Stress can affect us in many different ways, and we need to learn to cope with it effectively.
TO have some pressure in our lives is normal and, indeed, unavoidable. But when there is too much pressure, or it goes on for too long, and it becomes more than we can cope with, then our health can suffer. This unpleasant reaction to too much pressure or other types of demands placed on us is called stress.
Think of blood pressure – we all have it, but when it gets high, we should do something about it. Stress is just the same.

What is stress?
When we find ourselves under some kind of pressure, our bodies respond automatically by releasing adrenaline to ensure we are prepared for action and are able to meet the challenges before us:
•Muscles become tense
•Our breathing becomes faster and shallower in an effort to get more air into the body, and we may feel breathless
•Heart races
•We feel like we want to run, yet legs might turn to jelly
•The mind is racing and we may feel dizzy and lightheaded
•We have difficulty swallowing
•We may feel sick
•We shiver or sweat more than usual
This automatic reaction to a threatening situation is known as the “fight or flight” response. The body produces hormones, including one called adrenaline, which help prepare our bodies either to run away or be poised and ready to react.
These changes are short-lived and recede when the pressure or threat stops. The body’s response sharpens our mental and physical skills, focuses our attention, fires us up and is generally very helpful in helping us cope with pressure.
Too much pressure, on the other hand, makes us less productive and often results in health problems. So an acceptable amount of pressure can make us feel good and too much can make us feel vulnerable and out of control.
Stress affects people of all ages and from all walks of life. One in five people has a problem with stress at any given time, and that figure is reflected around the world.
We tend to think that stress comes from being too busy and pressured, but it can be just as difficult to cope when we are in a situation where we do not have enough to do. Being unemployed or in a boring job which we don’t enjoy, for example, can make us frustrated and stressed and we can find ourselves at a low ebb.
Some people learn to live with it and use it positively; others find it impossible to switch off and struggle to cope.
Although our bodies react to excessive mental pressure, it is not a physical problem. However it can make us more prone to illness. It can also affect our immune systems so that we can take longer to recover from illness.
However, it is important to keep in perspective all the physical effects of stress. Given all the risk factors for a heart attack, for example, stress is a comparatively minor risk factor. However, to cope with stress, many people eat more fatty foods, drink alcohol, and smoke, all of which are linked with an increased risk of heart disease.
Stress affects us in different ways:
The way it affects our thoughts:
•We worry too much about things that we know do not merit such worry
•We find it hard to concentrate
•We have difficulty making decisions
The way it affects our feelings:
•We feel worthless, hopeless, and depressed at the prospect of never getting on top of things or finishing anything
•We have difficulty relaxing
•We constantly expect the worst to happen
The way it affects our behaviour:
•We are constantly tired and on edge, and irritable with those around us
•Minor interruptions, delays or frustrations can make us irritated, distressed or angry
•We lose interest in food or over eat
•We smoke or drink too much
The way it affects our body:
•We have panic attacks
•Our usual sleep patterns become disturbed, so that we find it hard to fall asleep, or need much more sleep
•We suffer from physical health problems like headaches, indigestion or a sore back
•We lose our sex drive
Understanding stress
If we look at our lives, we may be able to identify particular areas of our lives which can cause stress. These may include: l Problems with relationships
•Money worries
•Coping with unemployment or redundancy
•Problems at work – work changes, an excessive workload, anxiety about a promotion, or job security
•Worries about personal health or the health of those close to us
•Poor housing
•Poor education
•Feeling isolated or lonely, lacking support
•Being abused or harassed
•Being discriminated against on the grounds of sexual orientation, gender, race or ethnic origin
•Lacking control over our lives
•Environmental factors like pollution, extreme temperatures or noise
Some of these things we cannot foresee. They happen to us out of the blue. Others are unavoidable, events or changes over which we have little control, although we may feel that we are in some way to blame and have brought this on ourselves.
We may also fall into the trap of feeling that we should be able to cope, no matter what has happened.
As well as the demands made on us by other people, each of us makes demands on ourselves. We may aim to achieve certain things, whether at work, at home, or in our personal lives. We have expectations of what we should be able to do.
If we find that we cannot meet the standards we have set ourselves, we may put ourselves under pressure to do better. That can produce an enormous amount of stress, despite the fact that our expectations may have been unrealistic in the first place or that we have been prevented from meeting them by things beyond our control.
Some people become more vulnerable to stress after a traumatic experience. Perhaps they have been bereaved, have been the victim of a serious crime, or have suddenly become unemployed. As time passes, they may find it difficult to recover, to get back on top of things, and instead feel constantly overwhelmed.
It is often a gradual build-up of stress from various different sources that can take us to breaking point, rather than one obvious trigger.
There are many steps we can take to learn to handle situations differently so that we are less likely to feel stressed. These are outlined later. It is important to remember however, that it is not necessarily our fault that we are reacting in this way. We may find ourselves in intolerable situations, and we may have to make changes in our lives to make them more bearable.
What you can do??
Stress can make it hard for us to cope with day-to-day demands. We become more and more exhausted, tense, and irritable. Other people find it hard to be with us, and even the closest relationships can become fraught. The whole experience can make us feel we are losing control over our lives and that there is no way of regaining that control.
We may feel we have to give ourselves a kick to get over the stress we feel, but that kind of self-punishment can be destructive and can diminish our self confidence and self-esteem. We become more isolated, which leads to depression and further isolation. It becomes a vicious circle.
Instead of creating such a self-destructive spiral, we can learn to accept that there are very real reasons for us to be stressed. So by accepting that there are reasons for our stress, we can then take steps to help us reduce the effects and to learn to cope.
