Beat Stress Feel Better by Men's Health Forum

BEAT STRESS FEEL BETTER Men’s Health Made Easy

Completely Revised. Third Edition.

MEN’S HEALTH FORUM The Men’s Health Forum’s Man Manuals are full of easy-to-read information on a wide range of men’s health subjects. Founded in 1994, the MHF is the independent voice for the health and wellbeing of men and boys in England, Scotland and Wales. Our goal is the best possible physical and mental health and wellbeing for all men and boys. Beat Stress, Feel Better © Men’s Health Forum All rights reserved. You must not reproduce or transmit any part of this booklet in any form or in any way without written permission from the Men’s Health Forum. This includes photocopying or scanning it. Printed in the UK. ISBN: 978-0-85761-036-2 Men’s Health Forum, 49-51 East Road, London N1 6AH Registered charity number 1087375 Company limited by guarantee number 4142349 – England

020 7922 7908 www.menshealthforum.org.uk

OTHER MEN’S HEALTH FORUM PUBLICATIONS Our award-winning Man Manuals - men’s health made easy. Recent titles include The Man Manual, Man MOT, Man MOT for the Mind and Size Isn’t Everything (on penis health). Available as single copies or in bulk. Some titles also available as ebooks or as PDF manuals. shop.menshealthforum.org.uk/mm We also offer publications for professionals and training. This publication has been fully referenced and researched under the sadly now defunct Department of Health Information Standard and reviewed and approved by the Forum’s medical peer review panel chaired by Dr John Chisholm. A full list of references is available at: menshealthforum.org.uk/MMreferences The MHF encourages your feedback at: menshealthforum.org.uk/MMfeedback

CONTENTS Don’t Worry, Be Happy

What Causes Stress? work, unemployment and low pay, money, endings, physical health, partners and friends, sexuality, social media, loneliness, drink and drugs, urban blues, winter blues, neurodiversity, life in a pandemic

Who Are You Kidding?

What Rattles Your Cage?

What Works? connect, be active, notice, learn, give, eat well, sleep well, sing, dance, laugh, have sex, write, be mindful, talking therapies, CBT, medication

Works For Me

Jargon Buster

Is Your Mate Off His Game?

Want More Info?

In the UK in 2020, at least ten men took their own lives every single day. Inspired by the book Brain by Ian Banks • Text by Fabio Zucchelli, Richard Shrubb, Steve Baxter and Jim Pollard • Edited by Jim Pollard • Cartoons by John Byrne • Photo credits p35 • Publication: August 2014 Last revision: February 2022 • Next revision: February 2025 This new edition was made possible thanks to donations in memory of James Kelly (1978-2022).

DON’T WORRY, BE HAPPY Don’t worry, be happy. It’s easier said than done. But if you can crack it, even a little, you’ll get a lot more out of life. This booklet is full of good ideas to enable you to beat stress and feel better. Just one could make the difference. Inspired by the ground-breaking Brain manual by Dr Ian Banks, Beat Stress, Feel Better has been written by a team of professional health writers with personal experience of many of the challenges discussed in this booklet.

WHAT IS STRESS? Stress is normal. It is what we feel when a situation is hard to handle. Adrenaline rushes through the body, increasing heart rate and boosting mental

TOO MUCH STRESS CAN: > DAMAGE YOUR IMMUNE SYSTEM AND HEART > INCREASE YOUR CHANCE OF SERIOUS HEALTH PROBLEMS > REDUCE YOUR LIFE-EXPECTANCY > DAMAGE YOUR SEX LIFE 4

and physical alertness. We feel sweaty, tingly and get butterflies. This ‘fight or flight’ response was very useful to our ancestors coping with physical threats such as a marauding mammoth or sabre-toothed tiger. Today’s ‘threats’ are often far less serious but far more frequent. The trouble is that stress hormones such as adrenaline and cortisol are harmful when we don’t actually need them. Over time, they can damage the immune system and the heart and reduce both physical and mental well-being. This means it’s not healthy - or practical - to go into ‘fight or flight’ mode every five minutes. It’s much easier - and healthier - to respond in a less stressful way. But how do you do that? If we can figure out how we feel and what has caused it, we can respond more smartly. That’s what this booklet is all about. The first part - starting on page 6 - looks at common causes of stress, the second part - starting on page 19 - looks at what we can do about it.

WHAT ARE THE SIGNS OF STRESS? Well, we’re all different. This booklet should help figure out your own signs of stress for yourself but some of the more common ones are listed on page 17.

WHY DOES IT MATTER? Stress causes mental health problems. One in four of us will have a mental health problem this year. They’re responsible for half of all long-term absences from work. Unchecked mental health problems can be very serious indeed. About three-quarters of the people treated for depression are women but about three quarters of the people who take their own lives are men. Since depression is a major cause of suicide, something doesn’t add up. Is it us? Talking about stress is not a sign of weakness. It takes balls.

WHAT CAUSES STRESS? Life can be a right pain in the butt at times. Here are some of the common causes of stress today. Which of them push your buttons?

WORK Stress, depression and anxiety are the main causes of days off work in the UK. British men work longer hours than European men - less time for us and our families. Insecure jobs and contracts increase stress. But do our attitudes to work make it worse? The pressure to ‘succeed’ from school onwards promotes competition and comparison. You might say this motivates us. But does it? After all, no matter how well we’re doing, there’ll always be someone doing better. How will we ever be content? Work to live. Don’t live to work. > Speak to someone at work responsible for occupational health.

