How to cope with severe, possibly long-term stress

October 26, 2024 6:16 AM

I’ve currently got a couple of very stressful situations going on simultaneously and I am stressed the fuck out. One is an ongoing problem with my mentally ill adult child that could blow up spectacularly at any time, and meanwhile is draining us financially; the other is a coworker’s impending maternity leave, during which I will be insanely busy working long hours. I’ve done it before and it was horrible.

The work situation is what it is, I’ve already talked to my bosses and gotten some backup but I’m not confident it will be enough. I’m sure everyone will do what they can but there is very little chance it’s not going to be a zoo. The adult child situation is just hard and there is no good solution at the moment.

Currently I am extremely stressed out and anxious. The bad days are way outnumbering the good ones right now, and I’m worried about a few things: how to keep functioning through the stress when dropping the ball is not an option (I need both the job and the kid); how to lower the anxiety level so it’s more tolerable; and what if anything can be done to help prevent the stress from wrecking my health. I’m already in therapy, but I need more ideas for how to cope than we’ve been able to come up with so far. The recent escalation of stress was unexpected so we’re just beginning to address how to cope when you can’t fix the situation or escape from it.

Currently my symptoms are severe anxiety attacks: tightness in chest, nervous sensation in the pit of my stomach, nausea to the point of nearly throwing up, trouble sleeping, constant worrying, having a hard time focusing. When I’m not in the middle of one of these attacks, there is always a baseline of uncomfortable anxiety in the background.

So… what have you got for me? What can I do from a self-help standpoint to make this more tolerable and protect my health as much as possible?

I KNOW it’s not a good situation, and I know that ideally I’d be able to take steps to improve the situations themselves rather than trying to white-knuckle through. Believe me, steps have BEEN taken and this is what I’m left with.

posted by Serene Empress Dork to Grab Bag (30 answers total)

Are you opposed to medication as an approach to help triage?

Drugs like Ativan and Valium (benzos!) can help treat episodes of acute anxiety (although long term use can lead to abuse) but have been very helpful for me to deal with anxiety attacks.

If you see this as a short term episodic thing, they can help!

Of course, there are also long term agents like SSRIs like Prozac, but that's a different deal.

Medication can certainly help commitment behavioral changes like more regular exercise, mindfulness exercises, etc
posted by kbanas at 6:29 AM on October 26, 2024 [10 favorites]

Here's what I did when faced with something similar:
1) Changed the ringtone on my phone for the ill person so that I didn't stress out every time I head that ringtone in public. This was huge.
2) Did my best to set aside 30 minutes of time every day for, I guess, meditation. Just some time when I was pretty sure that I wouldn't be bothered. Sacrificing 15 minutes of sleep for a quiet cup of coffee in the morning was worth this.
3) Realize that getting through the day is enough. Is your house messy? Is the laundry not done? It's ok. You can do it tomorrow. That said, I found it helpful to do stuff when I saw it so I wasn't creating work for future me. I put my clothes in the laundry hamper rather than dropping them on the floor. Roughly making the bed everyday made it welcoming at the end of the day.
4) Can you shift your hours slightly at work so you can just work in the quiet rather than dealing with everyone's questions? An uninterrupted hour in the morning can be helpful.

I'm sorry you're dealing with this and I wish you luck.
posted by donpardo at 6:45 AM on October 26, 2024 [18 favorites]

I too was going to recommend meds. Klonopin has saved me during times of overwhelming stress and anxiety. I take a half pill of the lowest dose and it just makes it so the noise in my head clears and I can keep moving instead of spinning out. Keeps panic attacks at bay and allows me to not just curl up into a ball to try to disappear. Total lifesaver.

The only other thing that helps is me in these kinds of periods of my life is sleeping as much as possible. Just doing only what has to be done and sleeping the rest of the time so I'm not just letting the thoughts swim around my head.
posted by greta simone at 6:46 AM on October 26, 2024 [2 favorites]

So very sorry that you are at this point. In addition to anti-anxiety meds, regular massages helped my anxiety tremendously. It’s one more thing to fit in but as someone who, as my massage therapist put it, “really expresses anxiety through [my] body”, I was able to relax a little and get some sleep. The deep sleep allowed me to cope a lot better than I had been; supplements that helped me also were a B complex, Vitamin D (I hate the sun), and magnesium. Wishing you well.
posted by corey flood at 7:01 AM on October 26, 2024 [6 favorites]

If you don't want (or can't get) anxiety medication, I've found L-Theanine very helpful to take the edge off severe anxiety. It's a supplement, the substance that's responsible for the relaxing effect of green tea. It's extremely safe, very low incidence of side effects, and it's evidence based.

