Some stress is important in our lives to help us cope with certain challenges.  It is a normal physical response to events that may make us feel threatened or upset our balance in some way.  In a sense, stress is the body's way of protecting us. Much like anxiety, when stress is functioning properly, it can help us to feel energetic, enthused and alert.

However, stress can become problematic when there is too much or too little of it. A lack of stress can leave you feeling under stimulated, whilst too much stress can result in a range of health problems, such as: 

• Headaches
• Palpitations
• Panic attacks
• Stomach aches
• Dizziness
• Exhaustion
• Muscle tension
• Hair loss
• Irritability
• Low motivation
• Poor concentration

These symptoms can have an effect on our functioning, mood and behaviours. It can affect our work, relationships and sense of self worth. Feeling stressed can also cause us to experience:

• Low mood
• Weight gain or loss
• Disrupted sleep
• Anxiety
• Fear

People experience stress for different reasons. Sometimes, it can be due to negative factors or events (e.g. loss of a loved one, relationship breakdown, failing an exam) but can also develop as a result of positive experiences (starting a new relationship, beginning university, starting an internship).  Stress can both be acute (e.g. dealing with the loss of a job) and chronic (e.g. existing in a bad relationship)

How can I manage it?

Individuals deal with stress in different ways.  Some people use drink, drugs, smoking, food and denial. Although these may seem to help in the short term, they can exacerbate stress and cause further problems in the long term. There are other ways to deal with/reduce stress which can be beneficial to you:

• Identify the trigger: Sometimes triggers exist without our awareness. Take some time to write down the things in your life which are problematic, or may be causing stress. Is there a practical solution to deal with it? Might there be other ways you can tackle or approach these situations? Are there people who can help?
• Concentrate on the present: Try to concentrate on the here and now. Immerse yourself in the present and try to disengage from past worries or events, or from thoughts about things you do not have control over
• Take a step back: Sometimes, we can get so stuck in the complexities of a situation, it is hard to see the bigger picture. STOP and take a step back.  Try and evaluate the situation from a different perspective. Are there different ways to manage? Devise an action plan which might help you deal with the problem in a step by step fashion.
• Take care of yourself: Sounds simple, but it is something we can easily forget to do. Take time out for yourself, engage in pleasurable activities, socialise with friends and family. Try and eat a balanced diet, and engage in light exercise where you can. Try and be compassionate to yourself, say encouraging words and commend yourself.
• Relaxation: Try utilising relaxation techniques. This can include deep breathing, muscle relaxation, imagery techniques. You can also aid relaxation by getting a massage or relaxation exercise. Yoga and meditation can also be helpful.
• Laugh: Laughter is one of the best cures for stress. Try to engage with things and people who make you happy and distract you. Take part in a comedy show, watch funny movies and shows.
• Balance: Try to maintain a healthy work-life balance - make a list of things you have to tackle during the week, and cross them off as you go along. Reward yourself when you have achieved your goals and completed tasks. Try and engage in an equal amount of pleasurable activities. If it initially feels too difficult to do, schedule some 'me' time in your diary. Much like you would try and attend lectures etc, attend to yourself.
• Manageable goals: Set yourself manageable and realistic goals. Sometimes we take on too much without realising it, or we aspire to unrealistic standards.
• Time management: It is important wherever possible to manage your time. Try and devise a schedule for yourself and compose a list of priorities. Know that if you can't get to everything, it won't be the end of the world, and acknowledge the things you have done well or have been able to complete.
• Communicate: If you are feeling overwhelmed, try and talk to someone about it. It is important not to suffer in silence as this can also exacerbate stress and distort thinking. Talk to a friend, a colleague, a tutor, your lecturer, or a counsellor. They may help you to develop a different perspective and think of practical ways to manage your stress. 

The Student Counselling Service run a Stress Management Workshop. You may find the handout helpful.

Anxiety is a natural adaptive response.  Our body reacts automatically to prepare us for action. Known as the flight or fight response, adrenalin is pumped into our blood streams which triggers energetic, quick reactions and acute reactions. 

The experience of anxiety can range from mild to severe. Severe anxiety can sometimes lead to panic. It is important to note that experiencing some anxiety is normal. In fact some anxiety can be helpful. Examples of when anxiety can be helpful include:

• Writing an exam in forty minutes
• Running a race
• Going on a date

Unhelpful anxiety can occur in situations where the flight or fight effect is not necessary. Examples of these can include feeling anxious in a social gathering or experiencing high levels of anxiety in a work setting.

