Imagine the following: Susan is a 39-year-old mother of two and she is constantly tired. Both she and Tom, her partner, are working in full-time stressful jobs. His work involves some travel so Susan is often left carrying the can. Both their children are in creche and it is a constant battle to drop them off and collect them as she commutes a distance to work.
Recently Susan has been promoted, but she is struggling to keep all the balls in the air. She lives in a state of constant anxiety with tension headaches, sleep difficulties and teeth grinding at night. A drip-feed of caffeine is needed to counteract her exhaustion, and she is losing weight because she just feels too wired - and exhausted - to eat healthily.
Susan is a perfectionist who procrastinates at home and at work. As a result, problems are mounting up. She is also a chronic catastrophiser and that ratchets up her stress levels.
On top of all that, her mother has developed early dementia and much of the responsibility of finding a carer and dealing with any problems falls to Susan.
Struggling to cope, Susan finds her usual glass of wine turning into two or three as she tries to wind down in the evenings. She depends on social media to keep in touch with her friends. At night she is exhausted but too wired to sleep and instead spends hours browsing online. When she does sleep, the nightmares are horrendous. Her libido plummets and Tom is not happy about the disappearance of their sex life. Things come to a head. She finally breaks down in front of Tom. She has had an awful day, ending with a full-blown panic attack in her car. She got phone calls at work from both the creche and her mum's carer, all looking for an instant response. She feels tired and weepy.
Susan's story mirrors many of those who come to see me. She says her life is a mess and she feels such a failure. All her friends are coping with their lives. What is wrong with her? The answer to Susan's question lies in two words - toxic stress, which is an increasing challenge to our mental and physical health.
Stress is nothing new. Its has always been a part of life: short periods of stress such as sitting exams, job interviews or giving public presentations, or longer periods of stress such as long commutes, financial difficulties or relationship conflicts. But what happens when toxic stress or burnout comes calling? When it is so persistent and pervasive that it overwhelms our physical and psychological reserves with dire consequences for our health?
The long-term consequences of toxic stress can be serious, with an increased risk of heart attack, high blood pressure, cardiac arrhythmia, stroke and cancer as well as the mental health risks of bouts of depression, anxiety, addiction and self-harm. So here is my guide to stress-proofing yourself...
1. ACCEPT YOURSELF
The problem: Unconditional self-acceptance is the most important resilience skill of all. It involves learning how to be 'comfortable in your own skin'. Let's go back to Susan. She has always suffered from stress-related anxiety because she places impossible demands on herself in every part of her life and rates herself mercilessly if she can't satisfy these demands. She struggles with the 'healthy school lunchbox', the chaotic house, the work deadline and most of all not having time to network with friends. It's an intolerable pressure, and her self-rating regularly plummets. In modern parlance, Susan would be described as having issues with self-esteem.
Like Susan, we're all living in a world of self-rating, driven mainly by social media and unrealistic expectations of ourselves, others and life itself. Nowhere is this more prevalent than in our schools and colleges.
I think self-esteem is a myth. It suggests human beings can be rated, one against another. In practice, all of us are unique, special human beings and must learn to accept ourselves as we are.
If, for example, I fail at a task and just believe 'I am a failure' then I don't have to change my life. If, however, I stop rating myself as a failure, but accept that I can assess what I failed at, then I can make changes so that I am less likely to fail at the task the next time. 'The only failure in life is not getting back up again' lies at the heart of resilience.
This is a much more challenging concept as it forces us to explore our behaviour and if necessary change it, while accepting ourselves as the wonderful individuals we all are.
The solution: For Susan to develop this skill, she will need to jot down in a notebook whenever she falls into the trap of self or other rating. She must later challenge it on paper and continue for roughly three months. Can she as a human be a failure, for example, or has she just failed at a task? This allows her rational mind to increasingly overrule her emotional mind which is trying to convince her that she is weak, worthless or a failure.
2. LET GO OF PERFECT
The problem: Being a perfectionist has almost destroyed Susan's life since her teens. She constantly searched for imperfections in herself. It led to her becoming persistently anxious as she not only demanded 100% perfection in life but also rated herself mercilessly if she couldn't achieve it.
The solution: For Susan (and those of us like her) to break free of this destructive form of thinking and behaviour, she will need to, once again, write into her notebook occasions when she sought 100% perfection and later challenge it on paper.
She will also have to practice some simple CBT exercises to help her get used to managing 'the imperfect' in her life. For example, her husband might be asked to cause chaos in the kitchen and she must live with the mess for 24 hours.
3 STOP THINKING THE WORST
The problem: Catastrophising, or visualising the 'worst-case scenario', adds to distress. In Susan's case, a simple phone call from the creche, for example, might start a cascade of catastrophic thoughts, ending with her visualising her child in hospital with meningitis. This drains reserves of energy making her increasingly anxious.
The emotional mind is so much stronger than the logical mind. If the former turns negative, it can swamp the latter. To counteract this, we need to develop techniques to challenge it.
