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Your Better Mental Wellbeing Podcast
Every Friday, GP and mental wellbeing expert Dr Neera Dholakia, and software developer and neuroscience researcher Soen Trueman, will help you discover how you can manage stress and build resilience through discussion and practical exercises, so that you can live a healthy, productive and meaningful life.
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Episode 4: Loosening the Grip of Long-Term Stress

Do you have times in your life when you feel endlessly stressed, thinking you can't cope or finding it difficult to deal with things?

That's what we are talking about today on Episode 4: Loosening the Grip of Long-Term Stress.

We explore the the topic of long-term stress, its effects on mental and physical health, and ways in which listeners can manage and mitigate its impacts. We look at two main coping strategies: problem-focused coping that deals with the reducing or removing the cause of stress, and emotion-focused coping that works to reduce the emotional distress associated with stress. We also offer a wealth of practical tips around time management, reframing thoughts, breathwork, mindfulness and deep muscle relaxation. 

Your Better Mental Wellbeing is a weekly podcast helping you to manage stress and build resilience with easy evidence-based tools.

We're your hosts, Neera and Soen.

Dr Neera Dholakia is a GP for Boots Online Doctor and the NHS. She is an expert in mental wellbeing and has extensive experience designing mental health services whilst working for NHS England, Healthy London Partnership and mental health trusts. As well as promoting self-care, she also works to improve mental wellbeing in the workplace.

Soen Trueman is a full stack developer with Boots Online Doctor, specialising in graphics design, user experience, and user behaviour. Soen’s interests in behavioural analysis extends to psychology and further to neuroscience, which he is currently studying at Harvard University.

Links to this week's discussion:

[02:34] The Stress Bucket Analogy

[03:58] Effects of Long-Term Stress on Physical Health

[10:00] Problem Focused Coping Strategies

[12:00] SSTA (Stop, Slow Down, Think, Act)

[15:42] Emotion Focused Coping Strategies

[18:37] Importance of Relaxation in Stress Management

Key takeaways:

-Managing long-term stress is essential for mental and physical health.

-You can identify the feelings and behaviours that impact on how you cope with stress.

-Use problem-solving and relaxation techniques to reduce stress and improve your ability to deal with it when it's there.

Join us next week for a guided Impactful 10: Muscle Relaxation.

Find our more:

For transcripts visit our website: https://yourbettermentalwellbeing.show

For great health, lifestyle and wellbeing information visit: https://onlinedoctor.boots.com

The information in this podcast is not intended to replace your own GP or other doctor’s professional medical advice.

00:00/21:14
Read Full Episode Transcript
Neera

Do you have times in your life when you feel endlessly stressed, thinking you can't cope or finding it difficult to deal with things? You can find a way through to reduce your stress and cope with it better.

That's what we're going to talk about today on Your Better Mental Wellbeing, helping you to manage stress and build resilience with easy evidence based tools.

Hello and a very warm welcome to you. You're listening to Episode Four: Loosening the Grip of Long-Term Stress. I'm Dr. Neera Dholakia. I'm a GP for Boots Online Doctor and the NHS, and my expertise is in mental health and wellbeing. I've enjoyed working with NHS England, Healthy London Partnership and mental health trusts, designing services for mental health, and I'm really pleased to be hosting this show, focusing on improving your mental wellbeing.

Soen

And I'm Soen Trueman. I'm a software developer for Boots Online Doctor. I have a background in neuroscience research and I'm looking forward to helping you understand the science of mental health and wellbeing.

Neera

Just before we get into it, I wanted to let you know that Boots Online Doctor has lots of great information on lifestyle and wellbeing. You'll find this on the website at onlinedoctor.boots.com

Let's get straight in and talk about what long term stress means. It's different for each person. This might mean times when you have lots of competing demands on you, such as work, family and general life things, or stressful things that have been going on for a long time. For example, this could be emotional stress or physical health issues. And of course it could be all of those together.

Soen, what things in your life are causing long term stress?

Soen

For me, health is a big issue, because mine can be so unpredictable, making it difficult to plan ahead, keep to commitments and maintain relationships.

This is especially true now that we are living with COVID, which can strike us at any time, causing extra stress to your colleagues, your friends and your family.

Neera

For me, working in healthcare at the moment is not easy, and it's also about managing work with family life, and then trying to fit in exercise and eating some vegetables. And I also do think about climate change and what the world will become in the not too distant future, and I often find watching the news stressful as well.

So we've got our own personal stress, but also external stressors that have an impact. So first, let's explore why it's important to be able to effectively deal with stress.

Soen

Picture a bucket in your mind, and we'll call this your stress bucket. Now, imagine that every time something stressful happens, that becomes a drop of stress going into your stress bucket. Hopefully, most of the time that bucket is light enough for you to carry. But with each stressful event, it keeps getting heavier and heavier, which can be exhausting to carry and then eventually the water will overflow. You end up feeling overwhelmed and not in control of how much is going in.

