relieving stress and burnout
Dr Jess says: Stress is a word that nearly all my patients use at some point, to describe how they are feeling, or what has caused their symptoms. A terrifying three in every four people in the UK have felt so stressed in the past year, that they have felt unable to cope. Although stress is more commonly expressed by women, men experience similar feelings, but are less likely to seek help.
With so many of us struggling, learning how to deal with stress and truly switch off should, in my opinion, be a regular lesson in school, from early childhood.
When you feel more relaxed and in control, life is much more fun, and you aren’t tipped over the edge by triggers, like running late or an unexpected bill, and you learn to build a reserve tank, to help you prepare for life’s ups and downs.
The tips below really work, but you have to do them regularly. Just as you have to maintain your car or your home, you also have to continue to evaluate your workload and stress levels, and balance them with ways to cope.
Stress management is likely the most important tool you can develop for your life to improve your long-term health. In my experience of my own life and that of my patients, it doesn’t matter how good you are with healthy eating, exercise or vitamin supplements – if you are experiencing chronic levels of high stress, it will inevitably damage your health.
what is stress?
Stress is the way your body responds to threats or the demands placed upon it. Stress can be mental, emotional, physical or chemical, like infections, pollution or even extremes of heat or cold. However, we most commonly use the word to mean mental and emotional stress; a feeling of unmanageable pressure upon us. There are three types of stress reaction:
Acute (sudden trauma): When we first feel or experience stress, our body reacts in a pre-programmed way and begins to release hormones and chemicals which create physical, mental and emotional reactions in our body. This initial response is called an ‘acute stress reaction’ and is commonly known as ‘fight or flight’.
This mechanism kicks in as a result of sudden, intense trauma or shock, like the loss of a loved one, the loss of a job, the breakup of a relationship, or through experiencing violence against us. The hormones adrenaline and noradrenaline are released, heart and breathing rates increase, the pupils dilate and there is heightened anxiety, detachment or numbness. We feel on full alert. Blood flow in the body moves to the arm and leg muscles so we can run away or fight, and diverts energy away from the digestion and urinary systems, which aren’t needed urgently at that moment.
Episodic: When acute stress happens regularly, it is called episodic stress. Those people who are always having a crisis, or with multiple regular traumas, where ‘everything that can go wrong, does’, can be experiencing episodic stress.
These people can become pessimistic and only see the negative side of life. They can struggle to organise and order the demands of their lives, taking on more and more, until it becomes chaotic and self-fulfilling. Stress becomes part of this personality, and they can believe it is necessary to have stress to keep going. ‘Type A’ personalities could be described as episodic stress seekers, and this way of living can be difficult to change.
Chronic (long-term): When acute stress is ongoing for a long period of time, or many demands are made on the body and mind for long periods, it becomes chronic. Causes include long-term financial difficulties, abusive or difficult relationships, health problems, bullying or difficulty at work. Those who have experienced adverse childhood events (ACEs) like abuse or neglect are much more likely to suffer from chronic stress.
One in five people in the UK suffers from work-related stress. In fact, money and work are the top two causes of stress in the under 55’s. These two factors, along with relationships, time poverty, health problems and demands of family life can all be major causes of stress.
When we are under long-term stress, we release large levels of cortisol from our adrenal glands. Cortisol has a necessary role in our bodies, regulating blood sugar and the immune system and it has wide-ranging effects throughout the body. Unfortunately, continued high levels of cortisol from stress can have a big impact on our health. In fact, long-term stress is likely more dangerous than smoking.
are you suffering from stress?
Common symptoms or conditions associated with excessive stress include:
- Feeling overwhelmed, tearful or struggling to cope
- Irritable or angry, with a short fuse
- Poor memory and concentration
- Panic attacks
- Fatigue and exhaustion
- Insomnia and sleep problems
- High blood pressure
- Joint pain and stiffness
- Frequent illnesses or infections
- Digestive problems
- Weight gain
- Headaches and shoulder or neck tension
- Hormonal problems
- Teeth grinding
how do you diagnose stress?
Whilst we may not need to be ‘diagnosed’ with feeling stressed, there are tests that can help us assess the effect that stress is having on us, and how well we are coping with it.
Cortisol, the main hormone produced by our adrenal glands, can be overproduced when we are under extended periods of stress. Cortisol is production is regulated by something called the HPA axis (the hypothalamo-pituito-adrenal axis), basically the hypothalamus and pituitary in our brain send messages to the adrenal glands and through feedback loops turn on and off their signals. With long term stress we can find that the HPA axis becomes overstimulated or less responsive and we can develop something called HPA axis dysfunction. HPA axis dysfunction is what causes many of the symptoms above and one of the best ways to test for it is to measure your salivary or urine cortisol levels throughout the day so we can see how you are responding to stress.
