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BRITISH BROADCASTING CORPORATION
RADIO SCIENCE UNIT
CHECK UP
Programme 7. - Stress
RADIO 4
THURSDAY 08/09/05 1500-1530
PRESENTER:
BARBARA MYERS
CONTRIBUTORS:
SARAH JARVIS
PRODUCER:
ERIKA WRIGHT
NOT CHECKED AS BROADCAST
MYERS
Yes hello. Well there is no question that prolonged stress is bad for our health - heart disease, diabetes and depression are just some of the serious medical conditions in which stress plays a part. The science behind this was the subject of a Radio 4 documentary last night. But why are some of us more susceptible to stress than others? Is it because we're unfortunate enough to experience more stressful life events - bereavement, family breakdown, difficulties at work - you may have heard that being discussed earlier in You and Yours. Is it that some of us have personalities that may be less resilient or have we simply not acquired the necessary coping skills - if only we could relax, not worry so much, shed some of our responsibilities - as if.
So how do we cope? I don't suppose that there is simple single answer to that but plenty of our listeners have found ways of handling stress and they've been emailing us at checkup@bbc.co.uk. And calling our number, which is 08700 100 444. The lines are still open for comments and for questions.
And here to help us deal with them is Dr Sarah Jarvis, she's a GP and she's the Royal College of General Practitioners spokesperson on the subject today.
Thanks for joining us Sarah.
JARVIS
My pleasure.
MYERS
Let's go to our first caller - Geraldine is waiting on the line, wondering whether chest pains might be related to stress. Are you suffering from chest pain then Geraldine?
GERALDINE
They've just started really over the last month or so and I'm wondering if in fact they are an indication of heart disease.
MYERS
Are you under stress do you think?
GERALDINE
I've been having a very bad time the last couple of years - I've had two bereavements - and because of the circumstances of them I've not been really able to pull myself together some days about them.
MYERS
Okay over to Sarah Jarvis, is Geraldine right to be worried, chest pains warning bells?
JARVIS
Well the first thing is that Geraldine has got one of the most common causes of stress and I'm really sorry - one bereavement in two years is bad enough but two is enough, quite frankly, to push most people into feeling pretty stressed. Chest pains are a very common physical manifestation of stress, there are lots and lots of physical causes. And it's quite interesting, I'm really quite sad that so many patients come in and they desperately want a physical diagnosis of whatever is causing them to be stressed and so they have what we call somatisation - they have physical symptoms ...
MYERS
Psychosomatic.
JARVIS
Absolutely. Chest pain however is quite a common one and of course one of the things we need to bear in mind is that not only can stress cause you chest pain but it can also cause you to think that chest pain is much more serious than it is. If you were feeling perfectly fine and you got a muscle twinge and almost all of us get sharp pains in our chests, mostly at the front, sometimes at the back, usually made worse if we take a big breath or if we cough or if we twist. That's almost invariably the strain of the muscle of the chest, it's very, very common but of course if you've got stress anyway you may well feel that you're dying or that something more serious is going on. And almost by definition, for instance, if you have a panic attack, where one of the most common symptoms is chest pain, you don't really have a panic attack unless you think there's something seriously wrong with you and unless you think you're dying. So if Geraldine's pain is sharp, if it's made worse when she twists or moves or takes a big breath, if she's not short of breath, if she's not coughing up blood then the likelihood is it's probably due to stress. But I have to say I think anybody who's getting chest pain I would like to send them to their GP first time round.
MYERS
And Geraldine how do you feel that you're able to cope with the stress of what you've described as fairly significant life events, I mean clearly if this is a symptom is there anything that you think you can do or any further help that we can give you?
GERALDINE
Well sometimes I'm very much relieved by listening to music and I can take my mind off things a bit but then it suddenly all overwhelms me and I can't - I break down, I just can't stop crying and then - well as I say the last couple of months I've had a lot of tightening pain - of feeling in the chest, it's not so much a pain as a tightening and I can feel my heart thumping and I just think oh no it's going into something wrong with me now, I just get very frightened that, you know, it's going to be the end of me in a way.
MYERS
Well it sounds as though you can take some reassurance from what Sarah has said, although the pain of heartache is quite real isn't it, when you've lost someone.
