e. Eating disorders (blog 5): Coping with stress

Life can be stressful!

You may have noticed that already.

But, life is hard for everyone.  Not just you.  Life hasn't singled you out - fortunately - and decided to make your life especially difficult.

Every person suffers through hard times during their lives.  The details of their suffering may be different from yours - but life is, at times, painful and sad and unfair and lonely and scary and disappointing and really hard - for all of us. 

I know this for a fact - as  I've been a medical doctor for over 26 years and, as a doctor, I've been privy to the personal stories of tens of thousands of people.

Patients leave my office and, as they walk out my door, they reattach  their 'social masks'.  These masks smile out at the world but, underneath, people struggle with problems in their lives, painful memories, sadness, and all sorts of other difficult emotions and issues.  Yet, to the world looking on - to you watching these people as you walk to work or as you pass them in the shops - they mostly appear to not have a care in the world. 

I know otherwise.

I'm telling you this so that you don't feel alone in the world with your problems and stresses - either in the past, present, or future. 

Even that person you know who professes to 'have it all':  a lovely house, a lovely job, a lovely family, a lovely cat, a lovely car, a stack of lovely friends  … lovely lovely lovely … happy happy happy …  Well, if that person tells you that they 'honestly' have never had any real problems or worries during their life - ever - then they are lying!
 
Fact! 

Show me a person (even a celebrity in a gossip magazine, or models, or anyone) who says that their life is really easy and wonderful - all the time - and I'll show you a great big liar!

The reasons that these 'my-life-is-always-great'  type people pretend  to have such a wonderful and trouble-free life will vary. They may want to impress you - or seem superior  to you - or they may simply not want to talk about their problems to you - or anyone else.  But they are lying if they say that their life is always wonderful.

But it is important for you to simply know that you are not alone in having problems and stresses in your life. We all do. 


However, it is true that some people cope better with life and its problems than other people.  And, as a result of having established better coping strategies - these people will usually find that their lives are happier and easier and more productive - in spite of troubles that arise along the way. 

And, fortunately, healthy and very effective coping strategies can be learned - as I will discuss in this blog looking at positive ways to cope with stress.

You can learn to cope with stress - and life - better.  You can find a happier and more content life.  It is fairly easy too.  And some parts are really fun.


I will quickly add - before we discuss stress and coping - that, amongst all this doom and gloom about how hard and difficult life can be - obviously,  life is very often wonderful and exciting and joyful and loving and great fun!

Just not all of the time. 

And, maybe we wouldn't appreciate the really wonderful and marvelous times so much - if we didn't also experience the sad and difficult times - as well.


As taught in art:  The shadows are as important as the light.

And, when the hard times finish, and the sun comes out again - as it always does … eventually … we might find that we've learned something from our difficult experiences. We might find that we've grown in maturity and we've come out stronger and wiser. 

By the way, even what I just wrote in the above paragraph is a type of 'coping strategy'.  The strategy is that we have given meaning, in our lives, to the hard times.  Those  sad and difficult experiences didn't happen for nothing.  Sometimes - something good can come out of really hard and sad experiences.

But more about the specific coping strategies later.  I have digressed … again.

So, my experience - from my own life, and from the stories patients tell me about their lives - is that from difficult and sad times in our lives - we often do learn our best 'life-lessons'.

And, difficult and stressful times push us to learn life's lessons faster.

These life-lessons are not so much about intellectual topics - such as capital cities of the world, or theoretic physics. The lessons relate, instead, to issues more important  in our journey through life - the subjects associated with wisdom. 

And the concepts relating to wisdom are very difficult to master - but crucial for 'growing' in our lives. Really hard life experiences may be necessary for us to learn some of these things.

Wisdom teaches us lessons relating to what life is about: love, compassion, tolerance, patience, forgiveness, helping...    

When I was young and growing up in an abusive household - I often reminded myself of the old adage :

'Smooth seas never made a skilled sailor'.

I reminded myself  that - in learning to cope with the really difficult and unhappy life that I had back then - I would learn the lessons needed to help me to cope with similarly difficult times later on - during my adult  life. 

