Coping with stress after illness

All of us go through a health setback at some point in our lives but it isn’t just illness that’s stressful –   recovering from illness and injury can bring its own stresses and strains.  Here, Dr Frances Goodhart and Lucy Atkins, authors of How to Feel Better, look at what stress is and how to spot the signs that it is having a negative effect on you even despite the fact that your physical symptoms are improving.

stress after illness

What is stress?


It sounds like a silly question, but stress is actually surprisingly difficult to define. One person’s stress is another person’s excitement. You might hear a teenager say, ‘Oh my God, I’m so stressed, I don’t know what to wear to the party tonight.’ But the same word – stress – is used to describe what a soldier experiences in battle. There is no blood test or scan that can identify stress. It is an internal, personal, psychological experience.


Essentially, stress is about overload. Unhelpful stress kicks in when you perceive (that is, you think or believe) that you do not have the capacity to manage the demands you are facing.


How you perceive your abilities can change day to day. On some days you might be able to cope with anything, but on others the same events would completely stress you out. Perhaps you woke up feeling tired, or you have a headache or have been busy for days – for whatever reason, you just don’t feel as strong and capable as usual. Stress starts to build.



Spotting the signs of stress


Some of the signs will be obvious to you, but others might be far more subtle. It is worth understanding exactly how stress manifests itself for you. You might be surprised by what you uncover. Common signs of stress are:


Thinking Signs: Short-term memory problems; difficulty concentrating; racing, intrusive, unhelpful thoughts; decision-making difficulties; inability to ‘switch off’; thoughts that focus on what you cannot do or how much there is left to do; loss of confidence in your ability to achieve what you want to achieve.


Feeling signs: Feeling tense; agitated; irritable; sad; depressed; lonely; overloaded; overwhelmed; helpless.


Physical signs: Having tight muscles; aching muscles; headaches; altered breathing patterns; increased heart rate; tightness/butterflies in the tummy; stomach aches; nausea; tiredness.


Behaviour signs: Being snappy and irritable; experiencing appetite changes; sleep problems; less energy and activity; seeing other people less; eating; drinking (alcohol) or smoking more.



The stress tipping point


Often, when people are stressed they say that something ‘tipped me over the edge’. A certain amount of stress can actually be useful – it can be a great motivator, helping you perform brilliantly in a job interview, revise for an exam, or talk to the bank manager. Life would be pretty dull without a bit of stress. The trouble is that stress does not arrive in neat packages at just the right time to ensure that we reach our full potential. It can land on you in great big wallops.


When stress involves feelings of major overload it is no longer positive or motivating. You don’t feel ‘buzzy’ and powerful, you feel tense, inefficient, unhappy, wound up or overwhelmed. You feel you’ve been pushed over the edge.


A health problem can do this very effectively. Psychologists have developed a stress scale of 43 particularly stressful circumstances. Number one on the list is the death of a spouse, closely followed by divorce. Personal illness or injury comes in at number six.



Why do health problems make you stressed?


There is often pressure – either self-imposed or from others – to look and sound as if you are doing brilliantly. You’re supposed to look just as good, if not better than before. You’re supposed to feel optimistic. Your stiff upper lip must be made of reinforced steel. If, deep down, you do not feel either strong or confident, then these expectations can add to your stress. There may also be a build-up of tasks from when you were out of action. If you feel you can’t meet all of these demands, your stress levels rocket.



Is stress bad for you?


Stress makes you feel rotten. It may even have an impact on your immune system, making you more vulnerable to coughs, colds and other illnesses. It can also slow the body’s healing process. Research into stress and illness is very complicated, but large-scale, high-quality studies do not show that stress itself directly causes serious illnesses such as cancer or heart attack. However, there is a lot of research showing that the unhelpful and unhealthy ways in which we respond to stress can make us seriously ill.


The evidence, when it comes to major health problems like cancer, heart disease and stroke, is that if you respond to stress by smoking, drinking alcohol, over-eating, not exercising, ignoring early warning signs or withdrawing from your friends and family, then you increase your risk of ill-health. If, on the other hand, you respond to stress by finding helpful, health-promoting ways to cope (which frankly work a lot better anyway), then being stressed is not a health risk.



Stress management


The key to stress management is to crack the vicious circle by learning simple, healthy and effective ways to cope. One useful technique is to keep a stress record.


Keeping a stress record for two weeks will give you a lot of useful information. It will help you to identify and understand the following: 1) What, exactly, makes you stressed (you might think it’s obvious, but by doing this, you’ll probably uncover that unexpected things push you over the edge too); and 2) How you respond, physically and emotionally, when stressed.


Getting to know your stress is the first vital step towards managing it. Twice a day – for example, before lunch and before going to bed – write down how stressed you felt during that portion of the day. Use a scale of 0–5 (0 = no stress and 5 = extremely stressed). If you have given yourself a 3 or more, it is time to take a closer look. See if you can:



1 Identify the trigger/tipping point What pushed you over the edge? Was it a specific event (your boss giving you a new task, a friend’s unhelpful comment, another bill arriving)? Or is it more internal (a headache, just feeling down, the fear of a follow-up appointment, the thought that you have too much to do, the idea that you did something badly)?


2 Identify what happened when you became stressed Did you feel physical tension, have racing thoughts, feel butterflies in your tummy, snap at the next person who spoke to you (or all of the above)?


3 Identify anything you did to manage your stress Did you breathe deeply, ask for help, try to do ten things at once, cancel fun things, order a takeaway, reach for a glass of whisky? Rate your stress management strategy on a scale of 0–5 (0 = as well as possible and 5 = as badly as possible).


An ongoing stress record will give you a way to monitor your stress levels and will also help you to notice when they start to reduce. This can be great motivation to continue your stress-reducing strategies.


Extracted from How to Feel Better, by Dr Frances Goodhart and Lucy Atkins. For more information and support, visit Anxiety careMind or Heads Together. More books on supporting and managing your mental health can be accessed through The Reading Agency and the Society of Chief Librarian’s Reading Well Books on Prescription book list.

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