Stress busters: Our expert answers your questions on stress and anxiety

1 July 2012

Most of us have experienced some degree of stress in our lives, whether it stems from home or the workplace. And while not always harmful, stress can be damaging to our physical and mental wellbeing if not addressed properly.

On Thursday 26 June, our medical experts were here to help, returning with another live chat - this time on managing feelings of stress and anxiety.

Dr Mark Winwood is the clinical director for psychological health for AXA PPP healthcare's specialist Health Services division - and with ten years of experience as a senior psychologist, he offered live, expert insight on managing stress and anxiety effectively. Here's what was said on the day:

Live chat participant: I'm not going to admit who I am, but I do need help. I'm good at my job, I work hard, but I'm not getting anywhere. The reason is that my behaviour lets me down. I lack self-belief; I constantly put myself down. I am very thin-skinned and defensive. I take challenges to my decisions personally. I damage relationships I have worked very hard to build. I can be abrasive, sometimes angry. My unpredictability means I'm not trusted with the responsibility that my manager has said I am easily capable of. I'm frustrated. My manager is frustrated. I hate being this person. I want to stop!!

Mark Winwood: You clearly have identified some things that are difficult for you - you describe a range of problems which would perhaps better be addressed by speaking to a professional. Your organisation may have access to an EAP or counselling service. Alternatively try visiting your GP and exploring supports available.

Suzy asked: I suffer quite badly with stress related to driving. I was in a road accident as a child, which led to my Father being killed. A few years later, I learnt to drive, but have always struggled with stress relating to the way others drive (not indicating / pulling out in front of me / etc). I have tried to cope with this but find myself getting extremely stressed to the point where I feel as though I am out of control. I need to drive as my partner does not, any tips on how to manage this?

Mark Winwood: Suzy - it is quite common for distressing things that might have happened in the past to affect the way be cope with similar situations in the future. So feeling anxious about driving maybe something you have learned because of the experience of losing your father in a road accident. It is also quite common to fear 'losing control'. There are many things you can do to reduce your anxiety to a more manageable level - taking action can be an important first step and makes you feel more in control although it may be uncomfortable to start with. Facing up to your anxiety is the first step in breaking the cycle. Relaxation techniques can be used to reduce the unpleasant feelings and therapeutic techniques that are available in self-help books and on-line that teach you to challenge the evidence around your fears may also help.

Nifnif asked: My other half works in the police force and his employers have recently changed his shift pattern which means that he will now have very little contact with his 4 year old son (with his ex-wife). The Olympic shift pattern they have imposed also means he will not see his son for 2 months and when he returns to normal shifts in September he doesn't know if he will have a job on his unit and may go back to what he was doing when he first started 20 years ago. He had a clash of personality with his direct boss which led to the original move. His ex makes contact very difficult too. Our relationship is now suffering physically and emotionally and, all in all, he cannot cope. He cannot go to the doctor for help as his employers will not allow any kind of medication. I am at a loss as to how to help.

Mark Winwood: With so many things going-on for your partner it is important for him to try and remain as healthy as possible by getting rest, exercise and healthy food. It sounds that you both feel overwhelmed by the difficulties you are experiencing - it might be an idea to sit and make a list if priorities and to tackle one at a time in order to feel you have some control over the problems you are dealing with. It could also be an idea for your partner to speak to his manager at work or his HR department to discuss his future. Medication is not the only way of coping with these difficulties and a conversation with his GP might really help him think of other ways to deal with these stresses. It is important for you to think o f what is important for you in this as well - and the effects this is having on you.

PARROT asked: I think I am suffering from stress, I constantly feel tired and most mornings feel nauseas! I was diagnosed with Glandular Fever 12 months ago but don't really know if this is still affecting me! I always need at least 10 hours sleep otherwise i feel dreadfully tired and lethargic! I am 40 years old. Could this be stress or still the Glandular Fever?

Mark Winwood: A very common feature of stress is fatigue and nausea - this is a physiological reaction to excessive amounts of adrenaline and cortisol being produced. Having glandular fever will also make you very fatigued and this can be a 'longer term' symptom of the illness. in order to answer your question it may be an idea to try and reduce your levels of stress to determine if the glandular fever is causing your symptoms. in order to do this it might be a good idea to identify aspects of your life that are stressful and then apply some stress reduction techniques such as relaxation to see if this has an effect. If you are still feeling constantly exhausted I would recommend visiting your GP.

