Grace under pressure

Handling stress is difficult for anyone. But as veterinary students or recent graduates, the mounting demands of digesting and understanding volumes of medical facts, finding a job or internship, managing finances and keeping viable relationships, are enough to make anyone boil over once in awhile. So how are you handling the pressures of everyday life? You may be surprised to find out you're not faring so well. But hopefully by the end of this article, you should have a much clearer understanding of stress and the importance of controlling it. You should be able to analyze the points of pressure in your life, and plan to neutralize them. You will also have an armory of different stress reduction methods. This will help you to control each stress with the most appropriate technique.

Understanding stress

Stress is considered to be anything that stimulates you and increases your level of alertness. Life without stimulus would be incredibly dull and boring. Life with too much stimulus becomes unpleasant and tiring, and may ultimately damage your health or well-being. Too much stress can seriously interfere with your ability to perform effectively.

The art of stress management is to keep yourself at a level of stimulation that is healthy and enjoyable. This article will help you to monitor and control stress so that you can find and operate at a level that is most comfortable for you. It will discuss strategies to reduce or eliminate sources of unpleasant stress.

Most people realize that aspects of their work and lifestyle can cause stress. While this is true, it is also important to note that it can be caused by your environment and by the food and drink you consume. The strategies that you should use to counter stress depend on the causes of that stress.

There are several major sources of stress:

• Survival stress

• Internally generated stress

• Environmental and job stress

• Fatigue and overwork

Survival stress

Where you are in a physically or emotionally threatening situation, your body adapts to help you react more effectively to meet the threat.

This is controlled mainly by release of adrenaline. The changes are quite powerful and useful in a 'fight or flight' situation. The main ones are:

• Adrenaline mobilizes sugars, giving your body access to more strength, energy and stamina. This helps you to fight harder or run faster.

• It reduces the blood supply to your skin and short-term inessential organs. This minimizes bleeding if you are hurt, and ensures that energy is not wasted on processes that are not immediately useful.

• You may experience nausea or diarrhea: this eliminates excess weight that might otherwise slow you down.

You may have experienced these changes as fear. Where speed and physical strength are important this adrenaline stress will be helpful and beneficial - fear can help you to survive or perform better. However where calm thought or precise motor skills are important, it is best to control and, ideally, eliminate these adrenaline responses.

Prolonged exposure to adrenaline can damage your health.

Internally generated stress & anxiety

Internally generated stress is stress that you cause for yourself. This can come from anxious worrying about events beyond your control, from a tense, hurried approach to life, or from relationship problems caused by your own behavior. It can also come from an "addiction" to and enjoyment of stress.

Stress can cause the levels of a chemical called noradrenalin to rise in and between nerve cells. This gives a feeling of confidence and elation that some people like. They can subconsciously defer work until the last minute to cause a "deadline high", or can create a stressful environment at work that feeds their enjoyment of a situation. The downside of this is that they may leave jobs so late that they fail when an unexpected crisis occurs. They may also cause unnecessary stress for other colleagues who are already under a high level of stress.

Other aspects of personality can cause stress. Examples are perfectionism, where extremely or impossibly high standards can cause stress; and excessive self-effacement, where constant attention to the needs of others can lead to dissatisfaction. A major cause of internally generated stress in many people is anxiety.

Environmental, nutritional and job stress

Your environment may be a significant source of stress. This can come from:

• Crowding and invasion of personal space

• Insufficient working and living space

• Noise

• Dirty or untidy conditions

• Pollution

• A badly organized or run down environment

Working environments are rarely perfect, however often you can improve your environment quite cheaply.

Chemical and nutritional stresses

The food you eat may contribute to the stresses you experience. Many veterinary students and new associates work very long hours and often become reliant on caffeine to help them get through studying or long work hours. Eating healthy also goes to the wayside and quick and easy meals often take the place of balanced-nutritious meals.

