Weekly Health Advice from PMGH – Stress

Welcome to another health update from the Port Moresby General Hospital, this week we are focusing on stress.

For more information, please contact info@portmoresbygeneralhospital.com
What is Stress?
Stress is a state of mental or emotional strain or tension resulting from adverse or demanding circumstances. The factors contributing to a person feeling stressed might include: environment (work, home, school), lifestyle, emotional and personal problems. For some stress is not always a bad thing, some people thrive on stress and even need it to get things done while others find it crippling. An event that may be extremely stressful for one person may not be stressful to another. There are many factors which can influence how we respond to stress such as personality, attitude and your general approach to life, how you feel about a problem, how a problem affects you, whether you have experienced a problem like this before, how much control you have over a situation, how important the outcome is to you, life experiences and life history, your self esteem and if you have the support of people around you. Issues that cause stress cannot always be resolved but changing your expectations of a problem may help. There are many things you can do to manage stress more effectively, a regular daily routine that includes a nutritious diet, exercise, regular sleep, learning how to relax, and adopting effective time management techniques.
Remember: If stress lasts a long time or overwhelms our ability to cope, it can have a negative effect on our health, well-being, relationships, work and general enjoyment of life. Talk to your doctor. 

World Heart Federation: How stress causes cardiovascular disease
Living a stressful life can cause people to adopt poor habits like smoking and eating badly, which in turn are risk factors for cardiovascular disease. But being stressed itself can alter the way the body behaves, and this can bring about changes to the blood and nervous system, which can have negative effects on your heart health. Studies show that acute stress triggers reduced blood flow to the heart promotes your heart to beat irregularly and increases the likelihood of your blood clotting. All of these can trigger the development of cardiovascular disease. If you already have atherosclerosis and become acutely stressed you may experience chest pains caused by the arteries to your heart contracting and reducing the blood flow. When experienced over an extended period of time, all these effects can cause damage to the lining of the blood vessels. This makes the blood vessels more susceptible to atherosclerosis. 

Anxiety UK: Stress can manifest itself as many different symptoms, ranging from physical to psychological and behavioural, and people may experience these to varying degrees. Physical symptoms can include; increased heart rate, sweaty palms, muscle tension, sleep disturbance, fatigue, vomiting, change in breathing patterns, dry mouth, headaches, nausea or dizziness, indigestion or heartburn and sudden weight loss or gain. Psychological symptoms can include anxious thoughts, irritability, low self-esteem and confidence, inability to concentrate, feeling fearful, feeling unable to cope, difficulty making decisions, feeling negative and lack of interest in life, feeling alone, loss of creativity, withdrawal, frustration and confusion. Behavioural symptoms can include altered sleep patterns, use of drugs or alcohol, changes in appetite, avoiding situations, changing habits, nail biting, teeth grinding, neglect of physical appearance, lack of communication, putting off difficult jobs and giving excuses.

Types of Stress
Stress can be positive or negative and is a normal part of life. The types of stress include:
Eustress: This type of stress is good for you and comes from facing a positive challenge which can improve motivation and performance.
Acute stress: (most common) comes from pressures and demands of recent events or anticipated demands/pressures in the near future. It is a brief period of stress related to a specific situation.
Episodic acute stress: When a person suffers acute stress more frequently due to too many acute problems being experienced or major life events, it can be harder to recover as the events add up.
Chronic stress: Daily stress, those suffering from chronic stress often don’t see a way out of miserable situations which can wear people away day after day. Chronic stress can be caused by ongoing pressures/demands that go on for a long period with little hope of improving. This type of stress can be very damaging to health and relationships. 

What can I do if I’m feeling stressed?
If you have been experiencing feelings of stress for a long time, it is important to seek help from a doctor as it can lead to mental health issues such as anxiety and depression which should not be left untreated. Your doctor may refer you to a counselor or psychologist. It is especially important to seek help If you: feel stressed often, particular things stress you, and you feel they are beyond your control, you feel your reactions to stress are extreme or worry you or you feel anxious or depressed about your stress. Depression can develop at any age, those affected are at an increased incidence of suicide which is why it shouldn’t be ignored. Anxiety and depression are both treatable; there are many psychological and medication options. If you are experiencing regular anxiety or depression, talk to your doctor. If you are experiencing feelings suicide it is important you seek help immediately at your nearest emergency department.  

Stress at Work
Stress in the workplace is very common and can be caused by many different factors including conflicts with others, long hours and feelings of isolation. Being under pressure or challenged often improves performance which can sometimes be a good thing but when demands and pressures become excessive, they lead to distress which is not good for your health. If you are feeling you are not being treated well by and employer or colleague, usually there are processes in place to deal with workplace issues such as harassment, victimization, unfair treatment, etc. If you speak up your issue may get resolved.

Eat for Wellbeing
Stress and nutrition are closely linked. What you eat can effect how you feel, increase energy or calm your mood. Those who stick to healthy well-balanced diet are less likely to be stressed then those who eat a poor diet. As stress makes you anxious, further stimulation can heighten this anxiety and even cause insomnia. Junk food which contains high levels of fat and sugar should be avoided when possible particularly to those experiencing stress. Tea, coffee, cocoa and energy drinks should be avoided when stressed as they contain neuro-stimulators like caffeine and theobromine, which are proven to heighten stress. The following foods as part of a healthy nutritious diet can help to reduce stress: Water, fresh vegetables, and fruits, fish, soups, and yogurts. Try to Limit: Tea, coffee, cocoa, energy drinks, fast foods and takeaways, butter, meat and shellfish, sugar, alcohol, soft drinks and commercially packaged baked goods. Try to plan nutritious meals and snacks in advance, so you are less likely to reach for foods which are high in fats and sugars as these can leave you feeling sluggish and unproductive. While we can’t always avoid everyday stressors, we can assist in changing how we react to them with a healthy diet. 