Adrenal stress testing (HPA axis)
It can be measured in our blood, urine or for ease, in our saliva. Whilst a one-off measurement can help diagnose medical problems like Cushing’s or Addison’s disease (diseases that require urgent medical treatment, affecting the adrenal or pituitary glands), for most of us, a better measurement can be taken from looking at cortisol levels over a 24 hour period. Ordinarily, cortisol levels should be high on waking and reduce slowly throughout the day.
A salivary adrenal stress test, including CAR (Cortisol Awakening Response), can help to visualise the times of the day where stress levels are out of balance. This can help identify stress triggers, time stress interventions and correlate cortisol levels with other health symptoms and the amount and quality of sleep you are getting.
An adrenal stress and CAR test can also assess whether your stress response (HPA axis) has become overwhelmed and is struggling to produce cortisol when you need it. This used to be called adrenal exhaustion or burnout by many practitioners, a condition documented by Hans Selye in the 1930s, who described the adrenal glands as a factory that is continually being pushed to increase its output into overdrive with little rest (during a long period of stress), until they reach capacity, breaks down and can no longer produce cortisol effectively. We now know it is more complex, rather than the adrenals being the only gland involved it is more likely to do with the feedback and responsiveness of the HPA axis, which after being constantly stimulated by stress, become unresponsive to their feedback triggers and fail to ask for cortisol to be produced. When cortisol levels are low the net result is exhaustion, burnout, ill health and in some cases chronic fatigue. Low points of cortisol on the 24-hour test can suggest the development of chronic fatigue and burnout. Addison’s disease – an autoimmune disease – should also be excluded with further testing by a medical practitioner if your cortisol is low.
Whilst conventional medicine and most conventional medical doctors do not talk about HPA axis dysfunction (despite overwhelming evidence), they acknowledge that we can can all experience difficulty when under high stress for long periods of time. In practice, Jess finds an adrenal salivary stress test or a urinary DUTCH test to measure cortisol through the day, incredibly useful. The Genova Diagnostics 24 hour test measures both cortisol and DHEA (which is also depleted after chronic stress, affecting hormone balance). A DUTCH (dried urine test for comprehensive hormones) is also extremely useful and accurate with more in depth testing of several hormone systems although significantly more expensive.
HRV (Heart Rate Variability) is a non-invasive, relatively easy way to predict whether stress is having a negative impact on you. By measuring the variation in the interval between your heartbeats, you can see any variations in your heart rate throughout the day. Evidence shows that the lower the variation, the higher your risk of both early death and cardiovascular disease, while other studies show stress and trauma reduces HRV.
You can now buy relatively cheap heart rate variability monitors for home use, such as the Elite HRV monitor, to measure your HRV daily. Following relaxation exercises and programmes to chart improvements, can have some success, but if patients have low heart rate variability, Jess often advises an adrenal stress test and a basic panel of blood tests to look at other possible risk markers and effects.
how do you manage stress?
Once you are aware that you are struggling with stress, or have reached a point where you feel completely overwhelmed, it’s time to look at the balance of your life, and start using the many techniques that can make a huge difference. Find the right one to work for you, and build them into your routine.
Although you may have heard of mindfulness and meditation, or feel the urge to do something creative, take a yoga class or go for a walk, until you put regular appointments in your diary to make time for self-care, you won’t experience the amazing benefits that a few minutes a day can make! It isn’t difficult, but it does require that you make your emotional health a priority.
It’s really easy to think that you don’t have time for stress-busting activities, but if you are feeling stressed or overwhelmed, the reality is that you really don’t have the time not to do them!
practical ways to deal with stress
Start with one of the most useful stress-reducing techniques you can learn: Time management. Jess remembers groaning when she was forced to attend this session during her training as a junior doctor, but the reason that the hospital insisted on it was that it actually saved lives – it’s still one of the most useful sessions she has ever taken as part of her training!
- Write everything down. Until you define and face your problems, it’s difficult to tackle them. Often, they are not as bad as you think. Get everything out of your head, write it all down on a piece of paper (Jess likes to mind map), and then organise it into different areas to tackle. Your brain may be amazing, but forcing it to try and retain all the jobs, worries, ideas and projects that you have makes it hard to focus on what is important. This creates stress: download your brain onto paper.
