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Stress Anxiety & Depression from PHPNE14

Stuart Grimshaw
March 18, 2014

Stress Anxiety & Depression from PHPNE14

Stuart Grimshaw

March 18, 2014


  1. Stress, Anxiety & Depression in IT Stuart Grimshaw, Lead Engineer

    - WANdisco @Stubbs Good morning, I’m Stuart Grimshaw, software engineer & team lead at WANdisco, I’m also Stubbs on the internet. ! Been a team lead & engineering manager at several Sheffield companies & suffered several bouts of depression & this talk covers the symptoms & effects of this very common problem in the software industry. ! I’ll talk a little about how it effected me, how I got treatment & what I do to try and make sure I’m OK now.
  2. I Can Not Heal You but there are plenty of

    places that can help. I’m here today as a speaker, not a doctor, might skim over the kinds treatment available, and I’ll hopefully show you it’s not something to be worried about and something you can treat, but I won’t be going in depth into any treatment, and you should try to use the content of this talk a guide to beating stress. ! If you recognise any of these symptoms and are worried about them, see your GP.
  3. This is the only bulleted list in this presentation •

    Your GP • IAPT (Via your GP) • NHS Direct • Samaritans • T yneside/Washington MIND If you do recognise any symptoms, there are several things you can do and the best place to start is your GP, which I’ll talk a little about later on. ! Access to most NHS treatment is through your GP, they’re the first person you should see about your symptoms. ! Your GP will treat your symptoms as they would any other illness. ! He’ll give you antibiotics :-) ! Describe a session with the GP - Do a standard test/set of questions - Discuss treatment if needed, ranges from ! If you’re worried about seeing your doctor, remember that ⅕ people suffer with stress & it’s the single most common thing we visit a doctor for.
  4. What is depression, stress & anxiety? Stress is a mix

    of anxiety (tension, nerves, butterflies in the stomch, tense muscles, esp in the shoulders & neck) & depression (feeling flat & sad) ! Often with sleep problems, panic attacks & anger.
  5. © Stress is an evolutionary response to danger, it is

    one of the many things that helped humans survive when dealing with things like bears was a very common problem. ! It’s a quick release of hormones that increases heart rate, blood pressure. Diverts blood away from the skin to core body organs, vital muscles, this also helps if you are injured & bleeding by keeping the blood away from wounds. ! We have increased focus, and in preparation for having to run you’ll start to hyperventilate, providing more oxygen to the body. On average a person will take 10 complete breaths in a minute, this provides just the right amount of oxygen for normal situations like watching TV or working at a computer. When you body needs more oxygen, you breath faster. ! When your body releases the fight or flight hormones you start to breath more quickly, and if you’re sat at your desk trying to code, you’re not using the extra oxygen that your lungs are providing, and that is when you start to feel that knot in your stomach because the oxygen isn’t being used. ! This makes your muscles try their best to use the extra energy, by twitching, bouncing your leg or just being tense in general. ! A rapid heart rate and primed muscles are very useful when trying to escape from a bear. Less so when trying to get v1.1 released.
  6. When does it become a problem? Stress becomes a problem

    when you feel it’s taken over. ! If it comes & goes for no reason. ! You might feel like you’re losing control of your life, like you can’t cope with things you used to be able to cope with. ! Stress is a lot like feature creep, a little is sometimes necessary & can be a good thing, it’s only really a problem when there’s too much. ! Some of the things below are common indicators of stress: find it hard to relax? find it hard to stop worrying & worry about worrying? brood about the past, things that have happened and what other might be thinking about you and the things you did or didn’t do find it hard to get through the day? find it hard to be cheerful most days? ! then the more you answer yes, the more stress is playing a part in your daily life.
  7. Is it just work? It’s not just work, there are

    other social factors that affect stress, things like ! Money problems. Being a single parent. Lack of control over your life. Feel you have a poor education. Poorer health. No support from others. Bad neighbours. ! They all add to the general feeling of not being able to cope, they’re often linked and you will more than likely feel that one is linked to, or causing another. Stress and it’s causes are circular and feed each other, as we’ll see in a couple of slides.
  8. What you feel What you think What you do How

    your body reacts The effects of stress can be broken down in to 4 groups: ! What you feel, such as being uptight flat easily upset guilt anger lost sense of humour ! What you think Brood on things you shouldn’t, why did they react like that, what if they don’t like me, what if I’ve blown my chance? Lose self confidence More self conscious hard to concentrate cut off from family, friends & social situations. hard to relax constantly waiting and fearing for the worst to happen. ! How your body reacts Aches & pains due to tense muscles. More prone to colds lack of energy headaches uptight/tense Hard to fall asleep or stay asleep, you wake up after only being asleep for a few minutes, and wake up a lot during the night. ! What you do Avoid things through fear on not coping, and one of the recommended ways to cope with that is to do them anyway, then next time you have an answer for “what’s the worst that can happen” Quick tempered Unable to sit still, jiggly leg syndrome, pacing the room, fidgeting.
  9. Drink Problems Health Problems Depression Stress Anger Self confidence Anxiety