JARVIS
The pain of heartache is extremely real and I do wonder Geraldine you said that sometimes it just all gets too much for you, I'm delighted that you're using things like music, relaxation of any sort, and of course quite often physical exercise actually, although it doesn't seem like it's relaxing, because it's kind of taking up all your concentration, can be incredibly useful for dealing with stress. But I do wonder if it's affecting you this much at this stage whether perhaps it has gone over into depression and whether perhaps you ought to be thinking about getting some counselling to help you through this.
GERALDINE
Well I did get some counselling, I didn't find it much help really because I had to go out to get the counselling and I was so upset for having to go through it that I could hardly get home again, you know, it was just awful. So I've kind of - I don't really think that for me that has worked because to talk about it over and over with some counsellor is the same as you do with friends and it doesn't, for me, it didn't particularly work I'm sorry to say.
JARVIS
Oh I'm sorry to hear that because for some people it can be very helpful and I'd hate other people to be put off but I'm sorry you've had a bad experience.
MYERS
Does it help the fact that Geraldine at least is acknowledging the difficulty she's having, she's perhaps experiencing these psychosomatic symptoms, she knows that she's had stressful events? I mention that in the context of an e-mail that I've got in front of me, it's someone who doesn't want their name mentioned, but she's pointing out that she is starting to deal with some of her symptoms, seeing the doctor, getting early nights, planning to tackle other demands on herself and she's saying her tip to everyone would be, be honest with yourself, don't pretend that everything is okay when it's not.
JARVIS
Absolutely and really there are 185 tips out there for dealing with stress and all of them are voluntary apart from the first one and rule number one is admit to yourself that there's a problem and admit that it's okay because it is so important for us to realise that we all live incredibly stressful lives. There's no such think frankly as a person who is inevitably going to be - inevitably going to get stressed and there's no such thing as a person who is immune from stress and that's equally important because the fact is that if life throws enough at any of us then we would suffer from stress.
MYERS
So even if you think you're a coper you could be overwhelmed, the way that you might be riding might actually crash over you?
JARVIS
Oh very much so. And what's very interesting is that I'll find patients come in and see me very regularly who will say this has happened and now so and so, you know, I find I'm crying all the time, I'm getting anxious, I'm getting irritable. And I'll say well you're obviously stressed. No, no, no nothing much has happened recently or the fact that I've been coping with my parents both being ill and my brother being in hospital and not knowing if my son was in the Tsunami and all the rest of it, that's all gone away now so I can't be stressed anymore. Well in fact of course it's very often the background that means that some tiny event can just push you over the edge, the straw that broke the camel's back is very much pertinent here.
MYERS
And knowing that it's stress means you can get something - something from your doctor?
JARVIS
Well not necessarily from your doctor because of course the first person you need to get something from is yourself, you need to accept that there's a problem, you need to recognise it and then you need to decide that you're going to take control. And if there's one unifying factor in all the sources of stress that people come and tell me about it always seems to boil down to control, you feel that you don't have any control, whether it's a bereavement has happened and you can't cope, whether it's stress at work, whether it's ill health, whether it's people making demands of you because you're the ultimate coper - it's basically too much being poured on top of you. So what you need to do is to work out how you can take control. And they don't need to be big changes, in fact very often it's a good thing to recognise that you can't change too much and again this is where people, for instance, who cope are particularly vulnerable to this, not only are they vulnerable to not accepting they're stressed in the first place but of course when they do get stressed they decide right I'm going to get it sorted and they're far too ambitious about what they're going to do. Recognise your limitations. My rule of thumb is that what you should do is to sit down and make a list of all the stresses in your life and look at them and work out which one is the biggest stress and then work out what you can do about that.
MYERS
So a battle plan really.
JARVIS
Absolutely.
MYERS
Well I wonder if this will help Jean, Jean Howell's ringing from Birmingham, and she knows what's causing her stress, which is a major operation that she's due to have quite soon. You know that that's going to be a big problem for you do you Jean?
HOWELL
To a certain extent yes. I've already had one six weeks ago, a minor operation. My problem is the stress that comes after an event, I seem to be able to control the dry mouth - that I have at the moment - breathlessness etc. etc., up to the event and then get over it and then a couple of weeks perhaps afterwards the body seems to give way and I have bouts of sickness and diarrhoea and sometimes fainting, as though my body's given in and said well I've done my bit now I'm taking over sort of thing.