- Clear a space. Tidy up your workspace. If it’s a huge job, then move items into rough piles by category, for further sorting later, but clear a space. Put important items into a ‘to-do’ file and then get back to organising things. If the idea of clearing space is overwhelming, set a timer and work on it for 20-40 minutes a day, depending on how much time you have. Make organising any clutter and mess that is getting in the way a priority. Once you are ordered physically, the problem feels clearer mentally, and you aren’t wasting more time looking for things.
- Get organised – If you have no time, then don’t waste what you have with being unfocused. Make a to-do list, look at it and manage it daily. Get a wall calendar, or a calendar app you can use, if you prefer electronic devices (there is an advantage to phone calendars, as you can set alerts to remind you of appointments). Any time-sensitive jobs can be written on your calendar to be done just before or as they are due. A year-to-view wall planner may help you to manage your time better, as you can easily see the busier times of the year and begin forward planning some of your workload for less busy times.
- Schedule stress-busting activities. Putting rest and self-care time in your diary, in the same way that you would for an appointment will help you make time for yourself. You can often deal with a busy day better, if you know you have scheduled a relaxing walk the next morning. If you are struggling to motivate yourself, take an evening class that interests you, or try something creative or musical. If you’re really stuck for time, visit our mindfulness area for quick videos and audio downloads to learn how to do regular mindfulness, that can fit in with any schedule.
- Financial stress. Money is one of the most common stressors. In our experience, the best book to help you successfully learn to manage money and get out of debt is The Total Money Makeover by Dave Ramsay (a life-changer for Jess). Online resources like moneysavingexpert.com also have great advice on debt. The most common themes running through all the advice are not to bury your head in the sand. Define the problem, work out the number, regularly watch your spending and run a budget to get debt under control. Once you are under control, always have an emergency buffer (put a small, regular amount away, to build one up), which stops any unexpected bills or job losses, from creating acute stress. You should aim towards having between one and three months of living expenses saved for these events. The recent pandemic shows the importance of building a contingency fund for the unknown.
- Relationship stress – There are some excellent relationship books for women, including: The Empowered Wife by Laura Doyle and Why Men Love Bitches by Sherry Argov. For men, we encourage No More Mr Nice Guy by Robert Glover and The Way of The Superior Man by David Deida.
diet, your gut and stress
can changing your diet affect your stress levels? Yes! It can make a big difference, because cortisol levels can be altered by foods, particularly stimulants – the most dangerous of which is sugar, but also caffeine and alcohol. These can increase cortisol levels, and therefore increase the negative and stressed feelings that you are experiencing. Reducing these may help.
One big problem with sugar is that we are designed to crave sugary treats and refined carbohydrates (white flour) when we are stressed, as in the short-term, they cause a dip in cortisol which calms us – but this is a very short-term fix. Over the longer term, high sugar and carbohydrate levels in our diet massively increase the physical stress on our body (not to mention many other effects). This increases overall cortisol levels, and worryingly, sugar focuses stress on our brain, affecting memory, learning and mood.
We also now know that stress has a negative impact on our microbiome and can contribute to leaky gut. The gut-brain axis is emerging evidence that our mood is strongly affected by hormones, nerve stimulation and immune chemicals produced by our gut. It’s a vicious cycle as stress can damage your gut and dysbiosis and leaky gut can increase issues with your mood and your ability to deal with stress. Eating a diet that is low in sugar and toxic and inflammatory fats, which is full of healthy probiotics and gut-nourishing foods, like the refresh programme, can restore your gut health and reduce your consumption of sugar and carbohydrates. For more information, visit our gut health & digestion toolkit.
caffeine. A sugar-laden coffee shop latte combines the negative impact of both caffeine and sugar. Whilst the activity may be relaxing in the short term, you suffer the consequences later of increased stress and anxiety. A compromise may be GABA oolong tea (a clinic favourite) or mushroom blends, added to low caffeine coffee (brands like SuperU or Four Sigmatic mushroom coffee). These can help to minimise and counteract the negative effects of caffeine.
can oranges help? Orange essential oil has been shown to have stress-busting properties. A study showed that cortisol levels were reduced in children undergoing dentistry who inhaled orange oil1. Whilst oranges may have stress-busting properties, the sugar levels in an orange (three teaspoons per orange), can offset this. The healthiest alternative to eating oranges is to infuse your water with orange (slice an orange and place it in a jug of water for a couple of hours to get the flavour, without the sugar), or use orange essential oil in a diffuser.
can digestive problems increase stress? This is a chicken and egg problem. Stress can cause digestive problems and damage the gut. Raised adrenaline and cortisol can have a negative impact on the gut, causing IBS, heartburn and even ulcers. Conversely, when your digestion is unhappy, it can raise your stress levels. Working on your diet by decreasing the amount of sugar you eat, increasing your intake of vegetables, and taking probiotics, aloe vera, activated charcoal and psyllium husk can all help. Visit our gut health & digestion toolkit for more help.
your posture and stress
Did you know that how you stand and sit can make a major difference to how stressed you may feel?
