Stress Management in the Workplace

Stress: What is it?

Stress as a response:

- is the way you feel when pressure is placed on you.

-- it’s the meeting of the individual with an external event.

Stress is not simply a function of what you do. It's also a function of how you react.

The Understanding of the physiological basis of stress is pioneered by three men:

Claude Bernard

Walter B. Cannon

Hans Selye

According to Claude Bernard (1800’s) , all living organisms attempt to maintain internal constancy (milieu interieur) or balance and how this struggle goes on despite changes in the environment.

Walter B. Cannon’s “homeostasis” [ Greek ‘homios’ (similar); ‘stasis’ (position) – steady position or state of being is the normal pattern of internal functioning under which living things operate.

Eg. Balance in heart rate (60 - 100 bpm) , temperature (90/100), respiration (12 - 20 bpm)

If the body did not maintain its internal balance and fluctuated greatly with the weather, it would begin to malfunction and breakdown.

Hans Selye, endoctrinologist (1926),

with his further studies confirmed that “ when an organisms operating systems (respiration, circulation, digestion, and temperature regulation) were thrown too far out of their normal range of functioning, the organism was in danger of dying. The demands created by the need to adapt to these external stimuli were far too great for their bodies to cope with.

The concept of Eutress and Distress

Eutress is a positive stress response stress that is deemed healthful, beneficial or giving one the feeling of fulfillment.

Word Origin. from Greek eu 'well, good' + stress,

Distress is a negative stress response

distress is anxiety, sadness, fear, suffering or pain, or a state of being

in trouble.

Stress is the feeling of being under too much mental or emotional pressure.

Pressure turns into stress when you feel unable to cope.

Both kinds of demands (eutress and distress) tax the body’s ability to stay in balance (maintain homeostasis).

In order to maintain homeostasis in the face of such demands, the body mobilized energy by initiating stress response. In a sense, the stress response can be viewed as energy-intensive process needed to maintain homeostasis in the face of eutress or distress that threaten to throw the body out of balance.

If your mind and body are constantly on edge because of excessive stress in your life, you may face serious health problems. Chronic emotional stress can affect virtually every organ system in negative ways, according to NIH. Prolonged stress has been shown to cause numerous health problems, including:

• Weakening of the immune system, making you more likely to have colds or other infections* High blood pressure* Upset stomach, ulcers and acid reflux* Anxiety• Increased rapid heart beat and heart palpitations* Panic attacks* Cardio-vascular problems* Increase in blood sugar levels* Irritable bowel problems* Backaches* Tension headaches or migraines* Sleep problems* Chronic fatigue syndrome* Respiratory problems and heavy breathing* Worsening of skin conditions, such as eczema

How do we Adapt to Stress Signals?

General Adaptation Syndrome (GAS).

Selye created a model for describing this nonspecific response and adaptations it forces the body to make.

It has three distinguishable phases: alarm, resistance, and exhaustion. These three phases are sequential; that is, the source of stress sounds the alarm to initiate the GAS and if the stress is not removed or coped with, the body progresses to resistance and eventual exhaustion. However, recovery is an alternative outcome to exhaustion when the source of stress is removed or coped with effectively.

Fight or Flight instinctAcute stress response

Walter Cannon 1920’s

Fight or Flight

mechanism in the body that enables humans and animals to mobilize a lot of energy rapidly in order to cope with stressors or threats to survival .

Fight or Flight: How does it work?

1. A threat is perceived

2. The autonomic nervous system automatically puts body on alert.

3. The adrenal cortex automatically releases stress hormones.

4. The heart automatically beats harder and more rapidly.

5. Breathing automatically becomes more rapid.

6. Thyroid gland automatically stimulates the metabolism.

7. Larger muscles automatically receive more oxygenated blood.

Symptoms of stress:

AngerDepressionAnxietychanges in behaviorfood cravingslack of appetitefrequent cryingdifficulty sleeping (mental)feeling tired and difficulty concentrating, unable to manage thingsunable to think clearlyhaving uncomfortable emotions. It affect your mental capacity bec. body and mind is inseparable. Emotions are disturbed.

Stress affects everybody, it is inevitable, but what is interesting is that what is stressful for one, may not affect another very much. Therefore stress is individual perception, a meeting of the individual personality with an external event.

In this light, it is therefore very important for you to know or recognize the things or events that makes you stressful.

Stress in the WorkplaceOne of the common stressors of people aside from pressures at home, family, relationships and financial issues is pressures in the workplace or employment or career issues.

And stress at work is a major issue.

It can be a significant cause of illness, and is known to be linked with high levels of sickness absence, staff turnover, productivity issues of organizations.

Work-related stress is the second most common compensated illness/injury in Australia, after musculoskeletal disorders.

Research commissioned by the Health and Safety Executive in the UK has indicated that:

stress-related illness is responsible for the loss of 6.5 million working days each year that costs society about £3.7 billion every year (at 1995/6 prices) (Cartwright and Cooper 2002)

In the US, Three-fourths of employees believe the worker has more on-the-job stress than a generation ago.-Princeton Survey Research Associates

Problems at work are more strongly associated with health complaints than are any other life stressor-more so than even financial problems or family problems.-St. Paul Fire and Marine Innsuance Co.