    Panic Sleep Problems Stress feeds itself. ! Get examples of these things in the office from the audience. For example, what can cause sleep problems in our line of work?
  10. And now some really bad news! Coffee is a stimulant,

    well caffeine is. Stimulants are bad for coping with stress. ! The effects of too much coffee are: feeling nervous, irritable, agitated, shaky, headaches, twitches, flushed face, upset stomach, increased heart rate, faster breathing & poor sleep. ! Sound familiar? Stimulants kick start the same process as the fight or flight hormones. ! Mix this with things that developers do, like pulling an all nighter & you can easily see how you can start on the circle from the previous slide. ! Worse news? One of the side effects of caffeine withdrawal is anxiety & depression!
  11. Who is affected by depression? Everyone. ! There are no

    studies that show men or women, kids or adults, one racial or cultural background or one profession or another is any more or less likely to have problems with depression than the next. ! Some people are effected more by the symptoms of stress & depression, but that doesn’t mean they are more likely to suffer FROM depression. ! It really can effect anyone as this next slide demonstrates.
  12. “After [I left my job] I suffered badly with depression

    and it had an impact on the whole family. I’ve been on medication for depression for the past two years, but back then I saw the doctor and then simply battled on.” Here’s a typical quote from someone with depression … I’m going to read it because it might be a bit small. ! “After [I left my job] I suffered badly with depression and it had an impact on the whole family. I’ve been on medication for depression for the past two years, but back then I saw the doctor and then simply battled on.” ! This is a fairly typical statement with the specific job title removed. The next slide has it filled in.
  13. “After QPR I suffered badly with depression and it had

    an impact on the whole family. I’ve been on medication for depression for the past two years, but back then I saw the doctor and then simply battled on.” - Ray Wilkins Ray Wilkins is a professional football coach and ex-England international, he played at the very top of his profession. He’s rich, he’s famous, drives a nice car, lives in a nice house and has what many of us would call an easy life, but stress, anxiety and depression still had a very real effect on him & his family. You can imagine the effect on his self esteem of being sacked from a job like that. After leaving QPR Ray was convicted of drink driving, in the rest of the interview that quote is taken from he linked his increased drinking to his depression. ! You cannot say “What’s he got to be depressed about” because different people react in different ways. What you may find a completely normal and relaxing situation, others will find hard & stressful. Footballers for example put a lot of pressure on themselves not to let their team mates down, if they lose they feel like a failure. ! Plenty of famous people who you might think have nothing to be depressed about suffer from stress, anxiety about their performance, their reviews, what people think of them, which as we saw earlier if left unchecked leads to depression. ! This can have parallels in IT where you may feel you are letting your team down, you worry what people are going to think of this code you wrote, or that they’ll think your stupid if you don’t understand the code they wrote, the task you’re being asked to complete or the deadline from your boss is unachievable, all things we find stressful, and so starts the circle from the slide earlier.
  14. My Diagnosis When I was a new developer I used