Several studies2,3 have shown that closed postures; slouched down, head and neck down, arms and/or legs crossed, can all have a negative impact on mood and increase feelings of stress. An open posture (standing or sitting straight, head up, arms or legs uncrossed) creates a more positive mood and increases feelings of relaxation and self-confidence.
If you notice that you have rounded shoulders, slouch a lot or have niggling back or neck pain, help is at hand! Our realign programme only takes a few minutes a day and is tailored to help correct a wide variety of common back pain causes.
the best ways to manage stress naturally
practice mindfulness and gratitude
Mindfulness has been shown to offset the effects of spending too much time on phones and computers, and can reduce anxiety, depression and stress by over 50% (which, incidentally, is better than many antidepressants). It needn’t be difficult, and it’s easier to include in your daily routine than you may think.
Gratitude, or being thankful, is a way to change your filter on the world. This is particularly good for those with a tendency towards pessimism, or who experience episodic stress. Write a daily gratitude journal and bring thankfulness into your consciousness, to enrich your life and lower your dependence on stress. Read more here.
the best nutrients for stress
There are at least seven critical vitamins, minerals and nutrients that we know affect our stress levels and mood. It is possible for deficiencies in these vitamins and nutrients to cause increased feelings of stress, and in many cases, you can improve cortisol and stress levels by ensuring your nutritional needs are met.
adaptogens and super herbs
Adaptogens are an amazing class of herbs that help the body cope with and recover from stress. Probably the most well-known and effective of these for emotional stress is Ashwagandha (Withania somnifera).
Reishi mushroom is another gentle, calming and strengthening herb that is great for long-term stress.
Jess’s all-time favourite Chinese herb for stress and mood is Chai Hu (Bupleurum Chinensis). Jess uses this herself on a daily basis, and has seen its remarkable calming and uplifting effect thousands of times in her patients, family and friends. Chai Hu can be taken as a tincture or as part of the classic Chinese herbal formula Xiao Yao San – ‘Free and easy wanderer powder’. Dr Jess has used a version of Xiao Yao San (soon to be available on The Natural Doctors as we feel it is so valuable) with hundreds of her patients to successfully improve feelings of stress and overwhelm, in her opinion it is a safe and powerful medicine that often yields excellent results with little to no side effects.
Astragalus membranaceus (Huang Qi) is a Chinese herbal medicine that is a powerful adaptogen and is used traditionally to boost energy and strengthen immunity. It is one of Jess’s most used herbs. Safe and gentle, it is often added to nourishing soups.
Our super-adaptogen combination, plant+. contains high-quality ashwagandha, reishi and astragalus.
CBD oil has been in the news for its numerous cited benefits in cancer and epilepsy, but did you know CBD can also be beneficial for stress? The medicinal part of the cannabis plant is particularly helpful where there is a lot of anxiety (including PTSD and generalised anxiety) and is good for calming, restoring focus and aiding sleep4. CBD Brothers, now known as the Original Alternative, is an excellent source.
yoga and martial arts
Both yoga and tai chi are wonderful moving meditations that are shown to significantly lower cortisol levels, to help manage stress and negative emotions.5, 6 If you find mindfulness and sitting still for meditation difficult, you may find these forms of stress-reducing exercise better for you. Visit the yoga area to find wonderful classes from the Yoga Family.
As an alternative, if you want to improve your fitness, posture and strength at the same time as helping your mind then also consider martial arts like karate (a favourite of Jess and Xandra). Karate has been shown to have a significant positive impact on well-being, chronic stress, anxiety and depression,7 which compares to practising mindfulness.
Cortisol is temporarily raised by exercise, but over the longer term, exercise reduces stress and cortisol levels for several days. Regular exercise is an essential part of managing stress, and the feel-good endorphins are a great natural high. Find a form of exercise that you love (consider martial art for maximum workout and stress relief) and do it regularly, as part of your routine.