What works for each of us may be different, but these are some things that may help:
•Work out what it is that is making you feel stressed and what you can do about it. There may be some things that you cannot change, or not immediately, but there may be others that you can alter.
For instance, if you feel swamped by the amount of work you have, try to sort out – perhaps with the help of a colleague or supervisor – which tasks are most pressing and then give them priority.
•Relieving stress is about how you handle it. Relaxation is an important factor in releasing tense muscles and clearing and calming the mind. Relaxation of muscles through massage can also be beneficial. Deep breathing exercises too can play a part in relieving stress. You can find our more about relaxation techniques from your doctor or counselor.
•Allow yourself a breathing space. Treat yourself to something you enjoy.
•Physical activity can boost your mood, self-esteem and body image, improve sleep, and reduce reactions to stress. Exercise has been shown to reduce anxiety and treat depression. If you have any concerns about your health, or any illness or injury, speak to your doctor before becoming more active.
•Try to eat and drink sensibly. Drink, drugs, and cigarettes in excess are not good long-term solutions to stress. We only find ourselves needing more and more to cope.
•Avoid stimulants such as caffeine, not only in coffee and tea, but also in fizzy drinks and high-energy drinks. Some cold remedies and headache tablets have a lot of caffeine in them, which can add up when taken throughout the day.
•Try to make sure you get enough sleep. Try to stick to a routine of going to sleep at the same time every night, and getting up at the same time every day. Try not to eat or drink a lot late at night and don’t drink a lot of alcohol – it may help you fall asleep, but you may wake up during the night.
Avoid working in bed. Make sure that your bed and bedroom are comfortable – not too hot, not too cold, not too noisy.
•Find someone you can talk to and use their support to talk through your feelings. Not everyone finds this easy. But it may be a surprise to discover that others are feeling the same way as you.
•If you’re not the sort of person that finds it easy to talk about your feelings, try taking up a sport or a hobby along with other people. It can prove to be a good form of relaxation and distraction.
•Try to pace yourself and tackle one thing at a time. Be realistic about what you expect of yourself. Learn to say “no” to other people, some of the time at least. Set aside time for yourself to do what you enjoy.
•Some people find spiritual practice helps either in the context of religion, or in something less structured, such as meditation. In a group setting, it can provide the additional benefit of social support.
Getting help
A lot can be gained from meeting other people with similar experiences. It can be valuable to find out we are not alone and to learn how others cope or have coped with similar sorts of difficulties. The encouragement and support from other people who understand what we are going through can be helpful.
A self-help approach can be an important part of treating stress, and self-help books can help us find out important information about it, and how it affects us.
They can also help us learn new skills to help us challenge worrying thoughts, and to help us learn ways of building confidence and facing up to fears.
It can be very helpful too to learn some relaxation techniques. In addition, many people find it helpful to attend a self-help group, which can provide mutual support and are an important source of information.
We may find that what we can do on our own is not enough, but sometimes it can be difficult to accept help too. It can be hard for us to be open about our fears and anxieties, but it can also be an enormous relief to stop putting on a brave front and to find that other people can help us overcome our problems.
There are different sources of support available, each offering different kinds of help. It is worth finding out what is available locally.
Counseling and psychotherapy
It can be valuable to have an opportunity to talk things over with someone outside your immediate circle of family and friends. Counseling and psychotherapy give people the chance to talk through their problems. Both focus on present day feelings and difficulties, which may be current or rooted in the past, and enable us to take more control of our life and to cope in the longer-term.
There are many types of treatments that are termed “therapy” and it is important to make a distinction between relaxing therapies like aromatherapy and reflexology, which help cope with the problem without actually addressing the causes, and psychotherapies that support people and help them address the causes themselves, and provide a long term solution.
Apart from finding which approach suits us best, we also need to find a counselor or therapist we feel we can trust.
Medical treatment
A large proportion of visits to the doctor are stress-related, but many more people do not seek medical help and struggle to deal with it on their own. It may be that they do not realize they have a problem. Some people are embarrassed to admit they have stress. Others may not be ready to ask for help, or may not believe that the doctor will understand or even know how to deal with the problem.
Some people will turn to their doctor when they experience the first physical signs of stress. It is important to have a check-up to rule out the possibility of physical illness.
You may also want to talk about alternatives to drug treatment, such as counseling, psychotherapy or self-help.
A prescription of anti-anxiety medication may be made (for example benzodiazepines, which are tranquillisers). They can offer some relief and can be helpful in the short term to get through a crisis. Regular use of these drugs may lead to dependence and is likely to result in the return of fear or panic symptoms when discontinued.
As a result, they are generally only prescribed for a short period of time. Tranquillisers are now rarely used and few are recommended for more than one month.
If you are having difficulty sleeping, your doctor may also prescribe sleeping tablets, again for a short time.
A number of medications originally approved for treating depression are thought to be effective at reducing worry and panic and you may therefore be prescribed these. Most anti-depressants take two to four weeks before they have any effect on our mood, so it is important not to give up too quickly if we do not feel better straight away.
Antidepressants should be taken as prescribed. Some patients experience mild symptoms when stopping, reducing, or missing a dose.
These can include dizziness, nausea, anxiety, and headaches. The drugs however are not associated with tolerance and craving. Antidepressants should be taken for at least six months after symptoms have disappeared, because this greatly reduces the risk of the symptoms coming back.
It is important to then go back to your doctor to find out if you need to continue with treatment. Some people may be advised to continue treatment for longer than six months.
This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. For more information, e-mail starhealth@thestar.com.my. The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.