Stress, Wellbeing and Performance part 3 of 3

TotalMSK Blog: Stress, the Individual, Wellbeing, Performance and the Workplace Part 3 / 3 - a Chiropractors perspective.

Stress, the Individual, Wellbeing, Performance and the Workplace Part 3

The effects of sustained, long-term "Stress"

Part three of the article on “Stress, the individual, Wellbeing, Performance and the Workplace”, is the third and final part of the three-part “stress-related” article.

Just a brief recap.  Part one looked at the physiological and psychological aspects of the “Human Stress Response” and how perception plays a large part in the stress initiation process. The “fight, flight and freeze” stress responses were also explained, along with the wide variety of physiological changes that occur throughout the entire body.

Part Two looked at the longer term effects of continually initiating the human stress response and how this interferes with the bodies day to day repair and maintenance processes. The second part of the article also looked at short and long-term physical, emotional and psychological (mental health) effects of overstimulation of the human stress response.

The final part of the article will look at effective measures that can be taken to help reduce the adverse effects of stress. As mentioned, in Part Two stress can be very positive within tolerable limits. Tolerable levels may be very different between individuals and dependent on many factors including, the type of stressor, combinations of stressors, previous exposure to various stressors, genetics, personality, resilience levels and coping strategies.

Coping methods/mechanisms

Stress related coping mechanismThere are many coping methods when it comes to dealing with stress, some “positive” and some “negative”. In many, respects it is important to have some form of coping mechanism and it surprising as to how many people have no form of coping mechanism be it “positive” or even “negative”. “Positive” mechanisms are named as such, as they don’t exacerbate the whole stress response cycle longer term and make things worse. Negative methods include a reliance or over-reliance on “stimulants”, like alcohol, nicotine, caffeine, other legal or non-legal drugs to cope.


Breathing exercises can be a particularly good way of calming the body, during or after the initiation of a stress response. The stress response tends to cause shallow breathing or hyperventilation. Adopting a slow deep rhythmic breathing cycle can help one take control and thus calm everything down. Taking control of ones breathing helps with developing a level of bodily self-awareness too. Breathing exercises are a significant part of various ancient arts including yoga and meditation, both of which can help take levels of self-awareness (see resilience) still further.

Stress and foodCertain types of food can also be a counterproductive method of dealing with stress. It is relatively common for people to crave certain foods when stressed, “comfort foods”, typically high calorific type foods including highly processed fats and sugars “junk foods”. Such foods may make one feel better briefly due to the increased energy intake. However, this is very short-term due to how the body controls blood sugar levels.


The human brain runs predominantly on glucose, though the safe level or tolerance is very narrow. If the blood sugar levels are too high or too low, then the body can start to shut down, and one can go into a coma. However, the human body is extremely good at maintaining safe levels of blood glucose levels, amongst other critical life-sustaining functions.

The human body will increase blood sugar levels from other resources in the body (fats, protein etc.) if levels drop too low and no food is available. The release of insulin within the body helps keep blood sugar levels within a safe limit or from getting too high. Typically, if one eats something particularly sweet, then one gets a “sugar high” and feels great, due to an increase in the release of neurotransmitter hormone serotonin within the brain. Serotonin levels within the brain have a direct impact on how we feel, and our mood and higher levels tend to make us feel good.

However, sustained high blood sugar levels can be dangerous for the brain and result in the release of the hormone insulin, to bring blood sugar levels back down to a normal safe level. The effects of the release of insulin may take between 15-20 minutes to take effect and result in a rapid crash in blood sugar levels. The drop in blood sugar levels can also result in a decrease in serotonin levels, and so we can suddenly feel “down”.

