At a time when all life’s challenges have been amplified by the pandemic – and awareness of burnout, at home and at work, has never been higher – stress might seem to be our baseline condition. For most of us, these periods of pressure pass relatively quickly. Even serious stress can be temporary and, given the chance to recover, we usually will. “But emotional resilience won’t solve everything,” says Rachel Boyd, from the mental health charity Mind. “Some of the causes of stress are very challenging to cope with, even when we feel OK.” Many of our everyday challenges have been amplified by the pandemic and its consequences for the economy and society. Those living with financial hardship, health conditions, or caregiving responsibilities, in particular, may feel there is no end in sight. But even if stress seems essential to your circumstances and you don’t have the option or the resources to change them, there are ways you can support yourself. Take your stress seriously Short-term bursts of stress can be weathered without a negative impact and can even be productive, says Victoria Zamperoni, senior research officer for the Mental Health Foundation. “But if stress is really intense, frequent or chronic, that’s when you see it having knock-on effects … and the threshold will be different for everybody.” Harvard University’s Center on the Developing Child distinguishes between positive, tolerable and toxic stress (the terms refer to the effects on the body, not the stressful event or experience itself – though questions of context, intensity and duration are relevant). Toxic stress response can result from strong, frequent or prolonged adversity without adequate support – and the health effects can accumulate and last for a lifetime. When your situation is so overwhelming, protecting your wellbeing can seem irrelevant or even impossible. But it’s important to take whatever steps you can. Ongoing stress can cause or exacerbate many serious health problems including cardiovascular disease, high blood pressure, heart disease and heart attacks, and stroke. It impairs your memory, thinking and judgment in the present, and has been linked to developing depression, anxiety and perhaps even Alzheimer’s disease. “Stress is a really important physical influence and it deserves to be taken seriously,” says Zamperoni. “If someone is struggling, they should reach out for help.” Be aware of the bigger picture “Stress is often a legitimate response to difficult circumstances, that no amount of resilience or self-care can overcome,” Boyd says. Much prolonged stress is a product of poverty, financial struggle and health conditions and exacerbated by cuts to benefits and support services. So any discussion of ways to cope must acknowledge that the solution lies in structural societal change, such as welfare reform, more protective labour laws and more support and resources for caregivers. Middle-aged women, in particular, shoulder the burden, often working full-time while also caring for young children and elderly parents. “It’s unfair to put all of the responsibility for staying healthy on the individual,” says Zamperoni. “At the same time, that social change is often slow – so people do need resources they can draw on in the meantime.” Find solutions that work for you Everyone’s experience of stress is different, says Zamperoni. “Stressors can vary by your environment, your past and present, and the social or economic situation you find yourself in.” Even genetics inform our stress response, meaning other people’s strategies won’t necessarily help you; the key is to come up with your own. Public Health England’s Every Mind Matters online tool helps people come up with a personalised “mind plan”. “You could say, ‘I’ve got to learn to cope’, but there are specific things that will help you,” says Paul Gilbert, a clinical psychologist and the founder of the Compassionate Mind Foundation. “What’s going to help you with your elderly relatives is not going to be what’s helpful on a Covid ward. Different stressors require different solutions.” Try to approach your stress with curiosity: what triggers it and what makes you feel better? Boyd suggests taking time to reflect on your specific experiences, either alone or with a friend. “You might be surprised to find out just how much you’re coping with at once.” Don’t underestimate the basics We all know the importance of movement, nutrition and sleep, but it’s not always easy to do something about it, especially when resources are stretched. In desperate circumstances, these might seem like simplistic solutions. But they can either exacerbate your experience of your circumstances or help you to cope. “A good night’s sleep makes a world of difference, which sounds like a pat thing to say – but it really does,” says Zamperoni. As stress is partly physiological, says Gilbert, paying attention to physical health is relevant to regulating our response. Even breathing matters: “Get your body into a position where it’s much more grounded.” If just the thought of taking this on is overwhelming, Boyd suggests only doing what feels comfortable, and taking small steps at a time: “Pick one or two things that feel achievable at first, before moving on to try other ideas. Something as simple as looking after an indoor pot plant or counting the birds you see from your window can help.” Establishing a daily routine adds to a sense of control. If making time for sleep or exercise feels self-indulgent when others are depending on you, reframe it as what you need to do to be an effective provider or caregiver for them. Surround yourself with support Not only does asking for help lighten your load, it will make your situation feel more tolerable. Individuals’ biological response to stress is moderated by genetics, over which we have no control – but also the availability of supportive relationships, which we do. The feeling that other people care about us activates the brain’s “soothing system” for managing stress, says Gilbert. Even if it’s not possible for us to remove ourselves from the stressor, we can still access a sense of “social safety” by turning to people for help, “rather than just trying to deal with the threat yourself,” says Gilbert. A 2018 systematic review of coping strategies in caregivers found that problem-focused responses – steps to change the relationship between the person and their environment, such as those that reduce time and labour – were associated with less psychological distress and more positive outcomes. Even talking about your stress with