Now Breathe!

Given everything that’s going on at the moment, it seemed to be a good time to think about stress and how to cope with it.

Firstly, what do we mean by stress?

Stress is the body’s reaction to any change, positive or negative, that requires an adjustment or response. The body reacts to these changes with physical, mental, and emotional reactions. Stress is a normal part of everyday life. You can experience stress from your environment, your body, and your thoughts.

It is a very individual thing; a situation that one person thinks of as stressful, another person finds relaxing or invigorating.

It can be good or bad e.g. we need the physical activity of walking upright and fighting earth’s gravity to maintain good bone density. Too little due to prolonged bed rest or a stint in a space station (!) and our bones thin and become osteoporotic. Too much, say from excessive road running in poor shoes, and we overload the bones which may result in stress fractures.

Similarly with mental stimulus; too little and we get bored and restless, too much and we risk burnout.

So what tips us over the edge?

Demands can come from work, relationships, financial pressures, health issues and many other situations, but basically anything that poses a real or perceived challenge or threat to a person’s well-being can cause stress.

It’s usually a combination of factors; too much stress, especially over a prolonged period of time combined with the feeling that you have little control over the situation, can overload you both physically and mentally and so have a negative impact on your well-being.

Most of us can cope with stress in one area of our lives, say work, as long as we have a happy and supportive home life and are in good physical and mental health. However, if home life or health is also affected then it can become harder to cope as we get tired and rundown without any section of life in which we can take a breather and recharge our batteries.

So what happens when you feel stressed?

The fight or flight response is triggered within the body and will cause both physical and mental changes.

It is a primitive, reflex protective response designed to protect us from harm.

The system affected is the autonomic nervous system; this is the part of the nervous system that governs most of the automatic functions within the body so digestion, temperature regulation, heart and respiratory rates, urination, pupil dilation, arousal, etc.

The sympathetic nervous system regulates the flight or fight response whilst its opposite number, the parasympathetic system, regulates the rest and digest response.

The fight or flight reaction begins in the amygdala, which sits deep in the brain and triggers a neural response in the hypothalamus. The initial reaction is followed by activation of the pituitary gland and secretion of the hormone ACTH. The adrenal gland is activated almost simultaneously, via the sympathetic nervous system, and releases the hormone epinephrine (adrenaline). The release of chemical messengers results in the production of the hormone cortisol, which increases blood pressure, blood sugar, and suppresses the immune system. The initial response and subsequent reactions are triggered in an effort to create a boost of energy. This boost of energy is activated by epinephrine binding to liver cells and the subsequent production of glucose. Additionally, the circulation of cortisol functions to turn fatty acids into available energy, which prepares muscles throughout the body for response. Catecholamine hormones, epinephrine, dopamine and norepinephrine facilitate immediate physical reactions associated with a preparation for violent muscular action i.e. punching someone or running away.

This amazing chemical cascade causes both physical and emotional changes readying the body for either fight or flight.

The physiological changes that occur during the fight or flight response are activated in order to give the body increased strength and speed in anticipation of fighting or running.

The intensity of emotion that is brought on by the stimulus will also determine the nature and intensity of the behavioural response. Individuals with higher levels of emotional reactivity may be prone to anxiety and aggression which are then acted on during the fight or flight response.

This should be a short term response and once the threat is removed, the parasympathetic system kicks in and returns the body and mind to its normal, balanced state. The fight or flight response was developed in early man when most threats required a physical and usually short term response. However, many of the stresses of the modern world are of a mental rather than a physical nature; they can often occur over a prolonged period of time. Much as you might like to punch the boss, this is generally considered unacceptable behaviour and we can’t run away from work as we need to pay the mortgage. With a lack of physical release for all this tension, it can have long-term negative effects on the body and mind.

With prolonged stress, this can lead to a state of constant hyper-arousal and various long term health problems which can include hypertension, type 2 diabetes, headaches, insomnia, irritable bowel syndrome and chronic pain, as well as heart disease, stroke and cancer. Depression, anxiety, and other mental health disorders, such as post traumatic stress disorder (PTSD), can develop when stress becomes chronic.

To add to the fun, we now have coronavirus added into the mix. It feels as if it is affecting all areas of our lives, it is happening over a prolonged period of time with no foreseeable end in sight and we feel that we have little or no control over our circumstances. We have reduced access to many of the activities that normally help us to cope with stress such as meeting up with family and friends or doing various sporting and recreational activities that all help us to stay sane. So, it’s not surprising that the coronavirus situation is making most us feel at least a little anxious and restless!

