Recognising what causes stress is the key to managing it effectively. Kathy Oxtoby looks at how it can be done…

Stress is part of day-to-day life, but when it spirals out of control it can lead to serious health issues. Long-term health risks associated with stress include sleep problems, frequent colds and coughs, headaches, bowel and stomach problems, low energy levels and high blood pressure.¹

The most common causes of stress in the UK are work-related, while financial stress often follows for the majority of the population.^2,3

Pharmacists have a crucial role to play in supporting patients to manage their stress. “Many people find ways to cope with their stress that are not healthy - such as too much alcohol, engaging in risky behaviours like gambling, isolating themselves socially, and not taking their medications for long term conditions like diabetes. This is where pharmacy can help people,” says Ade Williams, lead pharmacist at Bedminster Pharmacy in Bristol.

Recognising the symptoms

Pharmacists can help patients to recognise the symptoms of stress. “Stress can affect our emotions, our body and how we behave, in lots of different ways. Sometimes when we are stressed, we might be able to tell right away. But at other times, we might keep going without recognising the signs,” says Stephen Buckley, the head of information at mental health charity Mind.

He says if a patient or someone they care about is stressed, they might talk about some of the physical symptoms they experience, such as difficulty breathing, fatigue, headaches, and chest pains.

When looking to spot the signs of stress, Ade Williams suggests pharmacists “put up a mirror to themselves and speak to members of their own team - because we are under a lot of stress. By understanding the symptoms of stress, pharmacists are then better placed to have those conversations with patients.”

Patients’ behaviours, and the medicines they ask for, can point to stress. “It’s about observing their behaviours - they may be agitated and flustered, or not sleeping. Or they may ask for something to help them sleep or to calm them down,” says Lila Thakerar, superintendent pharmacist at Shaftesbury Pharmacy in Harrow.

Patients may talk with pharmacists about feeling irritable, angry, impatient, or wound up, anxious, nervous or afraid, over-burdened or overwhelmed, or “like their thoughts are racing and they can’t switch off,” says Mr Buckley.

Actions to help

Whether a patient is experiencing stress themselves, or is worried about someone else, pharmacists can advise that there are some practical things they can do to help reduce it.

Mr Buckley of Mind advises that people build their support network. “This could be friends and family, their employer, support at university or college, or peer support. Support from people you trust can make stressful situations easier to manage,” he says.

Working out what may trigger stress can help people to prepare for it, he advises. “Even if they can't avoid these situations, being prepared can help. Knowing what they can and cannot change could help them work out the best way to deal with stress.”

Setting time aside for breaks from stressful situations - even for a few minutes a day - can be helpful. This could mean going for a walk in a green space, taking care of indoor plants, or spending time with animals, says Mr Buckley. And looking after our physical health, such as “getting enough sleep, staying physically active and eating a balanced diet, can make stress easier to manage,” he says.^4,5

Simple steps to help ease sleep problems include establishing a ‘sleep routine’ - going to bed and waking up at the same time every day; relaxing at least one hour before bed by taking a bath or reading a book; making sure the bedroom is dark and quiet; and taking regular exercise during the day.⁶

Ms Thakerar advises that “people should not try to distract from their stress by adopting unhealthy habits like smoking or resorting to alcohol. This doesn’t make the stress go away: it makes it harder to deal with.”

Herbal medications are available from pharmacy to help patients manage their stress. “There’s lots of valerian-based medications, and homeopathic alternatives available,” says Ms Thakerar.

Patients can also be signposted to websites such as Headspace and the Stress Management Society, both of which offer advice on ways to relax and self-help techniques such as ‘mindfulness’, which is about focusing on the ‘here and now’. (See resources box.)

Managing work stress

Pharmacists can also help patients to learn how to manage stress caused by work. “If a patient often experiences feelings of work-related stress, they might be at risk of developing a mental health problem like depression or anxiety. They don't need to cope with stress at work alone,” says Mr Buckley.

“Recognising the signs of stress and learning about the causes of stress is a good place to encourage them to start, before moving on to figuring out what they find stressful and helpful,” he says. He advises people make a ‘Wellness Action Plan’ to map out what causes them stress and what keeps them well.⁷ “Once they know what's best, they might want to try talking to their employer. They may be able to make some changes to help the employee,” he says.

It's also important that they find out about the services in their workplace that are available to them. Some organisations have employee assistance programmes (EAPs), which offer free advice and counselling. Others have internal support systems such as mentoring or buddy systems, advises Mr Buckley.

Defined barriers separating work from home - especially now that more people work remotely - regular breaks, and spending time outside the workplace during the day, such as taking a brisk walk, are all ways people can manage and prevent work stress, says Mr Williams.

Signposting to support

If people are experiencing unmanageable stress and it’s affecting their mental health and impacting their daily lives, “encourage them to speak to their GP, who can talk them through support available,” advises Mr Buckley. Mind has produced a guide on how people can speak to their GP about mental health for the first time. (See resources box.)

“If they’re not ready and able to speak to someone face-to-face, they could visit Mind’s website for more information and ideas for where to get support. (See resources box.) Everyone deals with stress differently, so they should try and take time to find coping techniques that work for them,” says Mr Buckley.

Pharmacists can help people who are stressed and anxious to find the right sources of support for them. And that support process can start with a simple question. “Always ask people: ‘How are you doing - and how is your mental health at the moment?’,” says Mr Williams. “We need to be more deliberate in our interventions - especially when it comes to mental health.”

Resources to signpost people to

Anxiety UK: Types of anxiety.  https://www.anxietyuk.org.uk/types-of-anxiety/

Headspace: https://www.headspace.com/

Health and Safety Executive: Work-related stress and how to manage it. https://www.hse.gov.uk/stress/risk-assessment.htm

Mind: Find the words. Talking to your GP about your mental health. https://www.mind.org.uk/about-us/our-policy-work/you-and-your-gp/

Mind: Stress. https://www.mind.org.uk/information-support/types-of-mental-health-problems/stress/treatment-for-stress/

NHS: Stress. https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/feelings-and-symptoms/stress/

The Stress Management Society. https://www.stress.org.uk/

References

1. NHS Borders (2020) Stress. https://www.nhsborders.scot.nhs.uk/media/372191/Stress.pdf
2. Statistica (2022) Most common types of stress experienced in the United Kingdom (UK) in 2020. https://www.statista.com/statistics/1134359/common-types-of-stress-in-the-uk/
3. Statistica (2022) Stress in the UK - statistics & facts. https://www.statista.com/topics/6735/stress-in-the-uk/#topicHeader__wrapper

4. Mind (2022) How to cope with sleep problems. https://www.mind.org.uk/information-support/types-of-mental-health-problems/sleep-problems/about-sleep-and-mental-health/
5. Mind (2022) Physical activity and your mental health. https://www.mind.org.uk/information-support/tips-for-everyday-living/physical-activity-and-your-mental-health/about-physical-activity/
6. NHS (2021) Insomnia. https://www.nhs.uk/conditions/insomnia/
7. Mind (2022) Guide for employees: Wellness Action Plans (WAPs). https://www.mind.org.uk/media-a/5760/mind-guide-for-employees-wellness-action-plans_final.pdf