Examples of stressors you may not be aware of are:

• Caffeine: This raises your levels of stress hormones, makes it more difficult to sleep, and can make you more irritable. Many people report as big a reduction in feelings of stress after switching away from coffee as they do after giving up smoking. Note that there is often as much caffeine in a cup of tea as there is in a cup of coffee.

• Bursts of sugar from sweets or chocolate: These can make you feel more energetic in the short term. However your body reacts to stabilize abnormally high sugar levels by releasing too much insulin. This causes a serious energy dip shortly after the sugar high.

• Too much salt: This raises your blood pressure and puts your body under chemical stress.

• Smoking: Most people who smoke feel relaxed after a cigarette. If you smoke, however, try taking you pulse before and after a cigarette and think about the difference. Smoking puts your body under chemical stress. Most people who have given up smoking feel much more relaxed generally after the initial 'giving up' period is finished.

As well as these specific sources of stress, you may experience stress if you eat an unbalanced or unhealthy diet. You may find that some dietary deficiency or excess causes discomfort and illness which generates stress. If you are obese, then this causes physical stress on your internal organs and emotional stress as your view of yourself declines.

While there is a lot of crooked, biased, nae or incorrect dietary information around, you can normally rely on nutritional advice from your doctor or from government health education. Before you accept advice, examine the motives of the people offering the advice!

Lifestyle and job stress

Many of the stresses you experience may come from your job or from your lifestyle. These may include:

• Too much or too little work

• Time pressures and deadlines

• Responsibility for people, budgets or equipment.

• Frustration and boredom with current role

• Lack of clear plans and goals

• Demands from clients

• Disruptions to plans

• Frustration at having to overcome unnecessary obstacles.

• Financial or relationship problems

• Ill-health

• Family changes such as birth, death, marriage or divorce.

Fatigue and overwork

Here stress builds up over a long period. This can occur where you try to achieve too much in too little time, or where you are not using effective time management strategies.

Optimum stress levels

The level of stress under which you operate is important: if you are not under enough stress, then you may find that your performance suffers because you are bored and unmotivated. If you are under too much stress, then you will find that your results suffer as stress-related problems interfere with your performance.

It is important that you recognize that you are responsible for your own stress - very often it is a product of the way that you think. Learn to monitor your stress levels, and adjust them up if you need to be more alert, or down if you are feeling too tense. By managing your stress effectively you can significantly improve the quality of your life.

Optimizing stress levels

The approach to optimizing stress depends on the sort of stress being experienced. Strategies to deal with short term stresses focus on managing adrenaline to maximize performance. Short-term stresses may be difficult meetings, sporting or other performances, or confrontational situations. With long-term stress, fatigue and high adrenaline levels over a long period can seriously reduce your performance. Optimizing long-term stress concentrates on management of fatigue, health, energy and morale.

Naturally there is some element of overlap between these.

Short-term stress

Table 1 shows the relationship between stress and the quality of performance when you are in situations that impose short-term stress:

Where stress is low, you may find that your performance is low because you become bored, lack concentration and motivation. Where stress is too high, your performance can suffer from all the symptoms of excessive short-term stress. In the middle, at a moderate level of stress, there is a zone of best performance. If you can keep yourself within this zone, then you will be sufficiently aroused to perform well while not being over-stressed and unhappy.

Table 1: The relationship between stress and performance

This table, and this zone of optimum performance, are different shapes for different people. Some people may operate most effectively at a level of stress that would leave other people either bored or in pieces. It is possible that someone who functions superbly at a low level might experience difficulties at a high level. Alternatively someone who performs only moderately at low level might perform exceptionally under extreme pressure.

The best way of finding your optimum level of stress is to keep a stress diary for a number of weeks.

Long-term stress

The problems of long term, sustained stress are more associated with fatigue, morale and health than with short term adrenaline management.

Tabel 2: The relationship between long-term stress and performance

Table 2 shows the way in which performance can suffer when you are under excessive long term stress:

The graph shows stages that you may go through in response to sustained levels of excessive stress:

• During the first phase you will face challenges with plenty of energy. Your response will probably be positive and effective.