Work-related or job stress

The concept of job stress is often confused with challenge, but these concepts are not the same.

Challenge energizes us psychologically and physically, and it motivates us to learn new skills and master our jobs. When a challenge is met, we feel relaxed and satisfied. Thus, challenge is an important ingredient for healthy and productive work. The importance of challenge in our work lives is probably what people are referring to when they say "a little bit of stress is good for you.

With stress, job demands cannot be met, relaxation has turned to exhaustion, and a sense of satisfaction has turned into feelings of stress. In short, the stage is set for illness, injury, and job failure.

Challenge Vs. Stress

The National Institute for Occupational Safety and Health (NIOSH)

Nearly everyone agrees that job stress results from the interaction of the worker and the conditions of work. Views differ, however, on the importance of worker characteristics versus working conditions as the primary cause of job stress. These differing viewpoints are important because they suggest different ways to prevent stress at work. According to one school of thought, differences in individual characteristics such as personality and coping style are most important in predicting whether certain job conditions will result in stress-in other words, what is stressful for one person may not be a problem for someone else. This viewpoint leads to prevention strategies that focus on workers and ways to help them cope with demanding job conditions. Although the importance of individual differences cannot be ignored, scientific evidence suggests that certain working conditions are stressful to most people. The excessive workload demands and conflicting expectations described in David's and Theresa's stories are good examples. Such evidence argues for a greater emphasis on working conditions as the key source of job stress, and for job redesign as a primary prevention strategy.

What are the main work-related stressors?All the following issues have been identified as potential stressors at workplaces. A risk management approach will identify which ones exist in your own workplace and what causes them. They include:

Organization culture

Bad management practices

Job content and demands

Physical work environment

Relationships at work

Change management

Lack of support

Role conflict

Trauma.

Causes of Work-related StressSome of the factors that commonly cause work-related stress include:Long hoursHeavy workloadChanges within the organizationTight deadlinesChanges to dutiesJob insecurityLack of autonomyBoring workInsufficient skills for the jobOver-supervisionInadequate working environmentLack of proper resourcesLack of equipmentFew promotional opportunitiesHarassmentDiscriminationPoor relationships with colleagues or bossesCrisis incidents, such as an armed hold-up or workplace death.

Symptoms of work-related stressThe signs or symptoms of work-related stress can be physical, psychological and behavioural.

Physical symptoms include:

FatigueMuscular tensionHeadachesHeart palpitationsSleeping difficulties, such as insomniaGastrointestinal upsets, such as diarrhoea or constipationDermatological disorders.

Behavioural symptoms include:

An increase in sick days or absenteeismAggressionDiminished creativity and initiativeA drop in work performanceProblems with interpersonal relationshipsMood swings and irritabilityLower tolerance of frustration and impatienceDisinterestIsolation.

Psychological symptoms include:

DepressionAnxietyDiscouragementIrritabilityPessimismFeelings of being overwhelmed and unable to copeCognitive difficulties, such as a reduced ability to concentrate or make decisions.

Work-Related Stress is a Management Issue

It is important for employers to recognize work-related stress as a significant health and safety issue.

A company can and should take steps to ensure that employees are not subjected to unnecessary stress.

Work-related stress is a management issueEnsure a safe working environment.

Make sure that everyone is properly trained for their job.

De-stigmatize work-related stress by openly recognizing it as a genuine problem & a significant health & safety issue.

Discuss issues and grievances with employees, and take appropriate action when possible.

Devise a stress management policy in consultation with the employees.

Encourage an environment where employees have more say over their duties, promotional prospects and safety.

Organise to have a human resources manager.

Cut down on the need for overtime by reorganizing duties or employing extra staff.

Take into account the personal lives of employees and recognize that the demands of home will sometimes clash with the demands of work.

Seek advice from health professionals, if necessary.

How to Manage Stress at WorkSelf-help for the individual:

Think about the changes you need to make at work in order to reduce your stress levels and then take action. Some changes you can manage yourself, while others will need the cooperation of others.

Talk over your concerns with your employer or human resources manager.

Make sure you are well organized. List your tasks in order of priority. Schedule the most difficult tasks of each day for times when you are fresh, such as first thing in the morning.

Take care of yourself. Eat a healthy diet and exercise regularly.

Consider the benefits of regular relaxation. You could try meditation or yoga.

Make sure you have enough free time to yourself every week.

Don’t take out your stress on loved ones. Instead, tell them about your work problems and ask for their support and suggestions.

Drugs, alcohol and tobacco, won’t alleviate stress & can cause additional health problems. Avoid excessive drinking & smoking.

Seek professional counseling from a counselor or psychologist

If work-related stress continues to be a problem, despite your efforts, you may need to consider another job or a career change. Seek advice from a career counselor or psychologist.

