle pressure.

• Identify your best time of day, and do the important tasks that need the most energy and concentration at that time. For example, you might be a morning person or an evening person.
• Make a list of things you have to do. Arrange them in order of importance, and try to focus on the most urgent first. Some people find creating a timetable useful so they can plan when they can spend time on each task. If your tasks are work related, ask a manager or colleague to help you prioritise. You may be able to push back some tasks until you’re feeling less stressed.
• Set smaller and more achievable targets. When you’re under a lot of pressure it’s easy to set yourself large targets that are often unachievable. This can make you feel more stressed and if you don’t reach them, it can make you feel disappointed and frustrated. Setting smaller more achievable goals can make you feel in more control and you can see your achievements more easily.
• Vary your activities. Balance interesting tasks with more mundane ones, and stressful tasks with those you find easier or can do more calmly.
• Try not to do too much at once. If you take on too much, you might find it harder to do any individual task well. This can make you feel like you have even more pressure on you.
• Take breaks and take things slowly. It might be difficult to do this when you’re stressed, but it can make you more productive.
• Ask someone if they can help. For example, you could ask a friend or family member to help with some of your daily tasks so that you have more time to spend completing your tasks that are causing you to feel stressed.

Treatments for stress

Stress isn’t a medical diagnosis, so there’s no specific treatment for it. However, if you’re finding it very hard to cope with things going on in your life and are experiencing lots of signs of stress, there are treatments available that could help. These include:

• Psychotherapy also called “talk therapy”
• Ecotherapy
• Complementary and alternative therapies
• Medications

To access most treatments, the first step is usually to talk to your doctor or healthcare provider.

Psychological therapy

If you are struggling to cope, or the symptoms of your stress or anxiety won’t go away, it may be time to talk to a professional. Psychotherapy also called “talk therapy” and medication are the two main treatments for anxiety, and many people benefit from a combination of the two.

Talking with a trained professional can help you learn to deal with stress and become more aware of your own thoughts and feelings. Common types of psychotherapy which can help with stress are:

1. Cognitive behavioral therapy (CBT), which helps you understand your thought patterns, recognize your trigger points and identify positive actions you can take.
2. Mindfulness-based stress reduction, which combines mindfulness, meditation and yoga with a particular focus on reducing stress.

Debriefing

Critical incident stress debriefing is one of the most commonly considered interventions after a traumatic event ¹⁵. Classically, critical incident stress debriefing is carried out in 7 stages, as follows:

1. Introduction (purpose of the session)
2. Description of the traumatic event
3. Appraisal of the event
4. Exploration of the participants’ emotional reactions during and after the event
5. Discussion of the normal nature of symptoms after traumatic events
6. Discussion of ways of dealing with further consequences of the event
7. Discussion of the session and formulation of practical conclusions

It should be kept in mind that research efforts have not shown critical stress debriefing to be effective in preventing PTSD, depression, or anxiety. In some cases, if performed poorly, debriefing can even harm survivors by increasing arousal and overwhelming their defenses. Operational debriefing, which focuses on normalizing emotional response, informing patients of services available to them, and providing general support, is safer.

In engaging in a 1- to 2-session intervention after a traumatic event, there are several guidelines that should be followed to help avoid harm and maximize the chance of benefit, as follows:

• Provide trained individuals to perform the intervention
• Avoid ventilating feelings at high levels; this can lead to contagion and flooding rather than calming and improved ability to cope with feelings
• Do not pressure individuals to talk about things they do not want to talk about; respect their defenses, including denial

Critical tasks to cover include the following:

• Psychoeducation to help patients see that the feelings they are having are not a sign of weakness or mental illness but a normal reaction to a very disturbing situation
• Discussion of ways to improve coping skills, including getting adequate rest, recreation, food, and fluids
• Avoidance of excessive exposure to media coverage of the traumatic incident
• Discussion of common cognitive distortions, such as survivor guilt and fears that the world is totally unsafe
• Explanation of the signs and symptoms indicating that the survivor should get professional help

Cognitive-behavioral therapy

Whereas 70% of those receiving supportive therapy or no therapy after a traumatic event develop PTSD, only about 10-20% of those who receive cognitive-behavioral therapy (CBT) shortly after such an event develop PTSD ¹⁶. Moreover, patients who receive CBT with or without hypnosis report less reexperiencing and fewer avoidance symptoms than patients who receive supportive counseling. Individuals are aided by the following:

• Seeing that people are concerned about them
• Learning about the range of normal responses to trauma and hearing that their emotional reactions are normal responses to an abnormal event (rather than a sign of weakness or pathology)
• Being reminded to take care of concrete needs (eg, food, fluids, and rest)
• Cognitive restructuring (changing destructive schema to more constructive ones [see the Table below])
• Learning relaxation techniques
• Undergoing exposure to avoided situations either via guided imagery and imagination or in vivo
• Desensitization to painful memories via repeated controlled exposures and systematic desensitization

Current data suggest that if the resources are available, a course of CBT should be offered to those at high risk for developing PTSD. CBT should be performed by someone trained in the technique. Severe, relatively common destructive cognitions may arise after a traumatic event and may have to be addressed.

Brief school intervention

A brief school intervention lasts 1-2 hours and uses 4 therapists per class. A teacher is present, and parents are informed. The intervention includes the following steps:

• Introduce the therapists, and ask students to guess why they have come to the classroom
• Explain that therapists have come to talk about the disaster, and encourage students to share what they know for 10-30 minutes; validate correct information, and be calm
• Have children draw while therapists circulate, and ask students to tell them about their drawings
• Reassure students that their symptoms are normal and will ease; that people have different symptoms; that disasters are rare; and that teachers, parents, and counselors are available to help them
• Having students do a second drawing in which they depict a future and a positive state of the world is very important; the first picture is likely to focus on the trauma, their loss, and its effect on them; ideally, the second picture should show healing and restoration of normal life
• Thank the students and the teachers, and redirect their attention to learning.

Mindfulness therapy

Mindfulness is a technique you can learn which involves making a special effort to notice what’s happening in the present moment (in your mind, body and surroundings) – without judging anything. Mindfulness has roots in Buddhism and meditation, but you don’t have to be spiritual, or have any particular beliefs, to try it. Studies show that practising mindfulness can help to manage depression, some anxiety problems and feelings of stress. Some structured mindfulness-based therapies have also been developed to treat these problems more formally.

The way you think (and what you think about) can affect how you feel and act. For example, if you think or worry a lot about upsetting past or future events, you might often feel sad or anxious.

The theory behind mindfulness is that by using various techniques to bring your attention to the present (usually focusing on your body and your breathing), you can:

• Notice how thoughts come and go in your mind. You may learn that they don’t have to define who you are, or your experience of the world, and you can let go of them.
• Notice what your body is telling you. For example, tension or anxiety can often be felt in your body (such as in a fast heartbeat, tense muscles or shallow breathing).
• Create space between you and your thoughts, so you can react more calmly.

Mindfulness aims to help you:

• become more self-aware
• feel calmer and less stressed
• feel more able to choose how to respond to your thoughts and feelings
• cope with difficult or unhelpful thoughts
• be kinder towards yourself.

Many people find practising mindfulness helps them manage their day-to-day wellbeing, but it doesn’t always work for everyone.

Here are a few exercises you could try. You don’t need any special equipment:

• Mindful eating. This involves paying attention to the taste, sight and textures of what you eat. For example, when drinking a cup of tea or coffee you could focus on how hot and liquid it feels on your tongue, how sweet it tastes or watch the steam that it gives off.
• Mindful moving, walking or running. Notice the feeling of your body moving. You might notice the breeze against your skin, the feeling of your feet or hands against different textures on the ground or nearby surfaces, and the different smells that are around you.
• Body scan. This is where you move your attention slowly through different parts of the body, starting from the top of your head moving all the way down to the end of your toes. You could focus on feelings of warmth, tension, tingling or relaxation of different parts of your body.
• Mindful coloring and drawing. Focus on the colors and the sensation of your pencil against the paper, rather than trying to draw something in particular. You could use a mindfulness coloring book or download mindfulness coloring images.
• Mindful meditation. This involves sitting quietly and focusing on your breathing, your thoughts, sensations in your body and the things you can hear around you. Try to bring you focus back to the present if your mind starts to wander. Many people also find that yoga helps them to concentrate on their breathing and focus on the present moment.

Different things work for different people, so if you don’t find one exercise useful, try another. You can also try adapting them so that they suit you and are easier to fit in with your daily life.

Ecotherapy

Ecotherapy is a way of improving your wellbeing and self-esteem by spending time in nature. This can include physical exercise in green spaces or taking part in a gardening or conservation project. For example, doing things like growing food or flowers, exercising outdoors or being around animals can have lots of positive effects.

Spending time in nature has been found to help with mental health problems including anxiety and depression. For example, research into ecotherapy has shown it can help with mild to moderate depression. This might be due to combining regular physical activity and social contact with being outside in nature.