> Try to leave work at work – avoid work emails, texts or calls in ‘your’ time. > Talk to a trade union – visit tuc.org.uk. > Perhaps ask your employer for flexible working or other adjustments. > If you have a family, visit workingfamilies.org.uk.

UNEMPLOYMENT AND LOW PAY Unemployment, underemployment or pay so low you can’t live on it is not your fault, however it might feel. > Try to make use of government services such as Jobcentre Plus and Find A Job on gov.uk > Make sure you claim all the benefits you’re entitled to. Billions of pounds go unclaimed every year. Work-related benefits include Jobseeker’s Allowance and Universal Credit and Pension Credit. There are also benefits related to housing, disability and for caring. Be inventive. Could you do something different? Could you work for yourself?

MONEY Whether it’s struggling with bills, long-term debt or over-spending on Christmas presents, money means stress. Try not to get into debt in the first place. If you do, it’s never too late to seek money advice. Sooner is always better. > Assess the type of debts you have. Which are the priority? How much could you reasonably pay? > Talk to Citizens Advice (www. citizensadvice.org.uk) or the government’s free Money Helper service (www.moneyhelper.org.uk). The governmentbacked Breathing Space scheme may give you extra time. > Talk to the people you owe money to. > There are also money and budgeting apps available. Some banking apps are also useful for tracking your cash. Can your bank help? If you need to borrow, look around. Use a local credit union. Interest rates are often far, far lower. Visit findyourcreditunion.co.uk

ENDINGS Don’t underestimate the impact of grief on your well-being. The death of a loved one brings several stages of grief. Give yourself time to grieve. If you need support, try bereavement support services (such as cruse.org.uk) or other grief counsellors. But it’s not just death. Other life changes which shock and to which we need to adjust include moving house, splitting up with a partner, changing job or children leaving the family home.

PHYSICAL HEALTH Physical health problem can be a sign of stress while ignoring them can be a cause of stress. Erection problems are a good example. They could be a sign of heart disease, diabetes or depression while ignoring them is sure to lower your mood. Feeling unwell or being in pain makes it harder to cope with other challenges; adjusting to a longer-term condition involves grieving for the old you. Some long-term conditions can directly affect mood including thyroid disorder, diabetes, Parkinson’s Syndrome or multiple sclerosis. So can the diagnosis of a serious illness. If you have symptoms you’re concerned about, the sooner you see a GP, the sooner they can be sorted and the less serious they’re likely to be long term. In all cases, your GP should offer advice on counselling, medication and other support for your well-being as well as on the physical disease itself.

PARTNERS AND FRIENDS Love hurts. Relationships, family disputes and struggles with your identity and sexuality can be a huge factor in happiness. Social media ‘friends’ provide a distraction but may jeopardise other real relationships. The only advice that works is: find a time to talk. It may be uncomfortable but bottling it up is worse. There’s no right way to talk about this stuff – just say it how you feel it. (If you’re worried you’ll lose your temper, see page 15.)

The talking therapies (see page 23) discussed in this booklet are particularly useful for relationship problems. Relate (www.relate.org.uk) and other organisations provide talking therapies for individuals, couples and families.

SEXUALITY Be who you are. If your sexuality isn’t harming anyone else, enjoy it. (If it is harming someone else, get help before you commit a crime.) If you need to talk to someone about your sexuality and you don’t know a local organisation, you’ll find some suggestions by following the links on page 35.

SOCIAL MEDIA Half the world may use social media but it is still relatively new and there is little research into its long-term effects. However, a systematic review published in 2020 suggests that in some people it can have negative effects on mental wellbeing. On one hand, it is a form of communication and connection (which are usually good things) but, on the other hand, it can feel like we are living our lives under a microscope. Some may like this but others may not. It is important to be honest with yourself about how social media is making you feel. If you feel it could be affecting your mental wellbeing, give it a break for a while. See how you feel.

LONELINESS More of us are living alone, further from our families, relationship break-ups are high and communities are less tight. In the UK, one in ten people feel lonely and half of us think we’re getting lonelier. Loneliness has been compared to smoking because of the damage it can cause to our long term health. We’re social animals; loneliness makes us unhappy. If you’re down, it could be that you’re lonely.

DRINK AND DRUGS What goes up must come down. This is generally the case with alcohol and all other drugs including prescription ones if taken in too large a quantity. Even smoking can drag your mood down in the long term. As well as your physical health, the hangover will often affect the way you feel about yourself. You may feel anxious, depressed and disgusted with yourself. Long term, drinking too much too often can cause serious mental health problems including severe depression, paranoia and hallucinations which can only be sorted by a doctor. An active social life is good for you but it all adds up. If you’re concerned about overdoing it, see ‘Am I addicted?’ on page 13. The Forum also publishes a manual on alcohol: Serious Drinking.

THE URBAN BLUES Most of us live in towns. We interact, travel and communicate more than in rural areas. Add in unhealthy workplaces, noise and fast food and it’s not a recipe for calm. Make your space less stressful by, for example: > Removing clutter > Making it more personal – putting up a family photo at work > Making a sanctuary – removing intrusions (especially electronic ones) in one room (the best bet is the bedroom).

THE WINTER BLUES We all need daylight and the sun on our skins. Grey skies are gloomy. Being too hot or too cold will also affect your mood. Seasonal Affective Disorder (SAD) - or ‘winter depression’ - is linked to low exposure to sunlight. If you find yourself regularly despairing during darker days, talk to your GP. There are options available including special lightboxes. Visit sada.org.uk.