Hence, some people can get in a cycle of highs and lows through binge eating as a means of coping with stress. Binge eating can also lead to an increase in weight and feelings of guilt and thus further stress. There is also increasing evidence, that the constant cycle of releasing insulin within the body in such cases can lead to Type II diabetes. The human body is exceptionally good at adapting and this has relevance for addiction formations, movement pattern changes due to injury, tissues changes due to activity or lack of and even diabetes.  Type II diabetes, it is thought to occur due to the bodies tissues becoming immune to the effects of the hormone insulin over time. The result of this immunity means that the insulin no-longer works effectively to control high blood sugar levels safely. However, foods and nutrients can also have a very positive effect on stress, as will be discussed later.

Impacts of stressAs discussed in Part One, the stress response naturally turbocharges the bodies systems and senses ready to “fight, run away (flight)” in any perceived stressful situation. The body may also “freeze” if the perceived “stressor” is more than the individuals capacity to deal with the situation at hand. Many people may choose to turn to such stimulants as a coping mechanism, as such things may make them “feel” better in the short-term. However, as discussed in Part Two, prolonged stress can reduce the bodies ability to cope with the effects of stressful events and even impact the immune system. For the body to process various stimulant substances, the body will be required to use up more valuable resources, and those very resources will already be in short supply due to the effects of long-term stress. In essence, stimulants are further and artificially “turbo-charging” and already “turbo-charged” system. Such a situation is not sustainable, and it is just a matter of time before there is a severe or catastrophic failure somewhere within the body.

Multiple coping strategies or interventions can be used to manage “negative” levels of stress. One could break such methods down according to when one is attempting to impact the human stress response, with an intervention. Interventions can be applied at various points in the stress response cycle and or exposure to a stressor(s), e.g. pre-exposure, during exposure, or post-exposure. It is important to remember that each of us is unique and individual personal preferences are likely to dictate which types of intervention one finds useful in dealing with stress. Also, it is often possible to combine the benefits of various kinds of stress-reducing individual interventions, e.g. (exercise and music), or (soft music, candles, incense and a book) etc. Ideally, one needs to find the “right” intervention or group of interventions that work for you.


Candles / Incense / Essential Oils

Stress reduction and relaxation candlesCandles, incense and essential oils have been used for millennia to create particular types of atmospheres. Historically, there have been many types of essential oils and incense associated with relaxation including; Bergamot, Cedar, Chamomile, Cinnamon, Jasmine, Lavender, Lemongrass, Pine, Sandalwood, and Vanilla. A local aromatherapist or health food store should be able to provide further details. Again one can combine the use of candles, incense or essential oils with other stress relieving or relaxation techniques. One should also follow the manufacturers instructions when using such products due to the possible risk of fire.


Being creative can be a particularly useful and positively challenging way of reducing stress levels. Creating something can give one a feeling of achievement, can be a highly social experience and help develop problem-solving skills. Creativity could be anything from artwork, model work, baking, sewing, through to a multitude of arts and crafts activities.

Deep breathing exercises

Breathing exercises can be a particularly good way of calming the body, during or after the initiation of a stress response. The stress response tends to cause shallow breathing or hyperventilation pattern. Adopting a slow deep rhythmic breathing cycle can help one take control and thus calm everything down. Taking control of ones breathing helps with developing a level of bodily self-awareness too. For example, one could breathe in for the count of three seconds and then slowly breathe out for the count of three seconds, while completely relaxing the body the exhale. Self-awareness can then be developed by learning and processing the feeling of how relaxed tissues "feel". Breathing exercises are a significant part of various ancient arts including yoga and meditation, both of which can help take levels of self-awareness (see resilience) still further.

Diet / Supplements

Research has demonstrated that diet and or supplements can prove highly beneficial in helping the body deal with the effects of “stress”. Research has identified that some nutrients can be useful in improving how the human body deals with stress. Such nutrients include; Complex carbohydrates, Omega 3 fatty acids, Proteins (Tryptophan, Phenylalanine and Tyrosine), Vitamin C, Vitamin B, Magnesium. Many of these particular nutrients have a significant role in stress-relieving hormone production and levels of the neurotransmitter hormone Serotonin in the brain. Serotonin has a massive impact on how one feels and one's mood. That said, one should seek professional advice before embarking on a complete diet change and or taking lots of supplements. A suitably qualified professional is likely to include a nutritionist or dietician.

