David Bailey, director of the St John's Counselling Service, says the stress levels in Hong Kong are the highest he has seen since assuming his post five years ago.

He believes that most people are experiencing stress in one, or a combination, of the following three areas: environmental stress, arising from concerns related to work or finances; situational stress, arising from a specific issue such as the Sars virus or the death of a loved one; and emotional stress, arising from relationship problems.

If left untreated, the effects of stress can be debilitating. These include a loss of enjoyment in life, fatigue, aches and pains, anxiety, problems sleeping and depression. Longer term, chronic stress can contribute to more serious health problems, such as heart disease and cancer.

Mr Bailey says stress is natural, but we should strive to minimise the unnecessary clutter. There is no universal yardstick for healthy stress levels, as some individuals have dispositions, most likely genetically inherited, that enable them to handle more stress than others.

Mr Bailey says the best approach is to focus on reducing exposure to stress and developing effective coping techniques.

'You should not just focus on the amount of stress you have. You should focus on the variety of coping mechanisms and coping skills,' Mr Bailey says.

'You can live with a high amount of stress if you have coping mechanisms that work well.'

Hong Kong is one of the least stress-aware cities in Asia. Residents of Manila, Taipei and Bangkok are generally more willing to take time out to unwind.

One reason for the disparity is Hong Kong's high-calibre workforce. The work culture tends to attract high-achievers, just the kind of people who are less likely to admit there is a problem when the pressures build.

'When you're successful you get used to being successful and you are not used to needing help, assistance, or needing to think about stress management,' Mr Bailey says.

'Most people think about stress management only in emergency situations, rather than on an ongoing basis. It is the same kind of thinking where people go to the doctor only if they have an emergency, rather than having regular check-ups.'

Of course, high stress can occur in any age group or income bracket.

We are all familiar with anecdotes about nervous bankers underwriting million-dollar deals, but individuals with low-paying, routine jobs are also at risk, according to Jane Climas, a counsellor with Resource, the Counselling Centre.

In recent months, the clinic has experienced a surge in requests for help from people across the economic spectrum. As a non-profit organisation, it charges clients on a sliding scale. Those earning above HK$35,000 should expect to pay about HK$400 per hour; those earning less pay about HK$200 per hour. In most cases, the centre can arrange counselling sessions within 48 hours.

One of the first steps in developing a stress-relief programme is to examine one's internal dialogue, Ms Climas says. Becoming aware of how you talk to yourself during difficult situations is an important indicator of what you are really feeling. Watch out for the tendency to use negative language, such as 'could have' or 'should have'.

A classic example is when running late for an important meeting. Some people will initiate a highly critical internal dialogue.

As the negative thoughts creep in, stress levels rise, breathing becomes shallow, palms sweat, thinking ability slows. Ultimately, we arrive at the meeting feeling light-headed and with diminished cognitive abilities.

'We all have these tapes running in our heads all the time,' Ms Climas says. 'We have to try and tap in and say: What message am I giving to myself now? Is it a negative one? A critical one?'

By focusing on positive thoughts - 'the glass is half full' mentality - we foster a perceptual shift that has a physiological parallel - lower heart rates, reduced muscular tension and lowered perspiration. Ms Climas calls it the opposite of the 'prison cell' of negative thoughts where individuals tend to put stress on themselves.

'I'm very much of the belief that what you think affects what you feel, affects your actions,' Ms Climas says.

Relaxation techniques are also important in changing the way we think. Regular yoga, breathing exercises, and taking time out to do the things we love can be important in maintaining a balanced life. These activities condition us away from thinking too seriously about problems and creating a mental distance between work and our private lives.

To keep work-related stress in check, Ms Climas suggests a little common sense. Turn off your mobile phone when at home, and do not check e-mail or roam the Internet in the evening. Try to fill your non-working hours with activities you enjoy doing. Take a Latin dance class, join the National Geographic Society, or sign up for an art class. Fostering these interests can rekindle an interest in life and encourage a healthy shift of mental gears.

