Taking a simple stroll today around town and with plenty of time on my plate, I decided “Let’s see who is smiling and having a good, stress-free day today!” It is a simple game really: you just start counting people with your eyes and observe. 20 is usually enough to get a rough statistic about the place you live in. 1,5/20 (7,5%) was having a goooood day today! The 0,5/20 is honestly subjective: the person had a smile but I was unsure if it was a genuine one. As for the other 5%, I can still picture her: female, in her 30’s, caucasian, wearing a black shirt and sunglasses, driving one of those “Beetle”-car-look-alikes, with the sunroof popped open, and a broad smile on her face. That was great, but…
What happened to the rest of them? STRESS is definately one of the main key words. That got my neurons firing: Can people in this country be really that stressed out? There are anti-depressants and anti-anxiety drugs available… but even they don’t do the trick, do they?
Ever looked at a graph of countries and the first thing you were trying to find is if your country is somewhere in there and hope it was doing good? Well trust me, Cyprus baby (#55 on the list), you were doing OK in 2013 considering the competition. [P.S.: My other country, Palestine, was not recognised as a nation at that moment, therefore lack of data]. What am I talking about? In 2013 Bloomberg took 74 nations and based on several factors, they had published the most stressed-out countries of the world. Check the link for yourself.
All in all, it is important to always remember that stress is:
1. Universal
2. Unavoidable
3. Hardwired in our bodies from our ancestors [guess what would have happened if you came across a lion (stressor) thousands of years ago; with no stress in your body, you had better chances being eaten alive than staying alive].
We have all been under a stressful situation. Simply go back to your memory bank, think of the test that you thought would determine the rest of your life, or the fact that you have a deadline tomorrow, and boom! Your palms are cold or sweating, your heart is racing.
Hey, it’s not all bad; small bouts of stress can even be beneficial! They command you to take action and get things done! Yet we all know that CHRONIC stress is a toxic risk factor for our well-being and has baaaad effects primarily on our:
1. mental and physical health
2. relationships
3. finances
4. others
I remember as I was still doing my rotations, the family members of the loved ones who were hospitalised, used to come up to me and go: “What could have caused this?” My mind was running as fast as it could, trying to catch up with the answer, trying to download the causes of myocardial infarction I had memorised for that same year. Before I could even open my mouth to reply, they would start rumbling: “It is stress, isn’t it? And his blood pressure…”
So… How does stress work? And since we know that stress affects our world, why don’t we learn methods to manage it and become resilient to it?

How stress works

I knew before going into medicine that this life will be stressful at times. So what I needed to do -unconsciously mostly- was to find strategies to combat and limit stress and its side effects. Truth is stress is there, in every job, in every post. Anyway, I am a firm believer of the “Law of Attraction” so it didn’t took long to discover MOOC sites like: coursera, edx, futurelearn, iversity, lynda. Even sooner, I discovered Clay and his course “Becoming a Resilient Person – The Science of Stress Management”, which I strongly suggest if you are into the topic. He offers solid advice in a fun way and offers the course again on June 2nd 🙂
Stress according to Robert Sapolsky is “anything that knocks us off our homeostatic balance”, where homeostatic balance is an ideal state of balance in our body (ideal temprature, blood pressure, etc).
But first, how does our body react to stress -for, for every action there is an equal and opposite reaction-? We all know the “fight or flight response”, more correctly the “fight-flight-freeze response”. A stressor nowdays, however, can affect us over time. Even if no stress exists, its anticipation can simply activate the same stress response!
Several parts in our brain light up when we are under stress (check out this simple infografic):
1. Our amygdala, part of our limbic system, responsible for emotions and memories (which blocks the frontal part of our brain, responsible for logical decison-making), and activates
2. Our hypothalamus which stimulates our Sympathetic Nervous System (SNS) and the adrenal glands to secrete the so-called catecholamines, the most popular being adrenaline (=epinephrine) and noradrenaline (=norepinephrine). It also secretes CRH, which stimulates
3. Our pituitary gland which secretes a hormone called ACTH, which itself stimulates
4. Our adrenal glands which produce cortisol, the stress hormone.
It is not surprising that cortisol is highest in the morning, when -for the most of us- our body reacts to the alarm clock (yes, a stressor!). Cortisol now is responsible for increasing the blood sugar (glucose) levels, by blocking insulin (a molecule responsible for increasing the glucose absorption from tissues and therefore decreasing the blood sugar levels, keeping them in homeostasis).
The long-term side effects of cortisol, which is essentially a steroid hormone, are even more serious:
1. Suppression of our immune system increased susceptibility to infections and decreased would-healing
2. Impaired cognition, depression, psychological stress
3. Decreased thyroid function
4. Abdominal fat accumulation, increased weight gain
5. Reduced bone formation, with predisposition to osteoporosis
6. Muscle wasting
7. Increased gastric acid secretion, predisposing to gastric/peptic ulcers, and many more…
In fact, high cortisol levels and their side effects are observed with a disease called Cushing’s disease (or even to Cushing’s syndrome).
Hence, it is significant we figure out how to combat stress with sound stress management strategies. Check them out at sforstressmanagement 🙂