Help somebody else

Helping others to reduce stressHelping others can be a perfect form of stress relief and can help provide context or perspective around our stresses. Random acts of kindness or acts of selflessness have been shown to increase levels of the neurotransmitter dopamine within the brain. The increase in levels of hormone dopamine makes us feel-good, which also helps to damp-down the stress response.

Relaxing Music

Sitting quietly and listening to relaxing music can be an excellent way of calming the body after exposure to a stressful event, or can be a good way of unwinding at the end of the day before bed. Listening to music can be combined with any number of other techniques aimed at damping down the stress response and even developing self-awareness. Examples might include; (candles, incense, essential oils), breathing exercises, meditation, mindfulness, progressive muscle relaxation, reading or journaling).

Saying No

In contrast to helping others, one can also take on too much. It is essential to learn to say “No” and not take on every conceivable job, task or undertaking available and purely for the benefit of others who are perfectly capable. Regularly, agreeing to do absolutely everything can leave one feeling stressed and physically, emotionally and psychologically fatigued. Inevitably, this situation leads to undertakings not being completed to one's best ability, which can add further stress.

The Great Outdoors

Getting outside and just enjoying being at one with nature can be hugely relaxing and there are so many ways of doing this, with many combining the benefits of exercise. For example, walking is a fantastic and healthy way to get out and explore the countryside and can provide peace, quiet and solitude. Even pottering around the garden can prove to be very relaxing and highly creative use of time. One could combine such activities with the relaxing benefits of listening to music. Equally, there are multiple types of sporting activities that one can perform outside. Some sporting activities provide the additional benefits of social interaction, which again can help reduce stress levels.


Stress reduction through petsAlthough pets can cost money and require different levels of commitment, they can be highly beneficial. Pet’s provide companionship, but can also increase levels of neurotransmitter serotonin within the brain. The act of stroking a pet can produce increases in serotonin in both the pet and the owner. Research has linked serotonin levels to feelings of mood, happiness and general well-being. Such sentiments, help moderate or reduce stress levels.

Playing games

Games can be a highly social and fun way of reducing stress levels. Social type games can also enable one to interact with others, frequently involve problem-solving skills and can promote feelings of happiness, especially if not taken too seriously.

Progressive Muscle Relaxation (PMR)

Progressive Muscle Relaxation (PMR) is a method of creating a level of deep relaxation in the whole body and developing a level of body self-awareness (see resilience). The technique works through a series of muscle group contractions and relaxations. By consciously contracting and then relaxing specific muscles or groups of muscles one can gain awareness of what tissues feel like, or more importantly how "relaxed" feels. One might wish to try this technique either by starting at the top of the body and working down or from the bottom and working up, though one could begin anywhere really. A particularly good way to perform this technique is with the aid of breathing.


For example, pick a muscle or group muscles (Quadriceps, thighs), breath in as you contract that muscle group and hold. The entire process from breathing in and contracting the muscles should take around 10 seconds. Then slowly exhale out as you relax the muscles and process or think about how the "relaxed" muscles feel. One can then maintain a slow and relaxed breathing pattern, and the entire muscle relaxation process should take or last around 20 seconds. One can then move on to another group of muscles and apply the technique again. The idea is that one gradually and systematically relieves tension throughout the body. One could also use the method while listening to soft relaxing music, or with the added atmosphere of candles, incense or essential oils.

Don’t procrastinate

It is far to easy to procrastinate and put things off that we do not want to do or are just dreading doing. However, by continually putting something off, one in effect has a constant “stressor” and one which will gradually build up over time until the point the thing/task has to be done very last minute. Hence, it is better to try to get things done sooner rather than later from a stress perspective.

Read a book

Reading to reduce stressSitting down quietly or even with soft instrumental type music in the background and reading a book can be a good way of unwinding and calming the body. One can also further enhance the relaxing atmosphere with the addition of candles, incense or essential oils. Many people find laying in the bath and reading very relaxing, even if the pages of the book may get damp.

