Stress

Understanding stress

Stress is part of everyday life. Situations and your ambitions create stress, but it brings out your best and keeps you alert. However, too much stress can drive you to 'burnout'.

What is burnout?

Burnout is a condition that develops when you work too hard for too long in a high-pressure environment. You become physically and emotionally exhausted.

Who does burnout affect?

Burnout can affect anyone at any age, and not just high-powered executives. However, over-conscientious perfectionists are most likely to suffer burnout. They are highly competitive and impatient. They've got high expectations of themselves and of others, but cannot share out work and responsibility. They're used to being in control, and are unlikely to ask for help when things go wrong.

When does stress affect our performance?

The 'human function curve' shows how stress affects our performance and can lead to burnout.

Zones of the human function curve from drone zone to burnout.

The drone zone
With little to challenge you, you'll be uncommitted, sluggish and bored.

Performance improving
With some stress, your performance and job satisfaction will improve.

The 'C' zone
In this ideal state, you'll be full of energy, totally focused and find work effortless. You'll be cool, calm and collected.

The fatigue zone
If you allow stress to build up unchecked, your performance will begin to decline sharply. You may become irritable and overuse caffeine and alcohol, causing insomnia (difficulty sleeping) and aggression. Without rest, tiredness can lead to exhaustion.

The exhaustion zone
Your performance will continue to decline, and you'll become more aggressive and resentful. Often, you will use alcohol to tackle your insomnia.

The ill-health zone
Your physical health will suffer, leading to mental-health problems.

The panic zone
You'll now believe that things are out of control. You'll feel disorganised and nervous, and may even experience panic attacks. Any extra pressure can now lead to breakdown and burnout.

Breakdown and burnout
You may now be reluctant to go to work, feel constantly tired due to insomnia and agitation. It can cause clinical depression, which brings with it the risk of suicide. Road accidents, marital breakdown, alcoholism and drug addiction are common.

"The 'old me' used to thrive under pressure. I took short lunch hours and worked a lot of overtime. Now I feel a general nervousness, and if anybody upsets me I'm likely to erupt like a volcano. My self-confidence has been shattered, and I've lost all my interest and enthusiasm. I only feel resentment and despair."

What are the signs of burnout?

Symptoms of burnout include:

Insomnia leading to tiredness
Irritability or outbursts of anger
Depression
Having too much caffeine or alcohol
Low productivity accompanied by feelings of low achievement, regular absence and a high sickness rate
Being accident-prone
Being cynical and defensive, and finding fault
Headaches, backache, indigestion, weight loss or gain, shortness of breath, regular or lingering colds

What are the physical signs of burnout?

Too much stress and burnout can lead to:

Ulcers
Irritable bowel syndrome
High blood pressure
Angina, heart attacks and strokes
Migraines
Drug and alcohol addiction
Asthma
Diabetes

How is stress and burnout treated?

The effects of stress will vary between individuals. For example, you could be suffering from depression or drug addiction, so you may need a short course of medication. You may be offered therapy to help you change your attitudes and behaviour, and to help you develop a lifestyle and strategies for coping better with stress. You should try to avoid stressful people and situations, and you may even need a period away from work.

Self help

There are several ways in which you can reduce the effects of stress.

Reduce the amount of alcohol you drink. Men should not drink more than 21 units a week, and women no more than 14 units, with two alcohol-free days. One unit equals one small glass of wine, one pub measure of spirits or half a pint of beer.
Reduce your caffeine intake. Caffeine causes anxiety restlessness, irritability, palpitations and headaches. As little as150 milligrams of caffeine a day (about two cups of coffee) can create these symptoms.
Get enough sleep. Caffeine and nicotine are stimulants, so avoid them within six hours of bedtime. Instead, drink a hot milky drink before bedtime. In the evening, avoid fatty foods and instead eat meals that are rich in protein and carbohydrate. If you worry at bedtime, write down your problems and possible solutions after your evening meal. It will help you relax and put things into perspective.
Exercising for over 20 minutes, three days a week, reduces the levels of adrenaline released by stress, and encourages deep sleep. (However, avoid strenuous physical exercise within two hours of bedtime.)
Meditation is good for your health. It recharges your tired brain, lowers blood pressure, heart rate and cholesterol, and reduces anxiety. Try yoga, progressive muscular relaxation, the Alexander technique, autogenic training or listening to gentle music. Try meditation for 20 minutes, twice a day.
Short breaks are better than long holidays, helping you avoid pressure building up before you go and a mountain of work to come back to.
Pets can be calming, and give you unconditional love and affection.
Get enough sleep. Sleeping pills are unnecessary if you can change your lifestyle.
If you're ill, don't ignore it. Go and see your doctor or take time off work.
Avoid conflicts with other people.
Learn to accept what you cannot change. To ignore this only leads to unhappiness and bitterness.
Plan ahead to avoid too much pressure building up.
Walk away from stressful situations.
Spend time with people who are rewarding rather than critical and judgmental.
Practice controlled breathing using the lower part of your lungs. On the first breath in and out count one, and repeat until you reach the 10th breath in and out, then count back down. Repeating this technique for several minutes will help you relax and free your mind of any worries.
Finally, remember that a balanced life is the best way to overcome burnout.

Finding help

Contacting your GP is often the easiest way to get help and further treatment. He or she may offer you counselling or dietary advice, or refer you to a specialist for further assessment. This may lead to outpatient treatment or, if more serious, day or inpatient treatment. As a day or inpatient, you might be offered massage, aromatherapy and reflexology.

If you're worried about talking to your GP, you can:

consider writing down your concerns and questions;
take a friend or family member with you;
see another doctor in the practice; or
join a new GP practice.

The type of professional support offered will depend on the services that are available in your area and the arrangements that your primary care trust (PCT) have with other health authorities or private providers. Treatment for stress is also available privately through Priory. Please call 0845 2 PRIORY (0845 2 774 679) or email info@priorygroup.com for help or more information.

If you feel that you or a close relative are affected by stress and would like help or more information, you can ask your GP or contact any of the following organisations:

International Stress Management Association UK
07000 780430 (www.isma.org.uk)

Depression Alliance
0845 123 23 20 (www.depressionalliance.org)

NHS Direct (England and Wales)
0845 4647 (www.nhsdirect.nhs.uk)

NHS 24 (Scotland)
08454 242424 (www.nhs24.com)

The Samaritans
08457 90 90 90 (www.samaritans.co.uk)

Priory
0845 2 774 679 (www.priorygroup.com)

If you are interested in receiving treatment from us, your GP will be able to refer you.

If you or your relative have private medical insurance, your insurer will probably insist that your GP refers you to us.

Why should I choose Priory?
Our service
At Priory, our committed and professional staff provide the highest standards of care, understanding and service for everyone. This service brings hope and confidence, allowing our patients to take control of their lives within a safe and secure environment.

Expertise and innovation
Through our close links with the public and private sectors, we've developed the expertise and innovation to offer consistent and successful treatment. And, as Europe's leading independent provider of specialist mental health, neuro-rehabilitation and special education services, we bring experience and an excellent reputation.

We admit patients 24 hours a day, seven days a week.

Please click here to view a list of the Priory hospitals that can help with stress.

This document has been edited by Dr Christopher Mayer MBBCh FRCPsych, with the help of Plain English Campaign (www.plainenglish.co.uk)

Click here to download a free Self Help Leaflet