[DEAR DOCTOR] Practical steps to arrest stress

As an attending physician who comes across a wide range of patients on a routine basis, I have come to realise that more often, we just missed it! A number of individuals, including attending health personnel, often fail to realise that behind the chains of most patients’ complaints is deeply-seated stress. We are less inclined to think or admit that new changes in our mood and behaviours are given signs of stress or that we are facing stressful conditions without appropriate stress-coping mechanism in place.

Case study

Take the case of 34-year-old Ladi as an example. She is a thorough-bred female military personnel, strikingly attractive well-brought up mother of three who is presently separated from a rather violence-prone husband, who derives pleasure from physically and psychologically assaulting her at the slightest provocation. With the aforementioned cumulative assaults coming from the home front, Ladi became hypertensive at 25. She also developed recurrent exacerbating asthma / heartburn disease and other symptoms of an otherwise unexplainable deeply-seated condition.

But even with the separation, after her military commission, from her domestic violence-prone hubby, Ladi’s condition did not improve. She is always in and out of the consulting room, getting tossed from one specialist doctor to another; in spite of these, fundamentally her condition did not appreciably improve, and the reasons for this are not far-fetched.

Ladi’s background checks revealed that she is under recurrent psychosocial stressors’ attack – our friend is burdened heavily with the responsibilities of taking care of her three under-10 kids alone as well as paying their school fees – something in the region of 80% of her gross pay, with no support from the husband.

With this, Ladi finds herself more than fully engrossed in her work, breaking her unbearable physical and psychological limits in order to get extra income to meet up her responsibilities as a single mother and the breadwinner of the extended family. Of course, the repercussion of these overstretched limits is rebound of the complaints around the aforementioned medical conditions.

In truth, all work but no play with little rest, for a troubled soul, soon leads to stress and its derivatives: anxiety neurosis and depression. This is the fulcrum of this presentation.

Common condition

It has been estimated that psychological problems, including stress, anxiety and depression, are behind one-in-five visits to a doctor; although, often times in our setting, attending doctors who have limited experience on appreciating the tolling effect of stress commonly missed this diagnosis. Often, doctors end up treating the physical symptoms and non-germane diagnoses rather than treating and evaluating the psychological illness and conditions.

‘Stress’ is defined as “the adverse reaction people have to excessive pressures or other demands placed on them” (According to the Health and Safety Executive (HSE). Stress symptoms include a pounding heart or palpitations, a dry mouth, headaches, odd aches and pains and loss of appetite for food and sex.

Work stress

Some pressure at work can be motivating, but when it becomes excessive it can eventually lead to work-related stress.

Work stress can be sparked by things such as a formal warning, bullying, victimisation, increased work pressure, deadlines and management changes.

Stress can cause changes in those experiencing it. In some cases there are clear signs that people are experiencing stress at work and if these can be identified early, action can be taken before the pressure becomes a problem. This may make it easier to reduce and eliminate the causes.

It is important that everyone looks out for changes in a person’s or a group’s behaviour. However, in many cases the changes may only be noticeable to the person subject to the stress and so it is also important to look at how you are feeling and try to identify any potential issues you may have as early as possible and take positive action to address them; this may be raising the matter with a line manager, talking to an occupational health professional or your doctor.

Signs of stress

If one is suffering from some of the following symptoms it may indicate that one is feeling the effects of stress. It is advised that if one finds that work or aspects of the work bring on or make these symptoms worse, speak to the relevant personnel / authority as appropriate. It may be that some action taken at an early stage will ease the stress and reduce or stop the symptoms.

Emotional symptoms

• Negative or depressive feeling
• Disappointment with yourself
• Increased emotional reactions – more tearful or sensitive or aggressive
• Loneliness, withdrawn
• Loss of motivation commitment and confidence
• Mood swings (not behavioural)

Mental

• Confusion, indecision
• Can’t concentrate
• Poor memory

Changes from your normal behaviour

• Changes in eating habits
• Increased smoking, drinking or drug taking ‘to cope’
• Mood swings affecting one’s behaviour
• Changes in sleep patterns
• Twitchy, nervous behaviour
• Changes in attendance such as arriving later or taking more time off.

Please note these are indicators of behaviour of those experiencing stress. They may also be indicative of other conditions. Hence if you have a reason to think that any of the stated indicators as related to existing complaints, it is advised to seek a doctor’s attention. Similarly, if you are concerned about a colleague or relative try to convince them to see their doctor. A stitch on time saves nine!

Stress management advice

On the other hand, the way we deal with stress can encourage unhealthy behaviour, such as smoking and drinking too much, which can increase the risk of heart disease.

Good stress management in the workplace is therefore critical to your overall health.

Life coach Suzy Greaves says one of the key skills to managing workplace stress is knowing how to say no.

“I’m constantly challenging clients who say they have no choice but to overwork,” she says. “I coach people to become empowered and believe they have a choice.”

She explains that saying yes can win you brownie points in the short term, but if you take on too much and fail to deliver, it can be a disastrous long-term strategy.

“Have confidence in your ‘no’ when you think it’s the right decision, even though it may not be the most popular one,” she says. “In the long term, your ability to say no will be one of your most valuable attributes.”

Voice it out

One other thing is that one can prevent exhaustion by knowing how much work you can take on. By taking on too much, you could end up doing nothing well.

First thing is to calculate how long you’ll need to deal with your current workload so that you can see if you have any extra capacity.

“If you’re extremely busy and your boss asks you to do more, you can politely say no. Outline your reasons in a specific, measurable way, but always offer a solution.”

Learn to recognise the physical effects of stress and do something about it before it makes you really ill. Beware of work stress spilling over into other areas of your life.

It is advised that whatever the source of one’s stress, speak to the manager or someone in your organisation that you feel comfortable talking to. Or get outside help.

In the same vein, it is a good management strategy for employers to ensure the health, safety and welfare of their employees are on the front banner of the company’s policy. It is wise counsel for employers to conduct risk assessments for work-related stress in respect of the work’s environment.

Going forward, if the problem is not work-related, it might get resolved by taking some pressure off you at work while you resolve the stress in your personal life.

Meanwhile, take care not to overreact to small changes in behavior of an individual and taking this as signs of stress, knowing that no person is fixed to behave or react to all events the same way always. This is why a professional assessment of the individual and condition being faced comes handy. First step is to see a doctor or other relevant professionals.

However, one is quick to note that in our highly faith-based society, religious leaders – pastors, imams, counselors etc have come to occupy the space in stress management albeit on a one-explanation-fit-all basis: prayer alone solves the matter, which for most cases amount to ineffectual intervention. The better approach is a “no-denial” approach, even with prayers; take practical steps to intervene effectually to correct and readjust the stress-provoking social and physical environment.