So, what can we do about it?

We can’t do a lot about the external stuff at the moment but we can focus on ourselves in a good way.

Hopefully, by the time that you read this, some of the lockdown restrictions will have lifted and you will be able to do more of your normal activities.

Keeping the body working is a good way of resetting the autonomic nervous system to a more relaxed and balanced state as physical activity will help to use up the excess adrenaline, as well as encouraging the release of serotonin which helps with lifting your mood. Even if you can’t do your normal sporting activities, a brisk walk will help especially this time of year as, even on a cloudy day, your Vitamin D levels will still get a boost. Just take note that the sunlight frequency to stimulate Vitamin D production is between 11am and 1 pm, between March and October, so a lunchtime walk is ideal. Melatonin, also from exposure to sunlight, can help with sleep.

Keeping the brain occupied and active is also useful. Anything that gets the brain working is ideal.

It’s worth bearing in mind that it takes, on average, 10 – 20 minutes for the effects of adrenaline to wear off. Well written dramas are usually timed so that you get a burst of adrenaline every 10 to 15 minutes. This means that you get a gradually increasing effect over the length of the programme. Whilst entertaining, they may not aid restful sleep.

Art and craft activities are enjoying a resurgence and can be a form of mindfulness.

Both Eastern and Western cultures have used meditation for centuries so yoga or Gregorian chanting can help reset your parasympathetic system.

Singing is excellent as it encourages deep breaths.

There are many sites available with advice on mental health activities so I’m going to focus on two physical techniques that can help to mediate the effects of an overactive sympathetic system.

I’ll come clean at this point; in a previous life I was a physiotherapist. Many of the effects of stress cause physical changes so it feels appropriate to use physical means of counteracting these effects. I specialised in the management of long-term pain conditions especially back and neck pain. So, for over 35 years, I have used these techniques with patients (and myself) and most have found them very beneficial in helping them to manage their pain.

Pain and coronavirus have a lot in common. They cannot be seen, can affect all areas of your life day in and day out and it can feel that you have little control over the effects. Both are stressful and can lead to a hyper-aroused autonomic nervous system. In a hyper-aroused state, pain and anxiety levels can feel higher so anything that can help to diminish these effects can be useful.

So, what are these techniques?

One is controlled deep breathing and the other is a progressive muscle relaxation technique.

There are many variations on these themes so I’ll like to explain why I use these techniques in this particular way.

When we are nervous or anxious, we tend to take a deep breathe and then exhale as a natural way of trying to relax; we even talk about taking a breather. Similarly, we will often stretch to try to reduce the tension in our muscles. These two exercises are a refinement of this process.

Controlled deep breathing

Firstly, find somewhere comfortable to sit or lie down. You should be warm but not hot and ideally, it should be quiet. Some find gentle music in the background helpful especially if there is much in the way of background noise.

Rest your hands lightly on the bottom of your ribs with your fingertips just resting on your stomach in the gap between the lower ribs.

Take a slow deep breath in through your nose (this helps to warm and humidify the air). Feel your rib cage expand and your stomach gently lift. You should feel your lungs fully expand. Hold for a moment, register how it feels to fully inflate your lungs and then gently and slowly breath out, feeling as though you have pushed out all the air from your lungs but this should not be forced. It can help to do this through pursed lips.

Your lungs will naturally want to reinflate so just repeat this process for another 2 cycles. Then return to your normal breathing rate. More than 3 or 4 deep breaths and you will tend to feel light headed. This is normal and will disappear as you return to your natural rhythm. As you improve your breathing, you may find that you can take more breaths before becoming dizzy. If you’re not used to using your lungs fully, you may find that you cough and clear some phlegm. In these days of keeping your lungs healthy, this is a good thing and will improve with practice.

Some people find it helps to count as they do the breathing exercises.

There are various counting methods cited as having different psychological affects. All will help to activate the parasympathetic system and so decrease stress and tension.

Over the years, I’ve found that there is no right or wrong counting rate. People will find the right rhythm for them, their physique and their fitness levels. A 6ft 4in man who cycles 20 miles a day will naturally have a greater lung volume and breathe more slowly than a 5ft female who spends all day at a desk.

So, just find the rhythm that suits you best. The most important aspects are that it is a slow and relaxed tempo and that you fully inflate and then deflate your lungs; it should not be forced but it should be controlled.

As well as being a very relaxing technique, it also encourages you to use your lungs fully and help clear the lungs of any secretions, especially from the bases.

