Stress: How to De-Stress without Doing Less (12 page)

To understand the second common problem, let's return to the idea of a self-esteem pie. Generally, as adults we get our self-esteem from a combination of these six factors, and life is fairly balanced. But for some people, self-esteem has come to be built with
too much dependence on one or two factors
. This is where personality can be a problem, as discussed in Chapter 9. If you happen to be very successful, the temptation is to build our self-esteem largely on that success (see the example in figure 11). But doing this makes
us very vulnerable, and if that one thing is threatened, we will find that we experience a lot of anxiety and stress. A challenge to that part of our life has implications not just for whatever it was we were trying to do at the time but for the much bigger question of who we are. One person I worked with who had done this, building a self-concept almost entirely based on being good at everything she did, broke down when I asked who she would be if we took her out of a work scenario. ‘I would be nothing,' she said, through her tears. This pressure can often result in a fear of failure and other issues such as workaholism or poor work-life balance, as we have to keep on that work treadmill in order to keep receiving this vital feedback that feeds our self-esteem.

Figure 11: Self-esteem based too strongly on one thing

A third way in which self-esteem can be difficult comes from a similar issue, in which
one feature is over-influential
, but this time
affecting self-esteem in a negative way
rather than supporting the entire self-esteem. Here someone might have things they know are positive about
themselves and would think that they were generally pretty decent if it weren't for one issue. That issue, often appearance, then dominates everything they think about themselves. So, because they are fat, ugly or thick, or whatever it is that they believe about themselves, their self-esteem is devastated and broken almost beyond repair, and nothing friends, family, loved ones or any degree of success anywhere else can do is able to change their view of who they are. It is as if their pie chart has become a Pac-Man, with that aspect of their self-esteem eating up anything else that might be positive (see figure 12). This can be very serious and, when it concerns feelings about appearance or weight, is often behind problems such as eating disorders.

Figure 12: Self-esteem eaten up by one thing

Of course, the fourth thing that can affect our self-esteem in adult life is if we are unlucky enough to encounter
something that presents a dramatic and serious challenge to who we thought we were
. Often these are situations
or circumstances in which something traumatic happens, and we are not able to control it or do anything to get ourselves out of it. These experiences challenge some of the most basic things we believe as adults: that we are in control of our own destiny and can protect ourselves and those we care about. They can bring home to us just how vulnerable we are. This alone is a serious challenge to anyone's self-esteem, but sometimes these incidents can bring an additional difficulty, especially if we feel that in some way an error or bad judgment on our part led to the situation. Anyone who has been responsible for a car accident knows the impact that has on them as they have to admit that they caused something very serious to happen. A severe challenge like that, even in adult life, can bring us almost back to square one, needing to build up our self-esteem from scratch. Just as difficult, though, can be a challenge from someone else. Being bullied is hard enough as a teenager, and it can be just as damaging as an adult; or a marriage that goes wrong, a boss who bullies and manipulates – these experiences can make us start to question the most basic things about ourselves, and this is a very stressful experience.

Difficulties with self-esteem, whatever their cause, are often very significant in problems with stress. Apart from being stressful in themselves, the extra emotions that are triggered, the unhelpful thinking patterns that often accompany low self-esteem and the impact that it often has on your life and relationships mean that stress easily rises to a level that is difficult to cope with.

So, how do you recognize low self-esteem in yourself? You may already be aware of it – perhaps your friends say that you do not value yourself as much as you should. Poor
self-esteem can also show itself in our relationships, if we allow people to treat us badly and feel unable to defend ourselves, or if we feel that we do not deserve to be defended. Ask yourself: do you see yourself the same way as those who care about you see you? If they think you are wonderful and you do not, then the chances are that you could benefit from some work on your self-esteem, which may be making you particularly vulnerable to problems with stress and with difficult emotions. You might find it helpful to draw a pie chart like the ones in this chapter to think about where you get your self-esteem from. If you are building it all on one or two things, you are likely to feel very vulnerable, and if those things are ever threatened, you will most likely find that you experience some quite extreme emotions because those things are so important to you.

