Those unable to manage stress effectively fail to adapt to the pressures and problems of life in appropriate ways. When a problem arises, they might lose their temper, blame someone else, look to someone else to put everything right; or they might take everything on their own shoulders, refusing help. They might become obsessive - their response to news of a soaring crime rate might be to insist all the windows are kept locked at all times, and that the house is never left empty, for instance.

Effective stress management starts with recognising the symptoms. All parts of the body and mind can be affected. Tension leads to neck and lower back pain, headaches, teeth-grinding, a high-pitched or nervous laughter, trembling, shaking, a nervous tic, high blood pressure, migraine and digestive problems such as irritable bowel syndrome.

Other symptoms include a fast pulse, thumping heart, hyperventilation, palpitations, sweating, dryness of the throat and mouth and difficulty swallowing. Insomnia and other sleep disorders are common, the there may be fainting, dizziness, a feeling of weakness and lack of energy.

Stress management is essential for a healthy mind, as well as body. Poor concentration, vague anxiety or fear for no apparent reason, periods of irritability and perfectionism followed by depression and lethargy and all signs of stress. Other warning signs include self-destructive behaviour such as eating and drinking too much, smoking excessively, relying on tranquillisers and even being unusually accident-prone.

The second step in effective stress management is to identify the causes. Write down a list of the things that cause you stress. Some are obvious - outstanding bills, a constantly crying baby, pressures at work - but you may not have realised that things you have been looking forward to such as moving house and marrying still cause stress. A longed-for holiday can cause stress, trying to cope with lack of communication, foreign money and travel delays.

The third step towards good stress management is to monitor your reactions. There are three basic ways of responding to stress - fight, flight or flow.

Fight response - you may meet people head-on, become impatient and lose your temper easily or you may internalise your feelings, becoming fixed and stubborn and objecting to change.

Flight response - pretending problems don't exist, or letting someone else deal with them.

Flow response - 'go with the flow', accepting the situation

The fourth step in managing stress is to develop a holistic approach. Be aware of what triggers off your stress symptoms and try to negotiate compromises with others. Don't be over dependent on others, but accept help when needed. Express your feelings. If you find it difficult to avoid shouting or crying, make sure you have a trusted friend to talk to who understands you. Eat a healthy, balanced diet, take regular exercise and get a good night's sleep. And lastly, try any of the therapies listed in the Guide to help you develop a healthy, relaxed attitude to stress.