Anxiety usually comprises an emotional component (e.g. fear), a physiological component ('butterflies', sweating, heart racing, faintness) and a cognitive component (I'll make a fool of myself, something bad is going to happen).

Thoughts associated with anxiety are usually characterised be danger or vulnerability. We can have fears about being embarrassed, humiliated or hurt in some way. In these instances, we may also adopt certain behaviours such as avoidance, overcompensation, perfection, escaping and finding safety mechanisms.

Anxiety can be reinforced and maintained through behaviours and beliefs. For example

• Situation: Feel highly anxious when giving a presentation
• Belief: If I give a presentation or speak in public, I will have a panic attack
• Behaviour: Avoid speaking in public or giving presentations

How do I begin to address anxiety?

Are there particular factors contributing to anxiety?

There may be certain things which may be causing stress and anxiety in your life. It is important to review what these situations/factors are and to think about ways to address these. For instance, it may be you have taken on too much, or are struggling with your academic work. There may be practical solutions to solve these situations, such as devising a manageable work plan, or talking to tutors/lectures.

It is important to try and take care of yourself, through trying top maintain a healthy work/life balance. Try to engage in enjoyable/pleasurable activities as much as try to look after your health through healthy eating and exercise. Surround yourself with supportive people and try to seek support from the services in the university where needed.

Negative thinking

Certain thoughts accompany anxiety and may maintain anxious states. Sometimes, when people feel anxious, thoughts can be distorted by the emotional state they are experiencing. Additionally, when people are anxious, it is not unusual for them to exaggerate the threat of the situation and to underestimate their ability to cope with it. In these instances, although it may be difficult, taking a step back and trying to realistically assess the situation (by modifying thinking) can help to reduce anxiety. Some of these thinking styles include:

• Catastrophic thinking: Catastrophising occurs when one consistently predicts the worst will happen
• Putting a negative slant on things: Focusing on the negative in the situation and seeing things through dark tinted glasses
• Predictive thinking: Predicting how a situation will turn out, usually in a negative manner
• Mindreading: Assuming one knows what others are thinking, usually negative thoughts
• Biased Thinking: Overlooking strengths and focusing on weaknesses, downplaying achievements and underestimating ability to cope

How to challenge negative thoughts

Ask yourself, what is the evidence that this thought is true? Ask yourself, am I being fair or realistic in the way I am assessing this situation?

Example:

• Negative thought: I am going to make such a fool of myself in my seminar. People will notice I'm anxious, and they'll think I'm weak and stupid.
• Balanced thought: I have given presentations before, and they have gone well. Also, it is a topic I know a lot about and others in my seminar have expressed their nervousness at giving presentations, so I'm not alone.

Distraction

When anxious, sometimes it is helpful to distract yourself.  This helps to reduce focus on the fearful aspects of the anxiety provoking situation. Distraction techniques come in different forms such as visualising a calming image, repeating a calming phrase, or focusing on a positive aspect of the situation.

Relaxation

Utilising relaxation techniques can also be useful in reducing anxiety. Breathing techniques are useful in these instances (regulate breathing whilst tensing muscles), as are imagery techniques (trying to imagine a safe, relaxing place and immersing yourself in this scene).  Relaxation classes and Yoga classes may also aid the development of coping strategies in anxiety provoking situations.

Test your fears

One of the most effective ways to overcome anxiety is to challenge the fears underpinning it. This may mean facing anxiety provoking situations and dropping the behaviours one employs when anxious (such as avoidance, over-concentration, over preparation).  Sometimes, we have learned responses to situations, and these need to be modified as a way of eliminating anxiety. For instance, previously, in a social situation, you might have prepared ahead of time what you were going to say and how you would act. By modifying some of these behaviours and giving yourself permission to just enjoy yourself, you may develop a new way to approach social situations because you have evidence to disprove your original beliefs/fears.

Understanding Eating Disorders

An eating disorder may begin as a way of coping with life, which becomes increasingly problematic.  Rather than using food to satisfy hunger a person with an eating disorder will use food as a way of dealing with difficult feelings and thoughts or as a way of coping with stressful events and situations. 

Men and women with eating disorders are preoccupied with food and/or their weight and body shape, and are usually highly dissatisfied with their appearance. The majority of eating disorders involve low self-esteem, shame, secrecy and denial.

Eating disorders range from those that may receive a medical diagnosis (such as anorexia and bulimia), to those that are not formally diagnosable but still cause great distress to many people. This former group of problems may be referred to separately as “disordered eating” problems.