Learning how to stimulate your Vagus Nerve and activate your parasympathetic nervous system is important. Your body needs help to get out of the constant "this is an emergency" state to be able to rest, digest, sleep and relax.

Some effective ways to do this are:
Slow, deep breaths. In, hold, out, hold.
Cold water on your face or the back of your neck.
Looking at something far away like the horizon, or clouds.
Singing.
Walking.

Take careful stock of what aspects of your situation you can control, and what you can't. Note (in a non judgemental way) when you find yourself ruminating about something you can't control. It will probably happen over and over again, that's OK, just keep noting it and remind yourself "this is something that I can't do anything about right now, thinking about it isn't helping either. "

Be aware of negative self talk and catastrophising. Don't try to fight it or fix it, just note it and try to distract yourself from your thoughts.

Be kind and patient with yourself. Self compassion isn't always easy, but it's essential.
posted by Zumbador at 7:18 AM on October 26, 2024 [16 favorites]

In addition to what others have said, don’t underestimate the basics. Make sure you are eating and drinking adequately. This can be hard when you’re feeling nauseated, but anything palatable in those moments, and in any amount you can handle. Don’t be afraid to lean on convenience foods when you need to - just add nourishing things to them like frozen veggies, salad kits, etc. That can help reduce food prep effort when your stress levels are high and it’s hard to get anything else done, let alone cook.

Hunger and dehydration wreak havoc on the nervous system, but stress makes us not want/able to eat and drink properly. So as much as you can avoid that vicious cycle.
posted by eekernohan at 7:24 AM on October 26, 2024 [6 favorites]

When my work stress is at its peak, that’s when I actually find it helpful to think through the “worst case scenario.” After my baby was born, I went back to work but I really just couldn’t keep up the hours I’d worked before. In my small organization, there isn’t necessarily anyone else to pick up the slack on certain things. And the person who could have, didn’t.

So I had to ask myself, if I go home and this task goes undone, what is the worst that can happen? Often it feels like a catastrophe at first, but after sitting with that feeling I often decided I could live with certain things just not getting done. No one got angry at me because they knew I was already going beyond my job description. And I wasn’t worried about losing my job, but of course YMMV.

If I could do one thing differently from that time, I would’ve been more explicit with my colleagues to make sure everyone was aware that certain tasks just weren’t going to happen. The more I was able to communicate professionally about what was beyond my capacity, the less guilty I felt.
posted by mai at 7:39 AM on October 26, 2024 [7 favorites]

Another possible thing to try - magnesium has transformed my experience of anxiety for the better.

Deep breathing exercises can help - I always feel slightly resentful of that as a suggestion because it seems so facile in the face of some of life’s serious challenges, but it’s free, always available at an instant, and there’s nothing lost by taking a few deep, slow breaths.
posted by penguin pie at 7:51 AM on October 26, 2024 [3 favorites]

You don’t mention where you are or what your work environment looks like, but if you are in the states, I would seriously explore partial leaves under FMLA and/or accommodations under ADA. It sounds like you may qualify for both (the former for caretaking your adult child, the latter for the anxiety attacks), but you’ll need to work through that. Your work will figure coverage things out if they are legally required to do so. Start with a conversation with your doctor about what level of work is appropriate for your health and go from there.
posted by moosetracks at 7:54 AM on October 26, 2024 [12 favorites]

In addition to anti-anxiety meds, regular massages helped my anxiety tremendously.

Yeah, I was going to say this. If you don't like massages, see if there's anything else that works for you to get your muscles relaxed on a regular basis. Besides feeling so good in the moment, it can also kind of reminds your body what it feels like to be relaxed and makes it easier for your body to start doing on its own. Once you've got that, it can also help to get into a habit of asking yourself a few times a day how your body is doing and sort of reminding your muscles to chill out.