Neera

My stress bucket is more like one of those collapsible plastic crates you get from places like Argos or Ikea or a local homeware shop, where it's bulging so much from all the stuff in it that the sides are collapsing outwards. One way I could deal with it could be to start filling up another crate and then another and another. Eventually there will literally be no more space.

Soen

I definitely have a heavy bucket. I have lots of things going on in my life, so I need to find positive ways to get some of that water out of the bucket and also find ways to stop some of that water getting into the bucket in the first place.

Neera

Yes, so eventually our overflowing buckets and bulging crates can lead to long term or chronic stress. And we can end up feeling overwhelmed, anxious, low in mood, and stop enjoying the things we used to.

Soen

Does long term stress also have an impact on our physical health, Neera?

Neera

Yes, absolutely. Long term stress has some significant effects on our bodies. One important part of our nervous system is called the autonomic nervous system, containing the sympathetic and parasympathetic nervous systems. It's like the control centre of our body and it helps to regulate vital functions such as the heartbeat, breathing and digestion.

Soen

Sure, in Episode Two, we talked about our stress reaction and how when we feel stressed, our sympathetic nervous system is activated and our bodies release adrenaline and cortisol or stress hormones. This gives us a burst of energy, increases our heart rate and blood pressure, sharpens our focus and heightens our senses to deal with this stressful situation. And then the body's calming mechanism, the parasympathetic nervous system kicks in to restore our rest, digest and relax mode.

Neera

With long term stress, the sympathetic nervous system is on overdrive at the start. When we have continued high heart rates and increased blood pressure, we are at risk of heart disease and stroke. Our muscles are tense, ready for action, but if this tension continues for long periods of time, it can lead to pain. Back pain, aching neck and shoulders, headaches and other areas of chronic pain. It can also affect our reproductive system, leading to low sex drive, erectile dysfunction and fertility issues. And through our autonomic nervous system, our gut is connected to our brain and stress can lead to changes in our gut bacteria, which influences our mood as well as causing digestive issues.

Soen

And we've got an episode coming up later in the podcast about how our food and nutrition affects our mood and stress.

So as we continue to try and cope with stress, both the sympathetic nervous system and the parasympathetic nervous system are being continuously activated, which eventually drains the body and we are less able to restore ourselves to our resting mode.

Neera

Yes, exactly. When we look specifically at cortisol, initially it has high levels and this releases glucose for energy. It helps our immune system and metabolism. But eventually these levels drop, staying low, and so we end up with less energy, we feel sluggish as our metabolism slows down, and are more prone to developing health problems such as infections and illness.

Soen

That makes sense. I've always wondered why I got sick when I took a break or went on holiday. My cortisol levels must have been high, coping with stress, and then when the levels dropped, my body gave in to the exhaustion. But then I suppose it gave me a chance to relax and reset, and my cortisol levels returned to a better baseline. When I'm stressed, I start procrastinating more and instead go out drinking and socialising more with friends and generally ignore my responsibilities.

And it's really common to develop some negative behaviours or habits to deal with the stress, both in the short term and long term. These could range from small negative behaviours such as biting your nails or procrastinating to much more disruptive negative behaviours. You might get angry and lash out at others or start drinking too much, or even exercising too much, gambling or shopping excessively. You might also stop doing social activities. As individuals, we all have our own ways of easing that long term stress, often by doing something to distract ourselves, or to help us forget, or to give us some temporary relief. And this might feel like the stress is a little better, but it doesn't deal with the stress itself, or change things long term.

Neera

Yes, I definitely have a habit of using distraction, mostly working more to help me cope with stress.

Soen

I'm very happy for you to do some of my work if you need some extra help coping.

Neera

That's very kind of you. But let's talk about some useful coping strategies.

Our coping strategies depend on our personalities and beliefs, what the actual stressful situation is, and also what resources we have available. And there are two main types of coping, problem focused coping and emotion focused coping. Problem focused coping is more likely to occur when we perceive the stressful thing to be controllable. It targets the cause of the stress in practical ways, using a logical and methodical approach. And the aim is to remove or reduce the cause of the stress. So by directly targeting the stressful situation, the actual stress from it will be reduced. For example, if you are feeling overwhelmed by housework, you can create a schedule with manageable tasks. By setting aside, say, 30 minutes each day to clean up after dinner means things don't pile up. And in fact, doing some housework or activity after eating helps to regulate your blood glucose, which is important for your general health and particularly for those of us at risk of developing diabetes.