Focusing on your body and physical movement is a way to shut off stressful thoughts and emotions and brings you into the present, as a moving meditation. The more stressed and busy you are, the more you need to make exercise part of your life.
acupressure for stress
give acupressure a try
When you’re feeling stressed, acupressure can be a fast and easy way to reduce that stress. Acupressure is similar to acupuncture, but without the needles. It’s simple to learn how to practice basic acupressure on yourself at home, at times when you need immediate relief. Massage the points below for 2-3 minutes each side.
- Pericardium 6
- Conception Vessel 17
- Kidney 1
You can regularly repeat these techniques until you feel calmer. If you haven’t tried it before, acupressure is a quick and easy way to calm yourself if you are feeling stressed.
ho’oponopono and shinrin-yoku
Finally, ancient rituals could hold the key to managing modern-day stress. Ho’oponopono, the ancient Hawaiian ritual of forgiveness, can help let go of pain and resentment causing stress in our relationships. Shinrin-yoku – the Japanese practice of forest bathing (walking in the woods) has been shown to have a dramatic effect on stress, anxiety, depression and high blood pressure.
the importance of play
In our busy, modern lives, many of us focus so heavily on work and family commitments that we never seem to have time for play. When we have some free time, we are more likely to chill out in front of the TV or computer, than we are to engage in fun and play, like we did as children. But play is not just essential for kids; it can be an important source of relaxation and stimulation for adults as well.
Whilst play is crucial for a child’s development, it is beneficial for people of all ages. Play can add joy to life, relieve stress, supercharge learning, and connect you to others and the world around you. Play can also make work more productive and pleasurable.
Play can be anything that you do just for fun. Play will look different to us all. It could be kicking piles of leaves in autumn, it could be throwing a frisbee on a beach. It could be a board game or a crossword on a rainy day, or taking a turn on the swings when you take your kids to the park.
why should adults play too?
It relieves stress. Play is fun and can trigger the release of endorphins, the body’s natural feel-good chemicals.
Play can improve brain function. Playing chess, completing puzzles, or activities that challenge the brain can all help prevent memory problems and improve brain function.
Stimulate the mind and boost creativity. Young children often learn best when they are playing, and it’s a principle that applies to adults, too.
Keeps you feeling young and energetic. In the words of George Bernard Shaw: “We don’t stop playing because we grow old; we grow old because we stop playing.”
- Jafarzadeh M, Arman S, Pour FF. Effect of aromatherapy with orange essential oil on salivary cortisol and pulse rate in children during dental treatment: A randomized controlled clinical trial Adv Biomed Res. 2013 Mar 6;2:10. doi: 10.4103/2277-9175.107968. PMID: 23930255; PMCID: PMC3732892.
- Zabetipour, Mohammad & Pishghadam, Reza & Ghonsooly, Behzad. (2015). (PDF) The Impacts of Open/closed Body Positions and Postures on Learners’ Moods Mediterranean Journal of Social Sciences. 6. 10.5901/mjss.2015.v6n2s1p643.
- Carney DR, Cuddy AJ, Yap AJ. Power posing: brief nonverbal displays affect neuroendocrine levels and risk tolerance Psychol Sci. 2010 Oct;21(10):1363-8. doi: 10.1177/0956797610383437. Epub 2010 Sep 20. PMID: 20855902.
- Blessing, E.M., Steenkamp, M.M., Manzanares, J. et al. Cannabidiol as a Potential Treatment for Anxiety Disorders Neurotherapeutics 12, 825–836 (2015). https://doi.org/10.1007/s13311-015-0387-1
- Zou L, Sasaki JE, Wei GX, Huang T, Yeung AS, Neto OB, Chen KW, Hui SS. Effects of Mind⁻Body Exercises (Tai Chi/Yoga) on Heart Rate Variability Parameters and Perceived Stress: A Systematic Review with Meta-Analysis of Randomized Controlled Trials J Clin Med. 2018 Oct 31;7(11):404. doi: 10.3390/jcm7110404. PMID: 30384420; PMCID: PMC6262541.
- Patel NK, Nivethitha L, Mooventhan A.Effect of a Yoga Based Meditation Technique on Emotional Regulation, Self-compassion and Mindfulness in College Students . Explore (NY). 2018 Nov;14(6):443-447. doi: 10.1016/j.explore.2018.06.008. Epub 2018 Aug 2. PMID: 30366832.
- Jansen P, Dahmen-Zimmer K, Kudielka BM, Schulz A. Effects of Karate Training Versus Mindfulness Training on Emotional Well-Being and Cognitive Performance in Later Life Res Aging. 2017 Dec;39(10):1118-1144. doi: 10.1177/0164027516669987. Epub 2016 Sep 29. PMID: 27688143.