Stress Management

You wake up, curse on the alarm clock, hit snooze, and after 3 times you get up. You drag yourself half asleep to the toilet, wash up and get dressed -if you are a female good luck; you will have probably changed 3 times already. You make your way to the kitchen -which is probably messed up cause… who has the power to clean the dishes from the day before?- and swallow a coffee as fast as you can because, before you know it, it’s already time to go to work… AGAIN… And you cannot even remember where the stupid keys are! AGAIN! This sadly happens to most of us on most days -if you are living alone! Can you imagine living with more than you? Already CHAOS, PANIC, STRESS rule and take over your body!
It is a fact: Most of us go to work ALREADY stressed! Now, we also have our work, our customers, AND our bosses to worry about it ON TOP! Oh, man…!
I can honestly say that the first time at work I felt stressed was my first day at work. Or should I say first week? Or was it more? To be fair, it was a mixture of feelings, most frequently switching from excitement to fear, to stress, to being proud. So I decided I needed to put an end to the negative stuff, especially stress. I dug deep into my notes from the past and found some answers. Before writing this article, I dug a little deeper for us, just to keep us up-to-date 🙂
I cannot STRESS enough how STRESS can kill you. So I hope you and I find these stress management strategies helpful. Please remember, just because it is working for me or others, does not mean it works for you. The list is quite long -options, options ;)- but even if you apply 1/10 of it, you will probably have better chances of limiting the effects of stress -especially chronic stress- than others. Just experiment with a technique for some time -if you are open to it- and see if it is sincerely for you or not.
I. What can I do to release stress in the moment?
1. Learn the physiological signs of stress and acknowledge how your body reacts to it. Do not ignore the signs, i.e. sweaty palms, increased heart rate, neck stiffness, upset stomach. More here.
2. Think of the stressor as an opportunity to grow and move on, rather than something negative. Shift your way of thinking and use the rush you get to focus undeniably to the task in hand.
3. Say over and over: “I got this! Done it before, can handle, time to crush it baby!” Believe me when I say, positive thinking will get you a long way! 🙂
4. Activate your yang, your parasympathetic nervous system (PNS) that is. The PNS has the ability to calm down the sympathetic nervous system (SNS), which is eventually responsible for the adrenaline rush. How to activate your PNS? A simple on-the-spot technique is the “5x5x5 deep breathing”: breath deep through your heart, feel your abdominal muscles and your chest expanding and contracting, imagine your diaphragm moving up and down. 5 seconds inhale, 5 seconds exhale, for a total of 5 deep breaths.
5. Write down a to-do list, prioritise, strategise. Everything will be clearer and you will be able to focus in no time.
6. Talk to someone you trust, someone who can listen and can give advice. Talking things through will always pave the path for a better understanding. It helps us to see the problem with a fresh eye and get to solutions faster. [PS: These kind of people are hard to find, so when you do, cherish them and show them how much you appreciate them]
7. Promote a calm aura, as if you are the Dalai Lama in the middle of a war zone. Relax your face, relax your shoulders, stand up straight, and keep your voice calm and reasonable. Why? Well, consider the last time someone talked to you in  a distressed tone -for me it will always be the nurses… How did you react?
II. What can I do to relieve/release stress on the long run?
1. Take time to define on paper your code of conduct, your dreams and visions, your values and rules, your ideals, ultimate goals, and beliefs. Be honest and ask yourself these little treasures:
A. Where do I stand today?
B. Where do I want to get to?
C. Why?
If question C does not stir up some emotion inside of you, know it is not the right one. So, keep asking why and you will get there. Finally,
D. How do I get to B? What can I do differently?
Knowing your core self will help your focus and allow you to say no to stressful things that may not even be as important or urgent for you and where you want to be.
2. Practice mindfulness techiques purposefully, intentionally, with an open mind & heart.
– mindful breathing
– mindful STOP: STOP and smell the flowers 😉
– mindful daily routine
– mindful eating: smell, sight, sound, texture, taste, temperature
– mindful commuting
3. Pay attention to the positives, rather than the negatives: think of something or someone that makes you happy or puts a smile on your face.
4. Practice gratitude:
– Write “Thank you” notes
– Write gratitude letters
– Journal 3 times/week about 3 things you are grateful for. I have noticed that the smaller and the more unimportant something may seem to be, the more I am grateful for it.
5. Volunteer (do acts of kindness), give
6. Connect with others and empower your compassion: with people you love, with people you feel can teach you something new, with strangers.
7. Relax:
– Progressive muscle relaxation
– Diaphragmatic breathing
– Guided imaging/visualisation through all our senses to get to our “Happy place”
8. Try destraction methods, i.e. cold showers (not a fan, lol)
9. Have a self-soothing, self-compassionate outlook on yourself: look at your mistakes with kindness, use constructive criticism with yourself rather than cold judgement, see the day as an opportunity for progress instead of perfection. Hug yourself.
10. Be proactive: Plan ahead, use prioritised action lists (what, where, when- even your recreation time!), use if-then statements (i.e. “If it is 20:00, then I will exercise”) and get excited about getting things done!
11. Count your little wins, give yourself a tap on the back, and celebrate your progress any way you feel like!
12. Spend time in nature, in green places.
13. Cherish & nurture your hobbies, recreation and leisure time. If possible do it away from work, and just play and have fun with others (more ideas here)
14. Pray
15. Self-reflect with the help of journaling
16. Use techniques like: Neural feedback or Emotional Freedom Technique (EFT)
17. Search and find a mentor or ask the help of a life coach
18. Define your inspirations, role models and heroes according to what you want to improve on.
Last but not least, what kind of a doctor would I be, if I had not mentioned the following lifestyle changes to consider:
-Nutrition: the what is just as significant as the how
The what: limit salt, sugar & red meat,  eat a “rainbow” of vegetables and fruits, go for healthier carbs & nuts, drink plenty of water
The how: mindfully, without TV, enjoy and talk to others
– Exercise: 30 min/day moderate, aerobic exercise (which means not being able to talk with ease) & weight bearing (yoga, pilates, weight-lifting)
– Sleep: 7-9 hrs/d is considered physiological.
Take care of your sleep hygiene, i.e. avoid exercise, alcohol, smoking, caffeine at least 2 hrs before going to bed. Control the sleeping environment, combat cognitive hyperactivity with breathing or meditation.