    to get a knot in my stomach when i knew I was behind, or I’d made a bad mistake. I used to almost feel the blood drain from my face as it went cold, what I now understand to be the fight or hormones redirecting blood to my more vital organs and away form my skin, I used to feel the panic & feel the shame. ! As the years went by I started to feel like this in a morning before work, because I thought I was going to make a mistake, let someone down or have a bad day, I worried about all the things that might go wrong that day and I felt the knot in my stomach before I even left for work. ! As I progressed and became more experienced I started to notice those things appearing less and less, I thought that meant I was getting better at dealing with these situations, better at coping, but what was really happening was that these feelings were there all the time, the only thing I was missing was their appearance. ! I was already stressed when the real stressful situations occurred, so I never felt the signs. It wasn’t a sign I was coping better, it was a sign I wasn’t coping at all. ! It was my wife in the end that begged me to go to the doctors because I wasn’t sleeping properly, I was horrible at home, irritable, snappy & not a nice guy to be around. We both put it down to the lack of sleep. ! My doctor noticed the signs straight away and started to ask me some questions that seemed unrelated at first, he showed me my answers and a list of symptoms of depression and asked if I thought that might be what I was suffering from. After this first diagnosis I was put on St Johns Wort, a natural depression treatment. I’m not sure if that helped, or the fact I recognised the problem and made some lifestyle changes to compensate, but after a month or so I felt a lot better and things returned to normal again. ! The 2nd time was more serious, and again my doctor recognised this, I was offered CBT or a 6 week long evening course run by Sheffield’s IAPT (Improving Access to psychological treatments), I chose the evening course as I wouldn’t have finished the CBT & a lot of the early content in this talk is taken from what I learned there. ! The reason I suffered a second bout of depression was because during the first I didn’t learn what the cause was, only how to stop it once it became a problem, so this time round I learned what the symptoms were, and most importantly I learned to recognise the circular nature of anxiety & depression. Recognising the symptoms I was having & their cause was the single biggest factor in my getting a handle on my depression. ! You could say the first time I took the managers solution to the problem and just put it off to the future, the 2nd time I solved it like an engineer by learning the root causes & stopping them before they become too much of a problem.
  15. My Symptoms Early signs that I’m suffering from anxiety are

    that my work starts to suffer, if the task at hand isn’t something that I really really want to do I’ll procrastinate, usually with reddit or Hacker News (make a graph from rescuetime) I have RescueTime installed & use that as a trigger when my daily usage of those kind of sites goes up for an extended period. ! I’ll spend a long time extrapolating the _very_ worst possible outcome from any given situation. My boss emails me for a meeting? Well that’s it, I’m fired, might as well clear my desk. His boss coming over from the US? Well we’re all being fired right? ! This does have it’s advantages though, it means I get a lot of practice running things through in my head, which when turned to problem solving & bug fixing is a great asset. ! I’ve never been so depressed that I’ve wanted to hurt myself, I’ve never thought about self harming or suicide, I don’t think that means my symptoms are less real or less severe, just that I haven’t had those feelings. I have other thoughts that constantly run through my head that are too personal to share, and they are a signal that I’m at my lowest, they are my red flags, my Nagios alerts. ! One of the other indicators I’m at my lowest, I sometimes feel I’m on the verge of a nervous breakdown, or that at some point in my life I will have one, and when I’m really low I look forward to it, perhaps because I think that would take me away from all the problems I think I have when I’m low. It might take me away, but would it fix them?
  16. My Treatment The only drug I’ve taken for my mental

    health was St John’s Wort, though how effective it was, I’m not sure. As I mentioned already during my first treatment I think the lifestyle changes I made at the time were of more benefit. ! On top of completing the course, and as a direct result of the things I learned while doing it I made myself get more sleep & take more exercise, there is debate around wether it’s chemicals that exercise releases in your body or the change in your state of mind that actually helps to relieve the symptoms. If you increase your self esteem you help break the circular nature of depression’s symptoms & causes.
  17. How I Help Myself I have 2 main tools I

    use to stop myself feeling anxious when I recognise those early signs, those new warnings in the log file, which is how it usually starts for me. ! The main symptom I get before I start to feel low is tension & anxiety. I worry a lot about the work that I’m doing and the consequences of not finishing it on time. That’s bad because I spend a lot of time worrying when I could be working. I can recognise the symptoms now & catch them. ! So instead of letting myself go off down that path I stop myself and just think about what actually happened last time and it’s usually nothing bad. I use that experience to really stop myself feeling stressed rather than just assuming it’s happening as some background process. ! I also use a form of meditation from the book “The Miracle of Mindfulness” we learned the technique on the IAPT course I attended & recognised it when I started to read the book (which I admit I never finished) I recognised it straight away. ! The technique is basically counting up as you breath in and out, start by counting to 4 or 5 and breath again but this time count 1 more until you can get to 7, 8 or even 9 so that you extend the amount of time it ties for a single breath & you take less overall breaths over the corse of a minute. ! I also try and limit the number of things I do outside work, and limit them to things with my family, get more exercise & get more sleep, no more all-nighters. ! The important thing here is not the techniques I use, but the fact I can recognise my symptoms early enough & deal with them before they get too bad.
  18. @Stubbs https://joind.in/10913 • Your GP • IAPT (Via your GP)

    • NHS Direct • Samaritans • T yneside/Washington MIND Questions?