Using CBT to treat Stress

Stress is best described as the feeling we experience when the perceived demands made on us (or those we place on ourselves) are greater than our perceived ability to cope. We often talk about stress as feeling under pressure, feeling overwhelmed, feeling tense and feeling emotional.

Stress is a natural occurrence in most people’s lives and it is inevitable in this world due to ill health, social, economical, financial, environmental problems, war, starvation, unemployment, busy schedules, dreams and a desire for greater learning, experience and achievement, and so on. Everyone experiences stress when they find themselves in challenging or in difficult situations. Stress is primarily a physical response to a perceived threat: the body automatically releases a complex mix of hormones, cortisol and norepinephrine to prepare the body for action, known as the fight or flight response. The heart pounding, fast breathing and boost of energy that happens automatically is accompanied by a shutdown of other functions not deemed necessary.

A mental health foundation study in 2018 in the UK found that 74 % of people have felt so stressed that they have been overwhelmed and unable to cope. 51% of adults who felt stressed reported feeling depressed, and 61% reported feeling anxious (

There is no thinking involved, blood flow is redirected to the most important muscles needed to fight or flee and this process occurs as a body’s response to danger. However, when the state of stress is prolonged or repetitive, we begin to experience psychological symptoms of stress such as memory loss and inability to concentrate, poor judgement, negative thoughts and worries. This comes at a great cost to our busy lives and during these times we are likely to experience feelings of anger, irritation, panic, anxiety, guilt and so on. Stress can also be detrimental to our physical health and can lead to emotional and physical burnout.

Here are some common symptoms of stress that you may relate to but you do not have to experience all of them to feel stressed out.

The physical symptoms of stress are low energy, headaches, upset stomach including diarrhoea, constipation and nausea, aches, pains, and tense muscles, chest pain and rapid heartbeat, insomnia, colds and infections, loss of sexual desire and/or ability, nervousness, shaking, ringing in the ear, cold and sweaty hands and feet, excess sweating, dry mouth and difficulty swallowing, clenched jaws and grinding teeth.

The emotional symptoms of stress include agitation, frustration and mood swings, feeling overwhelmed or feeling like you are losing control, difficulty in relaxing and quieting the mind, feeling low about the self, feeling lonely, worthless and depressed, avoiding others.

The cognitive symptoms of stress include constant worry and preoccupation, racing thoughts, forgetfulness and disorganisation, inability to concentrate and focus, poor judgement, poor decision-making or inability to make decisions, catastrophic thinking.

The behavioural symptoms of stress include changes in appetite, procrastinating, avoidance, use of distraction and substance like alcohol, drugs and cigarettes, and fidgeting, restlessness, pacing, nail biting, skin picking, hair pulling.

Cognitive and Behavioural Stress Management
A helpful way to look at stress is to separate it into two different categories, External and Internal stress:

External stress is life stress: anything from everyday hassles to stress at work, deadlines, exams, difficult boss, money problems, relationship difficulties, getting married, getting divorced, the loss of a close one and the list goes on. Any situations that are difficult will automatically create stress. Managing life stress is not easy but by learning organisational skills and problem-solving skills we can better control it.

Internal stress is a bit more complex: experiencing psychological symptoms of stress is unpleasant and sometimes frightening. Our relationship to our negative thoughts, feelings and sensations accompanied by external stress often manifests itself as the fight or flight reaction: we avoid or we fight back or anything in between. However, the avoidance or fight of internal reaction to stress is futile. The symptoms we try to eliminate happen automatically and we do not have control over them, this realisation often lead us to feel like we are failing, losing control or unable to cope.

The good news is that we can learn to relate and respond to internal stress in ways that minimise and eliminate its negative psychological and physical effect on our health and well-being. Cognitive Behavioural Therapy and Mindfulness can teach us how to do just that.