And, I was right. 

I learned so much from those hard times.  I learned about resilience; and asking for help from others; and persevering through hard times - over many years -  if need be; and remaining optimistic and hopeful about  life - even during the darkest and most lonely times; and I learned to appreciate that even when some parts of life were really hard and sad - there was always some other part of my life where I could find some happiness and comfort. There was always at least one kind person in my life - somewhere: a kind teacher; a nice neighbour; a good friend.  I found that the sun always shone somewhere in my life - no matter how dark other areas became.

So, I learned that bad times weren't pervasive in my life.  I learned to localise the bad times - to only one part of my life - where they existed. And, from the other happier areas of my life - I could find solace and joy - to help me through. 

And, later, when my life became less difficult and I found love and peace and contentment  - I learned to never take those things for granted.  I knew to value them more than money or status or prestige or fame or glory or any of the other relatively shallow things that I might have otherwise confused with being necessary for a happy life.  

I knew to value love and peace in my life as a treasure.   I knew to be grateful for those things. 

So, my difficult and lonely childhood gave me some wisdom and coping skills which helped me to manage the difficult times I experienced later in my adult life. And, with that, I have had a happy and contented life. Not an easy life.  No-one's life is easy.  But I have had a wonderful life - none-the-less.

And I've learned so much.

When I was a teenager, I also suffered with a horrible eating disorder (ED) - anorexia nervosa and later bulimia - for around three years.  And, from that, I learned about compassion for others.  I learned that people don't always choose bad things that happen in their lives.  But, with the help and love and support  from other people around them - they can recover. 

And my illness gave me an understanding of how it felt to suffer with a chronic illness:  anxiety, depression, low self esteem.  I can now empathise with other people who are imprisoned by mental illness. And, I can give them hope for recovery - just as I recovered.  This understanding has helped me to help my patients who suffer with all types of  illnesses and problems:  psychological, physical and social. 


And, as the mother of a daughter who suffered with a really severe ED (anorexia nervosa) - I learned to ask for help.  I learned about patience.  I might write  blog about that later.  Patience …  

Patience to wait years. 

Many … years. 

And all the hours - and all the days - and all the weeks - and all the months of struggle and pain - which  build slowly into years … requiring so much patience.

That was a really hard life-lesson for me.

A Chinese proverb which I often recalled during the many years of coping with illness and problems in my own life is as follows:

'Don't push the river, it flows by itself.'

As I've written in previous blogs, a river is often a symbol or metaphor, in our dreams and in stories, for the passage of life moving forward. 

You can cry and scream and carry on and demand that things should be different in your life - all you like - but time and life still move on unhurried and as they were.

Your 'carry-on' will make no difference.  You'll just knock yourself out in the process.  So, maybe a better strategy is to step back,  acknowledge the difficult times - as a part of life - and learn to cope in a healthy way during these hard times - and learn to be … patient …

I believe that  things in our lives often happen for a reason - even if that reason isn't obvious to us for a very long time - or ever - sometimes. 

And, I think that things in life happen in the time that they are meant to:  We may want to meet a lovely man/or woman to be our soul-mate - now!  Or, we may want our new 'start-up' business profiting and growing successfully - now!  Or, we may want to become wealthy - and leave the job we hate - now!  Or we may want ourselves, or a loved one, with an ED - to get better - now! 

And, so we join dating sites; and we work 18 hour days; and we buy lottery tickets; and we tell ourselves, or our loved ones, with ED's to 'just get better fast'.  Now!  And we scream in frustration at how life never  seems to works out well for us  - no matter hard hard we push for things to happen as we want them to - now. 

We push the river so hard!

And then we might take a break.  Mostly due to exhaustion … and frustration. And, because it isn't working anyway.

And right then, when we're not looking at those dreams of ours anymore - and we calm down and forget them - something really wonderful will blow into our lives … in the time that it was meant to happen.  The time that it was always going to happen. And, usually that time is not the 'now'  that we demanded.  

But, we have learned to be patient - whether we wanted to or not. 