Get a good nights sleep.

Sleep can have a considerable impact on the body and the latest research suggest that between 7-9 hours per night is ideal. While we sleep, our body carries out many essential maintenance and repair functions, including laying down memories. Lack of sleep or disturbed sleep interferes with the body’s ability to carry out these crucial functions. Research has shown that a person's perception of pain increases after a poor nights sleep. Research has also found a link between the level of pain perception increase and the amount of sleep. One such study has found up to an 81% increase in patient pain perception as a result of 3 hours or less sleep. Other studies have linked both a lack of or too much sleep with various types of cardiac disease, longer-term. A poor nights sleep in many respects is another “stressor”, though there are ways to help get a good nights sleep:-

  • Try to get 7-9 hours of sleep per night.
  • Avoid stimulants before bed, coffee, alcohol, nicotine.
  • Try and maintain a regular sleep pattern (wake time and bedtime).
  • Wear comfortable clothing in bed.
  • Ensure the pillow height and bed are correct serviceable.
  • Do not have a television in the bedroom.
  • Avoid phone or tablet use while in bed and before sleeping.
  • Use other stress relieving techniques to help get to sleep (soft music, essential oils, slow breathing, progressive muscle relaxation (PMR), notepad and paper by the bed).


Socialising in any capacity can have a significant impact on stress levels, be it with friends and family, specific support groups, common interest groups or sporting activity type groups. As the old saying goes, “a problem shared is a problem halved”. Social groups can help provide physical, emotional and psychological support to individuals, can offer perspective around stressors and help individuals identify ways to deal with stressors or stressful situations.

Talking Therapies

Talking therapies to help with stress

Cognitive Behavioural Therapy (CBT)

Cognitive Behavioural Therapy or CBT is a form of talk therapy. The process involves trying to change one's perception, or more specifically the way one thinks about five highly interrelated aspects of life; (situations, thoughts, emotions, physical feelings and actions). The idea is to stop the reinforcement of negative thought cycles, which can become entrenched over time. In many respects, if one puts in the same inputs in any given situation, then one can only expect the same output or outcome, as nothing has changed.

For example, one could be applying for a new job and get rejected, as do thousands of people every day. One can then either choose to submit further job applications for other roles in the same manner and not change anything or learn from the experience (situation, thoughts, emotions, physical feelings) and then change tact (action). Changing one's tack might involve updating ones CV, gaining feedback after job applications, targeting a specific type of role, broadening ones job search, looking at different industries etc. CBT is commonly used to help with anxiety and depression, which can both result from long-term stress.


Counselling is a form of talking therapy and is usually provided by a suitably trained and qualified professional. Counselling provides a safe, secure and confidential environment for people to discuss personal problems, difficulties and emotions affecting multiple aspects of life. Counsellors are not there to prescribe solutions to problems or issues, but to facilitate a process for individuals to find their answers. Hence, counselling can prove very valuable when dealing with current and future stress and stressful situations.

Exposure Therapy

This form of intervention is a type of behavioural therapy and designed to help people confront their fears “stressors”. The process involves gradually exposing patients to elements of fearful situations/stimuli, over time but in a safe and non-threatening or dangerous way. The technique aims to progressively get the patient comfortable with aspects of their fear until they can finally fully confront the fear. Exposure therapy is a type of training aimed at reducing the initial stress response in a given situation and is commonly used with anxiety.

Write it down / Journaling

Stress reduction through journalingWriting things down and even journaling can be an excellent way of helping to reduce stress. The very act of writing things down can help to clear the mind of “stressors”, provide context, clarity, understanding and even enable one to visualise or identify possible solutions. Having a notepad by the side of the bed can be very useful if one is struggling to sleep due to there being something on one's mind. Off-loading the information to paper can clear the mind and help one get back to sleep.