NEURODIVERSITY We’re all different but some of our brains are more different than others. Neurodiversity refers to conditions like attention deficit hyperactivity disorder (ADHD), dyslexia and autism spectrum disorder in which brains are ‘wired’ a little differently from what is typical for most humans. Sometimes the divergence may be useful - a gift for numbers or music, for example. But difference can also cause difficulties. All of us can sometimes struggle as individuals to fit in or find our place in wider society. But this can be harder if your brain works differently to most. It can cause anxiety, depression and detachment and lead to relationship difficulties and bullying. Diagnoses of neurodiverse conditions are increasing but it is probable that many adults remain undiagnosed. Many only find out they have a condition when their child is diagnosed (see John’s story on page 29.) The Autism Act 2009 gives you the right to a diagnosis, regardless of age. It is important that health professionals understand when the people they’re working with live with neurodiversity.

LIFE IN A PANDEMIC Living with Covid-19 has affected everybody’s mental wellbeing and we need to be honest with ourselves about that. To feel better, remember the five ways to wellbeing (see page 21). There is a lot of Covid junk on social media. Be wary if you don’t know the exact source (even if it was shared by a friend). Stick to reputable sources of information like the NHS, the BBC, the World Health Organisation and the Men’s Health Forum and don’t gorge on it. For the latest official government guidance, check gov.uk It’s good to be aware of your feelings including the feeling of being overwhelmed. But feelings don’t last forever. And nor will any particular phase of the pandemic.

WHO ARE YOU KIDDING? We’re all different, we’re all unique. Living a lie is pretending to be someone you’re not - even to yourself. Are you living a lie? We might hide it behind all sorts of things including drink, aggression and even hard work, but a lot of us are not comfortable in our skin. Perhaps it is related to childhood, family, culture, sexuality, ideas of right and wrong (see Why do I lose it? on page 16). We’re not responsible for what happened to us as kids but only we can do something about it as adults.

WHAT CAN I DO? Be honest with yourself, especially if you’re often angry or feel disrespected. Then, if you can, find someone else you can be honest with. It doesn’t have to be a mate or family member. It can be someone you don’t know. You’ll

find organisations by following the links in this booklet. Feeling uncomfortable in your own skin won’t get better with time. Most likely it will get worse. Old-fashioned ideas of what it means to be a man can make it difficult for us to talk honestly. Some of us can’t even ask for directions in the street because we don’t want to look vulnerable. But silence isn’t a sign of strength. Silence is easy: you just keep your mouth shut. Being honest is the real strength. Accept yourself as you are and be fine with it. If you’re not hurting yourself or anyone else, what’s wrong with being yourself? (Even if that is different from what you think society and other people want.) Try not to use alcohol, cigarettes, gambling or drugs to relieve stress – these can all contribute to poor mental health.

AM I ADDICTED? You can become addicted to almost anything – drink, gambling, sex, drugs, football, slots, porn, masturbation, work, computer games, exercise, sugar, shopping. The list goes on. Something fun that gets you buzzing in small doses can become dangerous in big ones, leading to physical and mental health problems. Broadly there are two types of addicts: > The ‘topper-upper’ who needs a fix regularly; > The ‘regular binge user’ who gets blasted every so often. Symptoms of addiction include depression, anxiety, paranoia and hallucinations. It will begin to affect your work and your relationships. Addictions mask health problems such as depression. Choosing to be high or drunk all the time may suggest you’re hiding something from yourself. Coming off your chosen high may allow you to see what needs to be done. If you’re concerned, ask yourself these questions: > Do you think about X while doing something else and look forward to it? > Do you feel you need more X each time to get the same enjoyment? > Have you made efforts to cut back on X? > Do you do X for longer than intended? > Have you put X before more important things like relationships or work? > Have you lied to others about your involvement with X? > Do you use X as a way of escaping from problems or of relieving, for example, feelings of guilt, anxiety or depression?

If you answer yes to some of these, stop X for a month. If that is too difficult then you have a problem and need to do something about it. It’s not too late. Your body can repair itself from even the strongest physical dependency, even after many years, but you need to give it time to do so. If you have an addiction, support is availble through your GP and other health professionals. There is also peer-to-peer or self help support available from others facing similar challenges. The twelve steps approach used by Alcoholics Anonymous and similar organisations is probably the best known but there are others. Check out what is available locally and online.

COULD I HAVE AN EATING DISORDER? Eating disorders such as overeating, anorexia (self-starving) or bulimia (binge-eating and purging/vomiting) affect far more men than we realise. This may be because of an increase in Body Dysmorphic Disorder, where people see themselves as failing to have what they think is the ‘ideal body’. These days eating disorders organisations are well aware that these conditions affect men too and can offer useful advice and support. NHS weight management services can offer a personal consultant and exercise and diet plans. Talking therapies are also useful.

WHAT RATTLES YOUR CAGE? Identifying what is behind your stress is the first step to dealing with it. Which of the common causes stress you? Look at the big three areas in our lives: > work > relationships > home life. Short-term ups and downs are normal but when you start having long-term problems in one or more of these areas, the stress will mount. That’s not because you’re weak, that’s because you’re normal. You may react by getting out of a situation - the ‘flight’ response - and in some cases a new start might be what you need. But if you keep changing jobs, partners or moving home, it may be that it’s not the situation that needs to change but your reaction to it.

