Feeling the pressure: how counselling works to reduce stress

A recent episode of the BBC series ‘The Truth About…’ dealt with what it and the World Health Organisation called a 21st century health epidemic: stress (4th May, 2017). Stress, it told us, is a primal emergency reaction to a perceived threat. It is a physiological and neurological reaction in which a part of the brain, the amygdala, tells the adrenal glands to release stress hormones (cortisol and noradrenaline) in order to sharpen our reactions and send extra oxygen to the brain. Thus we experience stress in the body as an increase in breathing rate and body temperature, preparing us for the ‘fight or flight’ response. The programme then presented us with various sensible strategies to make sure that occasional or acute stress (which is useful) does not tip over into the debilitating effects of chronic stress (such as insomnia, high blood pressure and coronary heart disease). The strategies include:

• cognitive reframing, which involves - for example - thinking of an event or experience which makes you feel anxious as exciting instead
• nutritional fixes - eating foods which turn down cortisol production, such as those rich in magnesium, like walnuts and almonds, or antioxidants, found in blueberries
• increasing exercise, again to reduce cortisol and release endorphins
• mindfulness meditation, to deal with the stress-inducing effects of a wandering, ruminating mind.

Counselling clients often say to their therapist: ‘I feel really stressed’, and part of the counsellor's work is to help clients to interrupt the stress cycle and to support them with these kinds of day-to-day strategies that give them back a sense of control. But counselling is not just about providing cognitive and behavioural ‘strategies’ to deal with the symptoms of stress. If that were the case, the counselling room would be a bit like a chemist, dispensing cures.Counselling involves a relationship between two people and gradual emotional shifts. So how does counselling work in relation to stress and how does it sit with these ‘strategies’?

Even though stress is thought of as a recent phenomenon, interest in how the body and mind respond to external pressures is centuries old. From the eighteenth-century exploration of the relationship between ‘nerves’, ‘passions’ and disease, to nineteenth-century theories of the way in which bodies ‘adapt’ to external change, to the rise of interest in fatigue, especially workplace fatigue and psychosomatic illness in the early twentieth century, scientists have long found ways to describe the often difficult relationship between the mind, the body and the external world.

In the later part of the twentieth century, the term ‘stress’ (meaning the mental and physical pressure exerted on an individual by external events) became a focus of scientific psychological study. Debates between psychologists focused on the best way to measure stress and thus to reduce it. Arguments fell into two camps. There were psychologists who saw the measurement of ‘stimulus’ (life event) and ‘response’ (illness, distress, etc) as the only objective, scientific way to understand stress. In the other camp were those who introduced a third term into the equation: stimulus (life event), organism (the individual undergoing the life event) and the response. These psychologists sought ways to take into account the meaning of the stressful life event to the individual experiencing it. From this perspective, the individual’s ‘appraisal’ of an event as stressful or otherwise is a better way to understand their response to stress than an attempt to ‘objectively’ measure how stressful an event is. Such studies argued that to effectively reduce stress, or its impact on the individual, we need to account for the things that predispose someone to respond adversely to or to cope well with difficult life events.

This shift from understanding stress as the impact of a life event on mind and body to paying attention to the impact of the meaning of the life event on the mind and body, is central to the understanding of the way that counselling works in reducing the impact of stress. Our emotional responses to the things that happen to us (sadness, anger, fear, shame) are important clues to the way that we process stressful events. The way in which two clients respond emotionally to a similar ‘stress event’ (a bereavement, a relationship break-up) are never exactly the same, so the route to ‘recovery’ will not be the same either. Counselling helps clients to identify, understand and, most importantly, experience their emotional responses to stressful events (in the past or present) and thus their meaning, in a safe, boundaried relationship, in which their needs are primary. Once we can identify the particular ways in which we respond to stressful events, including how we cope with them, the strategies for day-to-day management stand more chance of success. So notice the way you think, eat well, exercise and meditate, but to give these strategies staying power, notice how you feel and seek acceptance and understanding for those feelings.