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All you need to know about stress – in adults and kids

By: Katie Roberts

We all make New Year’s resolutions that eventually fizzle out – hands up if you’ve already broken a no-alcohol vow; but this is one pledge that we really should abide by. Stress is a word thrown around flippantly, but managing and minimising stress is something positive we can and should do for our health, relationships and career. To start the year on an optimistic note, we asked some local specialists about the impact of stress on the mind and body, and advice on what changes to make.

Your pulse races, the breath shortens, blood pressure rises and the body is flooded with cortisol and adrenalin. Whether it’s after a run-in with a taxi driver, the kids misbehaving or a bad meeting with the boss, this fight-or-flight response is our body’s natural mechanism to meet life’s challenges, big and small.

Stress can affect your daily life

Expat afflictions
Expats on international postings can be stressed by different factors from those in their home country. For some, it’s a more demanding career involving frequent international travel and late-night conference calls. Jessica Lamb, Assistant Director and Counsellor at The Counselling Place, explains this it can feel impossible to manage everyone’s expectations and that this can put pressure on family relationships.

“Downtime can be infiltrated by work demands,” she says, “making it hard to switch off, relax and focus on family activities. “Non-working spouses often face the pressure of ‘single parenting’, while helping their family to adjust to the transition and making the adjustment themselves.

“For some who have previously had a career, there may be an identity crisis along with the ups and downs of making friendships and building up a support network in the expatriate community.”

The competitiveness of expat life adds to the pressure. People feel obliged to make the most of their overseas posting by earning more, progressing professionally, exercising, living a healthy lifestyle and socialising. Children often experience academic and social pressure, which can be compounded by missing family and friends. And, although Singapore is very westernised and largely English-speaking, there are still cultural differences that, while interesting, can be testing on occasions.

Stress Trivia
1. Stress has only been recognised recently as a phenomenon. Scientist Hans Selye coined the term in the 1940s, and here’s how he described it: “Stress, in addition to being itself, was also the cause of itself, and the result of itself.”
2. Stress is one of the few English words to appear in languages that don’t use a Romanised alphabet script.
3. In Chinese the symbol is made of two characters, one for opportunity and one for danger.

It's hard to break the cycle of anxiety alone sometimes 

Boiling point
Jessica says alarm bells should ring when you feels overwhelmed. “Symptoms include preoccupation, a lack of focus on the present, over-thinking and worrying, mental exhaustion and a lack of enjoyment of life, irritability and high sensitivity to criticism. There may be a focus on the negative and an inability to enjoy activities that were previously enjoyed. Other reasons for concern include unhealthy coping behaviour such as addictions, isolation, over-eating or under-eating.

“People often place very high expectations on themselves and, while many expats are high achievers with successful careers, their efforts can be undermined by irrational negative beliefs such as ‘I have to be perfect’, or constantly trying to prove themselves because of a deep-down insecurity.”

A qualified counsellor can help identify stress triggers. “Making changes in one’s life, or shifting unhelpful beliefs and expectations, can relieve stress and enable a person to manage their life and life pressures in a healthier way,” she advises.

Jessica also suggests stress mitigation techniques that can start immediately:

Learn to relax and self-soothe. Deep breathing exercises, visualisation, meditation and exercise can all help. Work on time management. Structure your lifestyle into manageable chunks and give yourself permission for recreational activities and free time.

Stress and kids
Children find stress much harder to articulate but demonstrate behaviour similar to that of adults, such as irritability, agitation, worry and over-thinking. They may also withdraw, experience disturbed sleep, start wetting the bed or appear anxious and clingy. They may complain about physical symptoms such as stomachaches, headaches, loss of appetite or nausea.

Let it go
Clinical hypnotherapist Nancy Ho, from the Regional Hypnosis Centre, believes the underlying factor behind much of the stress that people experience is fear. “Fear comes from our thoughts, especially the ‘what if’ thoughts. These thoughts create negative emotions which trigger subconscious thoughts,” she says. As many of us know, our worries and anxieties can be magnified a thousand times by constantly rehashing and replaying them in our mind – sometimes consciously and sometimes unconsciously – and it can become overwhelming if this persists.

Nancy says unchecked mental stress has negative consequences, sometimes resulting in physical symptoms and even psychosomatic illnesses. While some people view hypnotherapy sceptically, much research has shown it to be successful in behaviour modification and change.