Life will not be rushed. And some things that we want - just aren't on the cards for us - ever.  And that is life as well. 

As Mick Jagger wrote:  'You can't always get what you want.  But you might just find … you get what you need.'

I don't think that life is all fate, though.  We still make choices  and these choices make a major difference in our lives. But, life still happens in its own time - mostly.

Possibly, sometimes problems in our lives persist - until we have learned the lessons that those difficult times are trying to teach us.  And, only with the wisdom learned - can we 'jump to the next level' - as if in a game; a sort of  'game of life'.  And then, with the wisdom learned and the  skills acquired - we can find our way out of the problems that persisted for so long - or continued to recur in our lives.


Patience:  a life lesson which took me many years to learn.  And, I really did try very hard to 'push that river'. 

I became exhausted - and angry - and frustrated - and then I learned - to be patient.

So, how is it then, you might ask, if life is so hard for all of us, that some people seem to enjoy their lives so much more than other people? Why is it that some people don't seem to be so bothered by life's hard times and challenges?  Why are those people happier, and healthier, and more successful in life, and more resilient - than other people facing similar  difficulties?  

Conversely, why is it that some people just can't cope with life's problems?  Why do those people develop unhealthy lifestyles (ie. alcohol or drugs or obesity), or mental illnesses (ie. anxiety and depression and eating disorders), or become bitter and resentful and angry at life, and other people, or they just 'give up' trying - and become reclusive, and adopt an 'illness' mentality, and withdraw from the work-force and the world - or even become suicidal?


If life is so hard on all of us - then why is there such a massive difference in how different people respond to life's challenges and disappointments and sadness and hard times?   And, as a result, their life experiences are so vastly different?


In other words: Why do some people cope so much better with life and its problems than other people do?


Good question. 


And that is the discussion for this blog - the fifth in my series of blogs discussing eating disorders (ED's).


In this blog I will look at stress and coping with that stress. 


And, I am discussing this topic in a series about ED's - because if an individual suffering with an ED wants to recover, and avoid future relapse - then  healthy ways of coping with stress need to be learned. 


ED's are an unhealthy way of coping with stress and problems in life. The ED is, however,  still a 'coping mechanism' - maladaptive and unhealthy and ineffective -as it is.  And, for this reason, some people might quite reasonably conclude that maladaptive (unhealthy) 'coping strategies'  are really just a form of 'not coping.' 

But, if we plan to take the ED away from an individual (which they had previously used to 'cope' with stress) - then we need to be mindful that we will need to replace that 'coping strategy' with another coping method - or even numerous healthy coping methods.  Otherwise the sufferer of an ED will feel more anxious about letting the ED go - and they may not want to recover .  Also, relapse, during future stressful events,  is more likely to occur if the ED sufferer has no other established coping strategies to fall back on. 

And, without learning healthy and adaptive ways to cope with stress - an ED sufferer may use 'unhealthy' coping strategies - in addition to, or instead of, the ED - such as:  drugs, alcohol, self harm. 

In fact, sadly it is a fact  that sufferers of ED's are much more at risk of developing other addictions - such as drugs and alcohol addictions - as I have discussed in earlier ED blogs in this series. For example, studies have shown that around 72% of alcoholic women under 30 - also have ED's.  Furthermore, around 25% of buimia nervosa sufferers - also experience alcohol abuse or dependence.  And, other drug addictions are higher in sufferers of ED's as well.


So a healthy and successful recovery from an ED - must include a discussion about alternative 'adaptive' (healthy) coping mechanisms - which will need to be learned .

Note:  There are many different types of adaptive (healthy) coping mechanisms - and for this reason, you can have a wide range to choose from - to work out what suits you best.  And, with this large repertoire of healthy 'coping strategies' at your disposal - you could use any combination of them as well, or different ones at different times - depending on the situation and how you feel or what is available to you.


So, here we go.  Let's replace the ED with some healthy coping tools to help you cope with life and its kicking boot.


But firstly, a quick definition of 'stress' - as if you need me to tell you!  But I will anyway … so here goes:


What is stress?

Stress occurs when a person feels that the demands made on them exceed  their ability to cope.