Training and Resilience

Resilience - David Stirling, a founding member of the Special Air Service (SAS)

David Stirling, a founding member of the Special Air Service (SAS)


Training is an excellent example of a pre-exposure intervention and used in many professions notably the military and emergency services. Training scenarios attempt to be as realistic as possible and aimed at preparing the individual for real-life stressful events/situations. Hence, when the individual then has to confront a real-life stressful situation, the scenario is not likely to be entirely new and overwhelming to the person. Such training can make the difference between life and death and how people react in any given situation.


One can view resilience as a collection of behaviours, perceptions or even coping strategies observed as being used by people deemed as resilient. Resilience techniques cover all aspects of the stress response, pre, during and post. There may still be much debate on whether a level of resilience is genetic (nature) or developed through experiences (nurture). Selection courses for the Elite military and Special Forces units will undoubtedly be looking to test various types of resilience levels within potential candidates including physical and mental aspects.  The following list is not exhaustive, but each one of the characteristics can help one deal with “stress”, build resilience and provide drive and purpose. Many of these attributes or characteristics relate to one's perception of events and how one views the world around us.


Exercise and physical fitness are critical aspects of Elite military forces and the training they undergo. Furthermore, activity has been linked to more resilient people and is a great way to deal with “stress” and in many respects is a very logical way to deal with stress. After all, the initiation of the “stress response” primes the human body for some form of physical activity, typically “fight or flight”. Hence, it is logical to then provide the human body with some form of constructive physical activity to utilise all the resources unleashed during the “stress response”. Besides physical activity has countless health benefits, it also helps to flush the system of hormones released during the stress response. Exercise also results in the release of endorphins which have many beneficial properties. Endorphins are the body’s natural painkillers, but they can also help one sleep and have a large and positive impact on one's mood. Hence, the release of endorphins after the initiation of the “stress response” may be viewed as desirable, as the endorphins help to calm the body.

Individual Attitude

One's attitude or perception of what happens in everyday life can either be hugely positive or hugely negative to one's levels of stress, physical wellbeing and mental health. All of us have encountered events in life, which can be extreme on a scale of pleasantness to unpleasantness. Many things happen in life which can take people out of their natural comfort zone and can either be viewed positively as challenges or negatively as hugely stressful.

Elite and special forces selection processes, continuously look to “push the boundaries” and take potential candidates out of their comfort zone and to see what happens. In some respects, having to go outside of one's standard comfort zone is a means of training and self-development and a way to push the boundaries. If one were to view all events negatively, then one usually tends to give up. However, resilient people never quit and metaphorically dust themselves off after failures or adverse events and forge on with the next challenge and take learning from the process.

Control of destiny or locus of control

Our perception of life in general also has a massive impact on how we feel and process events or experiences. Resilient people have been found to have a "locus of control" or view that they have a high degree of "control over their destiny". Many of our decisions in life have a significant impact on subsequent opportunities or events. One can either take the view that “nothing good ever happens for me, I’m so unlucky”, or one can make an effort to change things. Hence, if one takes no-learning from life’s experiences, then one cannot expect anything to change, as the same inputs will result in the same output.

If one looks at Elite military personnel, then nobody would join these units if they believed that they had no control over their destiny. In essence, such staff would be partaking in the highest risk activities and assuming that they had no control over the outcome and so most tasks would be pure suicide. Such personnel and organisations are continually pushing the boundaries and learning from experiences. Part of the founding ethos for the British Special Air Service (SAS), was and still is to this very day “the unrelenting pursuit of excellence”.


Like attitude and locus of control, optimism plays a considerable part in the lives of resilient people. After all, if one had just had a negative experience and were not optimistic about learning from that experience and moving forward, then nothing would change. There are certain events in life that we have very little control over like being born, ageing or even death. However, there are far more events and life experiences that we can profoundly or positively effect. One can either chose to focus one's efforts on those things that we have little control over “a pessimistic view” or focus on the things we can change “an optimistic view”. If one lacked optimism, then one is never likely to try new things or do anything differently.