Anorexia nervosa

Anorexia is when someone either starves themselves or exercises excessively in order to keep their weight as low as possible. Anorexia is arguably the most well-known of the eating disorders, but the least common of the main three disorders. It is also the one with the highest mortality rate.  People with anorexia live at a low body weight, beyond the point of slimness and in an endless pursuit of thinness by restricting what they eat and sometimes compulsively over-exercising.

Symptoms of anorexia include:

• severely restricting daily food and drink intake
• engage in excessive exercise to burn off further calories.  
• Having an inaccurately large self-perception of body size
• Being extremely frightened of gaining weight. 

Bulimia

Bulimia involves a condition where someone tries to control their weight by binge eating and then deliberately being sick or using methods of emptying their bowels, such as taking laxatives. In contrast to anorexia, people with bulimia have intense cravings for food, secretively overeat and then purge to prevent weight gain by vomiting or using laxatives.

People who suffer with bulimia nervosa are often a normal weight for their height and build which makes it less likely that the condition is noticed by others, this can mean that the problem can continue undetected for many years. A person with bulimia will binge not because they are physically hungry but as a way of coping or of filling an ‘emotional void’.   

Symptoms of bulimia include:

• being preoccupied with food and feeling out of control around it
• having an inaccurately large self-perception of body size
• skipping meals as a way of restricting calorie intake
• binging on large amounts of fatty or sugary foods
• purging by vomiting, taking laxatives, diuretics or enemas to rid yourself of food
• engaging in excessive exercise to prevent weight gain

Binge Eating Disorder

Binge Eating Disorder is a pattern of disordered eating that is the most common of all eating problems. It is similar to bulimia in that sufferers feel compelled to binge, but there is no subsequent purging action to rid the binged food, resulting in problems with being overweight or obese.

Unlike compulsive overeaters, a person with binge eating disorder will eat constantly throughout the day, eating when they are not hungry but feeling unable to stop.  As with bulimia, this is due to use food as an attempt to deal with unpleasant emotions. 

Symptoms of binge eating disorder include:

• feeling out of control around food
• the inability to stop eating, even when full
• feeling embarrassed about the quantities of food eaten

Acknowledging that eating is a problem

The first step in treatment is to acknowledge that eating is a problem and that food is being used to manage difficult feelings. If you are struggling with eating problems, you will have to want to change your life to give up your illness. Ambivalence – which is part of the process but can be overcome to help overcome an eating problem.  This is done by acknowledging the unhealthy thoughts that resist help.

Support Groups

Beat (Eating Disorders Association)

Beat provides online support as well as a helpline combined with a network of UK-wide self-help groups to help adults and young people in the UK beat their eating disorders

Telephone Helpline: 0845 634 1414
Email helpline: help@b-eat.co.uk
Website: www.b-eat.co.uk

The BEAT website provides online help and support including live chat and message boards. You can also check to see whether there is a support group in your area. 

Anorexia & Bulimia Care (ABC)

Anorexia and Bulimia Care (ABC) has 22 years of experience as a UK national eating disorder organisation.

Sufferer's Helpline: 01934 710679
Parent Helpline: 01934 710645
Website: www.anorexiabulimiacare.org.uk

Provides information and advice to sufferers and their families.

MGEDT (Men Get Eating Disorders Too)

This organisation works to raise awareness of eating disorders in men.Their website provides information about male eating disorders and also has an online forum.

Website: www.mengetedstoo.co.uk

Medical Information

National Institute for Health and and Care Excellence (NICE):

The NICE eating disorders clinical guideline covers physical and psychological treatments, treatment with medicines, and what kinds of services best help people with eating disorders.

NICE Website: https://www.nice.org.uk/guidance/ng69

King's College London  (KCL) Eating Disorder Toolkit for carers:

Website: https://www.kcl.ac.uk/ioppn/depts/pm/research/eatingdisorders/resources/toolkit-for-carers-feb3-09.pdf

Books

Eating Disorders: The Path to Recovery by Kate Middleton
Cognitive Behaviour Therapy and Eating Disorders by Christopher Fairburn
Care for a loved one with an Eating Disorder – The New Maudsley Way by Janet Treasure and Grainne Smith
Eating Disorders for Dummies by Susan Schulherr
Getting Better Bit(e) by Bit(e): A Survival Kit for Sufferers of Bulimia Nervosa and Binge Eating Disorders by Ulrike Schmidt and Janet Treasure

As individuals, we may experience low periods from time to time. Naturally, our mood varies and we may feel under the weather, fed up or experience periods of sadness for a variety of reasons.