Fiona asked: I think I react very physically to being stressed - within hours of feeling pressure my hands break out in blisters which has been diagnosed as eczema, and now I've noticed I get a sore right shoulder during periods of stress. What can I do to stop this happening?

Mark Winwood: There is plenty of research evidence to suggest that there is strong link between stress and physical wellbeing. Muscular and skeletal pain can be made worse due to stress - if we are anxious we tend to tense our bodies and this prolonged tension can cause pain. This might be happening in your shoulder. Relaxation techniques have been found to be really helpful in addressing this. These are readily available on the web or via self-help guides such as 'manage Your Mood' by Veale and Wilson

Everred asked: Can eczema be caused by stress?

Mark Winwood: Eczema can be caused by a number of factors including allergies. There is evidence to suggest that some skin conditions such as Eczema and Psoriasis can be exacerbated by stress. There are a number of physical problems that are related to high levels of anxiety and stress.

Michelle, a blogger from Peachy Palate asked: If I manage my stress is it likely I can clear up my psoriasis completely? What other key signs should I watch out for that I'm stressed as it's something I'm clearly not 100% conscious of or perhaps I've just become accustomed to it!?

Mark Winwood: Studies have shown that stress and psoriasis go together. And while stress is known to make psoriasis worse also having psoriasis can also make you stressed. We are not sure how stress and psoriasis are linked but it may have to do with an effect on the immune system. Some people have their first flare of psoriasis during a particularly stressful time. there are 50 or more common signs of stress but things to watch out for are - stomach problems, sweating, headaches, irritability, difficulty concentrating, chest pain, breathlessness, dry mouth - any of these can be a sign that you are feeling stressed and reducing these symptoms may well help your skin condition.

jimmy_20 asked: Hi Mark, I am currently in the middle of changing jobs and also going through a divorce and as I am sure you can imagine it is quite a stressful time for me. I feel like I need help but don't know where to start or look, can you help?

Mark Winwood: Jimmy - you are currently going through two of the most challenging life events and it is normal for you to feel stressed. Saying that there are also ways you can reduce the uncomfortable feelings associated with this. It is really important that you make time for things you enjoy and plan some time to do these things. Also taking some time for exercise is really important as a feeling of wellbeing will make your problems feel more manageable. Speaking to a close friend about your feelings and needs can also help build resilience against stress. It is OK to ask for help. if you feel anxiety is effecting your health - contact your GP or a counsellor if you have access to one. These stressors are to degree temporary and getting few coping strategies could help you through the coming months. These may include looking at your strengths and applying them to different situations or challenging any negative thoughts about your future that you might have. Self help guides such as Manage you Mind (Butler & Hope) and on-line self help tools such as 'Living Life to The Full'

Emmar asked: Hi I find that my eye lid flickers when I think I am stressed - are the two related?

Mark Winwood: The most common things that make the muscle in your eyelid twitch are fatigue, stress, and caffeine. Eyelid twitching usually disappears without treatment. In the meantime, the following tips might help the symptoms Get more sleep, drink less caffeine and try lubricating your eyes with eye-drops. So to answer your question there is definite link between eye-twitch and stress.

Emmar asked: Thanks Mark, funnily enough I don't drink coffee or any of the associated drinks - but thanks for the answer!

Daisydiamond asked: I get the eye lid flickering too and only just realised its worse when I'm stressed. What causes this? Also, I've found stress harder to cope with since the menopause. Have never taken HRT but is there something that will help. The more I try not to be stressed the worse it seems to get!!!! Grateful of any guidance.

Mark Winwood: Daisydiamond and Emmar - the eye-twitch could well be caused by muscle tension which is a common feature of stress and anxiety. But also eye-strain if you spend a lot of time in front of the computer.

Mark Winwood: Daisydiamond - many women find an increased difficulty in coping with stress during the menopause. This is due to changes in hormone levels and for some women HRT has been helpful. As we get older we generally tend to find that after about 55 our general levels of stress tend to reduce. It sound that your stress levels are increasing due to failed attempts at trying to manage your stress. This is causing you to experience a worsening cycle - the more you try the worse it gets. The best thing to do is to try and break the cycle by trying something new. Sometimes - accepting your feelings of tension and stress can be helpful. There is a technique called 'mindfullness' which helps you do this and many people find it helps them feel much better. The techniques involve some meditation and relaxation. Try on-line and look at the mindfulness section.