Soen

We often rely too automatically on emotion focused coping, easing how we feel, using whatever strategy is easy for us, and this is often a negative behaviour, even when it's a situation that could be easily resolved with more problem focused strategies. But emotion focused coping is more effective for us in some situations, particularly if we believe that we are powerless to change the stressful situation. A specific example of this is when a loved one dies. The stress you experience can be overwhelming, and you can't change the situation because you can't bring that person back. Here, emotion focused coping helps to reduce the pain that grief can bring on.

Most people use a mixture of the two strategies in their lives. You can reduce the amount of water going into the bucket and also get some of that water out of the bucket by being problem focused. You can increase the capacity of your bucket by using positive emotion focused coping strategies and doing some related practical behaviour changes.

Neera

So let's talk about a constructive problem focused approach to coping with stress using some of the essential elements of problem solving therapy. Firstly, it's important to look at how you approach problems generally, or are approaching this particular stressful problem. If you can see problems as challenges and feel optimistic about solving them, then great, you're halfway there. If you instead tend towards seeing problems as unsolvable or mountains you can't climb, then it's a good first step to try and shift your mindset to something more positive. The good news is, you really can do this. Try using more positive self talk, remembering that you've coped with problems before and can again. Visualise yourself achieving your goal and overcoming difficult feelings.

Soen

Okay, so now I've got into a more positive mindset, what do I need to do?

Neera

Before you start tackling these problems, it's a good idea to really understand what it is. Especially if you're feeling overwhelmed and have too many things to deal with, it's a great first step to get the problem out of your head. Write it down so you can really visualise it. Remember that as you're writing your problems down, if any emotions do arise, simply acknowledge them and put them to one side. At the moment, we don't need to revisit those emotions, because we're just writing down our problems in a non-emotional way. Then simplify each problem by breaking it down into its component parts, little things that feel easily achievable to you.

Soen

For example, some people want to deal with lots of old clothes that they have, but haven't been able to face doing it. The first step could be writing down what you want to do with them, and why, and maybe visualise the space you get when they've gone. And then the specific steps you need to take. This could be gathering them all together, separating into ones that don't fit, ones you can mend, or ones you can recycle. Then deciding what to do with the ones that don't fit and then doing the tasks you need with that, and then onto the next one.

If you do find that the problem or stress is causing an overwhelming emotional response such as anxiety, frustration, anger, or feeling low, you can use a technique called SSTA, stop, slow down, think, and act. It's important to recognise and manage those emotions and behaviours to be able to think clearly before they take over and stop you from doing what you need to do. Here, when you think about a problem that is causing you stress and those negative emotions or behaviours creep in, just stop, slow down, be aware of your emotions and triggers and calm yourself down. Then you can think and plan in a more organised way. And this will enable you to do what needs to be done to sort the problem out or break it down and begin to work on those components.

Neera

So you have your wedding dress or favourite jacket that you just can't face getting rid of, but realistically, you aren't going to wear them again as they don't fit. But every time you think about selling them or giving them away, you feel sentimental and attached, and this stops you from parting with them. When those feelings come on, you need to acknowledge them and manage them so that you can be more objective and make a more rational decision and plan.

Soen

Okay, so what practical problem solving strategies can we start to utilise now that we're feeling positive and focused?

Neera

Time management. I know this sounds obvious, but if you're a time optimist like me, where I always underestimate the time needed for something and often view time as an ever expanding balloon, it can help to think about the actual time you need for a problem to reduce the stress and then add in some buffers. A common one is getting to work or taking the kids to school, so planning the journey with some extra time for any unforeseen things so you're not late and don't feel stressed at the start of the day. For me, this also means prioritising things and doing the hardest one first so that I don't spend all day thinking about it.

Soen

Another technique we can use to improve our time management is time boxing. If you have several large tasks that might take several days, don't just concentrate solely on one task for the entire day. Break it up and allocate yourself 30 minutes or an hour to work on it before your next commitment, and then maybe time block after lunch or dinner. Give yourself strict time slots to work on small chunks of the task, and you'll find that the variety in your day will keep you motivated and interested. It will also allow you to fit scheduled things in and around those time boxes, allowing you to remain flexible with your other commitments.

Another common way of problem focused coping is to create a to-do list of all the things that are troubling you. That's a great way to be constructive about the problem. It moves the problem out of your head and onto paper, and can actually reduce your stress as a result. But so many of us will write a to-do list, but will often be too ambitious and actually fail to tick everything off on it. Keep things small and achievable by breaking down big tasks, such as not writing an essay all in one go, but starting with just the first paragraph. Your brain will reward you with a dopamine kick for completing them, which will make you feel good and motivated. Personally, I use a mixture of timeboxing and to do lists to help keep my days structured and productive. But I also make sure to schedule some relaxation time as well, even as ironic as that sounds.