If you feel that a problem with self-esteem is part of the difficulties you are having with stress, be encouraged. Now that you know about it, you can start to do something about it! It is possible to rebuild self-esteem, even as an adult. Understanding how the experiences you have been through have led to your slightly wobbly self-image will help you to start to think about what the real truth about you might be. Do remember, though, that working through issues related to your self-esteem and self-concept is hard. It means taking apart the very foundation of who you are, so give it time. You need to be prepared to ask a lot of questions and look at the things you believe because it is likely that some of them are not actually true.

You can work through self-esteem issues with a counsellor or therapist. Ask your doctor if they can refer you or if they know any private counsellors in your area. There are also some good self-help books available that
work on self-esteem issues using a CBT-style approach. One I would recommend is
Overcoming Low Self-Esteem
by Melanie Fennel.
¹

HOW TO DEAL WITH A HIGH-STRESS LIFE

So far in this book we've been focusing on understanding stress more – what it is, where it comes from and what might make some of us more vulnerable to it than others. I'm very aware, however, that, for many of you reading, stress is not just something theoretical or something that affects other people. Stress is an issue you are facing right now!

In fact, for most of us, stress is not something unusual or occasional. We do not just have the odd week or so when stress hits us, which we can navigate until the next calm comes. Many of us – and I include myself in this category – live a life where we negotiate with stress every single day. Every part of our lives – juggling work, family, friends, hobbies, pastimes, chores and responsibilities – involves decisions and actions that affect how much stress we are under. Twenty-first-century life is all about stress. On the whole, most of us would probably say that although stress bothers us, we are able to keep going in spite of it – we keep our heads just above water and push on until things calm down a little bit. But each and every one of us operating under this kind of stress risks a time when we start to find stress getting the
better of us and having a very real and significant impact on what we are able to do. Ultimately, stress can have the power to stop us in our tracks.

Burn-out

Burn-out is a term used to describe what happens when we get exhausted – not just physically but also emotionally. It is a term used widely, although there are no specific diagnostic criteria. Burn-out occurs when our body and brain simply cannot continue functioning under the high demand and stress that has been the norm up to that point. Once again, it isn't about being weak and ‘caving in'; it is a physical and psychological reality. You just cannot carry on under that level of pressure any more. If this has happened to you, don't feel bad or guilty that it happened. It is simply a sign that you are human, and recovery is not about ‘pulling yourself together'; it is about getting some time away from that level of strain so that you can recharge and recuperate. It takes time.

Someone on the brink of burn-out feels worn out, physically and emotionally. They may have physical symptoms of long-term stress such as headaches, digestive problems or general poor health. Emotional symptoms are likely too, such as extreme mood swings with tearfulness or aggressive behaviour. Socially, burn-out leads people to struggle with things they would usually enjoy. Social occasions may feel like just one demand too many and the effort of keeping up a relaxed conversation just too much to bear. There are other symptoms. Often people at risk of burn-out are those in jobs that require them to give a great deal emotionally – very caring and supportive roles. These people are at
particular risk both because their job inherently involves giving a lot out, which takes its toll over the years, but also because they are likely to be the kind of people who struggle with setting clear boundaries and getting clear time away from work. Quite simply, they care too much, and that leads them to keep working when they really need to be resting. If they are pushing the boundaries too hard, however, the very compassion that led them to that work in the first place starts to be eaten away. Bit by bit they start to care less, and eventually, as true exhaustion sets in, the bits of their job that used to stir them simply make them feel under more pressure. They no longer feel any sense of accomplishment or find a satisfaction in what they do. They have lost the spark of a job they used to love.