Or, put another way, stress is the feeling you get when you think that you can't manage.  You feel: anxious, irritable, forgetful, unable to sleep, and unable to cope.

So, stress is subjective.  An event itself is without any emotion.  A single event may be very stressful for one individual - but only a minor inconvenience for another. And the same event (ie failing an exam) might be stressful - or not - depending on the 'significance' of the event to an individual.
  
For example:

I might fail my exam in highland dancing.  I couldn't care less!  Another excuse not to get out and dance or do too much exercise.  Yay!   Or, I might fail my exam to get into nursing studies - and, if I had always wanted to be a nurse,  then I might be very stressed  about the failed exam. 

I might try to 'cope' with my stress by:  going down to the pub and getting extremely drunk; eating a bucket of ice-cream and a couple of cartons of biscuits; starving myself again - or purging again with an ED; kicking the cat; punching a colleague who passed the exam and 'smugly' offered me sympathy;  blaming myself for being so stupid and useless; giving up entirely … on any future exams or anything else; locking myself in my room - and withdrawing from life. 

And, equally, you could swap those two exams around - and I might feel all stressed about the failed dancing exam - and go off and kick the cat and so forth after that - but I might feel unconcerned about the failed nursing exam. Or I might go 'off the deep end' - about both exams. 

But, you get the point.  The event has no emotions attached per se.  We interpret events and attach emotions to them - depending on a number of factors - as explained below.

Also, don't think that I was being sarcastic or exaggerating, in the above scenario about how severely stressed some people become over things like a failed exam.  Some people respond to such negative life events even more tragically than shown in the example I wrote.  For example, in India around 20 students each day kill themselves due to the stress related to exams - wanting to secure seats in prestigious schools - according to the National Crime Records Bureau.

So - events can be stressful or not, and people can cope … or not.

Alternatively, given the same event in the above scenario (failing a nursing exam/ or dancing exam) - an individual might not  feel very stressed or upset at all. 

If they had learned healthy and effective coping strategies - they might still feel disappointed about failing the exam - but they would 'cope' - and fairly quickly get back into life - happy enough - and continue on.  

They might even put the failed exam down to experience and learn from it. They might see it as simply a bit of a bump in life's road (this is an example of cognitive behaviour therapy (CBT) - discussed in blog 4 of the ED series:  CBT - avoid 'catastrophising', 'awfulizing',  and 'over-generalising' about how bad a failed exam is in the scheme of all the other wonderful things in my life).

They might deal with the disappointment by:  going for a run, or a swim; meditating, chatting to a friend or family member and then 'brainstorming ideas'  about what they could do next.  They might distract themselves, for little while, to give their mind a rest, and just watch a movie or listen to music. 

Eventually, once they had adjusted to the situation and they were feeling better - they could worked out a plan about what to do next. 

They could then spread their wings and walk out the door. (I love mixing my metaphors).

These responses to difficult life events - are all examples of  'positive' (healthy) coping mechanisms.  Healthy and adaptive ways to manage disappointments and set-backs in life. 

Using healthy strategies to cope in life - allows us to stay happy and retain our sanity and carry on - in spite of most of the difficult stuff life throws at us.


Maybe, years later, when the individual, in the scenario above, has long ago forgotten most of the details about the failed nursing/dancing  exams - they might even be glad that it all worked out as it did.  They might now prefer the path that their life took after the difficult experience years earlier.  Maybe they are now working as a teacher, or an artist, or a lion-tamer - or something in which they were more suited … and now they are happier than they would have been as a nurse - or dancer. 

Alternatively, they might have simply studied a bit more - resat the nursing exam - and passed it.  And fairly soon put the failed exam behind them - and simply chalked it up to experience.  And, they could have learned a little more about perseverance and resilience along the way - after the experience.   No dramas.   Just a bit of inconvenience and hard work. 


The choice on how to react to, and deal with, disappointments is one which you make.  Positive (healthy) coping strategies will reduce stress for you - and keep you in the game of life.  And life is like a game - I think.  You win some throws of the dice - and you lose some.  We all do.  You could either have fun in the game and enjoy it - or hate it and pout and shout at everyone how it isn't fair.