WHY DO I GET SO ANGRY? Men are generally more explosive in their anger than women, and often express it in more violent ways - violent language, violence against others or themselves, criminal violence or even suicide. Occasional anger is normal. The best short-term response if you feel you’re

losing control is to remove yourself from the situation (see ‘How to take a time-out’ on page 18). If you get angry often, easily or quickly and it is causing stress for you and others, you need to find a way to stop before it leads to something you will regret. Treatment can include CBT, psychotherapy and anger management courses. (More about these later.) The NHS website offers information and self-help tools for anger.

WHY DO I LOSE IT? We’re all different. Some of us dread deadlines; others love the adrenaline kick. This means different things trigger stress in different people. People who have had tough upbringings tend to release more cortisol hormone in stressful situations than those who haven’t. But you don’t have to have ‘had it tough’ for childhood to leave its mark. Anything painful that you haven’t talked about - or at least consciously thought about - can come back to affect you as an adult. Could the way you feel and behave today be related to something unresolved from your past? Genes may also play a role in how we respond, but the way our genes are expressed can be altered by our experiences, and our brains are especially malleable - or ‘plastic’ - in our early years. Even as adults we can rewire our brains to respond in more useful ways (through, for example, CBT or mindfulness - see pages 24 and 25 - and some of the other ideas in this booklet). It’s about working out your own triggers, how they affect you and how you can avoid or reduce them. When you’re feeling down, make an effort to think about what’s been going on in your life recently. The big things that have happened to you might make you prone to depression or anger but sometimes it’s the little things that we don’t notice, like not getting enough sleep, which trigger it off. Getting to know your own patterns can make the difference.

Sometimes it’s hard to notice these things. Family or friends may notice it first (so it makes sense to listen to them even if you don’t notice the same thing). Frequent mood swings could be a sign that you’re bottling up a problem or an addiction or perhaps have a mental health problem such as bipolar disorder. Talk to your GP.

DO I HAVE LOW SELF-ESTEEM? Low self-esteem - thinking poorly of ourselves - gets us off to a bad start when it comes to stress and mental health. Family, friends, teachers, the media, social media all send us messages about ourselves, both positive and negative. These are particular strong in childhood when negative messages can kickstart low self-esteem. We often mask low-self esteem with what, on the face of it, looks like the opposite: anger, self-righteousness or a sense of entitlement. If you’re kinder to others than to yourself or, conversely, if you blame others for things that are in fact down to you, think about how you really feel about yourself. Do you have low self-esteem? Try to respect everybody’s opinions and needs, including your own. Express your needs clearly and say ‘no’ when you want to. This is being assertive. Don’t confuse it with being aggressive.

WHAT ARE THE WARNING SIGNS? A relentless build-up of pressure, without the opportunity to recover, can lead to harmful stress. The important thing is to recognise the warning signs while you can do something about it. Common signs are: > Eating more or less than normal > Mood swings > Low self-esteem > Feeling tense or anxious > Not sleeping properly (or wanting to sleep all the time) > Poor memory or forgetfulness > Excessive drinking and/or drug use. > Feeling really tired and lacking in energy

> Withdrawing from family and friends > Behaving out of character > Finding it hard to concentrate and struggling at work > Losing interest in things you usually enjoy > Having unusual experiences, like seeing or hearing things that others don’t. > There may be physical signs too like headaches, irritable bowel syndrome or aches and pains.

HOW TO TAKE A TIME-OUT When you see your warning signs: > Remove yourself from the immediate source of stress if you can (you could say ‘I’m going to the bathroom’). > Give yourself a simple manual or mental task to ‘distract’ your mind. > Change scenery – somewhere peaceful such as a library, church or garden. > Take a walk. > Turn off social media, especially mobile phones and email. > Breathe deeply from the waist rather than the chest to relax the body (search YouTube for ‘diaphragmatic breathing’).

WHAT WORKS? So how do you change your response to stress? There are no rules. Different things work for different people. These ideas will help both reduce stress and increase your capacity to handle it. It’s tempting to drop the things you enjoy the most when you get overloaded. But not doing the good stuff won’t make the bad stuff go away. When you feel low, that’s when it’s most important to do the things you really love. It’s often just what you need to feel relaxed and good about yourself.

CONNECT - AND TALK If loneliness makes us unhappy, then connecting with others will make us happier. We all know how good it is to talk when you really connect with someone. For some of us, social media can only go so far. Indeed, research suggests social media can make some of us miserable. ‘A problem shared is a problem halved’ is a cliché because it’s true. It’s not about other people telling us what to do or being needy. It is simply that talking often lets us see the solution for ourselves in a way thinking alone can’t. We’re not alone - we often share the same problems. Having a chat about something doesn’t have to be a big deal. Share an activity with the person you want to chat to and talk while you’re doing it: washing-up, cleaning the car, painting a fence, playing a computer game.

Even if it barely involves talking, connecting with others and feeling part of something in whatever setting feels good: playing five-a-side, bowling, going to the pub, going to the match, cycling, whatever. Meet new people through a local club, group or internet meet-up - especially if social media are dominating your life.

BE ACTIVE - TAKE EXERCISE Taking exercise is proven to blow off the blues. In the short term, two happiness chemicals are released into your system – anandamide and endorphins, the so-called ‘runner’s high’. In the long term, exercise improves your all-round fitness. Of course, fit people still get the blues, but the less exercise you take the worse you feel. For the full ‘runner’s high’, get on your bike, jog or go to the gym. But low intensity exercise works too. Just a good walk will give you a lift. Or anything you fancy that gets the heart beating a little faster. Do it regularly. Set some simple goals. It’ll put some rhythm back into your life. It’s fun and you’ll feel and sleep better. There’s no pill that can do all that. IF EXERCISE WERE A PILL, EVERYONE WOULD BE TAKING IT.