Jane: Hi Mark, I've been stressed lately and now I have an infection that won't go away. My doctor has been prescribing antibiotics that aren't working. Is it possible the stress is stopping my body from healing itself and if so what would you advise? Thanks.

Mark Winwood: Jane - if you are using antibiotics to manage an infection that are not working it is best to return to your GP as the infection may insensitive to the drugs you are taking. Saying that - our ability to heal is effected by our psychological health - high levels of adrenaline and cortisol common to stress can have negative impact on our physical wellbeing. When we are stressed we sometimes do things to help cope which are in our best interest - for example we may drink more alcohol, smoke more cigarettes, not exercise, eat more unhealthy food etc as all of these things can also inhibit our ability to recover from illness.

Ianto asked: I've been using hypnosis tapes to help me cope with stress/ anxiety and they seem to work very well. However, I'm concerned that these things may be bad for me - is it healthy to use hypnosis tapes over the long term?

Mark Winwood: Hi Ian. Well done for finding something that works for you and has helped reduce your symptoms. There is no evidence to suggest that using hypnosis in the long-term has a negative impact. The fact that it is helping you relax and deal with any stressors more effectively is a very positive thing.

Ianto asked: One more question - are there any quick/ easy ways to assess your own level of stress? The reason I ask is that often in the past I'm unaware how stressed I am until maybe a few days in - would rather identify and deal earlier!

Mark Winwood: Ianto - there are a number of products on the market that 'claim' to assess your stress. But you are your best 'assessor' - try and notice how you feel when you are feeling well and then monitor any changes to that. Common early signs are sleep disturbance, negative thoughts, irritability- (but you may have your own) - if you notice these it might be time to start applying your coping strategies!

Seasonal asked: Hi Mark I tend to get clusters of migraine headaches when my stress levels increase. I've also started to suffer with panic attacks this year. Both these things put me out of action for a while. Are there any ways to reduce stress levels, anything practical that I could do?

Mark Winwood: Headaches and migraine are common symptoms of stress. Panic attack is an exaggeration of the bodies normal response to fear, stressor excitement - it tends to manifest in the build-up of overwhelming sensations ie pounding heart, feeling faint, chest pains, feelings of loss of control - you may be convinced that you are going to die making it a terrifying experience. There are 2 main types of treatment depending on the severity and frequency - psychological and medical (or combined). The psychological treatment is Cognitive Behaviour Therapy and the medical one is Antidepressant therapy.

Seasonal asked: How does Cognitive behaviour therapy work? Thanks for the detailed answer btw
Mark Winwood: Cognitive Behaviour Therapy or CBT is evidence based therapy and is available on the NHS and through Private Medical Insurance Schemes. It is a short term therapy (approx 8 -20 sessions), which can be delivered face to face, on-line or over the telephone. The therapy examines and challenges the relationship between the way you think and how that affects your mood and your behaviour. CBT will encourage you to develop new ways of thinking and to work out strategies for managing anxiety so you feel increasingly in control.

woodie19838 asked:What is the best method to unwind from a hard day in the office - particularly after a stressful one?

Mark Winwood: We often feel stressed at the end of a busy day at work - to relieve that pressure it is important to get a sense of control - so learning to manage your stress can be really helpful so try taking control of your thoughts, your emotions , your schedule and your environment. Try and book-in some 'you' time by making sure you have something to look forward to - exercise, hot bath, trip to the cinema, evening with friends etc.... Many people have a drink to unwind after work - which can be a quick-fix and very successful. However, over-time this can have negative consequences for your medical and psychological health and then increase stress.

888565 asked: A great deal is spoken about "stress" but in terms of it being a problem what actually is it. We might say we are "stressed" because we have a lot to do, a time deadline to meet or are unsure of the result of something. Is stress simply bad or does it need to be stress that causes something?

Mark Winwood: It might be helpful for us to think of the distinction between stress and pressure. Pressure is something that drives us and can be really helpful to assist us in reaching our goals and stops us stagnating. However, if pressure builds and we feel that we cannot achieve the demands that are placed on us either at work or home we start to get the negative feelings of stress. Stress is never good but pressure can be.

Brendanjmagill asked: Monday to Friday I suffer flu like symptoms and have poor quality of sleep yet at the weekend or on holidays I feel great so i am assuming this symptoms are related to stress of my job as they never appear when I'm not working. Am I correct and if so is there anything I can take?