Life is full of choice and  fate - I think.


Some factors which determine how stressful an event might be include:

- Your thoughts about the problem
- The level of anxiety you already experience
- How much the problem will affect you
- Has a similar problem happened before (and if so - did it work out well ... or not)
- The degree of control you have on the situation (less control - more stress it is)
- The duration of the event (ie. A loud noise lasting a few seconds vs hours of it).
- The importance of the outcome (ie result in job loss, fail year at uni)
- Coping styles ( better coping mechanisms - results in less stressful)
- Self-esteem (higher the self esteem - less stress)
- Social supports (more people around to support you - less stress)


Some stress in our lives can be a good thing.  Stress can motivate us to get going on projects and be the impetus for us to find solutions to problems and difficulties that we have.

However, high levels of stress are bad for our health - both mentally and physically.

Associated mental illnesses include: anxiety and depression and even ED's.

Associated physical illness include: high blood pressure, chronic tiredness, infections.  Also, 'chronic' (long-term) stress has been shown to accelerate aging and medical conditions related to aging. 

One mechanism for this is due to the fact that chronic stress results in the shortening of telomeres on cell chromosomes. Telomeres are situated on the ends of chromosomes - and they act to protect  chromosomes from damage.  Telomeres become shorter as we grow older. And, as they grow shorter - the chromosomes, which they had protected,  become more prone to damage. 

Telomeres have been described as being like the plastic nibs on the ends of shoe-laces.  As the plastic nibs become shorter and then disappear - the shoe-lace is prone to fray and become damaged. In a similar way - as the telomeres getting shorter on chromosomes - after which the chromosome will become more easily damaged. And, as this happens,  we age - and we develop illnesses associated with aging: heart disease, cancer, arthritis, dementia, a more aged appearance.  

So, it is because chronic stress shortens telomeres that long term stress is associated with accelerated aging of an individual and medical conditions related to aging - as listed above.


Worth mentioning here - is that stressful events are not always negative events in our lives - like failed exams, or deaths, or job losses, and so forth.  Change  itself - even positive change - is often stressful for us.  Stress can be associated with lovely things like: having a baby, moving house, retiring from the work-force; getting married. Yet, these events can still be very stressful for us.  The changes in our lives can be hard to adjust to.  We will need to 'cope' at these times - as well.



How to manage stress:  'Coping' mechanisms


In psychology, coping is defined as:  the conscious effort to solve problems - and attempts to master, reduce, or tolerate stress and conflict.

Two points to make before we look at different coping strategies - healthy (positive) and unhealthy (negative).


1.  People need to accept  responsibility for the role they play in creating and maintaining the level of stress they feel in life.


There is no point getting angry with other people. We can't change other  people.  We can only change ourselves - and,even then - we can only change some of the events in our  lives  and only some of the things within ourselves.  With some events and some situations we must learn to simply accept them.  For example - we can't grow taller, or younger, or win the lottery … just because we want to. Obviously.

So, there is no benefit in playing the 'victim' card.  If we see ourselves as 'victims' - that will simply disempower us.  We will suffer more, are achieve much less,  if we label ourselves thus.  'Victimhood' is a choice as well. (I wrote a blog on this topic - which explains this concept more).


2.  You will need to understand what are your stressors, and what  are your coping strategies - currently?

The cause of your stress may be as obvious to you as a punch in the face. And you may be absolutely clear as to how you try to cope.  (ie stressor: An 80 hour per week job.  Coping strategy:  Smoke 2 packets cigarettes per day, and  talk to your friends about your problems).

However, sometimes people find that they feel very stressed - but don't know exactly why.  Additionally, you may have an obvious stressor - but a few less obvious minor ones as well.