NOTICE Be aware of what is taking place in the moment you’re living. Slow down. Engage your senses. Taste what you’re eating and drinking. Listen to the sounds around you. Notice the environment you’re walking or driving through. It sounds easy, but the truth is that we’re often thinking about the past or fretting about the future, rather than fully participating. Mobile technology can make this even more difficult. For more on this, see the information on Mindfulness on page 24.

LEARN OR DISCOVER Learning proves - if you need reminding - that things can change for the better. And new skills and knowledge can help you out of a rut. They say knowledge is its own reward but it can also boost confidence, self-esteem and motivation. Take a class, read a book, visit a museum (try a virtual tour online).

GIVE OR OFFER TO OTHERS From the simplest thing like a smile and saying ‘hi’ to fundraising to volunteering, giving to others can make us feel better. Volunteering benefits everyone. You can help others, learn new skills, meet like-minded people and do something you enjoy. You may just want to get out of the house. Whatever it is, volunteering gets you out of yourself and thinking about something - and someone - else. It is especially useful if you’re between jobs.

THE CAN DO CHALLENGE The CAN DO challenge is based on the five ways to wellbeing: five evidence-based things that any of us can do to lift our mood and reduce feelings of anger and frustration. The five ways, covered on pages 19-21, are: > Connect - connect with other people (see page 19) > (Be) Active - move your body (see page 20) > Notice - take notice of the environment around you (see page 20) > Discover - learn something new (see page 21) > Offer (or give) - (see page 21). Set yourself your own CAN DO challenge: > do all five in a week or a day > find a single activity that ticks all 5 boxes > get five friends to do it too > make a day of it and do each activity for an hour. More ideas on the Forum’s website and in our Man MOT for the Mind booklet.

EAT WELL Nutrition isn’t just about physical health. Your brain needs nutrients like the rest of your body. If you eat rubbish, you will feel rubbish. This is particularly important if you work unusual hours or shifts Low levels of vitamins and minerals or changes in blood sugar levels from an irregular or unbalanced diet can affect mood. If your mood swings for no obvious reason, keep a food diary and see if certain foods, especially ones you eat a lot of, play a role. An old adage is ‘breakfast like a king, lunch like a prince, and dine like a pauper’. With a good breakfast you will be in a good mood as your day begins. Top up through the day after that.

SLEEP WELL After a stressful situation, sleep resets the balance. We underperform if we don’t sleep. Regular poor sleep also shortens life-expectancy. The mind needs sleep too. To dream. When people with anxiety or depression are surveyed, most of them sleep for less than six hours a night. (Recurring nighmares can be a sign of post-traumatic stress.) Keep fresh to function. If you’re having trouble sleeping, try these: > a warm bath (not too hot) so your body is at a temperature to rest > removing TV/computer from the bedroom > cutting down on booze and caffeine > relaxation exercises or yoga and/or a relaxation CD (serious exercise will have the opposite effect and keep you awake) > writing tomorrow’s To-Do list to clear your head > reading or listening to the radio - this can relax the mind by distracting it > keeping a sleep diary to spot the possible causes of bad sleep for you. Record what you did in the day (especially the hour or two before sleeping) and how well you slept afterwards.

HAVE FUN: SING, DANCE, LAUGH… Yes, really. Singing is good for the heart and the immune system. Just the way you breathe when you sing reduces stress. Singing as part of a group is even better. Join a choir or a football crowd. Sing in the shower. Dancing – in a nightclub, a ballroom or even your bedroom - boosts your mood too. As well being great exercise. Laughter, perhaps not surprisingly, also releases happy hormones. All three are free mood-boosters you can access any time.

HAVE SEX Sex is a great stress-buster for some. Helps you sleep too. Contact and intimacy is relaxing even if you don’t fancy the full works.

WRITE Anything creative boosts mood. But unlike say music or art, writing doesn’t require any special talent. Anyone can do it. More than that, it’s private. There’s evidence suggesting that writing about the challenges we’re facing and how we feel about them will make us feel better. (Like talking, it lets you see things in a different way from thinking alone.) But you can write about whatever you want - fact, fiction. Not sure how to start? Everyday write down one thing you’re grateful for and why. Thinking and writing about good things you’re thankful for will help.

FIND YOUR FLOW Find an activity that you can lose yourself in, something you become totally immersed in and energised by. These are often called ‘flow activities’. It needs to be something that’s healthy for you - we’re not talking about feeding an addiction or locking yourself away from the world. Find a hobby. Creative activities are particularly good. Hammering away at your guitar, throwing paint at a canvas, dancing madly, singing badly, it’s all good.