“Hypnotherapy is a safe, effective and practical way to work with the mind directly. While in a hypnotic, trance-like state, people are calm, focussed and often more receptive to suggestion,” says Nancy. She believes hypnosis unlocks subconscious information, such as our fears. “Finding the root cause, especially the fear factor, is the first step to deprogramming and then reprogramming the subconscious mind to deal with the fear, instead of perceiving it as a ‘sabre-toothed tiger’.”

Nancy reinforces her work by teaching patients self-hypnosis techniques to help them relax mentally. Using positive affirmations helps people remain optimistic. “I believe having a positive mindset can help people to view and deal with their problems as situations, rather than as life-and-death issues,” she says.

There are ways to try and stress less 

The next time you are feeling stressed, try this:

  1. Focus on the moment. Ask yourself: Will this really matter in two or five years’ time?
  2. Keep the situation in perspective. A child’s daily spelling mistakes may be inconsequential when children in the Philippines have lost their schools in a typhoon. Gratitude for what you have can mitigate stressful thoughts.
  3. Breathe. Even if you can’t close your eyes, perhaps because you’re driving, take 10 deep breaths. Try to relax the muscles in different areas of your body as you do so.
  4. Look at the situation from a different point of view. There’s a flipside to every situation, and perhaps even a hidden opportunity if you open up your mind.

Unlocking the spine
Stress is the most prolific problem that Dr Lynelle Kerr sees at her private practice, Innate. But despite the signals, she says, people don’t often identify their problems as stress. “Often, during a consultation the high-achieving, type-A people say, ‘I’m not stressed, but I have some physical symptoms going on and I can’t sleep’. I say, ‘Are you stressed?’ They often say, ‘No’.”

But, Lynelle says, deeper discussion reveals a stressful lifestyle that requires juggling a career, intensive travel and family. “Even high achievers complain they are not enjoying life, despite their apparent success. They say they don’t feel calm, they lose patience quickly, feel on edge, can’t switch off, feel unhappy and are not enjoying life,” she says.

 “People wonder why they have physical symptoms, such as sciatica, headache, tension and poor posture. I believe lifestyle and stress are strongly connected, and this is manifesting itself in physical, emotional and cognitive symptoms.

“When the body is chronically stressed the brain simply disconnects, so the body cannot feel the effects of the stress and it can’t switch off,” she says. The sympathetic nervous system (which mediates the neuronal and hormonal stress reaction commonly known as the fight-or-flight response) gets flicked on permanently. “When people are in that state it is exhausting: their muscles are tense, their brains are racing, they are hyper-functioning and very tired, but at the same time they can’t sleep.”

Lynelle trained as a chiropractor, but practises her own method that uses light spinal touches. “The spinal cord is a link between the brain and the body and I work with people at this core level to improve that connection.” She believes in waking up the spine and coaxing the brain into a parasympathetic state (which promotes maintenance of the body at rest). “When the spinal cord is free of tension and functioning more effectively, people regain the flexibility and plasticity of their nervous system response.

“Once this happens they are equipped to switch the stress response on and off. When necessary, they can function at a higher level, but are able to switch that off and return to the baseline relaxation state,” she says. “If the body can interpret the stress factors more effectively, then people can have a different experience of stress. Rather than being victimised by it, they can use it to their advantage and thrive under it.”

Lynelle says that once people feel their bodies relaxing and can distinguish between stress and ease, they start to say, “Wow, I was stressed after all and I didn’t know it.” 

Now for some good news
In a recent TED talk, health psychologist Kelly McGonigal examined new studies which show that how you view stress can change how it affects your body. People who worry about the impact of stress are worse off, according to the health statistics. Hear what she says about rethinking stress and stress mindsets on the fabulous TED website.


Heart to heart
Acute stress can cause an increase in heart rate and blood pressure, while chronic stress can also raise blood pressure and make the body more fatigued. Dr Reginald Liew, senior consultant cardiologist at The Harley Street Clinic Heart Specialists answers some questions about the impact of stress on that essential organ, the heart.

How does stress affect the cardiovascular system?
Stress can impact either indirectly or directly. For example, stress can cause blood pressure to increase (either suddenly in cases of acute stress, or chronically with persistent stress) which can put extra strain on the heart and increase the risk of a heart attack or stroke. Chronic stress can also cause persistent elevation of stress hormones such as adrenaline and cortisol, or cause chronic inflammation, which can increase cardiovascular risk.

How do repeated episodes of acute stress cause damage?
Acute stress is short-lived. Once the situation is resolved, the stress usually diminishes. It can be beneficial and create motivation, helping people focus on completing a task before a tight deadline. On the other hand, acute stress may actually be detrimental, worsening anxiety and impairing one’s ability to deal with the problem at hand.