Mark Winwood: Poor sleep is affecting more and more people - it also has a huge impact on our mood and our wellbeing. It is hard to say whether the poor sleep is making you feel stressed and then work is more difficult - or you feel over-whelmed by demands at work and that is affecting your sleep - either way improving your sleep will help you. There are medications you can take - but it may well be worth trying some other interventions that have more long-term effects and no side-effects. As with any sleep improvement plan you sometimes feel worse before you feel better.
1. Have a night-time wind-down routine - ie bath, read etc...
2. No caffeine or alcohol before going to bed
3. Promote your bed as the place to sleep - so if you are lying awake after 20 minutes - get up and do something non physical
 4. Only go to bed when you are tired
There is an on-line tool called 'Sleepio' which is a really good Cognitive Behavioural programme to help people with insomnia - I highly recommend it.

P-Duncan asked: Hello. I have read a bit about mindfulness meditation in newspapers recently, they were saying that it can reduce not only stress but it can also have a positive effect on depression as well. BUT most times I look into mediation it always seems to be a course costing a lot of money - can you tell me if meditation does work and if so, where can I learn it free?

Mark Winwood: Hi - I am not aware of any free meditation centres - however, you can download free guided visualisation scripts and podcasts which can be useful to help you achieve a relaxed state. Also if you go to you will find some free to download mindful meditation tools which can be really helpful.

From Liz, a blogger from The Mum Blog- How can you control negative urges (like snacking on rubbish) if you're feeling stressed? Can stress ever be good for you?

Mark Winwood: Hi Liz.  I don't think stress is ever good for you.  Stress occurs when the pressure build-up makes you feel unable to cope. Gaining control of these pressures is one of the first steps in tackling your stress. If you find yourself snacking on rubbish - try the following tip.  When you get the impulse to snack - STOP - think and take a breath - consider what you are doing - consider how you might feel once you have snacked on that food -  make an informed choice - and then proceed with an option that you have control over.  This will make you think twice before going for unhealthy options.  Make sure you have plenty of healthy snacks available and try and reduce temptation by not having the unhealthy ones around.

From Charlotte, a blogger from Mum of the Mig- How can I best support someone close to me who is struggling to deal with stress?

Mark Winwood: Hi Charlotte.  It is very difficult to watch someone we care about deal with difficult situations.  I always find that rather than second guess what might be the best sort of support for someone - you are better off asking them what they might find useful.  It could be that you can support your friend by listening to there concerns or  helping them priorities their problems.  However, practical help may be more helpful to reduce the pressure in this persons life.  Often by saying 'how can I help' you will automatically reduce your friends levels of stress as they will appreciate that they are not alone with their concerns and they have friends that care about them.

From the blogger notSupermum:I'd like to know what's the best way to deal with the first signs of stress. We all have to deal with stressful situations in life, but what's the best way to stop it developing into something we can no longer deal with?

Mark Winwood:  Hi NotSupermum - The symptoms of stress often build up gradually before you start to notice them.  Stress can affect how you feel, how you think, how you behave and also how your body functions.  Stress affects people in different ways, but if you are stressed, you may have a number of the symptoms I will now describe.  You may Feel-irritable,  anxious,  low in self-esteem, low in mood.  You may find that you: have racing thoughts, worry constantly, imagine the worst, go over and over things. You might notice that you: lose your temper easily, drink more, smoke more, are on the go all the time, talk more or talk faster, change your eating habits, feel unsociable, are forgetful or clumsy, act unreasonably, find it difficult to concentrate. Physically you might experience: headaches, muscle tension and pain,  stomach problems,  sweating,  dizziness, bowel or bladder problems, breathlessness, dry mouth, sexual problems. It is important to learn how stress affects you because it will help you figure out what coping techniques work best for you. It will also enable you to avoid resorting to unhealthy habits, such as smoking, drinking and comfort-eating.

From Claire, a blogger from The Lazy Girl's Guide to Life:What action can I take to avoid letting stress get the better of my own health?

Mark Winwood:  Hi Claire - Gaining control is the key to avoiding stress.  Stress management starts, however,  with identifying the sources of stress in your life. This isn't as easy as it sounds. Your true sources of stress aren't always obvious, and it's all too easy to overlook your own stress-inducing thoughts, feelings, and behaviours.  For example you  may know that you're constantly worried about work deadlines, however,  maybe it's your procrastination, rather than the actual job demands, that leads to feel stressed over a looming deadline.