• After a period of time you may begin to feel seriously tired. You may start to feel anxious, frustrated and upset. The quality of your work may begin to suffer.

• As high stress continues you may begin to feel a sense of failure and may be ill more frequently. You may also begin to feel exploited by your organization. At this stage you may start to distance yourself from your employer, perhaps starting to look for a new job.

• If high levels of stress continue without relief you may ultimately experience depression, burnout, nervous breakdown, or some other form of serious stress related illness.

Different people may move between these stages with different speeds under different stress conditions.

At a simple level it may appear that a measure of "toughness" is how well you keep on going under extreme stress. This is simplistic. It is certainly possible to be self-indulgent and use stress as an excuse for not pushing yourself hard enough. It is, however, also far too easy to let yourself be pushed to a level where your work, and physical and mental health start to suffer. The strongest and most flexible position is to actively manage your levels of stress and fatigue so that you are able to produce high quality work over a long period, reliably.

High performance in your job may require continued hard work in the face of high levels of sustained stress. If this is the case, it is essential that you learn to pay attention to your feelings. This ensures that you know when to relax, slacken off for a short period, get more sleep, or implement stress management strategies. If you do not take feelings of tiredness, upset or discontent seriously, then you may face failure, burnout or breakdown.

Choosing which stress management technique to use

Techniques that you select depend on the cause of the stress and the situation in which the stress occurs.

In choosing methods to combat stress, it is worth asking yourself where the stress comes from. If outside factors such as important events or relationship difficulties are causing stress, then a positive thinking or imagery based technique may be effective. Where stress and fatigue are long term, then lifestyle and organizational changes may be appropriate. If the feelings of stress come from adrenaline in your body, then it may be effective to relax the body and slow the flow of adrenaline.

Stress Diary Finding your optimum stress levels

Keeping a stress diary is an effective way of finding out what causes you stress, the level of stress you prefer, and your effectiveness under pressure.

In this diary, write down your stress levels and how you feel throughout the day. In particular, note down stressful events. Record the following information: At a regular interval, for example every hour, record routine stress. Note:

• The time

• The amount of stress that you feel (perhaps on a scale of 1 to 10)

• How happy you feel

• How efficiently you are working

When stressful events occur, write down:

• What the event was

• When and where did it occur?

• What important factors made the event stressful?

• How stressful was the event?

• How did you handle the event?

• Did you tackle the cause or the symptom?

• Did you deal with the stress correctly?

Analyzing the diary

After a few weeks you should be able to analyze this information. It may be interesting as you carry out the analysis to note down the outcomes of the jobs you were doing when you were under stress.

This should give you two types of information:

• You should be able to understand the level of stress you are happiest with, and the level of stress at which you work most effectively. You may find that your performance is good even when you feel upset by stress.

• You should know what the main sources of unpleasant stress in your life are. You should understand what circumstances make stresses particularly unpleasant, and should be able to see whether your strategies for handling the stresses are effective or not.

You will get the real benefits of having a stress diary in the first few weeks. After this the benefit you get of keeping it each additional day will reduce. If, however, your lifestyle changes or you begin to suffer from stress again in the future, then it may be worth using the diary approach again. You will probably find that the stresses you face have changed. If this is the case, then keeping a diary again will help you to develop a different approach to deal with them.

Once you have discovered the stress level you are happiest with, and understand what triggers unpleasant stress, make an Action Plan to control it. Some elements of this action plan will be actions you are going to take to contain, control or eliminate problems that are causing you stress. Other parts may be health related such as taking more exercise, changing your diet, or improving the quality of your environment. It may also cover stress management techniques that you will employ when stress levels begin to build.

Key points:

Keeping a stress diary helps you to learn how you handle stress. It helps you:

• Find out the stress levels you prefer.

• To know how effectively you operate under pressure.

• Understand the things tha