However, this differs from clinical depression, which is more intense, lasts for a longer period of time and can severely affect day-to-day functioning, relationships, self-esteem and work. Depression can be experienced by any individual at any point in their life, so it is important to remember you are not alone in experiencing this.

Depression can include a persistent low mood and a loss of interest or pleasure in life. Other symptoms which may be associated with depression include:

• Disrupted sleep patterns

• Loss of appetite

• Increase in appetite

• Persistent low mood

• Low motivation

• Decrease in energy levels

• Feelings of worthlessness or hopelessness

• Reduced sexual drive

• Negative thoughts and beliefs about oneself, others and the world

• Feeling irritable, short-tempered, tearful, angry or deflated

• Anxiety

It is important to note that some people may experience some or all of these symptoms for a brief period of time, and this may or may not be symptomatic of depression. An individual who is depressed will experience these symptoms for a persistent period of time.

What causes depression?

Depression can be a response to an event or situation which seems particularly difficult, distressing or threatening. Sometimes these situations can seem unmanageable or 'unfixable' and can trigger feelings of hopelessness.

Sometimes, depression may not have an apparent trigger and could be attributed to hormonal and chemical changes in our bodies. Conversely, it may be that depression is experienced as a result of a past event which may not have been processed and resurfaces at certain periods of our life.

Depression can also be experienced following the end of a relationship, disappointing outcomes in academic and personal life, loss of loved ones, or the occurrence of major changes in one's life. Whilst it is natural to experience feelings of sadness, as mentioned before, it is important to seek help if the symptoms are intense, persistent and affecting day to day functioning.

What maintains depression?

Negative thinking

Individuals who are depressed think in particular ways which may be taken as absolute truths. They may have negative thoughts about themselves, others, the world and their situation, often thinking that things will never change and everything is hopeless. Negative thoughts can affect the way we feel and behave; these maintain depression by affecting perception and exacerbating symptoms.

Examples of these negative thoughts include:

• 'I'm a failure; I can never get anything right'

• 'People dislike being around me, I'm not fun to be around'

• 'I'm unlucky; the world is a dark, gloomy place'

• 'I'll never amount to anything, I'll never succeed' 

Behaviours

Often, when we are depressed, we can engage with certain behaviours which may exacerbate or maintain the way we feel. These behaviours can include:

• Isolation: When an individual feels depressed, they may isolate themselves from others. A common concern depressed individuals have is 'I don't want to bring others down or have the way I'm feeling affect them' Other thoughts may be 'Others don't care about me' or ' Nobody wants to be around a depressed person'

• Avoidance: Similarly, avoidance of situations can be common in depression, especially if it seems too difficult or overwhelming to engage with.

How do I begin to address this?

As mentioned before, depression is experienced by many individuals, and there are some steps one can take and things one can try which can help to lift depression. These involve addressing some of the maintaining factors of depression

Modification of negative thinking

Often, individuals who experience depression engage in unhelpful or distorted thinking. They may adopt certain thinking patterns/styles which affect the way they feel and the way in which they engage with certain situations. In these instances, it is helpful to begin to develop a balanced way of thinking through challenging negative thoughts and developing a different perspective:

Become aware of your negative thinking: It may be useful to keep a thought log, particularly at times when you are feeling low. This will help to increase awareness of negative thought patterns

Recognise thought patterns

It is important to recognise that sometimes, the thoughts we have about ourselves, others or particular situations may be distorted and unfair perceptions. This is even more prevalent when one is experiencing depression. In these instances, it may be useful to learn how to challenge these thoughts so that thinking is more balanced. An example is given below:

• Situation: Friend walked by without saying hello.

• Thought: She ignored me because she does not want to be around me.

  Alternative/Balanced Thought: She was on the opposite side of the street and may not have seen me. She also might have had a lot on her mind and did not notice me. I saw her two days ago and she was very attentive and caring. She did tell me she had several interviews to attend this week.  

• Situation: Receiving feedback from manager

• Thought: I can't ever get anything right. I am such a failure

  Alternative/Balanced Thought: Although my manger pointed out that I needed to improve in an area, she also emphasised my enthusiasm and hard work. I can get help for the areas I need to improve in, and feedback for my work has been consistently good in the past.

Sometimes, it may be difficult to challenge these thoughts on our own. Talk to someone you trust, or speak to a counsellor who can help you to balance your thoughts.