MYERS
Is this what happened last time and is it what you fear might happen again?
HOWELL
Yes, this is why I'm ringing now.
MYERS
Okay, well let's see if we can get an answer for you Jean.
JARVIS
Well absolutely, well the great news Jean is that of course you are forewarned and again we seem to be giving in to trite sayings today. Forewarned really is forearmed in your case because the trouble with having an operation is that it is one of the major life events, poor health is a major life event, and again you don't feel like you're in control. You've, I hope, got trust in your doctors and you feel that you can put yourselves in those hands but of course after you get out of hospital you're effectively back on your own again, if you like. And again you may feel that you haven't learnt enough, that you don't know enough about what might happen. So what I would suggest that you do is again to make a battle plan, as we were talking about earlier, to work out what it was about your last operation that made you feel so stressed afterwards. And I know it'll be difficult going through that because of course reliving stressful events is very difficult, Geraldine was saying that talking about what had happened was very difficult, but the trouble is that unless you go through them you can't move past them. And if you, Jean, work out what it was that made you feel stressed - was it that you didn't know what was going to happen if there was a complication, was it that you weren't quite sure what was normal in your recovery, you'd been told what you could expect immediately after the operation but maybe you hadn't been told what to expect later on. And then what you can do is two things - the first is that you can make sure that you're in control, so you can make sure that you ask all of those questions. And you can also make sure that you've got somebody to talk to about it. So if, for instance, in your case, as you said, two weeks later you suddenly kind of feel that things absolutely flop then maybe you should think about going away and staying with friends at that time or maybe you could get a friend to come round and stay with you, so that you've got something to distract you, you can do something to take your mind off it in the knowledge that this time you've put yourself in control.
MYERS
And not to undermine what you just said Sarah, because that sounds like a lot of sense, but I mean you were saying Jean you had physical symptoms, that you had diarrhoea and such like, I mean could that be a very direct response to the surgery - perhaps the anaesthetic and so on and so forth?
JARVIS
It's not terribly likely to be a physical response two weeks later and it is absolutely classic. I mean if we look at the physical symptoms of stress - headache, muscle tension, dry mouth, stomach problems, nausea, vomiting, sweating, dizziness, palpitations, breathlessness, tingling all over your hands and your feet, sexual problems - there are endless physical manifestations of stress. And this is one of the reasons I suppose that I get so upset that people still consider there to be some sort of stigma attached to feeling stressed because the fact is that adrenaline, which is one of the many hormones which is involved in stress, not only gives us the dry mouth, the tingling, the stomach aches, the nausea, the diarrhoea, it's also kept us alive as a human race, you know, that's what determines the fight or flight mechanism. The fact that it's kind of working slightly overtime on this situation we shouldn't doubt that a. stress is very real and b. that it can have pretty impressive effects physically on our bodies.
MYERS
Jean, thanks for that call, I hope that's been helpful and good luck with the next procedure you're going into hospital to have. We'll go to another caller. We've got Jill waiting in Romford who's got a recipe for stress, I hope that's to alleviate stress rather than to cause it. Jill?
JILL
It certainly is yes. My two recommendations for dealing with stress are the Bach Flower Remedy and meditation. Have you heard of the Bach Flower Remedy?
JARVIS
I have absolutely heard of the Bach Flower Remedy and the Rescue Remedy.
JILL
Absolutely, most people tend to start with the Rescue Remedy and then move on to the others. I mean basically it's a system of natural medicine that treats a person's emotional state, not their physical symptoms directly, on the basis that an emotional disharmony will often precede a physical one, as we've heard.
MYERS
So do you use this as a preventive or do you use it at the time you're under stress then?
JILL
Because it's treating three things - it's treating your character, you temperament and your emotional outlook - you would use it - say you had a lack of confidence then certainly you would be using that on a more - on a longer term basis, perhaps a few weeks or months, rather than as a prophylactic.
MYERS
Okay and take us to this meditation because people may or may not go along with you when it comes to Bach remedies but the meditation I think probably makes a lot of sense to people - do you play tapes did you say?
