Anxiety and feelings of stress are symptoms, a response to pressure, the
more intolerable or persistent the pressure, the worse the anxiety.
And this does not necessarily mean a single, overwhelming difficulty.
More often it is an accumulation of things. This cumulative side of
anxiety is well documented in Barrie Hopson’s work on transitions, which he
has related to the Holmes and Rahe Social Readjustment Rating Scale (Griffiths
1981). This information is nowhere near as daunting as it might sound.
It can be a particularly useful and comforting piece of knowledge. It
shows, in easily understood terms, how all manner of changes – many of which
the majority of us might barely accepts as changes at all – and an accumulation
of such changes, can have a profound effect on our lives.
Drs. Holmes and Rahe found that the adjustment that an individual needed
to deal with various changes was remarkably consistent from culture to culture
around the world, and they gave mean values to a whole range of these (see
the abbreviated list below).
They found that illness or a change in health were likely if certain totals
were met during a one – year period. These were; 0 – 149 no significant
change likely; 150 – 199 mild stress and a 35% chance of illness; 200 – 299, moderate
stress and a 50% chance of illness; 300+, major stress and an 80% chance
of illness. It is estimated that it takes a year to replenish the energy
expended in adjusting to any of the changes described below.
These are the scale ratings that apply most:
- Death of a spouse – 100
- Divorce – 73
- Marital separation – 65
- Death of a close family member – 63
- Major personal injury or illness – 53
- Marriage – 50
- Marital reconciliation – 45
- Retirement – 45
- Major change in health or behaviour of a family member – 44
- Pregnancy – 40
- Sexual difficulties – 39
- Gaining a new family member (birth, adoption, relative moving in) – 39
- Major change in financial status (lot better, or worse, off) – 38
- Death of a close friend – 37
- Changing to different kind of work – 36
- Major changes in number of arguments with spouse (lot more or lot less) – 38
- Taking out a mortgage – 31
- Major changes in work responsibilities – 29
- Son or daughter leaving home – 29
- Trouble with in-laws – 29
- Major change in living conditions (building or remodelling home or deterioration of home or neighbourhood) – 25
- Change in residence – 20
- Major change in type or amount of recreation – 19
- Taking out a loan – 17
- Major change in sleeping habits (more or less or different times) – 16
- Major change in number of family get – togethers (more or less) – 15
- Holiday – 13
- Christmas – 12
This doesn’t mean that we are then ‘entitled’ to be in deep grief or depression.
It certainly does not present an excuse for the recurrence of an inability
to cope, but it does give reasons for anxiety symptoms if they occur during
such changes. It also means that the anxious person has found another
way to avoid believing that s/he feels terrible for no reason apart from ‘natural
Responses to such changes are not particularly simple either. Hopson
describes the ‘life cycle’ of a transition (a significant life – change), whether
it is planned, unplanned, sudden or gradual, as having seven phases.
- Immobilisation – feeling overwhelmed by the transition, unable to think or plan.
- Minimisation – coping by reducing or trivialising the transition, perhaps even experiencing a little euphoria in the process.
- Letting go – accepting that the transition has happened and cannot be unhappened. Feelings
start to rise again.
- Testing – trying out
new behaviour and situations. Plenty of energy available but a tendency
to stereotype people and things – how they should or shouldn’t be in relation
to the change – and to become angry or irritable quite easily.
- Search for meaning –
trying to understand how and why things are different now. Distancing
somewhat from the transition to get a better look at it.
- Internalisation – absorbing
and finally accepting the transition as part of life.
This is not a rigid series. Getting over bereavement and getting over
Christmas are going to involve different time scales and different levels
of feeling. Similarly, people do not move neatly from one stage to the
next. Some may get caught up in one stage or another and progress no
further, while others may fall back into an earlier stage after a setback
or further life change that occurs whilst they are working through the stages.
People too have different responses to any kind of change such as welcoming
or resisting or fearing. Those of us who are prone to responding in
the more negative ways will obviously have additional difficulties.
The important point with Hopson’s work and with the Holmes and Rahe scale
is that it is another weapon in our armoury of understanding. It allows
us to anticipate difficulties, and to ensure that new situations don’t come
as an overwhelming surprise to anxious people who are already all to liable
to react anxiously to the ‘threat’ of change. Charity workers have talked
to many people who have recounted obvious symptoms of bereavement – loss
of appetite, sadness, depression, emptiness, loneliness, ‘life is meaningless’
feelings – when discussing a lost job, a lost relationship or even their
lost youth and missed chances. The sad thing is that they had denied
themselves the right to feelings of grief, regarding them as some kind of
weakness or punishment instead of a natural process.
People are also fond of telling themselves that they should look forward
to things such as retirement, moving, the freedom gained by the children leaving
home. In reality, these changes may be painful and start a stress reaction
at some level. A person recovering from an anxiety disorder,
and the caring family, must accept that this person will have a fairly tenuous
hold on ‘real life problems’ for a while. New problems will always
be arising, some of which can be solved and some of which have to be endured.
It is vital, therefore, that the newly recovered person and the caring family
use their insight and knowledge to mark current and potential problems in
life: Builders are coming next month; her friend will be bringing the
baby round; the neighbours have a new dog. If problems are foreseen
early, small behaviour tasks can be undertaken or other anti – anxiety or anti – obsessional
preparations made. Certain practical, behavioural tasks will almost
certainly have been undertaken during the recovery process and it is absolutely
essential that such work is not given up. It can be modified or reduced
of course, but anxiety sufferers who are reaching towards a far better life,
should not be encourage to believe that all the work is behind them and that
‘it’ will never bother them again.
Source: Hopson, B. (1981) ‘Transitions: Understanding and Managing Personal
Change’, in Griffiths, D (