In either case a 'stress journal' may be useful.  In the journal (which you might carry with you in your bag - with a pen),  you can document:

-  the regular stressors in your life, and
- how you currently try to cope

Journal:

a. What caused the stress
b. How you felt (physically -ie racing heart, tight chest; and emotionally - ie sad, angry)
c. How you reacted to the stressful event
d. What did you do to make yourself feel better (ie smoke, purge, cry, go for a run)


After a couple of weeks - look at the journal and establish:

- what is stressing you (there may be more than one thing)?
- are your coping strategies healthy or not?
- are the coping strategies working?


Now - coping mechanisms:

1. Negative (unhealthy coping mechanisms):

 Negative coping strategies may temporarily reduce stress, but they cause more damage in the long run.

These strategies may be used occasionally (ie television to distract, a big ice-cream to cheer you up, a glass or two of beer) - and some would never be advised (ie. illicit drugs, violence)

Some of these negative (unhealthy) coping styles include:

- Smoking
- drinking alcohol excessively
- overeating or undereating
- distraction (with television or computer) - good short term - but eventually you'll need to deal with your problems.  And, try to avoid spending many many hours
- withdrawing from other people (friends, family, activities … the world)
- using drugs (some prescription - ie sleeping tablets, narcotics; illicit drugs ; cigarettes)
- sleeping too much
- procrastinating
- filling up every moment (to avoid thinking - or to calm your anxiety)
- violence (to other people, and to objects (punch hole in wall), or to self (self harm)


2. Positive (healthy coping mechanisms):


A. Avoid  unnecessary stress:

- Learn to say 'no'.  Know your limits - at work or at home.

- Avoid people who stress you too much - especially if they consistently stress you out.

- Take control of your environment - as much as you can.  If the news stresses you - then don't watch the news or read about it.

- Avoid topics that stress you a lot:  Politics or old family arguments and so forth.

- Reduce your 'to-do list'.  Do you even need one?  Who says that you 'must' or you 'should' do things? What, on your list, really isn't necessary. I dare you to cut the list in half.  I bet a heap of things don't really matter.  I don't even have a list at all.  never have! 

In addition to having no 'to-do' lists I cope by reducing my work load as much as possible.  For example - I never iron (the clothes I buy don't crease), I don't really cook (I reheat packet food mostly), I get my children to tidy their own rooms - and so on… 


B. Alter the situation:

- Express how you feel.  Try not to bottle your feelings up.  Don't be afraid to talk to people about your worries and frustrations and anger.  They will often have felt the same.  They might be able to comfort and advise you.

- Be more assertive.  Assertive does not mean aggressive.  You can assert yourself politely.  That is not being aggressive.  You are allowed to say what you want and what you think.  Other people do.  You can practice this gradually. Maybe, with little things to start with.  You'll feel better if you act authentically.

- Compromise:  Sometimes you can shift to a middle ground on issues or situations.   You change a little - and other people change a little. 

- Improve your time management:  You could try not to leave tasks to the last minute.  You could plan ahead - and try to finish early.  So, if it takes longer to finish - or to drive there - or whatever - you'll feel cool(er).

C.  Adjust your attitude:

Events have no emotion attached to the per se - as I've mentioned many times.  We attach emotions to events - based on how we interpret them. 

Cognitive behaviour therapy (CBT) is very helpful here - to learn to interpret events in the world in a more balanced, moderate, less catastrophic and 'awful', 'terrible' way. 

My fourth blog in this ED series looks at this area - CBT and letting go of perfectionism.


D. Accept  the things that you can't change:

Some stressors are unavoidable.  People die.  Accidents and illnesses happen. Sadly, these things are an inevitable part of life.  For all of us eventually.  Many things in life are beyond our control.

- So, don't try to control the uncontrollable: Accept the things that you cannot change (OK - So I'll never be a super model or six feet tall or  21 again).  But I can focus on the things that I can change - I can learn to write.  Wonderful!

- Look for the positive side to things:  Think of what you've learned from mistakes and hard times.  Your personal growth.  Wisdom comes from learning through hard experiences; painful as that learning is.  And, looking back on our lives - some things really do work out for the best.

- Share your feelings;  talk to someone you trust about how you feel.  Even if it is a counsellor or your local doctor or an old friend.

