Stress & Anxiety

Take three slow deep breaths

Can you do it?

Do you feel relaxed?

If not, read on and we'll walk through an initial approach to the assessment and management of stress and anxiety.

Eustress vs. Distress

Some stress in life is normal. Occasionally, it can be quite intense. Recall the feeling before writing an exam or speaking in public. The unique sensation is due to adrenaline from the sympathetic nervous system and its potent effects on many organs simultaneously. It makes your heart pound, your skin sweat, it increases your alertness, and decreases your reaction times. To feel anxious in this way is normal in some circumstances and is a healthy response to stressful situations. We call this "eustress" or "good stress." With practice, we can train ourselves to embrace it and see it as a sign that we're doing something important and have an opportunity to excel.

However, sometimes stress can be prolonged due to an underlying cause that is persistent or due to an inability to gain sufficient distance from the trigger. If the symptoms of stress persist, they can affect our wellbeing and in some cases, our ability to function normally. In such cases, this is "distress," or extreme anxiety, and it typically represents a medical condition.

Uncontrolled anxiety can present in many ways. Poor sleep, inability to relax, and irritability are often the first symptoms. Some individuals have somatic (body) symptoms such as palpitations, chest pain, shortness of breath, or tingling sensations. It can also affect perception, sometimes resulting in a sensation that things aren't real (known as derealization). These symptoms can be alarming and occasionally result in patients presenting to the emergency department.

If any of these symptoms are familiar or if you feel that something is off with your ability to relax, read on. Try to be objective and consider any symptoms you have that seem new or bothersome. If you feel that your symptoms are affecting your quality of life, consider using a screening tool such as the GAD-7 to get an objective (albeit simplified) measure of your anxiety. GAD-7 Screening Tool

Take a minute to reflect

You are the only person who knows everything that has happened in your life and how things have made you feel. If you're not sure what is triggering your symptoms, stop and reflect. Consider all possible sources of stress in your life. This can take a while. You will probably identify multiple culprits so don't anchor on any explanation too soon. There could be longstanding problems or new challenges or both.

Timing can provide a hint

If you are unable to unwind or have calmness of mind, ask yourself: When did my symptoms start and were there any life changes that occurred at that time?

Have you suffered emotional trauma, or do you have anxiety or fears that are hard to let go of?

How do you normally cope with stress? Has anything changed in your usual approach?

Consider these common strategies:

• Take time for things that you enjoy
• Make time to be outside
• Connect with supporters in your life
• Set small achievable goals and steadily work toward them
• Do things that have helped you relax in the past
• Mindfulness exercises
• Meditation
• Exercise
• Distraction
• Take a break from social media
• Start a healthy-eating streak

Have you tried these strategies and found they are failing you? If so, being assessed by a family physician such as Dr. Kwinter should be your next step. Often the assistance of an experienced professional is needed to get on a better course.

Collateral damage is common

Have you developed any unhealthy habits or coping strategies?

• Sacrificed time with family or friends
• Skipped exercising for longer than usual
• Detoured into poor eating choices
• Alcohol or substance misuse or abuse
• Reacted to someone in a regrettable manner

Next steps

If you want help with your stress or anxiety, please consider making an appointment with Dr. Kwinter. He will conduct a proper assessment that will include:

• Taking a focused medical history and review of systems
• Working with you to develop an understanding of how your symptoms affect your life
• Investigating what might be possible causes of your symptoms
• Checking for any underlying medical causes of the symptoms
• Determining if there are any appropriate treatments (pharmacologic or non-pharmacologic) that could help with your symptoms in the short term while making a plan for the long term
• Developing a holistic plan to help you regain the ability relax, reset, and feel better