Meditation and other things that involve deep breathing, like yoga, can also help with that, but in my case unless I've already built up a pretty strong habit of doing that recently, I have a really hard time focusing on things like that when I'm already stressed. If anything my panic just rises. But singing out loud can help me sometimes, or even just humming - especially things where you hold notes for a long time.

Journaling helps a bit (it's a place to dump everything without worrying about how your dumping affects anybody else). And if you're able to exercise, I know summer people swear by working up a sweat. I used to find swimming helpful both for relaxing and clearing my head.

Listening to music on headphones sometimes helps shut down thoughts throughout the day or when trying to sleep. Sometimes I use very angry or very happy music; other times music I know is relaxing, including some stupid new agey spa-type instrumental background stuff I found on YouTube searching for 'relaxation music'.

If you have any friends to talk or meet up with and find that it takes you out of your own head for a bit, or helps you take something off your shoulders, or gets you laughing for once - then try to do that regularly. Same if there's anything else that does that for you (sometimes making myself stare at plants swaying around in the breeze does that for me a bit).

I try to remind myself that I'm a cog in a marathon, not star in a sprint, to mix metaphors. Having my heart and brain race with worry or adrenaline isn't helping anything; the goal is to keep my head down, look straight ahead, and trust that the more steady I am as I keep moving, the smoother the way will be till the end and the more I'll be able to play my part, small as it might be in the scheme of things. Also, having been through the cycle of stress this many times means I've sometimes found myself starting to panic and then being able to catch that panic before it really takes off, take a deep breath, and remind myself I don't actually need the panic, just to keep my head down and keep going at my own pace. I'm very sorry to hear about what's going on with your child and I'm guessing that the unknowability there makes things even harder. With your work situation, though, I think you can tell yourself that you do know what will happen, long-term: it will be hard, there will be sprints, but there's an ultimate end date to this hectic period and you will get through it, whether you're stressed out or Zen about it. So there it might be easier to do the channeling-the-tortoise, marathon mentality thing where you just put your head down, breathe, and make yourself take it step by step without thinking about the end, which you can just trust is coming.
posted by trig at 8:04 AM on October 26, 2024 [5 favorites]

FMLA isn't paid and OP says they "need the job"; I supposed "need the job" could mean health benefits rather than pay, but just wanted to put out there that while FMLA is great for job-protection (if you've been at a job longer than a year), sometimes the lack of a paycheck means it's not a viable option for people.

BUT also:
"Employees may use FMLA leave in whole weeks, single days, hours, or in some cases less than an hour. Employees may use FMLA leave in the smallest unit of time made available by their employer for other types of leave, as long as that smallest unit of time is not greater than an hour."

So perhaps using FMLA to reduce your hours might be an option, if full leave isn't feasible financially? It sounds like your current plan is to work far in excess of 40 hours a week, so I'm guessing you're salaried, not hourly?

(And I have no idea what your work situation is, or what the constraints on hiring/training a temporary replacement would be, but having the plan for maternity leave be just "another employee does two jobs at once" seems... bad?)
posted by cnidaria at 8:07 AM on October 26, 2024 [4 favorites]

I had a similar extreme stress situation for about 5 years. I'm sorry you are going through this. In addition to the typical stress-relieving activities and meds, if fluctuating or decreased hormones are a possibility, hormone replacement therapy could be something to look into to help regulate your body's reaction to the stress. I also find acupuncture to be an extremely incredible body and mind reset; I know, I know, inexplicable as it is, there is little downside to trying with a reputable provider.
posted by RoadScholar at 8:26 AM on October 26, 2024 [1 favorite]

Short term disability leave is an option, even for four weeks. If your employer can’t be bothered to staff the workplace appropriately, they should not be surprised by the consequences of their choices (even fewer employees).

My other advice in this situation is that it’s worth finding money for your health. I have always regretted trying to power forward, I stayed sicker longer and made worse problems. Do not consistently prioritize the health and wellbeing of your child over your own health. Suggest using your therapist to brainstorm here. The solution might be radical solutions that prioritize you over your child, which would be incredibly difficult but worth thinking about.

Group DBT or CBT skills for anxiety, in addition to individual therapy, could be helpful. A lot of these programs are virtual, you could get accommodations from work to attend. I found these programs are very tiring so don’t go straight into work without a break.
posted by shock muppet at 8:36 AM on October 26, 2024 [3 favorites]

I, too, am going through the most stressful time of my life right now. (Look at how many of us are on this team!)