It's easy to talk lightly about burn-out, to joke about it with friends and colleagues, or to think that it is something that will never happen to us. But what if right now you are in the position in which stress has actually gone too far? We all have a breaking point – a point at which burn-out stops being something we live with and dice with week on week, and starts being something that has become a reality. No matter how much we would all like to think that we are immune to these kind of pressures and would never become ill ourselves, anyone can get to the point where the emotional, psychological and physical toll of stress means that we cannot go on – with work, or often with any kind of demand. It is as if the body finally calls a halt to things. People who have experienced full-on burn-out will talk of how they got to a stage where one day they just knew they couldn't do it – couldn't get out of bed, couldn't respond to their responsibilities, couldn't ‘pull themselves together' any more. Of course, it isn't about pulling yourself together
– that's the problem. Burn-out is not something to do with being weak, lazy or overly emotional. It is a genuine physical condition in which long-term stress has taken its toll on us and we need time to recover – and it may take us by surprise. Listen to the experiences of Mark, a doctor, who found himself having to take time out from work to recover from burn-out:

 

‘I never thought it would happen to me and I totally didn't see it coming. In my job everyone pushes themselves to the limit, and I wasn't unusual in working a lot of hours and not getting much time out. I've worked under a lot of stress for years so it wasn't anything new. I don't know really what pushed me over the edge that time. I'd been having some health problems – niggly things such as headaches, indigestion a lot and trouble sleeping. Things had been tough at home too – my long-term partner had got a new job that meant she was working away a lot and in the end we actually decided to split up, which was really hard. I was definitely feeling stressed – I found it really hard to turn off, was worrying about work even when I was at home, which I don't normally do. And when I was at work, my head used to race – it was as if the thoughts were going round so fast my head used to ache just with the pressure of all that thinking. I got to the stage where I was just going through the motions at work. I did the job but I didn't really care any more. In fact, I used to resent it if one of my patients didn't respond well to treatment. I took it personally and I hated that it meant I had to do more, or worry more out of hours. When it all came to a head, it was very sudden. I just woke up one Monday morning and knew I couldn't do it any more. I felt really stupid because I couldn't explain it, so in the end I called in sick and said I had a bug. But I went back to bed and just hid. I couldn't do it any more.'

 

Some of you reading Mark's story may well find that all of this rings true for what you are feeling right now. If things get to the extreme that Mark was describing, very often the only treatment at first is to take some time out, rest and re-gather yourself. It takes time for your body to recuperate and it is important you take that time. But often it is possible to do something before you get to that stage. Most people will find that they get some clear warning signs that stress is so high before they reach complete breakdown. The problem is that often we ignore those signs and carry on regardless. Some degree of burn-out isn't that unusual, and many people, particularly working in those very giving jobs, will find that they feel this way from time to time – often just before they take a long overdue holiday! It is easy to overlook those feelings and see them just as part of the job. Many of us expect that cycle of gradually getting more worn out and less motivated, then taking that long-needed holiday before returning to the job, trying to keep those feelings at bay. But burn-out is an issue we need to take very seriously.

Think about it this way. In certain professions, burn-out is one of the main causes for people leaving and moving on to something else. This means that for some people, the stress they currently manage day to day eventually drives them from a job they love and used to be committed to. Particularly if they work in one of those jobs in which burn-out is such a big issue, the way they handle stress might actually be one of the most significant things influencing how well they achieve in that career in the long term. This may be hard in the short term because they may have a genuine desire to do more, push themselves harder, go the extra mile. I have heard so many people say to me, ‘Well, this is just what you have to do to do this job well.' But I say to them that working in a way
that brings on symptoms of burn-out will only mean they do the job well in the short term. In the long term, they are likely to become more exhausted, more disillusioned, and eventually they may end up leaving.

So, if you really want to become great at what you do, take a good long look at how you can protect yourself from the stress it triggers.