Mitchell Method of Physiological relaxation

Most progressive muscle relaxation methods tend to tense up the very muscles that we should be encouraging to relax.

This pattern is easy to see in someone who is tense. The jaws are clenched, shoulders are hunched, they are usually frowning and hands are balled into a fist. Legs may be crossed and the body tends to lean forward so, in other words, they are getting ready to fight or run.

This alternative method encourages you to learn how to recognise tension in your muscles or joints. By instructing the opposite muscle groups to work, you will automatically send a message to relax the tense muscles and joints. With practice, your body will become familiar with this ‘position of ease’ and so it will become easier and quicker to relax with the right muscle cues.

As with the breathing exercises, find a comfortable position either sitting or lying down. Warmth helps muscles to relax and a quiet space can help with focussing on the new patterns of ease.

The instructions are the same for each movement:

Gently stretch away from the tense position; it should not be painful

Pause for about 5 seconds

Then just let go and take a moment to feel the new, relaxed feel of the muscles and joints.

To begin with you should try to work through the whole sequence. This will help you to identify the parts of your body that seem to feel the most tense and the patterns that help you feel most relaxed.

1. Shoulders. Pull your shoulders down towards your feet. Feel your neck muscles slowly lengthening. Hold for a slow count to 5 and then just let go.  Feel the new position of ease as you release the muscles.
2. Elbows. Stretch your elbows so that your arms straighten. Feel the front of your arms stretching. Hold for a slow count to 5 and then just let go. Feel the new position of ease as you release the muscles.
3. Hands. Stretch your fingers out straight. Feel your fingers uncurling. Hold for a slow count to 5 and then just let go. Feel the new position of ease as you release the muscles.
4. Trunk. Push your trunk into the bed or chair so that your body makes contact with the chair or bed.  Feel your body pressing into the chair or bed. Hold for a slow count to 5. Just let it go. Feel the new position of your body as you release the muscles. Feel that your body is completely supported by the chair and body and your muscles are able to gently support you.
5. Thighs. Roll your thighs away from one another. Feel your hips rolling out. Hold for a slow count to 5 and then just let them go. Feel the new position of ease as you release the muscles.
6. Calves. Pull your toes and ankles up. Feel the back of your calves stretch. Hold for a slow count to 5 and then just let them go. Feel the new position of ease as you release.
7. Eyes. Close your eyes but raise your eyebrows up as far as they will go. Feel the tightness in the muscles in your forehead for a slow count to 5. Then just let them go. Feel the new position of ease as you release them.
8. Mouth and jaw. Keep your lips lightly together but let your teeth part so pulling your jaw down. Let your tongue is dangle loosely in the middle of your mouth. Feel the difference in your mouth and cheek muscles as you do this. Hold for a slow count to 5. Then just let go. Feel the new position of ease as you release.
9. Breathing. Focus on your breathing; just think about taking gentle relaxed breaths. Now breathe in deeply feeling your lower ribs expand and then breathe out slowly. Do this once more and then return to your relaxed breathing pattern. With each breath feel your body getting heavier and heavier and gradually relaxing further down into the surface you are resting against.
10. Repeat the sequence. It can help to repeat the sequence 2 or 3 times, gradually feeling yourself letting go more and more.

When you start doing either the breathing or the relaxation exercises, it helps to do them daily. Gradually, your mind and body will learn the new patterns; you will develop new muscle memories and it will become easier and easier to trigger a general relaxed state.

You can then use these techniques in everyday life by doing a quick body scan whenever you start to feel tense.

With enough practice, you will find that you will be able to use just one stretch to trigger a chain response in your other muscle groups e.g. when driving in heavy traffic, if you notice that you are clenching your hands, then just stretching out your fingers, holding for 5 seconds and then just letting go, your shoulders will also relax.

Similarly, you can use just one or two deep breaths so breaking the tension pattern before it takes hold.

As with most things in life, it is not a quick fix but, over time and practice, these techniques can help in many situations.

If you are experiencing any difficulties with these techniques, then ask to be referred to a chartered physiotherapist. If you are struggling with mental health issues, your local Mental Health team can also give you valuable advice and support. The Every Mind Matters website has some excellent advice.

Hope this helps and keep well.

Theresa Parr (Red Lion Group committee member)

Theresa was a chartered physiotherapist working in both the NHS and private sectors, both in clinical settings and teaching at undergraduate and post graduate levels. She specialised in treating back and neck problems together with pain management.