a trusted friend will alleviate it. “It’s why, if you’ve got something a bit scary to do, such as going to hospital, having somebody come with you makes you more able to cope,” says Gilbert. Carers UK suggests joining a local support group to connect with people who are dealing with similar challenges. Its online forum also allows anonymous exchanges for those who feel uncomfortable about sharing publicly. Manage your ‘internal entrapment’ You might not be able to escape or change your situation, but you can manage the feeling of being trapped by it. “Internal entrapment” is the tunnel vision that comes from repetitive negative and self-critical thinking, warping perception and worsening our experience of stress. “What sometimes appears to be the stressor isn’t,” says Gilbert. We may even be undermining ourselves with self-talk: “What are you trapped with in your own mind? Do you live in your mind as a compassionate, supportive, empathic, validating self? Or when you experience threat, do you start to criticise yourself and put yourself down?” Whatever your situation, treating yourself with compassion will support you. Gilbert suggests taking whatever breaks possible from your stressors, doing breathing exercises and practising acceptance. “If you tell yourself you can’t cope, it just adds to your stress, rather than saying: ‘OK, this is a difficult situation, it’s not my fault, I’m going to find a way through.’” Understanding the bodily processes at play can also help to put stress into context, Gilbert says. “It’s not something wrong with your decision making, or that you’re just not up to it.” Allow the emotions, but not the spiral Understandable feelings of frustration, such as about making a mistake or not getting a job, can often escalate to a sense of: “I’m useless”, “Nobody’s ever going to want to hire me”. “Deal with the emotion without then having the second hit of self-criticism,” says Gilbert. The three to become familiar with are anger, anxiety and grief. Some stress may result from permanent life changes, says Gilbert: “If you learn to deal with the ‘big three’, it helps you to come to terms with them.” Likewise, emotional avoidance is an established risk factor for poor mental health. A recent UK-wide study of health and social care workers, exploring the toll of working through the pandemic, found that those who had positive coping strategies had higher levels of mental wellbeing, a better quality of working life and lower rates of burnout. There was an especially strong association for “active coping”: applying your available internal resources to controlling a stressor. Those who reached for negative coping strategies had poorer outcomes, says Paula McFadden, the study’s principal investigator and a senior lecturer in social work at Ulster University. “Things like venting can be therapeutic for people but if it’s ongoing, it also contributes to wellbeing decline.” The study also revealed an association between burnout and self-blame: “That’s an unusual one in a pandemic, with it being out of our control.” Do the most helpful thing Practising self-compassion is not necessarily comfortable or easy at the best of times, says Gilbert. “People often say, ‘It’s about being kind to yourself.’ Well, sure, but the key is how you find the courage and the wisdom to deal with your situation … rather than doing the things that will temporarily make you feel better.” Courage might be needed to leave a relationship, or care for an elderly parent, while it takes wisdom to recognise what can be let go, or what to do next. Both may take time to develop, says Gilbert. But sometimes the next step is about asking yourself: “What would be the most helpful thing?” It might be going to bed early enough to get a good night’s sleep – or accepting that you haven’t had enough sleep and are not fully functioning as a result. Shift workers often have to learn how to cope with being tired, says Gilbert. The key is to be clear about the best way to manage your body and mind to get you through, “and not doing things that make it more difficult.” “Sometimes accepting that there are some things happening to you that you probably can’t do anything about right now, will help you focus your time and energy more productively,” says Boyd. “If you feel prevented by your circumstances … it can help to focus on the areas where you do have some choice and power.” Explore your options at work If your stressors are not work-related – and even if they are – your employer may be able to do more to help. The Ulster University study of health and social care workers emphasised the important role of employers in supporting staff through the pressures of the pandemic, and helping them to recover. “People had so many additional pressures in their personal life, they found it sometimes impossible to juggle home schooling kids, caring for elderly relatives and trying to hold down their jobs,” says McFadden. “If employers allowed them to work flexibly, that helped them to cope with their stress at work.” If pressures in your family life could be alleviated by changes to your work patterns, it is worth raising that with your manager – as is the provision of any technology or equipment that would make it easier to work from home. Employers, meanwhile, need to take the initiative by making systemic changes to support staff to take breaks and holidays, to create pathways to expert psychological help, and to make available opportunities for extra recovery time, if necessary. The study showed that even relatively straightforward things, such as clear lines of communication and face-to-face time with managers and colleagues, made a difference to people’s work-related wellbeing and ability to manage stress. “Even if only virtually, connection really matters,” says McFadden. Indeed, the first step to managing the impact of working with long-term stress is to focus attention on what we can do as individuals to support ourselves, and what will work against us. “This is about employers and employees listening, so there is a shared understanding of what the workforce needs to do to help them.” In the case of the health and social care sectors, more funding is what is needed, the study concluded. But as the pressures from the pandemic continue, it is especially vital that we recognise that we are not operating in a vacuum and do what we can to support the workforce and each other. “It’s a really important message to employers, and to employees,” says McFadden. “Create the circumstances where people can adopt these ways of coping.”