beat your stress

by Alison Moore

Stress has become big business today. If you are looking for help to manage your stress levels you are likely to be met with a bewildering array of different therapies and practitioners.

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The choice includes conventional doctors, counselling services, alternative therapists and self-help. You may be offered help through your workplace or have to find something for yourself. So what is available and what works best?

the medical response

Depression, anxiety, headaches, irritable bowel syndrome... the list of illnesses linked to stress is endless. But although doctors may be able to treat the illnesses, they will not always have an instant solution to dealing with the stress.

If your first port of call with stress is your family doctor (GP), he or she will probably try to talk about the cause of your stress and suggest methods of lessening strain in your life or coping better with it.

'Most GPs would just take a problem-solving approach and look at where your stress was arising,' says Dr Ruth Chambers, a Staffordshire GP and professor of primary care development.

Medication is often not the best long-term answer when handling stress. So most doctors prefer to try to help you tackle the problem by examining the source of your stress, she says. In many cases they may refer you to a counsellor or community psychiatric nurse, who can help you talk through these issues.

Your GP may also suggest other practitioners who can help or refer you to a specialist mental health unit to see a psychiatrist, psychotherapist or clinical psychologist.

drugs for stress

In certain circumstances, some GPs may prescribe tranquillisers for a few days to help you through a particularly stressful time. It is worth knowing that tranquillisers can be addictive so that your GP is unlikely to prescribe them for long periods.

Beta blockers, which reduce palpitations, tremor and sweating, are also sometimes prescribed for short-term stress-related anxiety.

If stress is causing you to be severely depressed, your GP may suggest treating this with drugs – anti-depressants – to help you cope with a difficult period.

Antidepressants can be very effective in treating depression. They may be used long-term and are not generally believed to be addictive although they may have unpleasant side-effects and some people do experience severe withdrawal symptoms when they stop taking them. You should never stop taking them abruptly or without first consulting your doctor.

There are two basic types of antidepressants – the older-style tricyclic drugs and the new breed of selective serotonin reuptake inhibitors (SSRIs) such as Prozac. It is worth noting that antidepressants usually take two to three weeks to begin to alleviate symptoms so you should try to persevere. People also react very differently to individual drugs – if one doesn't suit you, there are others that can be tried which may have fewer side effects and work more effectively.

talking cures

It's good to talk – and this is often the first route your GP will suggest if you are having problems handling stress. Some practices will refer you to a counsellor or psychotherapist who is free-of-charge. If you do have to contact someone privately, remember it may cost hundreds of pounds for a series of consultations.

counselling

You may be referred by your GP to a counsellor who helps people generally cope better with anxiety, depression and other mild mental health problems. There may be a counsellor attached to your GP's surgery. Normally, such counsellors do not specialise directly in stress or managing stress. For this you will need to see a stress management counsellor. However, they should still try to get you to examine the causes of stress in your life and suggest ways you can better handle that pressure.

psychotherapy

Psychotherapy often delves more deeply into your background and formative experiences than counselling, and goes on for longer.

Ann Casement, chair of the UK Council for Psychotherapy, suggests: 'If the stress is continuing and does not seem to have some immediate cause, then that is a good time to see a psychotherapist.'

cognitive behavioural therapy (CBT)

CBT has become increasingly popular in recent years. It focuses on changing the way you feel and behave. The therapy works by aiming to show you how to recognise and challenge negative thoughts and to help you think more realistically. You will learn to question your responses so that instead of seeing the worst side of things, you find out how to see things as they really are. NHS provision is patchy and you may have to pay for these treatments.

stress management

stress counselling/stress management

The last decade has seen a rapid growth in interest in stress management and stress counselling. Counsellors or consultants in stress management can help you identify the underlying causes of your stress and understand how it affects you physically and emotionally. They then help you recognise the warning signs and teach you coping methods when stress becomes a problem. Techniques may include training in relaxation methods, self-assertiveness training, and time and energy management.

Former community psychiatric nurse Brian Potts, who runs a private stress clinic in Norfolk, says: 'We act like a mirror – people reflect off us and see what is happening in their own heads. Often I pick up on childhood difficulties which set people in a value system which makes them overwork.

'That is one of the most common things that I see – that people are trying too hard in life.'

