May 11, 2013

Positively Stressed

Mental health tip: Just cause it's positive doesn't mean it isn't stressful.

One of my friends is planning her wedding. She just sold her condo and she and her fiance are moving into their new house next month. Meanwhile, she was offered a promotion at work and her first short story was accepted--pending revisions--for publication in a national magazine, pending revisions. We recently met for dinner after not seeing each other for a couple months and when she told me all her news, I said something like "Wow, you must feel on top of the world!" Instead, she tearfully confessed "I'm so stressed out I can barely breathe. I've been taking sleeping pills almost every night to try and get some rest, and worst of all--I know I should be happy and enjoying all this!"

One of my mindfulness students is about to finish medical school. After four arduous years, he's going to graduate next month and is nailing down his plans to move to another city for his dream residency. In the meantime, he's training for his first triathlon and he and his girlfriend are expecting a baby in the fall. When he told me all his news, I remembered my friend and said, "Wow, that's a lot of stuff. You must be kind of stressed out." My student tearfully admitted that he hasn't been eating or sleeping well and is constantly picking fights with his girlfriend. "The worst part," he said, "is that I know I'm so lucky and that I should be happy instead of stressed out!"

What's going on here?

Both my friend and my student were compounding their stress with the erroneous belief that positive events should create only positive feelings. This idea meant that they were adding guilt on top of stress, making it worse.

Two things that helped:

a) Sharing the definition of 'stressor' that I use in teaching mindfulness-based stress reduction: "Any threat, demand, pressure, or change in the environment that requires the organism to adapt." Notice that this definition does not assume that stress is caused by negative events, but rather by pressure and change.

b) Introducing the Holmes and Rahe stress scale. Developed by two psychiatrists, this scale yields a total stress score based on life changes and experiences in the past year, including things like marriage, retirement, Christmas, change in personal habits, and change in number of family reunions.

Getting married, moving, changing jobs, morphing from student to professional, and preparing for a baby certainly all qualify as demands, pressures, or changes requiring adaptation, and almost all of them are listed in the Holmes and Rahe scale. My friend and my student were relieved to know that just cause it's positive doesn't mean it isn't stressful; acknowledging that positive stress is still stress allowed them to cut themselves some slack, decreasing the unnecessary additional stressor of guilt.

The next time you're feeling stressed out in the midst of an avalanche of good news or positive events, remember that just cause it's positive doesn't mean it isn't stressful.

NB: This first step will probably in itself make you feel better. However, an important second move is to take concrete steps toward stress reduction. My friend booked a massage, cancelled her bachelorette, and negotiated a week's vacation prior to beginning the new position at work. My student registered for a 10k race rather than a triathlon, and decided to stop collecting new baby gear until after the move. 

May 03, 2013

Sunday Neurosis

You know that creeping anxiety that develops on Sunday as the weekend draws to a close?

It's not just you! So many friends, patients, and mindfulness students have mentioned the "Sunday night feeling" recently that it merited a Google search. It turns out that Sunday-specific anxiety is a ubiquitous phenomenon: sources as diverse as Psychology Today and Victor Frankl--an Austrian psychiatrist famous for finding meaning in his concentration camp experience--have written about the Sunday feeling, with Frankl coining the term "Sunday Neurosis."

Sundays can be difficult for multiple reasons, including the following:

1) They're unstructured. Although we complain about workday constraints, many of us prefer routine and schedules. Saturdays are often filled with errands and chores, but Sunday is often a looser, lazier day--which is not comfortable for everyone.

2) We have to return to work the next day. Even if we're relatively happy with our job, the looming return to the office can be enough to stimulate apprehension. If we aren't happy at work, or left tasks undone on Friday, the Sunday feeling can intensify to dread.

3) We're still carrying childhood school anxiety. For many, the sad Sunday feeling has its roots in childhood, when we faced homework, the end of two days of play, and an early bedtime. If we were bullied or otherwise unhappy at school, Sunday night angst could intensify to outright fear.

4) We didn't accomplish all of our weekend goals--including relaxation. As Thursday and Friday roll around, we often build up our expectations of our precious two days off and generate unrealistic to-do lists. For example, we plan to--over the course of two days--catch up on reading, go to the market, visit our parents, sleep in, take the kids to the park, finally fix the leaky shower head, do a bit of freelance work, clean out the closets, and cook a couple dishes to freeze for dinner later in the week. Above all, we plan to relax and unwind--while accomplishing everything on the list above! Failure to meet our improbable goals contributes significantly to Sunday angst.

How can we decrease or manage Sunday Neurosis? Here are some solutions:

1) If your Sunday Neurosis is generated by unrealistic expectations for your two days off, try treating your weekend to-do list as a loose game plan, not a strict program. Better yet, identify two or three priorities and let go of the rest. For example: this weekend I will grocery shop, have dinner with a friend, and call my mom. Or: this weekend I will clean the bathroom (not the whole house), register the kids for summer camp, and take one hour to sit and read for pleasure.

2) If your angst is generated by the unstructured nature of Sundays, make a loose schedule for your day. For example, plan to go to the gym in the morning, catch up on personal email in the afternoon, and do laundry after supper before relaxing with an hour of TV. You don't have to schedule every minute of your day, but a general plan can alleviate anxiety created by lack of structure.

3) If your Sunday Neurosis is related to the upcoming return to the rush of the week, consider ways you can use your day to alleviate weekday stress. You might feel better about Monday if you took some time on Sunday to do laundry, make lunches, run errands, and otherwise prepare for the upcoming week. Getting the household to bed on time can also help.

4) If your Sunday stress is the result of a focus on Monday, try practicing mindfulness. Monday may feel looming, but today--now--is actually still the weekend. If your Sunday feeling is an echo of grade-school angst, remember that today--now--is 2013 and you're not in grade six anymore. Don't miss what could actually be a lovely day off by launching your mind back to elementary school or forward to tomorrow.

5) If your Sunday Neurosis stems from the upcoming return to work, consider some of the things you like about your job or are looking forward to. Are you going for lunch with colleagues this week? Finally submitting a big project?

6) If work-related Sunday apprehension persists, take the time to identify what is making you unhappy about your job and whether or not you can do something about it. For example, if having to be at work at 8am on Monday triggers your Sunday angst, can you negotiate to arrive at 9am and stay an hour later? If you feel isolated at work, is there a way to introduce more social contact into your workday?

Any combination of these strategies may be helpful in treating the uncomfortable Sunday night feeling. Since we tend to believe that our neuroses constitute a personal and idiosyncratic problem, just knowing that Sunday Neurosis is a common and known phenomenon may be helpful for some.

What's your strategy?