Do you have some very stressful moments in your day to day life? Things that feel beyond your control or overwhelming? We'll be taking you through some ways to manage these. Quickly being able to calm your mind and body is possible.

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 2, Managing Stressful Moments. 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.

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.

Now let's get to it and talk about stress.

Yes, I have a habit of clenching my jaw and grinding my teeth when I feel stressed. I can feel my jaw ache and also my neck muscles become tense, which gives me a headache.

So it sounds like stress is affecting us both in different ways during the day and at night. And stress can definitely affect your sleep, even if you don't realise it. So, what is stress?

Quite frankly, I wouldn't mind living without stress.

Actually, Soen, you're right, that little bit of adrenaline before the start of a race or that moment just before the roller coaster drops is stress preparing your body for what happens next.

But we do also have daily uplifts, such as having an interesting conversation with someone, completing a task, getting enough sleep, and also doing an activity you enjoy, and these uplifts can help us to balance the stress caused by daily hassles.

But what about when these daily hassles continue on and on, and perhaps you have several life events all contributing to a feeling of continual stress?

We've talked a little about the sorts of things that can make us feel stressed. So what does our body do when stress occurs? What is the body's stress reaction?

Okay, so imagine you're walking in a dark forest, and suddenly you hear a loud noise. Your heart starts pounding, your breathing quickens, and your muscles tense up. That's your sympathetic nervous system in action, getting you ready to either face the danger, run away from it, or be very still. And adrenaline gives us an instant burst of energy. It increases our heart rate, sharpens our focus and heightens our senses. And then cortisol is responsible for regulating our metabolism, our immune system, and also our blood sugar levels. It can increase our glucose levels for the extra energy our body needs to use, take action when there's danger.

Now it may surprise you to learn that the body's stress reaction is the same whether you hear a loud noise, encounter a lion, open an important letter or have to deal with a difficult person. The key difference is what you do in response to a stressful event.

The psychologists Richard Lazarus and Susan Folkman did a lot of research into stress, coping and managing stressful situations. They discovered that the level of stress a person experiences is directly related to how confident they feel about dealing with a threat. Their idea is that the way we interpret or perceive a situation or event determines how we respond to it. Our thoughts, our beliefs and our coping strategies all shape our stress response. And in fact, our response to an event can have a more powerful impact on our stress levels than the event itself.

Exactly. The other day I was in my GP surgery and I realised that the back of my trousers had some mashed banana stuck on it.

Yes, thank you. It was a bit disgusting. I felt a bit annoyed about it and tried to clean it off, but it was stuck on well. Previously, I'd have felt stressed that everyone would see it and I'd be conscious of it all day and try not to turn around. However, instead I thought: my patients are here for my medical care and are more bothered about being seen on time rather than what I'm wearing. I'm sure some people did notice though and were probably too polite to say anything. Now I know that seems like a very minor stressful event but it could have been different if instead I'd been going for a job interview.

Stress often occurs when you don't feel in control of a situation, but whilst you might not have control over the situation, you can control how you respond to it. So this response starts with a couple of assessments of the situation. The first assessment that happens is that we consider the potentially stressful event or situation and think, what does this situation mean to me? It could be, this is not important to me, or this could be good. Or, this is stressful. If your train is cancelled, you might think it's not that much of a big deal because you don't have to be there at a certain time. Or, you might think this is actually quite good as you won't have to go to that meeting now, so you can do something else. Or, you might see the cancelled train as stressful because you were due to meet up with friends. And then the second assessment happens almost at the same time as the first, where you consider how you feel about dealing with the event or the stress. So with the cancelled train, what are you saying to yourself? This could be something positive such as: I can figure out a way to attend the work meeting or to see my friends, or it could be negative, this always happens to me, I'm going to be late again and will miss everything.