BE MINDFUL Feeling very busy, overwhelmed or running on autopilot? Many people find that mindfulness helps. Mindfulness is about noticing the very moment you’re living (rather than thinking about the unchangeable past or the unknowable future.) Everyday mindfulness is about being aware of what you’re doing when you’re doing it. For example, you could dress mindfully, thinking about what you’re putting on rather than thinking about the day ahead or the night before. The NHS’s top tips for everyday mindfulness are: > Notice the everyday: the food you eat, the wind against your skin, clouds in the sky, birds in the trees - you get the idea. > Keep it regular: choose a mindful time - the walk you take to work or at lunch-time, for example. > Try something new: it’s easier to be mindful around the unfamiliar (even if it’s only slightly unfamiliar like a different seat in a meeting). > Watch your thoughts: be aware of your mind wandering, notice it’s happened and what the distracting thought is about. No big deal. Go back to being in the mindful moment. > Name thoughts and feelings: does thinking about X make you feel Y? Name that feeling and you’ll get better at recognising it. Mindfulness practice takes this further. Practices involve sitting (or lying or standing) and paying attention to sounds, thoughts, feelings or sensations in the body. Perhaps ‘scanning’ the body for these. Some practices are ‘guided’ either by a teacher in a class or by listening to audio. Others you can do by yourself. Some practices are minutes long, others last up to an hour. The thing they usually have in common is a focus on your awareness of your breathing and on bringing your attention back to this whenever the mind starts to wander. Mindfulness has evolved out of traditional Eastern meditation

practices. You’ll also find the idea in yoga and tai-chi and both can help with developing awareness of your breathing and thus beating stress. There are books (such as Mindfulness by Mark Williams and Danny Penman) and local groups. Anyone can ‘do’ mindfulness. It’s not aways easy at first but the process itself - however tough you find it - is calming and will help you get things in perspective.

TALKING THERAPIES There are many talking therapies. From one-off counselling sessions to long-term, in-depth psychotherapy. Each uses a slightly different approach. Some are one-to-one with a therapist, others are done in groups. Some men prefer the privacy of individual therapy; others find hearing from others with similar experiences useful. Your call. If you think that talking therapy might be useful for you, do some research into the various types and talk to your GP. You may even be able to refer yourself under the NHS IAPT initiative. Details on the NHS website.

COGNITIVE BEHAVIOURAL THERAPY (CBT) Recently the NHS has become interested in Cognitive Behavioural Therapy (CBT). It works by enabling you to recognise the patterns of thoughts, feelings and behaviour that lead to difficulties in your life, and looking at ways of shifting these patterns through the way you think and what you do. It doesn’t focus on the past but on improving the present. Unlike some therapy, it may only take a few sessions to help you understand your stress or a bit longer (12 sessions) to help with depression. The website Living Life to the Full (llttf.com) offers a free introduction to CBT online.

MEDICATION By the end of 2020, there were nearly 4.5 million people taking antidepressants in the UK (up from a little over three million in 2015).

The number was slowly increasing before the Covid-19 pandemic and continued through it. But drugs (usually anti-depressants called SSRIs) are no longer the automatic choice for GPs when people go to them with mood or stress problems. NICE, the UK body that provides evidence-based prescribing guidance to health professionals, suggests that doctors move the emphasis from medication to talking therapies for milder cases. Doctors should discuss with the patient what would suit them best and consider group CBT, individual CBT, self help, group exercise or group mindfulness or meditation, before moving to medication. If medication is suggested for you, it’s worth doing a bit of research first: > What are the side-effects? > How long before they should start working? (Most take 6-8 weeks.) > How long are you likely to have to take them for? > Are there alternatives to medication that might work better for you? > How easy are they to come off? The benefits of medication in cases of severe depression are generally accepted but there is debate about how useful they are for mild to moderate cases. Depending on your symptoms, you may need medication to stabilise mood before talking therapies and some of the other ideas discussed in this booklet will begin to help. Discuss it with your GP. Your local pharmacist may also be useful.

KEEP IT SIMPLE Whatever you do, keep it simple. Don’t try to do everything at once – set small targets you can easily achieve. Take control by keeping a routine: > Get up and go to bed at regular times. > Set small, manageable goals - like tidying up the house for 15 minutes. > Focus on taking things ‘day by day’- reminding yourself of this when you notice your mind wandering into the past or future. > Do not focus on the things you cannot change – put all your time and energy into helping yourself feel better.

WORKS FOR ME The team on Beat Stress, Feel Better all have personal experience of many of the issues discussed in this booklet. We’re all different - but here’s what works for them. (The technical terms in bold are explained in the jargon buster on page 32.)

Fabio: Learn to love yourself

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On the face of it, growing up I really didn’t have it hard at all. People often seem surprised to hear I’ve really struggled with low mood and anxiety. The causes of my decade and a half of depression were quite subtle, mainly to do with beliefs I built up about myself growing up.

The underlying force periodically taking me out of action for months, years even at a time, was self-criticism. And as Yoda from Star Wars would say, self-criticism leads to anger, anger to self-hatred and self-hatred is the path to the dark side. I’ve tried drugs and had more types of therapy than Woody Allen. Some helped at the time, some didn’t. It was only when I came across mindfulness and compassion-focused therapy that things really started to click.

Bulbs have continued to light up ever since. Practising mindfulness has massively helped, by teaching me to step back from the intensity of difficult thoughts and feelings, to stop myself from overthinking. The compassion part of it, which has been just as important, has been about coming to see myself as like anyone else: great just the way we are.

Richard: Recovery is a journey

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I had a massive breakdown in 1996, but didn’t get to see a psychiatrist until 1999. To my family, my breakdown appeared so gradual they didn’t realise I had finally lost the plot. To them I was just a weird, alcoholic, angry waste of space.

