Newsweek Mental Health - Stress, Distress and Anxiety

Stress, Distress and Anxiety: Real Causes and Real Solutions
Jeffrey P. Kahn, M.D. and Paul Le Schack, M.A.

It seems that stress is everywhere these days. On top of the usual work, family, health, and financial pressures, you'd think there isn't room for the strains of corporate downsizing, two-career families and social problems. Of course, you have to remember that feeling stressed isn't always a bad thing. Stressful situations can help you solve problems quickly, and get your work done on time. But when stress turns into distress or anxiety, it becomes yet another problem. So how can you begin to recognize when stress has become distress, and know what causes anxiety, and what you can do about it? While modern psychiatry understands the causes and solutions of distress much better than ever before, your own self-awareness is usually the best place to start.

Stress Self-Awareness
One reason that stress becomes distress is that often people don't even realize what is happening to them. Self-awareness is harder than it sounds, but you can achieve it by focusing in on your own symptoms. Ask yourself if you are tense, irritable or worried most of the time. Have there been changes in your sleep or appetite? Are you using alcohol or drugs too much, or more than usual? Do you have physical symptoms or pain that your doctor can't really explain? Do friends say that you look worn out or troubled?
Distress can also show up as changes in your relationships. Friends and family seem harder to get along with, or more emotionally distant. Relationships start to feel more troublesome than relaxing. And when that happens, a vicious cycle can start, with everyone pulling further and further away. In a similar way, any daily task at work, school, and home can feel burdensome. Instead of pleasure (or even relief) at finally finishing an imporant business plan or spring gardening project, you experience just more feelings of pressure and disappointment. You can soon end up feeling trapped by anxiety or despair.

Looking For Causes
When you are distressed, start making things better by trying to figure out which problems really bother you. Difficult circumstances are easier to spot than some other things, and there is a long list of unpleasant possibilities. Family arguments, personal illness, drug and alcohol abuse, workplace or career problems, financial setbacks and legal difficulties are just a few examples. Surprisingly, changes for the better can be just as stressful as changes for the worse. A long sought promotion or a wedding are usually welcome developments. At times, though, they can come with lurking fears of disappointment, or hidden penalties.
With any major change for the worse or for the better, distress is further compounded by uncertainty. It's much harder to adjust to change when you don't know what might happen next, or how to start planning for future changes. But understanding the problem often makes it easier to solve.

Problem Solving Skills
Once you've tried to sort out your situation, the next step is to work on problem solving skills. The best skill is talking with concerned family and friends. Someone who shares your concerns can help you to better understand your situation, feelings, and options. Other people can help with their observations and advice. Discovering new options is a major stress reducer. In addition, by just talking to someone you can often figure things out yourself, and sometimes realize the situation isn't quite as bad as it looks.
You might also consider help from support programs, human resource professionals at your job, or religious groups and leaders. Relaxation is another way to sort things out, and it takes different forms for different people. Exercise, music, hobbies, vacation, and even prayer can help.

When Self-Awareness and Problem Solving Fall Short
While self-awareness, problem solving skills and friendly advice are the best way to start, sometimes they are not enough to resolve the problem. For example, you may know what the problem is, but not how to fix it.
Clearly, there can be problems in the workplace itself. Organizational change, difficult people, and falling profits can heighten everyone's stress level. Human resource, Employee Assistance, and outside management professionals can help to alleviate some of the stress, uncertainty and discord.
There are times when serious distress needs more than just self-awareness and friendly support. Psychiatrists and other mental health professionals can help you figure out the problems, and find effective solutions. Make sure that you see someone with broad training and a good reputation. Start with a comprehensive consultation that looks at all the major possible causes of your distress. It may take two or three sessions, but the investment is usually worthwhile. The better the problems are defined at the start, the easier it is to find the most effective solutions.

Hidden Anxiety/Depression
At times, despite your best efforts, distress may be caused by concerns so bothersome that you can't let yourself think about them. When your mind hides the real concerns long enough, the distress can really build up. And if you can't let yourself think about it, it's a lot harder to get yourself prepared. However, once someone helps you figure out the hidden misperceptions, it gets much easier to figure out the solutions.
Even when there are obvious causes for distress, there can also be hidden anxiety disorders. Hard as it is to figure out the life problems that are eating away at you, it's harder still to know when an anxiety disorder is also there. Some clues are intense or prolonged anxiety, various phobias, pronounced shyness, severe stage fright, and obsessional thoughts or compulsive behaviors. Panic attacks are probably the most common anxiety disorder.
The best treatment for these hidden anxiety disorders is usually a combination of good psychotherapy and the right medicine. These stress-filled conditions probably involve different chemical imbalances, and usually respond to specific treatment. Medicine can treat anxiety disorders, while psychotherapy can help you adapt, and understand their causes and effects. Good treatment rarely is a choice between either medicine or psychotherapy alone. Friends, psychotherapy, and medicine work well together, and they all do different things.
When distress and anxiety go untreated for long enough, people can get depressed. Clinical depression is more than just unhappiness, and probably also involves chemical imbalances. Depression usually responds well to the right combination of psychotherapy and the right medicine. Other kinds of emotional symptoms, drug and alcohol abuse, and such medical problems as thyroid disease can also be hidden causes of distress.

Good Help Is Hard to Find
Unfortunately, mental health care is not always what it could be. Even if you have chosen a therapist carefully, you still might not find the progress you had hoped for. Talk with your therapist about your concern, and understand that it takes at least several weeks to start making progress. It is often difficult to talk about real problems, and some medicines don't start working until a month after you start taking them. Good treatment usually requires a comprehensive approach, and an investment of time, money and emotional effort.
If doubts persist, get the best second opinion possible, and then discuss it with your therapist. While basic treatment concepts are straightforward, they are not simple to carry out. Advice isn't always as helpful as it seems. The most effective psychotherapies usually help you to better understand yourself, your circumstances, and your options.
Don't count on a quick fix. Instead, work on recognizing when your stress level is increasing. Know how to handle stress early. And if distress does start building, know how to get the right help on the first try.

Jeffrey P. Kahn, M.D. is President, WorkPsych Associates, Inc., a New York City management and mental health consulting firm. He is also President of the Academy of Organizational and Occupational Psychiatry, and teaches on the psychiatric faculty of Cornell University Medical College.

Paul Le Schack, M.A., is Director of Employee Counseling for Comprehensive Health Services, Inc. He is a certified Employee Assistance Professional, and also an Adjunct Professor at Long Island University, Brooklyn Campus, in their counselor training program.