Self-Awareness (Physical and Emotional Awareness)

Physical and psychological self-awareness is particularly essential within the elite military and special forces environments, as teams tend to be small and a problem can impact the effectiveness of the entire team. Self-awareness can make the difference between life and death. For example, being able to spot the signs and symptoms associated with hyperthermia and hypothermia early on can save ones life or those around one. Many elite level athletes are also extremely tuned into their bodies and minds, as are most resilient people.

Lacking self-awareness can lead to both physical, emotional and mental health-related problems. Self-awareness helps one understand when things are not quite right or "normal". If one just blindly ploughs through life with no form of self-awareness then one can easily miss the early signs of something being wrong, be that physical, emotional or psychological. Even if one subconsciously notices telltale signs of a problem and ignores them, then one is usually heading for a severe and sometimes catastrophic failure. Such a failure could prove to be a life-changing event in some cases.

Hence, it is essential to quietly reflect and take stock of how everything is feeling (physically, emotionally and psychologically) from time-to-time and to study why things are feeling the way they are. If things do not seem to be “normal”, then one can then explore why via an external intervention or seeking professional help. There are various techniques for helping to develop self-awareness, such as meditation, mindfulness and yoga.

As a Chiropractor, the author is continuously surprised by the fact that relatively few patients have much self-awareness concerning how their bodies are feeling on a day-to-day basis and what is "normal" and not “normal”. Many people seem to have more awareness about the need for maintaining a car, house, bike or anything else than their body, health and wellbeing. Hence, education plays is a crucial part of the authors daily clinical work.

Sense of humour

A sense of humour is another tenet from David Sterling, one of the founders of British Special Air Service (SAS). Many resilient people who work in jobs which can involve extremes of pleasant and unpleasant experiences tend to have a good sense of humour. Sometimes people can be referred to as having a slightly “dark” sense of humour. Having a sense of humour can be critical when a situation is terrible or appears to be hopeless and can provide a great of way adding perspective. Staff within the NHS, Emergency Services and Military, will all need to have a sense of humour to deal with the sometimes extreme types of events and experiences they encounter regularly.


Social support/network

Resilient individuals have been found to have a good social support network, which typically is not hugely extensive. The social support network may consist of a relatively small core group of friends and family members. Such groups are good for sharing experiences, learning, self-development and discussing specific issues or problems.


Spirituality does not have to mean having religious beliefs or faith, though this is one of many forms of spirituality. Resilient people have also been found to be spiritual.  Spirituality could merely be, feeling at one with the world, understanding one's place in the world, or how one lives one's life.  In essence, spirituality can provide focus and meaning to one's life and help drive one forward.

The article was written by Dr Terry Davis MChiro, DC, BSc (Hons), Adv. Dip. Rem. Massag.,  Cert. WHS.

About the Chiropractor Author

The author possesses an unusual mixed background for a Chiropractor (McTimoney). His education, training and practical experience span over two decades and relate to both physical and mental aspects of health. He has also needed to push his own body and mind to the limits of physical and psychological endurance as part of his time serving in Britain’s elite military forces. His education includes a bachelor of science degree in Business Management, with a specialisation in psychology and mental health in the workplace, an Integrated Masters in Chiropractic, MChiro and a multitude of soft-tissue therapy qualifications. His soft tissue qualifications range from certificate level right through to a BTEC Level 5 Advanced Diploma in Clinical Sports and Remedial Massage Therapy. Terry also has extensive experience in security, work, health and safety and holds relevant certifications. He has also taught at Advanced Diploma level (Myotherapy / Musculoskeletal Therapy) in Australia, both theoretical and practical aspects including advanced Myofascial Release Techniques and has certification in training and assessment. Terry’s combination of knowledge through, education, training, his elite military experience and personal injury history have paid dividends for the patients he sees and has treated. Terry is still extremely active and enjoys distance running, kayaking, mountain biking and endurance-type activities.

Complementary & Natural Health Council (CHNC)
General Chiropractic Council (GCC)
Sports Massage Association (SMA)