Neera

Now we've looked at problem focused strategies, so let's move on to the slightly trickier emotion focused strategies. There are positive emotion coping ways and negative ones. Often the negative emotions that stress brings on cause us to use unhelpful emotion focused strategies first. We want to change or reduce our negative feelings, things like anxiety, frustration, anger, low mood and hopelessness. And we might do this by doing some of the unhelpful behaviours we talked about earlier. Doing something to distract ourselves, watching TV or gaming, or taking something to help us forget. Or giving ourselves some temporary relief by comfort eating, or just giving up and not thinking about the stressful situation. By doing these things, our negative feelings might improve, but we won't be any closer to actually managing the stress.

Soen

So, I can see that both of our coping strategies, you working more and me avoiding tasks, fit right into those unhelpful, emotion focused ones. And while it might ease how bad we feel in the short term, it's not effective at actually dealing with the situation, and in the long run, it makes it worse, and even more overwhelming. Ignorance might be bliss, but only in the short term.

Neera

And if I really think about it, for me it's about trying to make things more controllable. I know what I'm doing at work, and it stops me from thinking about the total chaos in my house, and feeling frustrated by not being on top of it. And I can see that by developing more positive and healthy emotion focused coping strategies, I would be able to think a bit more clearly and logically. And then I could shift towards being more problem focused.

Soen

So, what are some helpful, positive, emotion focused strategies we can utilise to help us get into a better mindset for tackling stressful problems?

Neera

We talked about breathing exercises last time to combat stress, and mindfulness meditation has been shown to increase our capacity to deal with stress. In fact, the most recent research shows that breathwork and mindfulness can actually help to lower blood pressure by reducing stress in people who have been diagnosed with hypertension

Soen

Another technique is reframing things into something more positive or supportive or paying attention to more positive things than negative things. Accepting things you can't control and talking to others also helps with negative thoughts. And showing self compassion improves our ability to cope with difficult emotions. Many people also find writing a journal useful to reflect on their thoughts and feelings.

Neera

In later episodes, we're going to talk about other key elements that help with long term stress: food, exercise and sleep. What we eat and put into our bodies, how well we sleep and how much activity or exercise we do. But one of the most important elements, the thing that can have the most impact but that we often forget or leave until last, is to make time for relaxation. This is a very powerful emotion focused strategy. You can't feel stressed and relaxed at the same time.

Soen

And relaxation doesn't have to take a long time, even just a few minutes can give you some space to reset and feel calm. The important thing is to be able to let go of that tension that has built up in your body and mind. Something relaxing where you don't need a goal and you can just be present in the moment and enjoy it. The sorts of things people find useful are: active relaxation, such as yoga, tai chi and walking, creative things, spending time in nature, listening to music, reading books or listening to podcasts, especially this one.

Neera

And something that's easy to learn and doesn't require any equipment, or even leaving the house, is deep muscle relaxation. It reduces the body's stress reaction and so reduces your heart rate, blood pressure. breathing rate, sweating and startle reflex. This also means that you won't feel the sensations you normally experience with anxiety and so reducing stressful thoughts.

And by reducing muscle tension, you can reduce pain that has developed as a result of the tension. This relaxation helps to restore and relax your body and your mind into its calm resting state. You can join me in the next episode. where I'll take you through a relaxation exercise in real time called Progressive Muscle Relaxation.

Soen

Neera, we've covered a good few things when thinking about how we can cope with long term stress, how we can reduce stressful situations in the first place, and what strategies are helpful to cope.

Neera

It's reminded me that I need to tackle the pile of old clothes that I've got and I could put that on my to-do list starting with my socks that have holes in.

Soen

And I look forward to scheduling the Progressive Muscle Relaxation into my relaxation time.

Neera

Thank you so much for listening to this episode of Your Better Mental Wellbeing.

Soen

If you liked the episode and think it would be useful for someone else, please follow and share. For more information and transcripts please visit our website at: yourbettermentalwellbeing.show

Neera

Join us next time for an Impactful 10 episode: Muscle Relaxation. And remember to live your values, accept yourself and let go.

About This Podcast
Your Hosts
Dr Neera Dholakia
Dr Neera is a GP and Clinical Lead for our Depression and Anxiety service. A safeguarding and mental health expert, she helps ensure services are both efficient and safe. As well as promoting self-care, she works to improve mental wellbeing in the workplace.
Soen Trueman
Soen is a full stack developer with Boots Online Doctor, specialising in graphics design, user experience, and user behaviour. Soen’s interests in behavioural analysis extends to psychology and further to neuroscience, which he is currently studying at Harvard University.
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The information in this podcast is not intended to replace your own GP or other doctor's professional medical advice.
Music credits: Main theme by AudioCoffee, Impactful 10 by Dream-Protocol, Jingle by Serge Quadrado Music