Tips for Managing Everyday Stress
Learning to handle stress in healthy ways is very important. Fortunately, it is easy to learn simple techniques that help. These include recognizing and changing the behaviors that contribute to stress, as well as techniques for reducing stress once it has occurred. The following tips from the Australian Psychological Society can help you look after your mind and body, and reduce stress and its impact on your health.
Identify warning signs: These vary from person to person, but might include things like tensing your jaw, grinding your teeth, getting headaches, or feeling irritable and short tempered.
Identify triggers: There are often known triggers which raise our stress levels and make it more difficult for us to manage. If you know what the likely triggers are, you can aim to anticipate them and practice calming yourself down beforehand, or even find ways of removing the trigger.
Establish routines: Having predictable rhythms and routines in your day, or over a week, such as regular times for exercise and relaxation, meal times, waking and bedtimes, can be very calming and reassuring, and can help you to manage your stress.
Look after your health: Make sure you are eating healthy food and getting regular exercise. Take time to do activities you find calming or uplifting, such as listening to music, walking or dancing. Avoid using alcohol, tobacco or other drugs to cope.
Notice your ‘self-talk': When we are stressed we sometimes say things in our head, over and over, that just add to our stress. This unhelpful self-talk might include things like: ‘I can't cope', or ‘I'm too busy', or ‘I'm so tired', or ‘It's not fair'. Try more helpful self-talk like ‘I'm coping well given what's on my plate', or ‘Calm down', or ‘Breathe easy'.
Spend time with people who care: Spending time with people you care about, and who care about you, is an important part of managing ongoing stress in your life. Share your thoughts and feelings with others when opportunities arise. Don't ‘bottle up' your feelings.
Practice relaxation: Make time to practice relaxation. This will help your body and nervous system to settle and readjust. Consider learning a formal relaxation technique such as progressive muscle relaxation, meditation or yoga; or make time to absorb yourself in a relaxing activity such as gardening or listening to music.
When to seek professional help: If high levels of stress continue for a long period of time, or are interfering with you enjoying a healthy life, it is worth seeking professional help. A mental health professional, like a psychologist, can help you identify behaviours and situations that are contributing to high stress, and help you to make changes to the things that are within your control. Seeking help can be one way to manage your stress effectively. Talk to your doctor. 

Harvard Medical School: Relaxation techniques
We can't avoid all sources of stress in our lives, nor would we want to. But we can develop healthier ways of responding to them. One way is to invoke the relaxation response, through a technique first developed in the 1970s at Harvard Medical School by cardiologist Dr. Herbert Benson. The relaxation response is a state of profound rest that can be elicited in many ways, including meditation, yoga, and progressive muscle relaxation. Breath focus is a common feature of several techniques that evoke the relaxation response. The first step is learning to breathe deeply.
The benefits of deep breathing: Deep breathing also goes by the names of diaphragmatic breathing, abdominal breathing, belly breathing, and paced respiration. When you breathe deeply, the air coming in through your nose fully fills your lungs, and the lower belly rises. For many of us, deep breathing seems unnatural. There are several reasons for this. For one, body image has a negative impact on respiration in our culture. A flat stomach is considered attractive, so women (and men) tend to hold in their stomach muscles. This interferes with deep breathing and gradually makes shallow "chest breathing" seem normal, which increases tension and anxiety. Shallow breathing limits the diaphragm's range of motion. The lowest part of the lungs doesn't get a full share of oxygenated air. That can make you feel short of breath and anxious. Deep abdominal breathing encourages full oxygen exchange - that is, the beneficial trade of incoming oxygen for outgoing carbon dioxide. Not surprisingly, it can slow the heartbeat and lower or stabilize blood pressure.
Practicing breath focus: Breath focus helps you concentrate on slow, deep breathing and aids you in disengaging from distracting thoughts and sensations. It's especially helpful if you tend to hold in your stomach.
First steps: Find a quiet, comfortable place to sit or lie down. First, take a normal breath. Then try a Deep breath: Breathe in slowly through your nose, allowing your chest and lower belly to rise as you fill your lungs. Let your abdomen expand fully. Now breathe out slowly through your mouth (or your nose, if that feels more natural).
Breath focus in practice: Once you've taken the steps above, you can move on to regular practice of breath focus. As you sit comfortably with your eyes closed, blend deep breathing with helpful imagery and perhaps a focus word or phrase that helps you relax.
Ways to elicit the relaxation response: Several techniques can help you turn down your response to stress. Breath focus helps with nearly all of them: Progressive muscle relaxation, mindfulness meditation, yoga, tai chi, and Qi Gong, repetitive prayer, guided imagery and creating a routine. You may want to try several different relaxation techniques to see which one works best for you. And if your favourite approach fails to engage you, or you want some variety, you'll have alternatives. You may also find the following tips helpful: choose a special place where you can sit (or lie down) comfortably and quietly, don't try too hard it may just cause you to tense up, don't be too passive, either. The key to eliciting the relaxation response lies in shifting your focus from stressors to deeper, calmer rhythms and having a focal point is essential, try to practice once or twice a day, always at the same time, in order to enhance the sense of ritual and establish a habit and try to practice at least 10–20 minutes each day.

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