Common symptoms of stress include:
- Trembling; feeling shaky
- Muscle tension
- Nervousness; edginess
- Sweating; cold hands and feet
- Initial insomnia (difficulty falling asleep)
Symptoms associated with moderate to severe anxiety:
- Shortness of breath
- Diarrhea ; frequent urination
- Panicky feelings; fears of losing control
Symptoms associated with specific anxiety disorders:
- Extremely intense, rapidly escalating anxiety generally lasting for 1-10 minutes (Panic disorder)
- Recurring, significant worries about: maintaining order in ones environment (accompanied by checking behavior; e.g. checking and rechecking if doors are locked, oven is turned off, etc.); unrealistic fears of dirt, contamination (accompanied by rituals, e.g. hand washing) (obsessive-compulsive disorder)
- Recurring nightmares, intrusive memories, anxiety attacks, and times feeling numb (Post-traumatic stress disorder)
Note: these three anxiety disorders have very small rates of spontaneous remission. Without professional treatment they can last for years.
Symptoms that can significantly interfere with functioning at school or work
- Impaired concentration and attention
- Inability to maintain focus
- Memory problems
- Very low frustration tolerance
The five symptoms listed above can severely interfere with functioning, and failure to succeed academically or occupationally can, in itself, become another source of increased anxiety.
Stress symptoms are often brought about by exposure to either very significant life events (e.g. the death of a loved one; being reprimanded or fired from a job). But also such symptoms often arise not from specific, highly stressful experiences, but from the accumulation of many lower-level stressors (e.g. when people take on too much).
There are four factors that are at the root of many stress symptoms:
- Loss of perspective which often leads to a perceived loss of control
- Lack of adaptive outlets for reacting to the stressors
- Sleep deprivation
- The use/overuse of caffeine and/or alcohol, both of which can contribute significantly to stress symptoms.
These are causes, but also each point the way to effective stress management.
"...and if the medication causes any headaches or hallucinations, please call me."
First it is worth noting that when people are experiencing severe stress reactions it is very common for friends or loved ones to offer useless advice, such as “You just need to relax;” “Don’t take things so seriously;” “You are too sensitive.” You better believe it, everyone who is experiencing severe stress has already done everything they can to turn the volume on stress symptoms. To have someone offer one of these platitudes never helps and often results in the person feeling misunderstood or angry.
Techniques that work:
When things are overwhelming, many people do feel a sense of loss of control. This always exacerbates stress symptoms. Three techniques can help:
- Don’t be caught by surprise. The more people can carefully assess up-coming stresses this can contribute to a greater sense of control. It may help to carefully think about and write down current and near future stressful events or situations and then label each as a high or lower-level priority. This may seem ridiculously simplistic, but it often helps. Writing down a list of stressors is a part of the key (i.e. not just thinking about this, but rather, putting it all down on paper actually makes this intervention more successful).
- When caught up in worries about a current stressful situation or event, stop for a moment, looking at the current situation…ask yourself: “In the grand scheme of things, how important is this?” …or “A week from now how distressed will I likely be about this particular stressful situation?” Let’s face it, many stressors are very important. Yet when people are under a good deal of stress there is a tendency to get caught up in the emotions of the moment and worry about all stressful situations; even those that are not actually a big deal. Once again, this approach may appear to be overly simplistic, but try this technique one of two times. Most people find that it immediately reduces stress symptoms to a noticeable level and helps people to regain a realistic perspective.
- Write down a list of things that are currently a source of worry or concern (again, there is something about writing this down that makes the technique significantly more effective). After doing so, careful look at the list and ask yourself two questions about everything on your list:
- In the grand scheme of things, how critical is this?
- Can I just choose not to do this? (often life gets crowded by the pressure to do too many things, and a common “to do” may be something you feel obligated to do, although you would rather not). You have a right to simply tell a person, “I’m under a lot of stress. I know I said I would do it, but I am just too busy (or overwhelmed)…I hope you can understand.” Most people experiencing severe stress have certain important issues that they must deal with, but also have a long to do list. This technique is about lightening your load by saying no to or eliminating unnecessary tasks.
Bottled up feelings can directly cause stress symptoms. Talking openly to a friend, family member or therapist about the underlying emotions (for example, angry feelings, grief, etc.) can often significantly reduce stress. Even if this does not lead to a solution for the particular problem, simply being honest, open and getting things off your chest often reduces stress symptoms. Another adaptive outlet is exercise.
Many people are chronically sleep deprived, and anxiety itself can interfere with sleep (both causing initial insomnia and reducing the amount of time spent in slow wave [deep, restorative] sleep). It has been clearly established that effective emotional regulation and good cognitive functioning require an adequate amount of slow wave sleep. The highest-yield approaches to getting more quality sleep include:
- Stop the use of caffeine, especially caffeine that is ingested after noon. Caffeine can cause insomnia and decreased time in slow wave sleep (both of which cause anxiety). Ideally, when there are significant stress symptoms the caffeine level should be zero. This (again simple) solution is very high yield. When people are under stress or need to stay up late at night, daily caffeine levels are often very high. If the amount of caffeine use is high, gradual discontinuation is required to avoid caffeine withdrawal.
- Alcohol is seductive, because the acute impact is decreased anxiety. But alcohol in the long run always increases anxiety, primarily by reducing the amount of time spent in slow wave sleep.
- Regular exercise. This should not be done in the 3 hours before retiring (exercising close to bed time can, in itself, cause initial insomnia). Exercising every day has been shown to be effective in reducing stress symptoms.
- If there is difficulty falling asleep (which is generally due to worrying), a very effective approach is to sit up in bed and write down specifically what you have been thinking or worrying about. This, at first may feel tedious. But, once again: simple and effective (works for about 75% of people). Try it just once, and most people will immediately feel the difference. A low cost, no risk experiment.
- In addition to the impact on sleep, caffeine always exacerbates anxiety and alcohol ultimately increases anxiety (primarily by reducing the amount of time in slow wave sleep).
The feelings of being out of control often accompany stress reactions. There certainly is a place for professional treatment (psychotherapy and/or psychotropic medications). But it is remarkable how often the simple yet effective approaches mentioned above are not taken into consideration. To use a technique and to feel it reduce anxiety is mastery (the opposite of feeling out of control).
The Goldberg Files
The Goldberg Files is based on the struggles of Dr. Goldberg as well as those of his many students which he observed while teaching medical school for 25 years. This extensive blog is dedicated to assisting students in dealing with the stresses of medical education. Want to learn more?