'We have a tendency to drop hobbies and the creative side during stress,' Ms Climas says.

Another important area is health and lifestyle. Regular exercise is widely regarded as one of the most effective anti-stress remedies. This should be accompanied by a proper diet, adequate rest and a regular sleep routine.

Most health professionals say exercises such as yoga or tai chi are especially good because they focus on both physical and mental states.

Hong Kongers have a reputation for working hard and playing hard. Unfortunately, many temptations can be a stressed-out individual's worst enemy.

Heavy drinking, gambling and recreational drug use are some of the most common outlets when we feel the strain, but also the most dangerous.

The reasons for this are linked to the basic architecture of the brain.

Research in the early 1970s established that brain cells communicate with each other via a system of chemical messengers. On a typical day, trillions of brain messages are sent and received.

It appears all messages can be broken down into two basic groups: happy messages that are carried by a messenger group known as the biogenic amine/endorphin system; and sad messages, carried by a different group of chemical messengers.

Most nerve centres receive input from both types of messengers and, just like an accounting department, remain satisfied as long as the inventory is balanced. Stress, however, causes problems with the brain's happy messengers. At times of prolonged stress, these messengers fall behind in their deliveries.

After prolonged periods of stress exposure, a chemical imbalance can arise known as overstress, Dr Burns says.

During this state, sad chemical messengers flood nerve centres, creating wide-ranging negative sensations.

Common complaints are fatigue, inability to sleep or feel rested, and a lack of energy and enjoyment in life.

About 10 per cent of the United States population suffers these chemical malfunctions, resulting in sensations of depression, anxiety and an inability to cope.

Stimulants such as alcohol, cigarettes, caffeine and recreational drugs such as heroin and marijuana - even sugary foods - can provide temporary relief by acting as a pick-me-up.They work by boosting happy messengers and temporarily restoring the balance in the overstressed brain.

But when the effects wear off, the imbalance is even greater, leading to heightened depression.

Cindy Leung Yuen-ching, principal social worker with the Hong Kong Family Welfare Society, says such drug use can result in cycles of addiction.

'By using pick-me-ups, the person merely puts himself into a shaky equilibrium where he tries to balance a host of stressors, on the one hand, against a variety of pick-me-ups,' Dr Burns explains.

'Since it is impossible for a person to accurately rebalance his brain chemistry this way, he will sometimes feel okay, but much of the time will have mood swings.'

These artificial stimulants inhibit the body's own self-correcting mechanisms. The brain has a natural mechanism that will restore equilibrium, says Dr Burns, but it must be left to function on its own.

Ms Leung agrees, saying that a better approach is to open channels of communication. Tell others the kinds of stresses you are under and how you are feeling.

If simply speaking to friends does not help, try talking things out with a professional counsellor. One-on-one sessions and group talks are widely available in Hong Kong.

'Don't just think it will go away,' Ms Leung says.

HOW STRESSED OUT ARE YOU?

Physical symptoms

Sleeping problems (insomnia, waking early)

Eating disorders (binge-eating, drop in appetite)

Body-aches (headaches, stiff neck, digestive problems, chest pain)

Loss of sexual drive

Emotional symptoms

Depressive mood, loss of interest in life

Anxiety, unable to relax

Irritability, mood swings

Cognitive symptoms

Inability to concentrate

Preoccupation with negative thinking (sensations of hopelessness)

Obsessive thinking

Hallucination, delusional

(thoughts of being persecuted, overheard)

Evaluation

If you have experienced three or more of the above symptoms, and they have lasted for two months or more, and they cause difficulty in study, work, family life or social relationships, you may be suffering from overstress. Community health experts recommend seeking professional counselling by speaking to a doctor or social worker.

Who to turn to

St John's Counselling Service,

2525 7208 (stjohnscathedral.org.hk)

Hong Kong Family Welfare Society,

2832 9700 (hkfws.org.hk)

Resource, the Counselling Centre,

2523 8979 (resourcecounselling.org)