Although I began experiencing symptoms of paranoid schizophrenia from 1996, I had been going downhill for a good five years before. Getting to grips with my diagnosis was the hard part. Admitting to yourself that you need help is the tough first step to recovery – if you don’t, suicide is a real risk. Take all the support you can and listen to care staff. Listen to fellow patients too. Recovery is a journey and there will be ups and downs, but hold on to the idea that you can beat it and you will. Recovery took me five years, before I did an MA in broadcast journalism and went freelance. I will never stop fighting, but will always take a positive attitude to it. I am disabled, but am a fighter. UPDATE, 2022: Aged 45, I was diagnosed with autism. That was like a bomb going off in my life story to date. It explained why I didn’t get on with kids at school and never fit in as an adult, my fondness for drink and drugs and ultimately my psychotic breakdown in my 20s. Before the diagnosis in 2020, I learned an advanced meditation technique. Ten times a week, I take half an hour out - literally escaping the world and just being me without chemicals making things weird. With over a year’s regular practice it’s made a massive difference. I’m no longer so reactive but respond to the world how and when I wish to. Living with my fat mog in a village in West Dorset and my daughter growing up with her mum just a few miles away, I’m the happiest I’ve ever been. Take a time out for you in a healthy way and you can be too!

Steve: I don’t have to pretend anymore

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I was diagnosed with depression ten years ago – but I had been struggling with it since childhood. I felt there was something inadequate about me – that everyone else was able to cope and it was just me who wasn’t able to live his life in the right way.

The shame this brought meant I found it hard to talk about how I was feeling to those closest to me, let alone act. Eventually I saw a GP who understood I was going through depression. Prescribed antidepressants, I began to feel more able to cope with the everyday strains, and learn the difference between ‘feeling low’ and the more serious chronic depression in my life. I’ve found huge support from writing about depression – from other people who are depressed and because I don’t have to pretend anymore. Sometimes, if you admit you’re vulnerable it can be the strongest thing you can do. UPDATE, 2022: I’m now working in a special school, which is a lot of fun, after being in mainstream teaching for so long. I was diagnosed with ADHD in 2020, which explained a few of the mental health issues I’d experienced in my younger years. Certainly the restlessness and the rejection sensitivity.

John: I didn’t know until I was in my forties

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I grew up when things like ADHD and dyslexia hadn’t been ‘invented’ so didn’t find out until I was in my early forties.

My 6 year-old son was tested. Teachers thought he had signs of ADHD but when the child psychologist described the symptoms I realised it was me she was describing and any traits my son had were just behaviours of mine he was copying.

I was shocked but when I did some reading, it rang lots of bells. There were crazy things I had done and bad decisions which, although they can’t be blamed entirely on ADHD, weren’t helped by the ADHD tendency to act without any planning and take on too much. ADHD adults, while often creative and quirky, tend to be extremely forgetful and disorganised. All of us are like this sometimes. The key word is ‘extreme’. You can be easily distracted or at another time so focused on one thing that you forget eating, sleeping and other people (relationships often break up over this). Sometimes we self-medicate with drugs, alcohol or high-risk behaviour. Because I work in drawing and the arts, some of my ADHD behaviour ‘sideways’ thinking, creativity, moving from one topic to another - fitted in well. But the chaos in my finances, relationships and other areas that needed focus and clear thinking were another story. The ADHD drug Ritalin helped me to begin to develop daily routines and organisation techniques. After about five years (and marriage to a very supportive and organised wife), I was able to stop the medication and manage myself with the routines and habits I had learned. It is not perfect, of course. I need to watch I don’t get too stressed or disorganisation quickly takes over again. UPDATE, 2022: As I get older, it is not so much that the challenges of ADHD lessen as that I have become a bit better at spotting the signs of creeping mental and physical disorganisation earlier and I revert to the good habits and practises that help me regain control. It is also encouraging to see that ADHD and other hidden disabilities are far more widely talked about these days and to be able to encourage those with similar conditions - at whatever age they discover them - that with support and a rethink on how we ‘naturally’ do things, life can improve.

WHAT WORKS FOR YOU? We can control some things, we can’t control others. That’s a simple fact. Your genes, what’s happened to you, what’s been done to you - these are out of your control, certainly when you’re a child. Then, look at the list of things that can cause stress beginning on page 6. It’s impossible to get through life (or even a week) without having a few of

them happen to you. Again, mostly out of your control. This means you can’t beat stress by avoiding it, pretending it doesn’t exist or that it doesn’t affect you. You can only beat stress by facing it. And that’s something we do have some control over. There are signs of stress just as there are signs of a physical health problem. If you ignore them, you’re in trouble just as if you ignore the symptoms of cancer. But, because we’re all different, we need to recognise our own warning lights. This can be tough because we need to be 100% honest with ourselves to do this. Of course, it’s natural to wonder where your stress comes from. Understanding what has happened to you, especially in childhood, will help you understand why you react and behave in the ways you do, especially in relationships. However, it’s not the main issue. In cancer, the main issue isn’t what caused it but what you can do about it, the treatment. Same with what’s going on in your head. So, although you can’t control the causes, you can try to control your reaction. Take responsibility for recognising stress, recognising how it makes you feel and finding a way to let it all back out again. All of the ideas in What Works (on page 19) fit the bill. There’s evidence for every one of them - with talking probably top of the list. Try to beat stress using things that are healthy in themselves: activities you put something of yourself into rather than those you simply consume. A world in which you can satisfy any need immediately increases the likelihood of addiction. Better to become ‘addicted’ to writing, exercise or music - and get your hits of good feelings this way - than to booze, food or porn. Taking action makes us feel better. Try some of the ideas and see how it goes. Think about your answers to these questions. You could write them down. > What sort of things or situations can create stress for you? > How might stress affect your work, home life and relationships? > What are the early warning signs that you might be getting over-stressed? > What works for you to beat stress?