This message is an important one for all of us, but it carries particular resonance for anyone who is working in a job in which giving of themselves – emotionally and physically – is a part of the job. Professions that involve this kind of giving – those with a high physical toll such as sporting careers, very physically demanding jobs or those that involve caring for other people or giving out to others and focusing on their needs rather than your own – are the professions for which burn-out is the biggest issue. Some studies of such professions found that half of the people who took part were at serious risk of imminent burn-out. Those most at risk are often those whose job is more than just something that brings in money; those whose job is a calling, a way of life, something that people love and is a huge part of who they are. These jobs include medical professions such as doctors and nurses and caring roles such as teachers, social workers and priests/pastors. That is the tragedy of burn-out as it often affects the people who are most motivated by their job, most excited by what the job involves and most committed to what they want to do. These people, if they become victims of burn-out, have to deal not only with the physical and emotional effect it has on them, but also with the fact that they had to leave that job, that they will never achieve the things they longed to, and that the people they so wanted to care for now have to manage without them. They may keep trying to return
to work but each time find the stress too much and end up taking further periods of time off. This repeated ‘failure' – because that is what it feels like – can become added to the other worries and emotions that are part of the situation and end up having a very serious effect on that person.

What to do if you think you are at risk of burn-out

If you are on the edge of burn-out, or know that you are having symptoms of long-term stress in your life, it is important to take action fast. Be aware of the early warning signs of burn-out. Often the first thing people notice is that something of the love they had for the job has gone, some of their compassion has diminished. You may find that you are starting to think of the people you work with or care for as problems rather than real people, or that you simply don't respond to things that previously would have really got you excited or emotionally involved. You might start to worry about this and wonder why you don't care any more, but this can be the first sign that you have been trying to care too much. Other symptoms can include those in the list given in Chapter 6 – but it may well be that some of those symptoms have moved on from being occasional concerns and have become serious health issues. Mild headaches may have become regular migraines that stop you from working, or being a bit more prone to infections may have led to a serious long-term infection that you just don't seem to be able to shift.

If you have symptoms like these, then the first step is to get some help and check that there is nothing more serious going on physically – so do see your doctor. You may also
be aware of things raised in part 2 that you think make you personally more vulnerable to stress. This next part of the book offers some practical ideas and takes you through some work you can do right now to help you to understand better why you are struggling so much with stress. It is worth discussing these with your doctor and looking into whether you can get some help or counselling. Most people who are referred to me because of problems related to stress do have something in who they are that is making them more prone to developing a problem with stress, and working through that certainly helps. Equally, however, I have never worked on stress management with anyone who has not benefited enormously from making some changes to their life and lifestyle that help them to deal with stress better. This part of the book is about the very important question of what you need to do in order to protect yourself from stress. This is not rocket science! Often there are simple changes that you can make which will help you right now to become more resilient to stress, and we'll be outlining some of these in the next few chapters.

Medication

A quick word on medication. Various medications are sometimes used for people struggling with symptoms of stress and/or conditions such as anxiety or depression. Very often people are resistant to taking medication. Some people feel that pills are not the answer, that they are an artificial ‘solution'. Others are worried that they will end up having to take the pills for ever. Some people feel that there is a stigma associated with taking pills and don't want to take them for that reason. I can appreciate all of those worries,
and I personally wouldn't want to take pills as though they were the only answer – they are not. But medication does have its place.

Think of it this way. Imagine life as rowing a boat across an ocean. Life is the ocean, and sometimes it is smooth, sometimes it is rough. On the rough days, waves sometimes come over the boat and you have to bail the water out. Some people, for whatever reason, also have holes in their boat. Maybe those holes are things that happened to them as children; maybe they are something life has thrown that damaged the boat. For whatever reason, their boat is damaged, so it lets water in and they have to bail out even more. If you are under a lot of stress, then you will have to do a lot of bailing over a long period of time, especially if there are holes in the boat letting in water too. Bailing in that way can get exhausting, and in a really rough time you might find that you cannot keep up. In that situation you might actually be at a very real risk of sinking under the weight of all that is going on.