The solution: Again, Susan needs to identify her catastrophic thoughts every day, writing them down in her notebook and then later challenge them on paper. She will have to provide 'evidence' such thoughts are true. Very quickly her rational brain will confirm they are not. By carrying out such an exercise over several months she will in time capture such thoughts in her mind before they take root.
4. DUMP THE PROCRASTINATION
The problem: Many of us procrastinate when stressed. In fact, procrastination was paralysing Susan's life. She couldn't bring herself to start a task or project, unless she believed it would be 100% perfect when finished.
The longer she delayed, the more stressed she became. She would then find herself rushing to complete the task at the last minute, while bitterly rating herself as a failure when she realised it wasn't as 'perfect' as she desired.
The solution: Susan needs to challenge her perfectionism and rating. She can then develop the skill of breaking tasks into smaller chunks with individual timelines ahead of the actual deadline.
5. SIT WITH YOUR FEELINGS
The problem: The source of physical symptoms of acute anxiety and panic attacks lie in the amygdala, which I call 'the Gunslinger'. The more Susan tries to stop her symptoms, the more danger the amygdala senses, turning up the dial, and the more it fires her stress system to release adrenaline into the bloodstream, which gives rise to all her symptoms. It's a vicious cycle.
The solution: Flooding is a simple technique to help deal with the physical symptoms of acute anxiety or panic attacks. The technique involves learning to go with the uncomfortable symptoms of anxiety, like a wave washing over us, while never trying to stop them.
If Susan can just sit with these physical symptoms - literally visualise herself stuck to the seat - and allow them to flood over her, without any other intervention, the Gunslinger will turn down the dial and eventually switch off.
6. FIND BALANCE
The problem: Work/life balance, or rather imbalance, lay at the heart of Susan's toxic stress. Her priorities had become skewed. Everyone else's needs mattered 'except her'.
The solution: Susan needs to develop the skill of creating a weekly healthy priority list and challenging it on paper over a three-month period.
She might, for example, sit down with her partner once a week to detail whether she put work or children or family or herself or her wider family or the rest in the right order or priority.
The key, of course, is that her number one and two priorities should be herself and others. If not, she could plan how she will shift things for the following week.
For over 36 years, Dr Harry Barry has been involved in the area of mental health and suicide prevention. He has written many books addressing topics such as anxiety, depression and toxic stress and appears regularly on TV and radio. His latest book Emotional Resilience: How to Safeguard Your Mental Health is published by Orion, £14.99
If you deal with stress by becoming aggressive or confrontational, developing the following techniques (in addition to the previous six) will help ...
Take the example of Colm, whose stress levels have gradually risen to a toxic level over the past six months. He is a hard, uncompromising and perfectionist manager who runs his work division without a trace of empathy or understanding for those he manages. He carries this approach into his home life, which is creating significant issues for his family, and his wife is considering a separation. Colm becomes easily frustrated and loses his cool regularly.
As a driver Colm is a bully and on occasion he comes close to road rage. He is constantly tense. His only release is a weekly game of squash where he has to win at all costs. He drinks heavily at night to relieve the tension and spends most of his evenings and early mornings answering emails. He feels that being able to survive on less than six or seven hours’ sleep is a badge of honour. It was only a question of time before his body gave way and he developed severe headaches and high blood pressure and a cardiac arrhythmia. Toxic stress has arrived.
7. EMBRACE DISCOMFORT
The problem: Discomfort, or more accurately how to avoid it, lies at the heart of someone like Colm’s toxic stress. All his life he has believed everyone around him, in fact, life itself must change so that he is never made to suffer disturbance, discomfort or hassle. And so his response to any situation not turning out as he wants is to become confrontational, frustrated and nasty. This triggers his ‘fight’ stress response.
The solution: Someone like Colm is going to have to develop the skill over several months of challenging, on paper, the situations in which he is trying to force the world to become the way he feels it should be. Life is full of discomfort, so he must learn to deal with this reality. Every time he becomes frustrated or tries to avoid the discomfort of making changes in his life while insisting other people change theirs, he needs to explore this on paper.
He will learn to accept he is the one who needs to change, not other people.
8. DEVELOP EMPATHY
The problem: Empathy, or rather lack of it, is also a major issue for many of us. Empathy involves learning how to sense where others are at from an emotional point of view. It allows us to navigate the social landscape of life smoothly. While some of us find this skill easier to develop and use, all of us can work on our empathy skills.
The solution: For someone like Colm this means accepting that a lack of empathy is destructive for himself, his family and work. If he is prepared to become more mindfully ‘aware’ of how other people react to positive and negative interactions and practice in a guided manner some simple empathy exercises, the results can be life changing.
For example, he might spend a month focusing on what happens in everyday situations, observing the non-verbal cues which he had hitherto failed to see. He would note how people respond to kindness in a positive open manner.
He would also note how people ‘shut down’ when faced with a brusque remark or lack of interest.
Colm would follow up by listening to others as they talk, trying to tune in to where they are at emotionally. This involves him mirroring emotions, asking himself how he would feel if what the person described had happened to him.