We spoke to Consultant Psychiatrist, Dr Jaya Gowrisunkur, about coping with stress during a time that can have a negative impact on mental health. We explore the causes of stress, the most appropriate treatment, and the best ways to avoid the pressures of Christmas.

Stress is a normal, necessary and adaptive response that helps us to deal with the challenges of life and the environment around us. When we perceive a threat, our ‘fight or flight’ reaction is triggered, which acts as an aid to survival and a way of managing change.

We all experience stress at some point in our lives but different people have different capacities to cope with and manage it. Some individuals thrive on high levels of stress, such as in stressful working environments, whereas others struggle a lot more with the pressure.

Whilst the ‘fight or flight’ response isn’t as necessary in modern day life as it was for our early ancestors, our bodies still react with a range of physical changes during times of heightened stress, including:

  • Raised blood pressure
  • Faster heartbeat
  • Increased breathing rate
  • Muscular tension
  • Changes in visual and hearing acuity

We have all experienced these feelings at one time or another. However, it is when this response endures for a long period of time that we can be left with the long-term negative effects of stress.

The effects of heightened stress

Absenteeism at work as a result of stress, led to a record 17 million working days being lost in 2015, costing the UK economy at least £2.4 billion according to the UK Statistics Authority. There were about 244,000 new cases of stress, anxiety and depression being diagnosed in the UK in that year. This is an under-reported problem and organisations such as Anxiety UK state that many people suffer in silence for fear of stigma or victimisation. Stress is something that should be treated as early as possible, in order to reduce the damaging effects to individuals and society.

How to spot the signs and symptoms of stress

Early intervention with any mental health condition is key to enabling a strong recovery, and recognising the signs and symptoms of stress in a patient at your GP surgery is crucial. Physical symptoms of stress can include:

  • Regular headaches
  • Unexplained nausea, vomiting, diarrhoea or constipation
  • Muscular aches and pains
  • Dizziness, palpitations, and sudden visual changes
  • Hyper sensitivity to noise
  • Insomnia and fatigue
  • Loss of libido

Psychological symptoms of stress include:

  • Anger
  • Impatience
  • Excessive worrying
  • Loss of confidence
  • Poor concentration
  • Forgetfulness

Behavioural changes that are linked to stress include:

  • Procrastination
  • Indecisiveness
  • Heightened aggression
  • Tearfulness
  • Loss of capacity to cope
  • Loss of resilience
  • Increased sensitivity
  • Inability to perform at work
  • Social withdrawal including withdrawal from family and friends
  • Relationship problems

Coping with Christmas

Pressures of modern day life can heighten the feelings of stress even more and for those who already suffer from this mental health condition, events such as Christmas can be an extremely difficult time.

Christmas is seen by most people as being a time for celebration – music, bright lights, presents, treats, socialising with family and friends and lots of food and drink. Sadly, this image is far from some people’s reality and issues associated with Christmas may cause significant stress. These issues may include:

  • Expectations to socialise and spend more money
  • The emphasis on loneliness at this time of year causes greater sadness
  • Feelings of loss or grief are heightened
  • Additional cleaning and cooking on top of already busy lives causes added pressure
  • Arguments amongst family during a time of closer proximity causes added tension
  • Financial worries are heightened with demands for buying the best gifts
  • Pressures on parents to provide the perfect Christmas for their children

A study conducted by eBay compared Christmas shopping to running a marathon in terms of the stress that it produces on the body, with women and the over-45s finding the experience the most pressurising and intense. 60% of those surveyed experienced shopping fatigue after 32 minutes and heart rates increased by an average of 33% during this time.

Christmas is also a time when most people, whether they struggle with stress or not, consume more alcohol than usual. This can cause people to behave in uncharacteristic, risky or embarrassing ways which can then have significant effects at work and at home, some of which are long-term. This of course can lead to greater stress on the individual.

Another aggravating factor that may contribute towards stress levels at this time of year is the role of social media which triggers the ‘one upmanship game’ during the holiday season. Platforms such as Facebook and Instagram not only fuel ‘FOMO’ (fear of missing out), but leaves people feeling as though they are failures for not having the best tree, decorations, presents or food.

All in all, the holiday season creates the ‘perfect storm’ of heightened physical, emotional, psychological and social stressors.

How to deal with stress

There is lots of advice that GPs can offer to patients, from support regarding simple life changes for coping with the symptoms of stress, to how patients can seek therapy and treatment.

During stressful periods such as Christmas, it is important for individuals to find safe outlets for emotions such as going to the gym or chatting to a friend. Below is some more advice that a GP could offer:

  • Focus on positives and celebrate the small achievements
  • Don’t catastrophise – ask yourself “what if everything goes well, not wrong?”
  • Forget ‘shoulds and musts’
  • Stop people-pleasing – it is OK if you don’t try to be everywhere or do everything
  • Let go of your inner perfectionist – look at what really matters to you
  • Have a break from social media and don’t compare yourself to others

Practical tips to share

  • Spread out your diary – it is OK to hold events in November and/or plan some for January
  • Prepare and plan in advance how your time is going to be shared
  • Organise, prioritise and set achievable goals
  • Set yourself a budget before Christmas shopping
  • Share the load – allocate tasks and give other people responsibility

Good habits to share and cultivate for self-care

  • Clean up unnecessary clutter
  • Open a window or go for a walk for fresh air
  • Take up a class, for example in yoga
  • Drink responsibly, limit alcohol or avoid it completely
  • Avoid self-medicating with alcohol and food

Some people who are stressed, anxious or depressed can turn to negative ways of coping, such as eating too much food or drinking alcohol, to make themselves feel better. At this point, one can never eat or drink enough because emotional distress cannot be reduced with this behaviour.

Clinical approaches to treating stress

A GP can provide education, information and practical tips to manage stress, anxiety and low mood and may direct the patient to self-help material including relaxation and meditation guides. There is a wealth of information available online and provided by voluntary organisations that is very useful.

The patient may also benefit from a referral to therapy. Treatment for stress can include:

  • Cognitive behavioural therapy (CBT)
  • Mindfulness-based therapy (MBT)
  • Medication including anti-depressants may be helpful in certain cases

A GP should offer the option of a psychiatric consultation if stress is severe or if the patient is developing depression and anxiety. If a GP is alerted to the possibility of alcohol and drug addiction and eating disorders alongside stress, the correct treatment can also be offered for these co-occurring conditions.

Psychological assessments allow a GP to determine what the current problem is, what triggers the stress and what the aggravating or maintaining factors are. A mutual collaborative understanding of the problem can be reached to formulate an agreed treatment plan.

Priory offers services that aim to address common mental health problems including stress, anxiety and depression. Priory also specialises in treatment approaches for addictions including alcohol and drug addiction and offers dedicated treatment programmes for eating disorders including psychological therapy.

An initial appointment can be provided with a consultant psychiatrist, who can help to clarify the issues and form a diagnosis, leading to a bespoke care plan.

For more details on the full range of Priory Services, please call 0800 840 3219 or click here to make an enquiry.