Repeated episodes of acute stress can cause repeated high surges in blood pressure, which can put extra strain on the heart and circulatory system. If a person has an underlying abnormality of their brain circulation or other pre-existing heart problems (such as underlying coronary artery disease), acute stress could be the trigger for a heart attack or stroke.

Repeated stress can also cause damage in other ways, leading to fatigue, anxiety, palpitations or sleeping problems.

Are there any known links between stress and cancer?
There is no firm evidence linking stress with cancer. However, associations between the two conditions may be due to the behaviours adopted by stressed people, such as smoking, over-eating or drinking alcohol, which may increase their risk for cancer.

What lifestyle changes do you recommend?
General lifestyle advice includes eating healthily, minimising fat intake, limiting alcohol, stopping smoking, and exercising regularly. Also, it’s advisable to identify the stressors and try to avoid them.

Yes, I can do this! It's going to hurt, but I can do this! 

10 long-term ways to manage stress
1. Be realistic about what you can do
2. Plan your time, commitments and activities
3. Eat a healthy, balanced diet
4. Think positively
5. Make time for yourself
6. Spend time with family and friends
7. Exercise
8. Learn some relaxation techniques
9. Get enough sleep
10. Space the major changes in your life

Relationships suffer when we mentally suffer

Baby blues
Despite decades of international research, the relationship between stress and fertility in inconclusive. One thing is certain: attempting but not succeeding to become pregnant can be a big cause of stress for many couples. Dr Kenneth Wong is a consultant obstetrician and gynaecologist at The Obgyn Centre. He says stress may affect couples who are frustrated by failed attempts to conceive naturally and, where there is no concrete cause for infertility, by the hurdles of undergoing unassisted conception.

Dr Wong reports a rising incidence in stress-related symptoms, especially with the growing awareness of conception techniques, both natural and artificial. It’s accepted that couples should continue to try for one to two years before concluding that they may have a problem with natural conception.

But, he says, more women are resorting to artificially assisted reproduction to escape the stress of timed conception, even where a cause of infertility has not been established.

“Ironically, such unrealistic expectations and even the treatments themselves often increase stress levels, which in turn may compound the problem,” he says.

Some research has suggested that pregnancy is more likely to occur naturally during months when couples are reportedly more relaxed. But the issue is cloudy for the success of fertility treatments, current evidence suggesting that the success of fertility treatments is not affected by emotional distress.

“This is likely to be due to the fact that for couples with an established cause of infertility there is a high chance that a medical fix can overcome the problem. However, for couples with unexplained infertility, some doctors still believe that the effects of stress could be significant,” says Dr Wong.

As for the impact on the female reproductive system, some doctors believe that hormones like epinephrine and cortisol remain high during periods of chronic stress, which could reduce blood flow to the uterus. In contrast, lower stress levels may increase blood flow or enhance proteins in the womb lining, which may facilitate implantation.

“In some studies, acupuncture has been shown to enhance success rates of IVF procedures, and some centres are currently researching the effect of massage therapy. My advice is to look at your own schedule; find time for breaks and relaxing activities which provide respite from everyday life.”

Ah, the attack of the invisible spot 

Skin Deep
Dr KS Lim is a consultant dermatologist and medical director at The Dermatology Practice. He says the most well known effects of stress on skin are acne outbreaks, hair loss, hives and eczema flare-ups.

“It’s known that stress can cause a surge in hormones, weaken an individual’s immune system and even alter the hair-growth cycle,” says Dr Lim. To combat acne outbreaks, he suggests a balanced lifestyle with more sleep, exercise and water; severe cases may require a course of oral medication. For hair loss, again a healthy diet is recommended and special shampoos and lotions which minimise hair loss and stimulate hair re-growth can be prescribed. In patients with eczema, skin moisturisers and antihistamines are prescribed to relieve the itching.

Lifestyle factors are important. While it’s easy to tell patients to take it easy and not to stress, that may be difficult to do in our modern society. “Distraction techniques for patients who tend to scratch their skin incessantly, like using a squeeze ball, can help. Our skins are also improved by not smoking, not drinking too much alcohol and eating a better diet,” says Dr Lim.



6835 9538

Regional Hypnosis Centre
6272 7118

The Counselling Place
6887 3695

The Dermatology Practice

The Obgyn Centre
6235 4188

The Harley Street Clinic Heart Specialists
6472 3703

The Harley Street Clinic Heart And Cancer Centre
6694 0050