Find out more about stress management in our special feature. To try out stress management for yourself check in to our stress gym.

time management

Many people feel stressed because they have little time or energy for themselves and for things that matter to them. Life coaches and time-management coaches can help you organise your life, identify the pressure points and help you make changes – which can reduce your stress.

Time management coaches concentrate on how you use your time – whether at work or home – to achieve your objectives.

Find out more about time management in the stress gym.

the alternative approach

There's hardly an alternative or complementary therapy which does not claim to help stress – and because stress is so subjective, it can be hard to prove or disprove their claims. So it may come down to 'if it works for you, don't knock it'.

Dr Edzard Ernst, professor of complementary medicine at Exeter University, says: 'Stress is a good indicator for complementary medicine but the best way to reduce stress is to abolish its cause.'

what works?

We asked Professor Ernst – one of Britain's top experts on research into the effectiveness of alternative medicines – to assess which complementary and self-help therapies are backed by strong evidence. He weighs up the merits of different therapies by reviewing the most up-to-date and reliable research comparing them. However, a verdict of 'no evidence' does not mean a certain therapy definitely does not work – it simply means that adequate research has not yet been carried out.

Talk to your GP before trying any therapy, especially if you are on other medicines or have other illnesses.

acupuncture

Some practitioners claim this branch of Chinese medicine, where needles are inserted into points of the body, is able to help stress-related problems. Professor Ernst's verdict: reasonably good evidence.

Find out more about acupuncture in our coping with stress feature and on Channel 4's complementary medicine website.

aromatherapy

A world away from the scented bubble baths sold as aromatherapy, practitioners will use a number of essential oils – possibly including geranium, lavender, petit grain and marjoram – in a carrier oil to aid massage. Professor Ernst's verdict: quite good evidence.

Find out more about aromatherapy in our coping with stress feature and on Channel 4's complementary medicine website.

biofeedback

Stress makes your body behave in a certain way such as tensing muscles and increasing your pulse rate. Biofeedback uses a monitor attached to your body to tell you when you are becoming stressed. Over time, you learn to respond to it and prevent it occurring. Professor Ernst's verdict: good evidence.

Channel 4's complementary medicine website has more information about biofeedback.

colour therapy

This involves sitting in rooms of a particular colour or under coloured lights. Different conditions are said to respond to exposure to different colours – so violet is used to counteract feelings of hopelessness and blue to relieve stress. It is not promoted as a cure for illness. Professor Ernst's verdict: no evidence.

Channel 4's complementary medicine website has more information about colour therapy.

flower remedies

The best-known of these are the Bach flower remedies which are marketed for a wide range of emotional difficulties. You can buy the individual remedies from many pharmacies or visit a practitioner who will make up a remedy specifically for you. Professor Ernst's verdict: no evidence.

Channel 4's complementary medicine website has more information about Bach flower remedies.

healing

Spiritual and faith healing, and the Japanese system of reiki, all involve the idea of healing energy being passed from one person to another. This can be done through the 'laying on of hands' or distance healing. Prof Ernst's verdict: some encouraging evidence but not clearcut.

Channel 4's complementary medicine website has more information about healing.

herbal medicine

If you are interested in herbal medicine you can consult a medical herbalist or buy herbal preparations over the counter. Unfortunately, there are now serious health concerns about the herbal medicine which has been shown to be most effective in relieving stress, called Kava, (or Kava Kava). Most herbal medicine retailers suspended sales of kava in December 2001 as a precautionary measure following reports of serious liver problems associated with the herb in Germany and Switzerland. No such side effects have been reported in the UK but the Medicines Control Agency (MCA) is assessing evidence on safety and recommends anyone taking kava products or food containing kava should stop doing so. For more information check out the MCA website at www.mca.gov.uk. You can find a herbalist in your local area on the website of the Institute of Medical Herbalists, www.nimh.org.uk.

Channel 4's complementary medicine website has more information about herbal medicine and Chinese herbal medicine.

massage

Being massaged is generally a very relaxing experience which many people find beneficial when stressed, whether done by a trained masseur or by a friend. It is thought to be particularly useful in reducing anxiety in the short-term. Reflexology involves pressure being applied to the feet or hands to promote well-being. Shiatsu, a Japanese form of massage, is frequently used for relaxation and stress relief. Professor Ernst's verdict: very good evidence for massage, some reasonably good evidence for reflexology and no evidence for shiatsu.