To identify your true sources of stress, look closely at your behaviours, thoughts and beliefs:

  • Do you explain away stress as temporary ("I just have a million things going on right now") even though you can't remember the last time you took a breather and didn't feel stressed?
  • Do you define stress as an integral part of your work or home life ("Things are always really busy around here") or as a part of your personality ("I have a lot of nervous energy, that's all").
  • Do you blame your stress on other people or outside events, or view it as entirely normal and unexceptional?

Until you accept responsibility for the role you play in creating or maintaining it, your stress level will remain outside your control.  Once establishing this you will be able to make choices which help you reduce your stress.

colnik asked: I have a busy life and recently been a bit stressful for lots of reasons.I am getting tremendous pain shooting up the back of my head. Never had this before altho I have been much more stressed than I am now. We are suffering particularly bad weather movements and the atmospheric pressures seem to be moving an awful lot---can this be making the pain sensation worse?

Mark Winwood: Hi Colnik - interestingly I have read recently that in a recent piece of research 3 out of 4 respondents believed that the weather had an effect on triggering headache pain.  No one is really sure why this occurs but some evolutionary scientists believe that it may a  naturally occurring protective factor encouraging the sufferer from moving to an environment with a more 'health' temperature or humidity.  The recent pain you describe in the back of your head, however,  could well be due to pressure build-up in your life, making you feel unable to cope  and causing a stress response.  As this pain is new - I would recommend visiting your GP so that any physical problems can be investigated and excluded where necessary.

Dervla asked: I was involved in a car accident back in December and was struck by a lorry from behind with some force leaving me in hospital for a week, however the physical pains are much better but I suffer with incredible palpitations both day and waking me through the night. I have been advised that it is anxiety but I have also developed tremors in my right hand and arm, more notable whilst holding a cup, eating or reading. I am extremely tired all the time and have aversions to certain smells and tastes, I have just had some blood samples taken today but I keep being told this is a normal reaction after what I have been through, but unfortunately I do not feel convinced.

Mark Winwood: Hi Dervla, thank you for your message the traumatic nature of a car can leave people with varying degrees of post-accident anxiety. Anxiety is a feeling of nervousness, fear, worry, and overall apprehension. This can happen after being involved in an accident where people may suffer from anxiety attacks which reduce their ability to drive or function normally in their daily lives. This intense panic and fear people can experience after an accident often causes people to harbour a fear of being in another accident or of riding in a car; everyday activities that people engage in daily.

Other types of anxiety after a car accident can include:

  • various ongoing health issues that create stress;
  • insomnia, nightmares, or disrupted sleep; and
  • Post-Traumatic Stress Disorder (PTSD).

Anxiety manifests differently for each person. Some people experience panic which can be very frightening, this can include some of the symptoms you are experiencing such as:

  • heart palpitations;
  • sweating 
  • trembling, numbness, and tingling;
  • shortness of breath and dizziness;
  • chest pain;
  • nausea, chills, and hot flashes;
  • fear and panic;
  • incoherent thoughts and inability to concentrate;
  • persistent, excessive, unrealistic worry;
  • exhaustion and sleep problems;
  • restlessness and irritability; and
  • development of phobia

It may be worth speaking to your primary care physician about the concerns you have about your symptoms and how you feel these may be linked to a psychological process rather than a physical one.

Go on-line and visit  they have some useful self-help information and guides.

optometrist asks: I had a back surgery in 2009. A few weeks ago I had a road traffick accident causing whiplash and my back pain has increased, working as an optometrist makes it worse. I am in agony at the end of the day after work. Is there anything that i can do to help?

We asked Jan Vickery, our Lead Physiotherapist to answer this question.
Jan Vickery: Yes, there is plenty that you can do at work.

  • Firstly, try to avoid prolonged periods of being in the same posture. Break up static postures by moving around as much as possible. It may not be feasible to go for a walk, but simply adjusting you working posture can have a big impact on discomfort. Similarly, try to avoid doing the same thing repeatedly. If you can, alternate or rotate the different tasks that you do so that this creates postural variation.
  • Aim to keep you back in an s-shaped posture and make sure that it is well supported whenever possible. This means that if you are sitting down, ensure that the arch in your lower back is well supported by the chair backrest.
  • Take a good look at your workplace - look at whether working heights and equipment layout are conducive to the optimal working posture.
  •  If you have Occupational Health support at work they will be able to give you further, more specific guidance.

Want to find out more about stress? Feel free to browse our stress factsheets, or leave a question for our panel of experts.