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.

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?

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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

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