Find out more about chair massage in our feature on stress therapies.

Get the low down on other alternative therapies in our special feature.

Channel 4's complementary medicine website has more information about massage therapy, reflexology and shiatsu.

self help

There are lots of ways you can help yourself to combat stress. Here are some common techniques.

exercise

All forms of exercise can help get rid of the 'pent-up' feeling that stress creates and release hormones which promote a sense of well-being. Try to get into a regular routine of exercising for at least 30 minutes, three times a week. Many people find rhythmic exercise – swimming, running or cycling – is particularly good for overcoming stress. Professor Ernst's verdict: reasonably good evidence.

meditation

You don't have to chant or take up transcendental meditation to meditate. Much meditation involves deep, calm breathing to start the process and then concentration on a particular object. This can be a repeated word, the ticking of a clock or even a point in the room. Many people prefer to meditate with their eyes shut, emptying their mind of all distractions. Others use visualisation techniques. Professor Ernst's verdict: some good evidence.

Channel 4's complementary medicine website has more information about meditation, breathing and visualisation.

relaxation

There are any number of relaxation techniques around, either taught by professionals or ones you can master yourself. You may even be able to find adult education classes in some of the more common techniques. Many health food stores, bookshops and audio shops sell relaxation tapes.

The Alexander technique is a method of training which improves posture and has an overall calming effect on the body. It is taught by qualified teachers.

Yoga is often recommended because of its relaxing qualities and the emphasis some forms put on deep breathing. Classes are widely available and need not be expensive.

Tai chi, a Chinese relaxation exercise, is also extremely popular.

Professor Ernst's verdict: some specific relaxation techniques are supported by good evidence.

You can find out more about t'ai chi in our stress therapies feature.

Channel 4's complementary medicine website has more information about relaxation, the Alexander technique, yoga and t'ai chi.

things to avoid

Many of us turn to old standbys, like a drink or cigarettes, as an instant stressbuster. But often these can do more harm than good.

• Caffeine is a stimulant so drinks containing caffeine may cause difficulties sleeping and contribute to anxiety. Try decaffeinated drinks for a week and see if you feel better.
• Alcohol is the first resort of many people after a 'bad day'. It is OK in moderation but drinking heavily has long-term health risks and does not get to the root of the problem. Excessive drinking can also lead you to become more violent or aggressive. If you find that you – or a friend – are using alcohol in increasing amounts, it may be a good idea to talk to your GP or contact an organisation which can help. Take a look at our 'get help' section.
• Lighting a cigarette is the normal reaction of smokers to stress but being without a cigarette produces the symptoms of stress itself. If you can't give up by yourself, talk to your doctor or pharmacist about help quitting.
• Street drugs – Some people turn to soft or hard drugs to relieve stress levels. This may seem to help you in the short term but in the long term hard drugs can cause serious medical harm, while becoming reliant even on soft drugs is not actually tackling the cause of your stress.

Find out more about alcohol and other drugs in our drugs section.

life experiences

it worked for me

We talked to some people about therapies they have found help them beat stress.

sweet smell of success

Successful businessman Richard Mais turned to aromatherapy when he developed severe headaches after slipping two discs. 'Nine out of 10 times we could put my headaches down to the tension of driving in rush-hour traffic,' says Mr Mais, who was commuting about 100 miles a day at the time.

He tried aromatherapy on a visit to Australia and decided to treat himself to a weekly session. 'I was a huge cynic. I could believe that a massage could relax you – but how could different oils make you feel different?' he says. 'But I became hooked on my Friday night aromatherapy – now I don't have the same stressful life, I go fortnightly to get rid of all the aches and pains.'

herbal concoction

When Diane Bramley consulted a medical herbalist about pre-menstrual syndrome (PMS) she had no idea her life would be transformed by the mixture of herbs she was prescribed.

'Within three days I felt better than I had for years,' she says.

'The stress I had suffered from was relieved and I just could not believe the difference in me.'