Being outside in natural light can also be helpful if you experience seasonal affective disorder (SAD), a type of depression that affects people during particular seasons or times of year. And people tell us that getting into nature has helped them with many other types of mental health problems.

Ecotherapy or spending time in green space or nature can:

• improve your mood
• reduce feelings of stress or anger
• help you take time out and feel more relaxed
• improve your physical health
• improve your confidence and self-esteem
• help you be more active
• help you make new connections
• provide peer support.

Grow or pick food

If you’re going fruit picking or foraging, be aware that not all wild plants are safe to eat. Before eating something you’ve picked yourself, make sure you know exactly what it is.

• Create a growing space. If you don’t have access to a garden, you could plant salad leaves or herbs in a window box or plant pot.
• Plant vegetables in your garden.
• Grow food together with others. Apply to share an allotment, or look for community gardens or food growing projects in your local area.
• Go fruit picking. Look for local farms or orchards that let you pick fruit to buy. You might also find fruit growing in urban spaces, for example wild blackberries.
• Learn to find edible plants, also known as food foraging. You could see if a foraging group meets in your local area. (The Woodland Trust website has more information on foraging.)

Bring nature inside

Save glass jars and use them to make mini gardens (also known as terrariums), using plants, soil, stones and anything else you’d like to include. Some people like to add seashells, or plastic toys or figurines.

• Buy flowers or potted plants for your home.
• Collect natural materials, for example leaves, flowers, feathers, tree bark or seeds – use them to decorate your living space or in art projects.
• Arrange a comfortable space to sit, for example by a window where you can look out over a view of trees or the sky.
• Grow plants or flowers on windowsills.
• Take photos of your favorite places in nature. Use them as backgrounds on a mobile phone or computer screen, or print and put them up on your walls.
• Listen to natural sounds, like recordings or apps that play birdsong, ocean waves or rainfall.

Do activities outdoors

If you’re going out on your own for longer than you usually would, or walking somewhere you don’t know well, plan ahead and remember to keep your safety in mind. If you can, let someone know where you’re going and for how long, and take your phone with you (making sure it’s fully charged).

• Take a walk in green space, such as a local park.
• Get creative. Draw or paint animals or nature scenes, or let them inspire a poem or song lyrics. If you enjoy writing in a journal, try doing this outside.
• Eat meals outdoors. Have a picnic in a local park, or simply sit in a garden. This might be something you could enjoy doing with other people.
• Watch the stars. Use a stargazing website, app or book to help you recognize different stars, or simply enjoy looking at the night sky. Give your eyes time to adjust, as it can take about 20 minutes before you can fully see stars in the dark.
• Try exercising outside. Run or jog through a local park, or do yoga outdoors. You could try it by yourself, or look for classes in your local area.
• Join a local walking or rambling group.
• Follow a woodland trail.
• Go beachcombing. Visit the seaside and search the shoreline for interesting things.
• Try geocaching. Geocaching involves looking for items in hidden outdoor locations, using a device such as a mobile phone or tablet.
• Be mindful in nature. Find things to see, hear, taste, smell and touch, like grass under your feet or the feeling of wind and sunlight. You could also listen to recordings of mindfulness exercises.

Connect with animals

• Watch out for wildlife. If you don’t live near open countryside, try visiting a local park to look for squirrels, fish, insects, ducks and other birds.
• Visit a local community or city farm. You might be able to help out by volunteering.
• Hang a bird feeder outside a window. If there’s space, you could build a small wooden nesting box on a tree or under a windowsill.
• Try birdwatching. You don’t need any special equipment.
• Try pet-sitting or dog walking. Offer to be a pet sitter in your local neighborhood, volunteer to walk dogs for an animal shelter, or ask to borrow a friend’s dog for occasional evening or weekend walks.
• Take part in a nature survey. This might involve counting birds, animals or insects in a particular time and place, or reporting individual sightings of wildlife.

Help the environment

• Go on a litter picking walk, for example, in the park or on the beach.
• Volunteer for a conservation project.
• Plant helpful seeds, such as berry bushes for garden birds or flowers to help bumblebees.
• Build an animal habitat, for example, build a hedgehog house or create a pond if you have enough space.