Lots of good advice here, and I'll add some quick notes.

-massage can be good but also be prepared for a really really rough night or next day if you haven't had one in a while. (Emotionally, mostly)

-exercise and meditation are the pillars upon which I rest my sanity. Making them a priority was inconvenient, but so worth it.

-microdosing mushrooms 2 or 3 times per week gives me the results I hoped for from some SSRI medications. After a few weeks, the rough times lose their sharpest edges and I'm better and to accept things as they are. I take them with B vitamins and I think the meditation work is tied very tightly to this success. Could be placebo! I don't care!
posted by Acari at 8:42 AM on October 26, 2024 [4 favorites]

FMLA varies both by state and employer. It is absolutely something OP should look into! Depending on size of company, work tenure, how much time is being taken off and in what increments / duration, any disability policy plan company has opted into, and the coverage provided by the state (sometimes paid! In my state it is), there are way too many factors for us to guess at what specific FMLA coverage could look like for OP. it sometimes can cover up to almost 100% of lost wages.

the first few steps would be:

- look into employee manual for FMLA and disability insurance policies
- look into state FMLA resources
- talk to a credentialed medical professional (IME, it must be an NP, or MD, or LICSW) and ask them if they’ll support you with documentation that FMLA is necessary

Feel free to PM me OP if you would like help navigating thru this research.

And best of luck. You will get through this.
posted by seemoorglass at 8:45 AM on October 26, 2024 [2 favorites]

I highly recommend a beta blocker like propranolol. I recently started taking one after struggling with anxiety and panic attacks for more than 30 years, and it’s amazing at eliminating the physical symptoms of anxiety like the ones you describe. I wish someone would have prescribed it for me years ago. I just asked my primary care doctor and she wrote a prescription.
posted by Clustercuss at 9:25 AM on October 26, 2024 [2 favorites]

Sing your lungs out in the car. Dance at night, during or after dishes. Reach for art/music/song that raises you up.

A 20-30 minute walk at lunch is l anxiety busting for me (I listen to happy/creative type podcasts.). It cuts the work stress into two halves rather than one long period of stress.

Cosy sweaters, mugs, candles at home at night.

Eat sitting on the ground or the floor. I know that sounds weird but have an indoor picnic. With candles and small bites of things (easy ones - baby carrots, mozzarella, bread, balsamic vinegar, etc.)

Small wholesome things.
posted by warriorqueen at 9:40 AM on October 26, 2024 [4 favorites]

Your plate is clearly very full. Consider if there are ways to reduce the domestic burden somewhat. Is it possible to offload some chores or outsource something. Or just not do it for a while or at least less frequently.
posted by koahiatamadl at 9:45 AM on October 26, 2024 [1 favorite]

Oh yes heartily co-sign propanalol! Clustercuss has it exactly right.

I see Ativan is mentioned upthread too - I have both as needed, I’ll describe both in case this is helpful

I would describe propanalol as my first line stress defense (alongside other things like art, walks, etc). It works really well if you take it early on - like the first symptom of stress, go ahead and take it. It just tamps down or eliminates the physical stress symptoms entirely. No effect to mood, cognition, energy etc (other than what the relief from physical symptoms might improve) and I’ve never experienced downsides.

Ativan is my “break glass in case of emergency” med - it’s a temporary mute button for the brain. Hence the potentially addictive or harmful effects of long term use. It can be an absolute godsend for the days or nights where you just need a mental break from the rumination and racing thoughts. It’s like a temporary full mental reset. It can however make you very sleepy and you should be very cautious about taking it during work, driving etc. depending on dosage and tolerance. DO NOT DRINK or mix other substances while on it. And if you have addictive tendencies you may not want to mess with it. One thing I didn’t expect at first, as silly as it may sound, is as soon as it wears off and your brain comes back online, so can all the mental stress symptoms. So basically, use it to get some deeper sleep, to have a weekend day of actual rest and relaxation before diving back into the stressful week, get some peace from racing thoughts. Those moments of true rest are necessary. But know that the following day you will wake up to the same ol brain doing its same ol brain things.
posted by seemoorglass at 10:02 AM on October 26, 2024 [2 favorites]