Diane, from Scunthorpe, believes stress was making both the PMS, and other conditions she suffered, worse. 'I was sleeping a lot – which is a sign of being depressed – and I think it was because I was getting so stressed out,' she says. After four months of seeing a medical herbalist, she now finds she gets fewer migraines and her skin condition, psoriasis, has improved.

and relax…

Melissa Branson (not her real name) has tried everything from conventional drugs to acupuncture in attempts to bring down her high blood pressure – thought to be influenced by stress. But almost all the therapies she has tried have only worked for a few months.

Although her blood pressure remains stubbornly high, she finds relaxation therapies help. 'Yoga did not bring down my high blood pressure but it made me more aware of my body,' she says. She has also taken up cycling to keep fit and uses relaxation and hypnotherapy tapes when she feels particularly stressed.

'I have to learn to live with high blood pressure – to manage it. I certainly find I have more energy nowadays,' she says.

help and info

Channel 4 is not responsible for the content of third party sites.

There are more ideas for ways to combat stress in our 'stressbusters' tips in don't panic.

There are also a number of organisations which can help you contact a therapist who may help you beat stress.

general

The British Acupuncture Council
63 Jeddo Road
London W12 9HQ
Tel: 020 8735 0400
E-mail: info@acupuncture.org.uk
Website: www.acupuncture.org.uk
Represents professional acupuncturists with an extensive training in acupuncture and the biomedical sciences appropriate to the practice of this therapy.

Aromatherapy Consortium
PO Box 6522
Desborough
Kettering NN14 2YX
Tel: 0870 7743477 (Mon-Fri 10am-2pm)
E-mail: info@aromatherapy-regulation.org.uk
Website: www.aromatherapy-regulation.org.uk
The governing body for the aromatherapy profession in the UK.

National Institute of Medical Herbalists
54 Mary Arches Street
Exeter EX4 3BA
Tel: 01392 426022
E-mail: nimh@ukexeter.freeserve.co.uk
Website: www.nimh.org.uk
Professional organisation of practitioners of herbal medicine.

Royal College of Psychiatrists
17 Belgrave Square
London SW1X 8PG
Tel: 020 7235 2351 (Mon-Fri 8am-7pm)
E-mail: rcpsych@rcpsych.ac.uk
Website: www.rcpsych.ac.uk
Offers public information leaflets and factsheets on mental health issues including depression, sleeping well, eating disorders, bereavement, social phobias and schizophrenia.

United Kingdom Council for Psychotherapy
167-169 Great Portland Street
London W1W 5PF
Tel: 020 7436 3002 (Mon-Fri 9am-5pm)
E-mail: ukcp@psychotherapy.org.uk
Website: www.psychotherapy.org.uk
Umbrella group for over 5000 practitioners all registered through member organisations. Will provide lists of registered psychotherapists free of charge; the database can be searched by local area or other criteria such as wheelchair access or language.

alcohol and smoking

alcohol:

Alcoholics Anonymous
PO Box 1
Stonebow House
Stonebow
York YO1 7NJ
Helpline: 0845 769 7555 (24 hours)
Tel: 01904 644026
E-mail: aanewcomer@runbox.com
Website: www.alcoholics-anonymous.org.uk
Runs self-help groups throughout the UK. The only requirement for membership is a desire to stop drinking.

Al-Anon Family Groups UK and Eire
61 Great Dover Street
London SE1 4YF
Tel: 020 7403 0888 (Mon-Fri 10am-4pm, answerphone available)
Website: www.al-anonuk.org.uk
Offers understanding and support for families and friends of problem drinkers. Alateen is for young people aged 12-20 who have been affected by someone else's drinking. See the website for details of branches in Scotland, Northern Ireland and Eire.

smoking:

For trained counsellors, call one of the smokers helplines:

QUIT
211 Old Street
London EC1V 9NR
Quitline: 0800 00 22 00 (Daily 9am-9pm)
E-mail: stopsmoking@quit.org.uk
Website: www.quit.org.uk
QUIT aim to reduce unnecessary suffering and death from smoking related diseases and to provide practical help, advice and support to all smokers who want to stop.

Smokeline
72 Finnieston Square
Glasgow G3 8ET
Smokeline: 0800 84 84 84 (Daily 12pm-12am)
Provides help and encouragement for those in Scotland who wish to stop smoking.

(updated November 2002, resources updated May 2005)