- Learn to forgive.  The world and everyone in it are not perfect.  You are not perfect.  Even if there are some people that you never want to see again in your life - you will be hurting yourself,and not them, to not let go of the anger.  I find that when I focus on all the wonderful things in my life now - I can let go of the misery and painful times from my past more easily.


Also, forgive yourself.  No-one is perfect.  Mistakes are an opportunity to learn. We all make mistakes - and then we let them go. And learn from them.  And forgive ourselves.

It has been said that: 'We did our best with what we knew then.  When we knew better - we did better.'


And, time tends to heal the pain of hard times.  Psychologists say that this is simply because, with time, we simply think about those things less often.  

But give yourself the time you need to heal. 

You can't push a river.


E.  Make time for fun and relaxation:

Psychologists have found that some things make people more happy and some things don't.

Wow!  Professors of the bleeding obvious - you might think.

But here's the kicker.  They also know what  those things are - and what they are not.

Studies in psychology have found that the following things affect people's lives:

* The things which bring happiness

- a balanced life (work and leisure - and not too much or too little of either)
- a job you enjoy
- achievable goals
- money (happiness does increase as you acquire more money - but only until you reach an income of about $100,000/year.  After that, more money does not make people any more happy. If you don't believe me - look at the stories of famous multi-millionaires and some rich celebrities).
- health
- friends and/or family - social supports
- control in your life

* The things which don't bring extra happiness

- great wealth (incomes more than around $100,000/year)
- high status
- prestige
- fame

So - what fun and relaxing things might you enjoy - to de-stress - and to have fun and stay healthy-ish:

Try to set aside rest and relaxation time for yourself - everyday.
 
It is your responsibility to look after yourself.  You deserve it - and you need it for your health and wellbeing.

- Go for a walk
- Spend time in a park or your garden with nature
- Call a friend.  Better still - arrange to catch up over a coffee, see a movie, walk together.
- do some exercise: - go for a run, a bike ride, the gym, have a swim.  Strenuous exercise is a good way to reduce tension.
- write in your journal/diary
- pamper yourself with - a  nice hot drink, a long bath, a good book
- listen to music
- watch a movie - especially a comedy
- yoga
- meditation

Note:  Endorphins are the body's natural opiates. They relieve stress and enhance pleasure.  Some things in this list do increase endorphins specifically: listening to music, exercise, smiling, laughing … dark chocolate (in moderation).


F. Prepare ahead of time - for difficult tasks (Proactive coping)

Anticipate what a difficult event will be like - and prepare for how you'll cope with it. 

For example - rehearse a speech, if you'll be giving one soon,  in front of a mirror, or  practice it in front of just a few family and friends. 


G. Stay connected to other people.

Seek friends or family or colleagues or a councellor or the GP or a help-line or someone you trust - to talk to about your worries and  problems. 

A support network is really helpful during the tough times - and also to share the good times with as well.

Even finding one person to talk to - initially - will get you going.  You may not need a very big group of people.  Even one or two would be good.

Research has shown that close, confiding relationships protects people from many stresses.

H.  Problem-solving.

This is a great technique which doctors often use with patients.  You could do it by yourself - or work through it with someone you trust who has reasonably good judgement.

It involves writing down what your stressor, or problem, is.  And then 'brain-storming' all of the possible ways that the stressor might be reduced or eliminated.

For example: 
Problem:  I'm stressed by all the housework I must do after a long day at the office.

Possible solutions:
- Leave the housework and accept that the house can be a bit messier.
- Arrange a cleaner for a few hours per week. 
- Get other people in the household to help.  Draw up a roster.
- Work less hours in the office.

And so on.

You can then try one of the solutions and see if it works.  If it doesn't work well - your could try another possible solution from the list.


I. Keep a sense of humour

Humour allows you to 'reframe' situations so that you can see the lighter side of them. You can choose to find something ridiculous and funny and silly - about many situations and many people - including yourself. 

It is wonderful not to take yourself too seriously. 

Also, smiling and laughing both help you to release tension from your body, and they increase the endorphins (the feel-good and stress-reducing chemicals) which your body makes.


J.  Try to achieve a reasonably healthy lifestyle.

You can increase your resistance to stress by improving your general physical well-being.