For me, a great example of this is when an electricity bill lands in my inbox. I've had a few issues with my electricity bill when the company got taken over. So even before I've opened it, I'm already thinking this is going to be stressful. And... I feel my body's stress reaction start. And then I have a flow of negative thoughts that I can't cope with it because the figures are always wrong, or it's an estimated rather than actual reading, and then customer services are so hard to get hold of, and the chatbot thing is really unhelpful, and that I don't have time to waste on it, and it's going to take a long time to sort out. And by this point, my heart's beating a bit quicker, my breathing is more shallow, my fingers are a bit sweaty, and my muscles become tense. Actually, I'm starting to feel a bit like that now, just talking about it.

Yes, exactly. And then, if I don't open the bill and address the situation, it remains on my mind, and the stress feeling builds up more. My response to the situation becomes more stressful than the actual situation itself. And I think if I was able to calm myself at that point of both when I see the email and then when I open the bill, I'd be able to have a more rational, problem solving approach to it.

What about you, Soen?

So you manage that initial stress reaction by recognising that you've jumped ahead to worrying about something that might happen, but that you know is actually quite unlikely. And by refocusing on what is actually more likely to happen, and reminding yourself that you can cope with whatever the outcome is anyway, you're able to deal with it more rationally and calmly.

Yes, exactly.

A really powerful technique is to focus on your breathing. Breathing is something we all do unconsciously all the time, but the way we breathe really impacts our physical and mental state.

And by intentionally engaging in slower, deeper breathing, we can increase the level of carbon dioxide in our body, which will activate our body's parasympathetic nervous system, our rest and digest mode, triggering our relaxation response and reducing the levels of stress hormones. Our heart rate slows, our blood pressure goes down, our muscles become less tense, and we feel more relaxed and calm. Breathing techniques have the short term benefit of reducing our stress reaction, but also longer term benefits of acting as an anchor, connecting our body and mind in the present moment.

So focusing on our breathing can direct our attention away from the stress or situation causing it, allowing us to regain a sense of control and clarity. And of course, the real bonus is you can practise these breathing techniques at any time without any special tools, building them into your daily routines, so that when you need them during stressful moments, they're ready for you.

Yes, there are three really simple ones that anyone can do. You can join me in the next episode where I'll take you through these in more detail, when you'll be able to actually experience and practise them in real time, but just as an overview for now.

The first technique, which I find really helpful in those stressful moments, is a 4-7 breath. Essentially, you take a deep breath in through your nose, or you count to 4 in your mind, and then breathe out through your mouth and count to 7. The key is for the out breath, the exhalation, to be longer than the inhalation, which is what activates a relaxation response. And once you've done it a few times, you can add in a pause after the inhalation, holding your breath, and this increases the relaxation response.

And the second technique is called diaphragmatic or belly breathing. This is where you place one hand on your chest and one hand on your belly, first noticing how you're breathing currently and then slowly deepening your breath by taking a slow deep breath in through your nose and then exhaling slowly through your mouth. Making sure the air is travelling down into your belly rather than staying high up in your chest. And the third common technique is called box breathing or square breathing.

So imagine a square box. Start at the bottom left corner. Take a deep breath through your nose, counting to four as you trace the left line going up. Then hold your breath as you trace the top line, counting to four. Then breathe out as you count to four going down the right side. And then hold for four as you return from the right bottom corner to the left bottom corner. And then repeat this box. And by maintaining a steady rhythm, it will regulate your breathing and bring focus back to the present moment.

Yes, it's made me remember about noticing those early signs of my stress reaction and taking action to stop it building up. I'm going to pay more attention to things that make me feel stressed, and then when I start to feel my jaw clenching, to breathe deeply and relax my muscles.

And what changes could you make to how you respond to stressful situations? And which breathing technique will you start with?

Thank you so much for listening to this episode of Your Better Mental Wellbeing. Join us next time for our first Impactful 10 episode, And Breathe. It's a short 10 minute episode taking you through breathing exercises to calm yourself quickly in real time.

And remember, to live your values, accept yourself and let go.