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Experts from the Priory on combatting stress, depression and anxiety

Paul McLaren

Some 526,000 workers suffered from work-related stress, depression or anxiety in 2016/17 with 12.5 million working days lost as a result, compared to 487,000 workers in 2015-16 and 442,000 in 2014-15. Contributor Dr Paul McLaren, adult psychiatrist – Priory’s Hayes Grove Hospital.

One in three ‘sick notes’ are now for mental health problems, amid increasing levels of anxiety across Britain, official figures show. “Work-related stress, depression or anxiety continues to represent a significant ill health condition in the workforce of Great Britain,” says the Health and Safety Executive, the national independent watchdog for work-related health, safety and illness.

As part of Mental Health Awareness Week, we asked some of Priory’s experts to talk about the one thing they wished others knew about stress and anxiety. Dr Niall Campbell is an adult psychiatrist at the Priory’s Hospital in Roehampton, south-west London as well as one of the UK’s leading experts on alcohol addiction.

“Many people mistake stress for a heart attack”

“Any junior doctor working in casualty will tell you that every day at least two or three patients, of all ages, come in, usually thinking they are having a heart attack. Examination and investigations are normal and a panic attack is often diagnosed which can be a great relief in itself, and appropriate therapy is recommended to prevent a recurrence.

Some degree of anxiety is an everyday experience for most of us and usually a brief reaction to surprises and stresses. More intense anxiety comes in the form of panic attacks. Sudden overwhelming anxiety episodes are also common, and can be very frightening. The good news is they are treatable. The worst thing to do is suffer in silence. Tell your GP. Treatment is hardly ever medication. It is usually Cognitive Behavioural Therapy which is quick, effective and such a relief.”

He says depression is often caused by stress at work. Dr Paul McLaren is an adult psychiatrist at Priory’s Hayes Grove Hospital in Kent and Priory’s high street Wellbeing Centres in Harley Street and Fenchurch Street in central London. “Stress is in the eye of the beholder. One man’s thrill and stimulation is another man’s terror. The most dramatic example is our response to the roller coaster. What makes the same situation scary or exciting is how we think about it, how we appraise it. If we think we can deal with it, it will be exciting. If we think we cannot, then it will be scary. These assessments are fast and automatic, but not fixed. They can be altered with psychological help and practice.

But chronic severe anxiety needs medication. Pathological anxiety – which is when the intensity, duration, and frequency of anxiety becomes distressful and chronic, and affects the way you function – can be a severely disabling condition. While most people who have anxiety as an illness can be helped with psychological treatment, for some the anxiety is so severe that medication is necessary. Anxiety as an illness is not just feeling a bit stressed. It can be deeply distressing. If the psychological treatment does not work, then medication should be considered. Sometimes people are left feeling they have failed or are ‘to blame’ if the psychological treatment does not work. They are not. ‘Psychological’ is the best first line treatment but it is not the panacea. Chronic severe anxiety is a serious condition which needs assertive medical treatment.”

Georgia Henderson is a clinical psychologist at the Priory’s Hospital in North London and works primarily with young people. “Understanding what made you stressed as a child can have a huge impact in recognising triggers. The way we respond to stress is learnt in our childhood and becomes encoded in our adrenal system. By understanding how you were calmed and soothed as a child, you can access the same type of support as an adult. This gives you the ability to treat stress from the inside out. Think about what your parents did to help when you needed support – did they talk you through it, rub your back, take you out for a walk, make you a sweet cup of tea. Focus particularly on the five senses; smell, sound, taste, sight and touch. Provide these things for yourself, or recruit your partner, friends or workmates to know how to chip in when you’re stressed. In the same way, understanding what felt tense or frightening in your childhood can have a huge impact in recognising your triggers and asking for help earlier.”

Dr Hayley van Zwanenberg is a consultant child and adolescent psychiatrist at the Priory’s Woodbourne Hospital in Birmingham, and Priory’s Group Associate Medical Director. “If a parent is stressed, a child struggles more. I often see young people’s mental health mirroring that of their parents; if a parent is stressed, the child struggles more. It is so important that a ‘whole family’ approach is taken when tackling stress and anxiety. Little changes in a family system can benefit everyone”.

Anxiety disorders, including generalised anxiety, panic attacks, social phobia, obsessive compulsive disorder and post-traumatic stress disorder are all treatable. The earlier people access help the better, as response to treatment may be quicker. The right therapies, (often cognitive behavioural therapy), plus or minus medication, (depending on how much the illness is impacting on the person), can help people recover and stay well within a relatively short period; often it takes only 2-3 months to have people feeling so much better and functioning really well.”

Alexia Dempsey is an eating disorders specialist at the Priory’s Roehampton Hospital: “If you comfort eat to manage stress, find a way of distracting yourself – and remember that dehydration is often confused with hunger. In emotional over-eating, we use food as a distraction from a negative emotion like stress. The foods are often carbohydrate-based and the pleasure we get from them is short-term but then we feel guilty because they are often high in calories, meaning they have an impact on our overall health and appearance.”

“So distract yourself from the urge to over eat. Take time to identify your trigger points and habits so you can identify when you are vulnerable to this behaviour. Try some mindfulness, this could be an App on your phone, and make sure you are drinking plenty of water because dehydration can often be confused with hunger and you might be eating when you should be drinking water. Sometimes your body just needs fluids. If you don’t like plain water, try it with a slice of fresh fruit as a healthy alternative. Find other pleasurable activities – painting your nails, playing sport, take a long bath or a long walk, meet friends and family and try to ride out the urge to eat if that is what you do to distract you from the stress or difficult thoughts you are experiencing.”

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