JILL
Well yes, certainly tapes - 20 minute tapes perhaps two or three times a week are very, very helpful. Basically because it slows everything down and when you're more measured and you're taking life in a slower way then you can function better. But I have to say that out of the two of them the Bach remedies are the ones that have turned my life around.
JARVIS
And it's terribly important here that they really work for you, so you've got the confidence in them Jill and that means that you are taking control of your life and that's so important.
MYERS
Generally speaking should you wait until you're in a stressful situation to sort of come up with a remedy or should this be maintenance therapy, something that's lifelong and ...
JARVIS
My personal feeling is that we are all in this day and age prone to stress. So if you've got something that you can do that you know consistently makes you feel good - in my case it's always booking my next holiday before I've finished my last one, even if it's six months away, at least I know it's there and it's something to look forward to. Even if it's something that you feel you don't need at the moment you should find that it allows you not to become stressed with things that otherwise might have stressed you because that's the trouble - even if life isn't throwing a lot at you, you don't know whether your self-defence, your defence mechanisms, your coping mechanisms are so low that that's what will tip you over into feeling stressed.
MYERS
Well I'm glad to say that people have taken us at our word and have phoned and e-mailed with all sorts of ideas. Self-hypnosis comes up, as a suggestion, reflexology is another one.
JARVIS
And they all have one thing in common - reflexology, self-hypnosis, meditation - they are making you set aside time for you and that's what this is really very much about. I'm a great fan of massage, of aromatherapy, chicken soup and a hot bath always works for me. But basically anything that means that you are setting aside time for you and you are taking care of you. One of the most common sorts of people who come into me with stress in the surgery of course are mothers because these days so many women are working and the tragedy is that of course they haven't had to divest themselves, they haven't been allowed to divest themselves, of the homemaking skills just because they're working at work - they're at work eight hours a day - and it does mean of course that they come very much the bottom of their personal list of priorities. And what you need to remember, as a mother, as someone who feels they haven't got time to look after themselves, is that if you're not coping, if you succumb to stress, and you end up not being able to cope you won't be able to provide of yourself to the other members of the family who depend on you. So in fact it's in your interest to make some time for you, it's in your interest to make sure that there really is, even if it's 15 or 20 minutes once a day - you know I cycle to work, it takes me only five minutes longer than it does to drive and yet I'm doing something physical, I find it incredibly relaxing despite the fact that I cycle through the middle of London.
MYERS
Do you think then we're saying we need to give ourselves permission to be kind to ourselves and to remember what it feels like to feel good and then to deploy that if you like, particularly when you've got a stressful situation coming up or you're trying to cope with something?
JARVIS
Absolutely, and it's not even a question of being kind to ourselves in fact, because actually it comes to the time where being kind to yourself is a self-preservation mechanism. So I think it's more a question of giving yourself permission to acknowledge that if you're not nice to yourself you're going to crack.
MYERS
Okay. Let's go to James Hall, he's in Manchester, and is interested in the relationship between stress and blood pressure - is that because you've got high blood pressure James?
HALL
No.
MYERS
No.
HALL
I did have it at one point when I had a quarrel with a bit of a fool, if I may put it that way. But my thoughts on this is more looking at it from a scientific point of view. I understand the sympathetic ...
JARVIS
Nervous system - absolutely - when we're talking about adrenaline and so on James.
HALL
Sorry?
JARVIS
We were talking about adrenaline and you're absolutely right, it's all part of the sympathetic nervous system.
HALL
Yes. Now logically then you're stressed and so your blood pressure goes up. Now supposing then you become unstressed, it comes down, but why doesn't it create low blood pressure at the same time?
JARVIS
Oh well it may well create low blood pressure and if you're very relaxed then your blood pressure very often will be low. But one of the big problems we have with blood pressure is that it doesn't cause symptoms, whether it's high or low at the time, unless it's incredibly high or extremely low. So of course we don't know about it. The big problem with high blood pressure is that you don't know about it, therefore you go into see your GP feeling just fine, your GP says you've got high blood pressure here's a prescription for medication to take for the rest of your life and you are now officially labelled a hypertensive and the high blood pressure tablets can make you feel worse than you did in the past, than you did before you had it. So it is very, very difficult when you have high blood pressure.