If you're part of a faith community or strong friend group, can you ask for help? Set up a meal train, ask people to take on a chore for you, get your groceries, etc. Having your community take some things off your plate so you have a little more time to rest, breath, walk, stare at nothing could be very beneficial to you.
posted by brookeb at 10:19 AM on October 26, 2024 [2 favorites]

What worked for me:

- When I feel anxiety rising, move my body. Take a walk break if I can, or close my office door or go in the bathroom and jump up and down, shake my arms, do pushups - just move the energy through my body.
- Meditate at least 10 minutes in the morning. Find a place in your house that's your meditation spot (could just be a chair or corner) and go there in the morning even if you don't feel like it. Insight timer is a great app for short, directed meditations that can be very specific (lots of good stuff for anxiety).
- Say NO to everything else. Fun creative projects, complicated social plans, interesting things at work, stuff you'd usually agree to, trips you get invited on - get your bosses on board with you saying NO. NOT NOW. Okay to say "maybe in the spring" or something but everyone should be told you are not taking on ANYTHING right now, for this season.
- If there is anyone else in your household who could take on a bit more cooking/cleaning/etc., ask for that!! Or as someone else suggested above, if money allows, one of the meal services or hiring a cleaner.
- Put away your phone (and computer and TV) an hour before the bed time you've set. Read, take a bath, do the dishes, even listen to audio - just don't look at a screen. You can set it nearby so you can hear it ring if part of your situation is being 'on call.' But let your body wind down a bit. I really like candlelight bubble baths.


The main thing for me was psychological. Namely changing two views:
- Not looking for personal validation in the things that were stressing me out (so for you, family and work), but turning instead toward things that will reliably bolster your self worth (for me spirituality, but could be friends, exercise, low key hobby, romantic relationship).
- Not saying to myself "it will get better as soon as..." as a justification for pushing past my limits. Instead, obeying those limits and listening to my body RIGHT NOW TODAY. (Taking a walk or going to get water even if I felt like I didn't have time, leaving work at the time I said I would, letting people down because I couldn't make it to a thing, etc.)
posted by Isingthebodyelectric at 10:24 AM on October 26, 2024 [5 favorites]

DBT is made for this. You can practice the skills without a group.

You’ll primarily want

Distress Tolerance skills—for coping with a crisis without making it worse

Mindfulness skills—really good for giving you a “break” mentally

But all the skills may be useful to you at one point or another. Flip through and try taking 20 minutes to read some of the bullet points and do a worksheet. If it isn’t working for you, move on.

Good luck—you can get through this.

https://static1.squarespace.com/static/577d2ce937c58194f7d39816/t/60c7e92fa3583448b8c6fa19/1623714139969/dbt_skills_training_handouts_and_worksheets_-_linehan_marsha_srg_.pdf
posted by knobknosher at 11:30 AM on October 26, 2024 [4 favorites]

Be an absolute dragon about getting as much sleep as you possibly can. Things I've found helpful:
- Blackout curtains
- Sleep headphones (I've been happy with Acoustic Sheep) and/or earplugs
- Having a distinct pre-bed routine (for me, a short set of slow stretches)
- Trying not to be on my phone before bed (why is this so hard)

If all else fails, I have a set of podcasts that I find interesting enough to actually listen to while being low-key so that they won't wake me up if I fall asleep. Those are especially helpful for those times when I wake up in the middle of the night, because of I can't get back to sleep, I can at least listen to them while keeping my body quiet. If you can't sleep, rest as deeply as you can.

Progressive muscle relaxation has been a big help in bringing me down from anxiety peaks.

Good luck to you. Give yourself grace to let go of or half-ass everything non-essential. I'm sorry things are so hard right now.
posted by EvaDestruction at 12:25 PM on October 26, 2024 [2 favorites]

I have been white knuckling through life since last December. Lots of good advice above, and I will add that although it can feel kind of soothing to lose myself in the internet, it's ultimately detrimental. I don't breathe well, I'm not moving, I'm not doing any of the things that make for a healthy mind and body. The minute I walk away I start feeling better. It's hard! I try to give myself tough love about it. And yet as you see here I am. Do as I say, not as I do!
posted by HotToddy at 1:04 PM on October 26, 2024 [3 favorites]

Good on you for looking out for yourself and working to get to a better place. Esp. from the place you are in. Not easy.

