Chronic Stress

Over the last few months, I have often found myself doing a mental rewind to March 10, 2020—the day before COVID-19 was declared a pandemic.

Back then, like many of you I imagine, I was going about my daily life—commuting on crowded transit, dropping my kids at school with runny-nosed classmates, thoughtlessly grabbing the un-sanitized grocery cart, having friends over for dinner. We weren’t all the epidemiologists and infectious disease experts we are today. And the pandemic platitudes “unprecedented times”, “flatten the curve”, and “social distance” wasn’t yet the most overused phrases in vernacular history. Neither was the more recent addition, “new normal.”

When we started the phases of re-opening, I wanted to stomp my foot in protest every time I heard the phrase “new normal.” The pandemic was not simply a traumatic moment that passed, it is an extended traumatic period. It is chronic uncertainty on an immense scale, made all the more intense thanks to social amplification on Twitter, Facebook, Instagram, Tiktok, and every news report. Our stress responses have been actively deployed for months already. We may start to experience our body’s backup generators as a “new normal” if we lack awareness of the chronic stress we’re going through.

Here are some strategies to increase your awareness of what is, plus some steps to take to cope with chronic stress:

1. Radical Acceptance

Dialectical Behavioural Therapy (DBT) teaches that pain is always an inevitable part of life but suffering is not. Suffering arises from our judgment about a situation (“It’s not fair”, “Why me?”) and refusal to tolerate a loss of control. Initial reactions like demanding certainty are to be expected. It’s when we get stuck in a place of willfulness and unwittingly direct all our internal resources to resist reality that we become entrenched into the pain we don’t want to be in. This exacerbates chronic stress even further.

Radical acceptance encourages us to simply acknowledge that something painful is happening in our lives at the moment, without judgment. It is recognizing what is, rather than getting caught up with how we think it should be. This does not mean making light of a difficult situation or giving up and doing nothing. Radical acceptance is the first step. By recognizing what is out of our control and what is in our control, we can direct our energy towards change and doing what is most helpful and effective.

This is not a destination we arrive at and the work is done. Sometimes people embrace radical acceptance only to have their willfulness re-emerge and say “No! No! No!”. If we anticipate this happening as part of the process so that we don’t judge ourselves when it does, then turning our minds back towards acceptance comes more readily.

2. Activate the relaxation response

Most people are at least somewhat familiar with the stress response, often just called “fight or flight” or “fight-flight-freeze.” When our brains perceive a threat, this response is automatically initiated. This wakes up the brain and gets the body ready to react effectively. When the threat passes, the stress response extinguishes and the relaxation response helps our bodies recover quickly and return to baseline. 

For most of us, the kind of stress we had before the pandemic was often accumulating over time and passing. Now we seldom come back to baseline but don’t realize it—like a mountain climber acclimatizing to high altitude, what felt like pressure yesterday doesn’t today. The stress response system we have evolved so brilliantly is supposed to be more like a backup generator. There when you need it, but not meant to be on at all times.

The good news is that the relaxation response has an ON switch. By consciously slowing down and controlling our breathing, we can activate it. The relaxation response helps counteract the toxic effects of chronic stress by slowing down heart rate, relaxing muscles, and improving mental clarity. We can’t control stressors, but we can regulate our breathing. Breathing lets us take in the oxygen we need to activate the relaxation response. It is a non-verbal way to tell ourselves we are OK.

While there are many different breathing exercises, box breathing (aka square breathing) is a tool that often works for people who’ve found other breathing exercises ineffective or hard to do. By adding a visual component, it gives your thoughts an external point to focus on, so they stop racing. 

Box breathing is deceptively simple, yet powerfully effective. To practice it, try the following:

• Slowly exhale and release all the air in your lungs for a count of 4
• Pause and keep your lungs empty for a count of 4
• Slowly inhale and fill your lungs for a count of 4 (use your diaphragm muscle and feel your core expanding)
• Pause and keep your lungs filled with air for a count of 4
• Repeat for as long or as little as you need

3. Keep up the self-care 

Stress does not feel good. It can drive us to avoid it with unhelpful behaviours (3 am online shopping, increased alcohol intake, comfort eating). We may recognize that these are not the “right” or “healthy” things to do in the long run but in moments of overwhelm, they are hard to resist. 

The pandemic may be unprecedented, but stress and anxiety are not. That’s why there are lots of tried and true stress reduction strategies. To cope with chronic stress effectively, we need an action plan to boost overall health so we have the energy and stamina to face ongoing challenges. Adequate sleep, hydration, nutrition, physical activity, and time spent outdoors all increase the production of mood-enhancing endorphins and decrease the production of stress hormones (like cortisol) in our bodies. 

While small behaviour changes may seem insignificant, cognitive behavioural therapy (CBT) tells us that our behaviours, thoughts, and feelings are interdependent, meaning a small positive change at one point in the cycle will lead to positive change in the rest of the cycle. 

Try to commit to one small step like focusing on hydration, stretching between activities, or getting more sleep. You may find that your one small step brings other positive effects.                         

4. Bolster resilience with positive self-talk 

Preparing for stressful situations is a way to reduce the stress experienced. Just as an athlete develops a competition plan and visualizes it using mental rehearsal, you can also develop and implement positive self-talk. Self-talk is that voice inside our heads that determines how we perceive situations. It includes our conscious thoughts as well as our unconscious assumptions. What that inner voice says has a strong impact on how we perceive stressful events. If we tell ourselves it’s too hard or we can’t do it, it will be and we won’t. If we change our script to more balanced self-talk, we can consciously choose to think about things more realistically and helpfully.

Try to prepare your script in advance. Focus on what needs to be reinforced to have a less stressful day, and try to go over it and rehearse it until it is second nature.

5. Continue (or start) to reach out for support

One of the upsides of the pandemic is how quickly and creatively therapists have moved to virtual platforms. It has never been easier or more convenient to access support. If your response to the pandemic feels particularly overwhelming, you might consider talking to a mental health professional about what you are experiencing. Even if you have no history of mood difficulties, the collective trauma and chronic stress of the pandemic could lead to anxiety and depression. Here are some of the symptoms of depression and anxiety to look out for: 

• Emotions: sad, hopeless, anxious, angry, lonely, ashamed, worried, overwhelmed, numb confused, panicked
• Physical: fatigue, muscle tension, shallow breathing, increase heart rate, lethargic, increased/decreased appetite, increased/decreased sleep, poor concentration, poor memory, poor focus
• Behaviours: procrastinating, drinking, binge eating, oversleeping, ruminating, avoiding
• Thoughts: I can't handle this, This will never end, Nothing will ever the same again, I give up

This is by no means an exhaustive list. If you are one of the many people experiencing any combination of these symptoms, know that therapy can successfully treat anxiety, depression, and chronic stress.