Changing your behaviours

Sometimes, when we are depressed, it may be difficult to find pleasure in things we used to do or engage with people.

As a starting point, it might be useful to engage in small, enjoyable activities which can help to elevate mood and help to gain a sense of achievement. Exercise is a good example of this, but it is important to tailor these activities to your preferences and interests.

It is also important to pace yourself when completing tasks. Set yourself manageable goals, and break each task down into steps or chunks. Also, start by completing easier tasks and work your way up to the more difficult ones. Track your progress.

Give yourself permission to do less. You don't have to do everything all at once. Take your time and reward yourself/acknowledge when you have achieved a personal goal

Try to engage with people and situations as much as you can, but again, pace yourself. Reducing isolation and avoidance is important to overcoming depression

Utilise your support network. Talk to people you can trust and who are supportive of you.

Further support

You may also find the Students Against Depression website helpful. 

Books

Mind over Mood by Christine Padesky and Dennis Greenberger
Beat Depression and Reclaim Your Life by Alexander Massey
Feeling Good by David Burns
Overcoming Depression by Paul Gilbert
Overcoming Mood Swings by Jan Scott

Low self esteem is having an overall negative view of yourself, judging oneself, or placing a negative value on oneself as a person. People with low self esteem may: 

• Have deep rooted negative beliefs about themselves/identity:  Such as 'I'm not good enough' and 'I'm unlovable'. These types of beliefs are taken as fact rather than being recognised as opinions they have of themselves.

• Frequently criticise themselves: They may put themselves down frequently, or joke about themselves in a negative way. They may also constantly blame themselves when things go wrong or doubt themselves

• Ignore their positive qualities: People with low self esteem may not accept compliments, instead, attributing their achievements to good luck or downplaying them/brushing them aside. Additionally, they may focus on what they didn't do or haven't achieved, and mistakes they may have made.

• They may also experience emotions such as anger, frustration, sadness, anxiety and may feel depressed, guilty or ashamed

Their feelings and beliefs about themselves may impact on their relationships and work, their ability to engage in activities and their personal care. They may isolate themselves, become upset or distressed by criticism, or always try to please others. They may be unable to stand up for themselves in their interactions with others; conversely they may be overly aggressive in their interactions with others.

Low self esteem can be maintained by a number of factors

Negative thinking: People with low self esteem may adopt unhelpful thinking styles which maintain their low sense of self worth. They may focus on the negative aspects of a situation and ignore the positives. They may also anticipate the worst possible outcome, or place blame on themselves when things go wrong.

Unhelpful behaviours: Certain behaviours we adopt may worsen or maintain low self esteem. These may involve avoidance of certain situations due to negative beliefs one might hold.

How do you begin to address this?

Low self esteem is commonly experienced by many individuals, and the good news is, we develop healthier self-esteem through many different avenues. As a first step, it might be helpful to talk with someone to make sense of your individual experience and think together about ways to address this. There are also some tips one can adopt to begin the journey to healthier self esteem:

• Start with a list of positive qualities: Whilst this may initially be difficult to do, try and list all your positive qualities, no matter how small or insignificant they may seem.  You can ask yourself questions such like 'What positive characteristics do I have? 'What are some skills or talents I have?' 'If someone shared my identical characteristics, what would I admire in them?'

• Maintain a positive 'you' journal:  In a positive 'you' journal, note down daily examples where you have demonstrated the positive qualities you have listed above. Start to notice your qualities on a daily basis

• Challenge unhelpful thinking:  You can do this by utilising thought diaries, question unhelpful thinking, and try to develop an alternative more balanced approach. Ask yourself 'Am I being fair to myself in thinking in this way?'  'What might be a different way I can think about this?'

• Adjust Beliefs: Try to develop more balanced beliefs and behave in ways which support these new beliefs. For instance, developing a belief of 'I am good enough' might correspond with more compassionate behaviour such as asserting yourself in interactions with others.

• Engage in enjoyable activities: Try new things, try to engage in hobbies and interests which allow you to explore your identity and elevate your mood

• Take care of yourself: Try to do nice things for yourself, be considerate and compassionate to yourself.

• Test your fears: Avoid 'avoidance' and isolation, approach situations with an open mind.  Try and engage with life, live in the moment, and take note of the small steps you make.

Books

Overcoming low self esteem - a self-help guide using cognitive behavioural techniques by Melanie Fennell
Self-esteem bible: build your confidence day by day by Gael Lindenfield