- regular exercise:  (although - you may need to check with you doctor first - if you haven't exercised for a long time and you have any other medical problems or you are older)

And, you'll more likely exercise if you make it:

- something you enjoy doing (if you hate the gym - don't go.  Find an exercise that you don't mind - or even like)
- accessible (not a drive across town to do it - better a walk around the block, or get off the bus a stop or two early)
- cheap (whatever you can comfortably afford.  But a walk around the neighbourhood is free.  A cheap exercise-bike from K-mart while you watch television is fine).

- Eat a healthy diet. 
Look - any improvement in your diet is a good thing.  If you can get in a few more vegetables or fruit - then that's great!  If you can cut back a bit on sugar and caffeine - you may even sleep a little better.

Reward yourself for any improvements that you make. Pamper yourself a little and enjoy each little success in changing toward a healthier lifestyle.  A dietician might also be helpful to start with.

- Get enough sleep.
Most people need between 7 − 9 hours  sleep per day.  Too little sleep is bad for you - but so is too much sleep.


K.  Mindfulness.

Mindfulness is something that eastern cultures have know about for millennia - but western cultures are only just learning.

Mindfulness is simply living in the present. 

It is living in the now - and not focusing back to yesterday and forward to tomorrow.  By living in the now we can find peace and relaxation.  We can release our worries about tomorrow and our regrets about yesterday.

Mindfulness does not need to be linked to any religion.
  
It is simply experiencing the present.  

This may be achieved through meditation - but it could also be achieved while watching a  sunset or a candle-flame; or going for a walk (listen to the sounds around you; smell the aromas or fragrances in the air; feel your clothes touch your skin and the breeze in your hair, taste the salt on the sea air - or the taste of the coffee in your mouth). 

You can be aware - dispassionately - of other thoughts drifting in and out of  your mind.  Just let them float by.  And exist in the now.

You could try doing this for a a few minutes daily - at first.  And gradually build the time up. Possibly to 15 or 30 minutes each day.  Or less.  Or more.  Whatever feels good for you.  Any mindfulness will be helpful to reduce your stress and help you cope.




So - I think that this blog is long enough now - so I'll wrap it up.



In summary people:

Chronic (long term) stress is bad for you:  mentally, physically, socially.

Stress and hard times, however, are a part of life.  You cannot avoid them.

But  you can learn better ways to cope. 

There are many different strategies to help you to cope with difficult life experiences.

You may choose a number of strategies for different situations and see how you go. You can work out what suits you, and what you enjoy, and what you can manage (time and cost and availability and so on) and these strategies will help your through life's struggles - but they will also help you to find happiness and contentment in your life.  And health.

You deserve it!

You deserve to have the opportunity to make your life as enjoyable and fulfilling and productive and fun … as the rest of us make ours.

Take baby steps … and reward yourself as you become more able to cope in your life… and as you let go of 'unhealthy coping styles' and replace them with more effective and healthier ones.


And these are also the strategies which you can use to help you to recover from an ED (let the ED go - as bad 'coping strategy') and then, later, to help avoid relapsing with the ED - during other stressful times in your life.

These strategies can also help those of you caring for an ED sufferer - or for any other chronically ill person, for that matter.
You need to look after yourself as well.
  
As I reminded myself when my daughter was very ill with anorexia nervosa for three years - I'm no good to her or anyone else if I get sick and if I'm not coping.  I must look after my own health and sanity - along with helping my daughter - and my patients - and any number of other people as well.

And so I did.  I took up hobbies (learning to write) , and I went walking, and I swam one kilometer - five days /week (when my daughter was at her sickest), and I  talked to people - social workers, doctors, nurses, my family and friends, and I asked for help when I needed it  …

Life is hard.  It just is.  For all of us. Although, as I mentioned, it can also be absolutely lovely and wonderful as well. 

But there are coping skills that will pull you through.  You can build a happy life. You can work at that. 

It is your choice.



                         *                                 *                           *


Take care and have a lovely week and I'll write another blog in this ED series within the next fortnight.