Low blood pressure doesn't cause symptoms either. But if you have high blood pressure because the doctor's taking your blood pressure - and that's a very common one, it's called white coat hypertension, even though we no longer wear white coats in surgery - but white coat hypertension is very, very common and of course very often patients will come in to see me and say oh I've had a terribly stressful day, don't take my blood pressure today. Well we would never dream of giving you blood pressure medication for life on the basis of a single raised blood pressure reading, for exactly the reason that you're talking about James, everybody's blood pressure goes up during the course of the day. And if we've got someone where we can't see any reason why their blood pressure should always be high when we check it these days we're moving more and more towards something called 24 hour ambulatory blood pressure monitoring - we have a little device attached to you and you actually wear it yourself for 24 hours and every 15 minutes it inflates and it checks your blood pressure. And that gives a much better measure. And you're quite right, we do tend to find that when you're feeling relaxed, often when you're asleep, your blood pressure will be very, very low. But what we're more worried about is high blood pressure because although low blood pressure can make you feel dizzy when you stand up it's high blood pressure that causes the heart attacks and the strokes.
MYERS
We know that blood pressure then is a risk factor for heart disease and I did say at the beginning that prolonged stress is bad for our health and heart disease is one of the outcomes. I mean is it very clear what that mechanism is and for example how long do you need to be stressed before you become perhaps more vulnerable to succumbing to a heart attack - is there clear evidence around that and how does it help us?
JARVIS
It's very much a how long is a piece of string question. There is now some evidence that relaxation techniques and stress relief can help to reduce your risk of having another heart attack if you've had one before. But there is, as yet, no concrete evidence that stress relaxation or that stress relief techniques will prevent you from having a heart attack in the first place. But if you think about some of the things that stress makes you do, it stops you from finding time to exercise, it makes you want to eat often more or less healthily, it makes you more likely to smoke, it makes you more likely to suffer from tiredness, it makes you more likely to drink alcohol to excess. So there are all sorts of things that stress does which make us more prone to an unhealthy lifestyle. And of course it's terribly difficult to tease out how much of it is the stress and how much of it is the unhealthy lifestyle that's promoted by those hopeless feelings that you get when you're feeling really stressed.
MYERS
Thank you. We'll go to Tam now, who certainly feels under stress, like a lot of people going back to school, going back to college, I think it's academic matters on your mind, is that right Tam?
TAM
That is right yeah.
MYERS
So what's the story?
TAM
Well I'm actually just finishing a post-graduate course and I have to hand in my final piece of work, which is a big dissertation, next week. And I've found that I've been stressed throughout the course and whenever I have a deadline I get stressed, so I find that's a necessary step to getting the work done.
JARVIS
Well there's nothing like stress to concentrate the mind is there.
TAM
Yeah exactly, but this time it just seems to have become sort of so overwhelming that it's actually stopping me from working rather than spurring me to work.
JARVIS
I think what you've demonstrated beautifully Tam is this sort of continuum of stress. A little bit of stress is absolutely necessary for us to motivate ourselves and in fact we will almost certainly find that the sort of really successful people in life are the ones who are very motivated, who maybe slightly more the sort of type a perfectionist, get things done, can't sit still personalities. But the trouble is you've now kind of moved along that continuum and it's got to the stage where the stress has become an issue in itself, it's not a motivator to get you to hand in your work on time, it's actually become an issue in itself. So really again you need to first recognise there's a problem - which you've done - be realistic and start prioritising, don't overestimate what you can do.
MYERS
We'll leave you with that thought because I want to squeeze in one very last tip. Amy is on the line from Brighton. Quickly with a tip.
AMY
Yeah I have a very good tip. When you're very stressed you come in or you go out and you scream as loud as you can once or twice and it opens up the chest and it's really tingling down and the relief afterwards is pretty ...
JARVIS
I can vouch for that - very therapeutic.
MYERS
That and laughter - laughter being the best medicine. Thank you very much indeed for that. Thank you for all your calls. Once again we're beaten by the clock. If you missed any of that expert advice from our special guest today Sarah Jarvis, then you can go to our website at bbc.co.uk follow the links to Check Up, you can listen to this and to all our topics again. Or if you prefer to speak to someone then you can call the free and confidential help line, that's 0800 044 044. This is the last in the current series, we will though be back in November to take your questions on health concerns that are important to you. Till then goodbye.
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