JARGON-BUSTER Life’s stresses can lead to various mental health conditions. Some of the more common ones appear in this jargon-buster along with other terms you might hear. Attention Deficit Hyperactivity Disorder (ADHD) ADHD is a learning difficulty which makes it difficult to focus on anything even for a short time. People with ADHD appear restless and may act on impulse. Anxiety (general anxiety disorder or GAD) GAD is constant worry (rather than worrying about a particular thing for a particular reason). As well as a feeling of dread, some people experience physical symptoms such as heart palpitations or dizziness. Anxiety can also be a symptom of other conditions including phobias and PTSD. Autism The brains of people with autism work differently from the typical brain. This can affect communication and relationships; understanding of feelings and information; the senses (for example, bright lights or loud noises may be difficult); and anxiety levels. Autism is a spectrum, meaning the impact can be very different in different people. Bipolar disorder This used to be called manic depression. It is a condition in which moods can swing from one extreme to another. People feel excited and highly active (mania) and then very low (depression). Body dysmorphic disorder (BDD) People with BDD worry about what they consider flaws in their appearance which are often unnoticeable to others. It can affect men and women of all ages. Borderline personality disorder (BPD) The most common personality disorder, BPD affects a person’s mood, thinking and behaviour and how they relate to others. Clinical Depression We all feel down from time to time. But depression is feeling sad for weeks,

months or longer. It can be a normal reaction to stressful situations or an overload of stress. It is common - about one in ten of us are affected in any one year - and, with the right support, most people make a full recovery. Neurotypical This terms refers to people whose brains are ‘wired’ in the usual (typical) way rather than as they are in autism or similar conditions. (See neurodiversity on page 10.) Obsessive compulsive disorder (OCD) People with OCD have thoughts and behaviours which become obsessive, compulsive and repetitive (such as an urge to clean or repeat routines in a certain way). Phobias Phobias are a type of anxiety disorder defined by the NHS as ‘an overwhelming and debilitating fear of an object, place, situation, feeling or animal’.Common examples include heights, spiders, crowds, performing and needles. Most phobias, even complex ones, can be treated. Post-traumatic stress disorder (PTSD) PTSD is an anxiety disorder that can follow very stressful or frightening events such as accidents, violence or abuse. PTSD may involve insomnia, nightmares and flashbacks. Psychosis Psychosis involves losing contact with reality. People might see or hear things that others cannot see or hear (hallucinations) or believe things that are not true (delusions). Social anxiety This is a long-term and overwhelming dread of social situations. It may even be difficult to do things with others watching. Schizophrenia This isn’t about split personalities or violence. It is a severe long-term type of psychosis involving hallucinations and delusions and a loss of interest in the the world, others and yourself. There is a full list of mental health conditions on the NHS website: www.nhs.uk/mental-health/conditions/

IS YOUR MATE OFF HIS GAME? Stress affects mental health. Every year, one in four of us faces a mental health challenge. That’s odds of 3/1 - so we all know someone affected. Because we don’t really understand mental health problems, sometimes we shy away from people who have them. We pretend we’re different, that these things won’t affect us. But they do. They hit people just like you. If you think a mate is bottling something up, there’s a simple way to make a difference: do something together - car, computer, exercise, garden, walk, even housework. Get him to give you a hand. Feeling wanted makes us all feel better. You don’t have to talk but if you want to, doing something together makes it easier. Open up yourself - if you think he has work issues, perhaps talk about your work. Try to: > Keep it real: take it seriously but don’t make it a big deal. > Ask how it’s going. Perhaps ask twice: how’s it really going? > Keep in touch more: text or email. > Do stuff. This gives you a chance to chat (and can be useful even if you don’t chat). It lets your mate see that you know he’s still the same person. > Talk. Swap stories: don’t ignore the difficult stuff if it comes up - you don’t need to solve it or be an expert, you just need ears. > Be there: ask if you can do anything. Perhaps, give him this booklet.

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www.menshealthforum.org.uk/MOT www.menshealthforum.org.uk/MMM www.menshealthforum.org.uk/EDDD www.menshealthforum.org.uk/SD www.menshealthforum.org.uk/DFM www.menshealthforum.org.uk/MTM

OTHER USEFUL ORGANISATIONS www.menshealthforum.org.uk/links On our website are lnks to other useful organisation. (The NHS website is nhs.uk)

SMALL PRINT The authors and publisher have taken care to make sure that the advice given in this edition is correct at the time of publication. We advise you to read and understand the instructions and information included with all medicines and to carefully consider whether a treatment is worth taking. The authors and publisher have no legal responsibility for the

results of treatments, misuse or over-use of the remedies in this book or their level of success in individual cases. The author and the publisher do not intend this book to be used instead of advice from a medical practitioner, which you should always get for any symptom or illness.

PHOTO CREDITS: Dave McCairley, Garry Knight, Casey Fleser, Elliott P, Bare Knuckle Yellow, Navaneeth KN and Cait Stewart who were all kind enough to make their images available through the Creative Commons for modification and commercial use. (If this is not the case, please contact us.)

BEAT STRESS, FEEL BETTER Too much stress can: > damage your immune system and heart > increase your chance of serious health problems > reduce your life-expectancy > damage your sex life. This booklet from the Men’s Health Forum answers the questions: > what causes stress? > what rattles your cage and makes you angry or stressed? > what can we do about it? Full of simple, practical tips that will make you feel better, this manual will show you how to develop your own personal tool-kit to beat stress. Men’s health made easy. WARNING: Reading this booklet could seriously improve your health. ISBN: 978-0-85761-036-2 www.menshealthforum.org.uk

Completely Revised. Third Edition.