Complementary and alternative therapies

You may find certain complementary therapies help you manage feelings of stress. These might include:

• Yoga. Yoga is a mind-body practice that combines physical poses, controlled breathing, and meditation or relaxation. Yoga brings together physical and mental disciplines that may help you achieve peacefulness of body and mind. Yoga may help you relax and manage stress and anxiety, lower blood pressure and lower your heart rate. And almost anyone can do it.
• Meditation. Meditation can wipe away your day’s stress, bringing with it inner peace. Meditation is considered a type of mind-body complementary medicine. Meditation can produce a deep state of relaxation and a tranquil mind. Meditation has been practiced for thousands of years. Meditation originally was meant to help deepen understanding of the sacred and mystical forces of life. These days, meditation is commonly used for relaxation and stress reduction. During meditation, you focus your attention and eliminate the stream of jumbled thoughts that may be crowding your mind and causing stress. This process may result in enhanced physical and emotional well-being. Meditation can give you a sense of calm, peace and balance that can benefit both your emotional well-being and your overall health. And these benefits don’t end when your meditation session ends. Meditation can help carry you more calmly through your day and may help you manage symptoms of certain medical conditions.
• Acupuncture
• Aromatherapy. Aromatherapy uses essential oils (oils extracted from plants) for healing. Some people find that the smell (aroma) of particular oils helps them to relax, sleep better, relieve pain and improve low mood. For example, when used appropriately lavender and camomile essential oils are thought to be relaxing and help you sleep. The essential oils can be used in many different ways, such as in creams, oil burners, massaged in to the skin or by adding drops to a warm bath.
• Massage. Massage uses touch in a sensitive and respectful way, taking account of physical symptoms, wellbeing, and your lifestyle. There are lots of different types of massage therapy, such as Shiatsu, Indian head massage and aromatherapy massage.

Other relaxation techniques may include:

• Deep Breathing or Breathing Exercises: This technique involves focusing on taking slow, deep, even breaths.
• Tai chi. Tai chi helps reduce stress and anxiety. And it also helps increase flexibility and balance.
• Biofeedback-Assisted Relaxation: Biofeedback techniques measure body functions and give you information about them so that you can learn to control them. Biofeedback-assisted relaxation uses electronic devices to teach you to produce changes in your body that are associated with relaxation, such as reduced muscle tension.
• Guided Imagery: For this technique, people are taught to focus on pleasant images to replace negative or stressful feelings. Guided imagery may be self-directed or led by a practitioner or a recording.
• Music and art therapy
• Hydrotherapy
• Self-Hypnosis: In self-hypnosis programs, people are taught to produce the relaxation response when prompted by a phrase or nonverbal cue (called a “suggestion”).
• Progressive Relaxation. Progressive relaxation is also called Jacobson relaxation or progressive muscle relaxation, involves tightening and relaxing various muscle groups. Progressive relaxation is often combined with guided imagery and breathing exercises.

Medications

Feelings of stress are a reaction to things happening in your life, not a mental health problem, so there’s no specific medication for stress. However, there are various medications available which can help to reduce or manage some of the signs of stress.

For example, your doctor might offer to prescribe:

• sleeping pills or minor tranquillizers if you’re having trouble sleeping
• antidepressants if you’re experiencing depression or anxiety
• medication to treat any physical symptoms of stress, such as irritable bowel syndrome (IBS), or high blood pressure.

The use of medications to decrease arousal and insomnia may have a long-term impact.

Beta blockers (as well as alpha-adrenergic agents) may limit hyperarousal both initially and over the longer term ¹⁷. For extreme agitation, aggression, psychosis, or dissociation, an atypical neuroleptic or mood stabilizer may be needed.

Diphenhydramine and other medications may be helpful for improving sleep. Benzodiazepines, by limiting hyperarousal and fostering sleep, can be helpful in the initial stages; however, continuous administration may interfere with grieving and readaptation, because these agents can interfere with learning ¹⁸. Longer-acting agents are particularly beneficial when medication is administered at the emergency site and follow-up treatment is in short supply.

Selective serotonin reuptake inhibitors (SSRIs) can be helpful in dealing with the core symptoms (including anxiety, depression, withdrawal, and avoidance) and can play a central role in longer-term treatment. Current research indicates that SSRIs prazosin and propranolol may be helpful in the treatment of PTSD. Benzodiazepines are often used but present significant risks especially to the elderly, individuals with co-morbid substance abuse histories, and traumatic brain injury.

Comorbid conditions such as attention deficit hyperactivity disorder (ADHD) should be targeted. Reduction in even 1 disabling symptom (eg, insomnia or hyperarousal) may have a powerful positive impact on the individual’s ability to re-compensate.

References

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