Seconding the L-Theanine recommendation.

Quality sleep can do amazing things. Lack of sufficient quality sleep can inhibit progress of other initiatives. Being underslept makes simple things less easy and complex things way harder. Highly recommend limiting or eliminating any caffeine intake within 8 hours of bedtime, else even if you can fall asleep, caffeine still in your system will prevent your sleep from achieving the most restful and rejuvenating segments of the sleep cycle.

Also, caffeine stimulates the production of some of the same hormones involved in the fight-or-flight response. A few of the things you described sound like they could be effects of those (e.g. caffeine stimulates adrenaline which increases heart activity which can feel like tightness in the chest). Not trying to suggest you drop caffeine, but maybe take a look at the volume, if you’re a regular caffeine consumer.

Similarly, alcohol, within a few hours of bed. Plenty of people report it helps them *fall* asleep; the research suggests most or all of them are falling quickly into a poor night’s sleep.

Last: my therapist has told me a dozen times (and i’m sure the source is in some thousand year old buddhist text): When a thing happens that causes us to suffer, it’s not the thing that causes the suffering, it’s the thinking about it that causes the suffering. Which reminds me of Victor Frankl:

“Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom”
posted by jerome powell buys his sweatbands in bulk only at 2:19 PM on October 26, 2024 [6 favorites]

I have no advice about de-stressing, but I have some thoughts about work. When your employer decides not to staff up to deal with a lack of employees, it is *their* choice, not *your* responsibility. Continue to do what you used to, and if things fall behind, they fall behind. This may be unpleasant to watch, but it really isn’t your choice, it’s their choice. It might be a good time to explore other jobs that might better appreciate your contribution to their success(but I understand that now is probably not the time).

Good luck, it sounds difficult. The other responses are probably more helpful.
posted by Gilgamesh's Chauffeur at 4:39 PM on October 26, 2024 [4 favorites]

Seconding what Gilgamesh's Chauffeur and >B?mai>/B> said. The company's failure to resource appropriately is not a reason to martyr yourself. They will let you do that, if you willingly proceed. Rather, you need to keep them updated on what isn't/ can't get done that someone else would normally be covering. So nobody can claim surprise, thinking that you weree


I used to be on a team. One got a new job, one just went on maternity leave ... and someone else just went on the equivalent of medical leave. Currently, it's not clear yet if there will be new hires, so my program manager and others have all been made very aware that some things will just be delayed until we find a staffing solution. Because I'm a team of one with defined responsibilities that don't change just because people covering adjacent projects have left.

Do you have someone in management in your court, who can help define the scope of your responsibilities even in this crazy new situation?
posted by canine epigram at 5:28 PM on October 26, 2024 [1 favorite]

Dealing with and trying to set boundaries with a mentally ill child is incredibly stressful. Not only is it anxiety provoking in the present, but it can also trigger all kinds of traumatic events from your own family of origin.

I've known people who have benefitted from support groups offered by NAMI, the National Alliance for the Mentally Ill. Apparently, support groups are both in person and virtual, and they're free, so maybe you could check it out?

Therapy and meds are fine, but there's nothing quite like being with people who are going through the same kinds of things that you are, imo.
posted by jasper411 at 9:55 AM on October 27, 2024 [2 favorites]

Going to bed early and taking a sleeping aid is helpful for me. When I know I am not going to sleep well and that that is going to fuck up my day and diminish my ability to cope, I give myself A LOT of extra runway for falling asleep. Like... A LOT. Sleep meditations help. Or podcasts. (I am leaning hard into the middle-aged white woman stereotype of angelically falling asleep while listening to reports of mass murder and/or dismemberment.)

For sleep aids, I do take a prescription Ambien tablet but honestly, this is just as good. I take it 3 nights a week so I am not taking Ambien continuously.
posted by DarlingBri at 1:08 PM on October 27, 2024 [1 favorite]

Response by poster: Thanks so much, everyone, for all the suggestions. I'm taking notes so I have a list of ideas at the ready when I need them.

The FMLA suggestion is not something I want to pursue at this time. However, it is something that would not have occurred to me and it's good to know it might be an option if needed. I do have quite a bit of PTO so I plan to make better use of it this time around and I've let my boss and backups know this.
posted by Serene Empress Dork at 6:12 AM on October 28, 2024