By Dr Jas, Clinical Psychologist
Struggling with our mental health is hard enough, but often the experience is made worse by a side dish of questions and self-criticism. Why is this happening to me? What does it mean? I am weak? Mad? Bad? The reality is far from any of these things. One useful model to start to make sense of these experiences is the ‘stress-vulnerability hypothesis’. While this sounds complicated, I can explain it using the idea of the ‘stress bucket’.
Imagine that we all have a sort of mental stress bucket. Life’s stresses pour in, and if enough pours in without any outlet, sooner or later everyone’s bucket will overflow. This overflow is when we experience mental health ‘symptoms’: feeling low and hopeless, anxiety, hearing voices, unregulated emotions manic episodes…. What the ‘overflow’ looks like may be different for everyone, but a key idea is that given enough stress, anyone can experience mental health difficulties. Examples of stress include obvious things like current or recent negative events – griefs and losses, work stress, debt and financial difficulties, difficulties in our relationships, poor health. However it also includes stresses that we may choose but nonetheless put us under pressure – like planning a wedding, or working hard to succeed at something that matters to us. It also includes a range of more subtle ongoing situations – things like social isolation, experiences related to certain aspects of our identity (gender, race, ethnicity, age, ability/ disability, social class, economic status etc), and even aspects of the environment like a lack of sunshine, a lack of access to sleep or good nutrition. If enough of these stresses pile in, we will experience difficulties with our mental health.
Where it gets slightly more complicated is the ‘vulnerability’ part of the model. While we all have the possibility of overflow in common, some people might be more vulnerable to this happening because their bucket is smaller. This means that it takes less stress before they start to experience symptoms. Importantly the size of someone’s bucket is not their fault. Our genetics and brain biology play a big part in our vulnerability to mental health issues, and so do our life experiences. Traumatic and difficult events in our earlier life clearly increase the risk of experiencing mental health symptoms when put under enough stress. However not everyone who struggles with their mental health will have experienced something they considered to be a major trauma. Again subtle or ongoing life experiences can also really increase our risk. Genetic factors and experiences interact with each other in complex ways. To use a physical health example – someone may have genes that increase their risk for lung cancer, but if they never smoke they are unlikely to be at increased risk. There is also new ideas of ‘epigenetics’ – the idea that our genes can be turned on/off or up/down depending on our experiences and those of our parents and grandparents.
While we don’t have much control over a lot of this, the stress bucket model also suggests there are ways that we can moderate the effects of stress pouring in. Helpful coping strategies can act like opening up taps in the bucket to let some of the water out, so we have less chance of things overflowing. Unhelpful coping strategies block up these taps and have the opposite effect – increasing overwhelm and symptoms. There are some things that all humans have in common as possible helpful coping strategies – time with people we care about and who care about us; making sure we are getting enough food, water, sleep, and movement; experiences that fit with our values and sense of meaning, that give us joy, excitement or a sense of achievement. Other helpful coping strategies will be more specific to us and our symptoms – like listening to music to lift our mood, tearing up pieces of paper to cope with anger, or having a cold shower to cope with an urge to self-harm. Examples of unhelpful coping strategies would be things like self-harm, isolating ourselves, lashing out, starving ourselves , misusing drugs and alcohol, self-criticism or driving ourselves too hard.
Things get more complicated again (and the analogy starts to break down a bit!) when we realise that the different parts of the model can also interact or form vicious cycles. For example certain stresses or life experiences mean we can’t access certain coping strategies, like having no money for enjoyable activities, being socially isolated, or having a lack of opportunity in our early life to learn helpful coping strategies from our caregivers. Also, certain symptoms like dysregulated (out of control) emotions, or just plain mental exhaustion from coping with so much, make it harder to choose good coping strategies over unhelpful ones, or to generally just manage the stresses and pressures themselves. Sometimes our unhelpful coping can actually make the pressures worse – like spending or gambling leading to debt. The way other people respond to our symptoms can also increase the stress and pressure – experiences of being misunderstood or discriminated against spring to mind.
While not a perfect model (it’s always more complicated than that!), the stress bucket idea has a few important take home messages. It’s not your fault. You aren’t broken. And if you take some time to understand your own ‘stress bucket’ and coping strategies, there may be some solutions or strategies that present themselves to support you in managing the tricky hand you have been dealt.
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