Benefits of preventing stress in the workplace

Reduced symptoms of poor mental and physical health

Fewer injuries, less illness and lost time

Reduced sick leave usage, absences and staff turnover

Increased productivity

Greater job satisfaction

Increased work engagement

Reduced costs to the employer

Improved employee health and community wellbeing

Where to get helpYour doctor

Psychologist

Your manager/direct superior

Human resources manager at your workplace

WorkCover Advisory Service Tel. 1800 136 089 USA

Disasters/Calamities/Emergencies

Disasters, calamities and emergencies are emotionally charged events that occur with little, if any, warning. Typically they unexpected, sudden and overwhelming. They can involve:

- severe, life threatening situations; -cause widespread disruptions that deny shelter, food, water, and medical care to vast segments of the population; - and interfere with communication and transportation.

For many people, there are no outwardly visible signs of physical injury, but there can be nonetheless an emotional toll. It is common for people who have experienced disaster to have strong emotional reactions. Understanding responses to distressing events can help you cope effectively with your feelings, thoughts and behaviors, and help you along the path to recovery.

Natural Disasters/Calamities/Emergencies

Man-made

Affected residents often experience confusion, fear, hopelessness, sleeplessness, anxiety, grief, shock, guilt, and shame.

The effects of a disaster, terrorist attack, or other public health emergency can be long-lasting, and the resulting trauma can reverberate even with those not directly affected by the disaster

What to do during disasters?Most of the things we do during disasters are reactive because usually they

come without warning

How to Minimize Stress in Disasters, Calamities or Emergencies

1. Anticipate – do advance preparation2. Over-react

Mobilizing local public health workers and emergency responders who shoulder the responsibility for ensuring the health and safety of affected people; helping them to cope with these devastating situations; and re-establishing normal function. However, this responsibility can take a heavy toll on public health workers and emergency responders as well, particularly in emotionally charged situations with widespread turmoil.

How to Cope

Understanding responses to distressing events can help you cope effectively with your feelings, thoughts and behaviors, and help you along the path to recovery.

What are common reactions and responses to disaster?Following disaster, people frequently feel stunned, disoriented or unable to integrate distressing information. Once these initial reactions subside, people can experience a variety of thoughts and behaviors.

Common responses can be:

Intense or unpredictable feelings. You may be anxious, nervous, overwhelmed or grief-stricken. You may also feel more irritable or moody than usual.

Changes to thoughts and behavior patterns. You might have repeated and vivid memories of the event. These memories may occur for no apparent reason and may lead to physical reactions such as rapid heartbeat or sweating. It may be difficult to concentrate or make decisions. Sleep and eating patterns also can be disrupted — some people may overeat and oversleep, while others experience a loss of sleep and loss of appetite.

Sensitivity to environmental factors. Sirens, loud noises, burning smells or other environmental sensations may stimulate memories of the disaster creating heightened anxiety. These “triggers” may be accompanied by fears that the stressful event will be repeated.

Strained interpersonal relationships. Increased conflict, such as more frequent disagreements with family members and coworkers, can occur. You might also become withdrawn, isolated or disengaged from your usual social activities.

Stress-related physical symptoms. Headaches, nausea and chest pain may occur and could require medical attention. Preexisting medical conditions could be affected by disaster-related stress.

How do I cope?

Fortunately, research shows that most people are resilient and over time are able to bounce back from tragedy. It is common for people to experience stress in the immediate aftermath, but within a few months most people are able to resume functioning as they did prior to the disaster. It is important to remember that resilience and recovery are the norm, not prolonged distress.:

There are a number of steps you can take to build emotional well-being and gain a sense of control following a disaster, including the following

Give yourself time to adjust. Anticipate that this will be a difficult time in your life. Allow yourself to mourn the losses you have experienced and try to be patient with changes in your emotional state.

Ask for support from people who care about you and who will listen and empathize with your situation. Social support is a key component to disaster recovery. Family and friends can be an important resource. You can find support and common ground from those who've also survived the disaster. You may also want to reach out to others not involved who may be able to provide greater support and objectivity.

Communicate your experience. Express what you are feeling in whatever ways feel comfortable to you — such as talking with family or close friends, keeping a diary or engaging in a creative activity (e.g., drawing, molding clay, etc.).Find a local support group led by appropriately trained and experienced professionals. Support groups are frequently available for survivors. Group discussion can help you realize that you are not alone in your reactions and emotions. Support group meetings can be especially helpful for people with limited personal support systems.

Engage in healthy behaviors to enhance your ability to cope with excessive stress. Eat well-balanced meals and get plenty of rest. If you experience ongoing difficulties with sleep, you may be able to find some relief through relaxation techniques. Avoid alcohol and drugs because they can be a numbing diversion that could detract from as well as delay active coping and moving forward from the disaster.

Establish or reestablish routines. This can include eating meals at regular times, sleeping and waking on a regular cycle, or following an exercise program. Build in some positive routines to have something to look forward to during these distressing times, like pursuing a hobby, walking through an attractive park or neighborhood, or reading a good book.

Avoid making major life decisions. Switching careers or jobs and other important decisions tend to be highly stressful in their own right and even harder to take on when you're recovering from a disaster.

When should I seek professional help?

If you notice persistent feelings of distress or hopelessness and you feel like you are barely able to get through your daily responsibilities and activities, consult with a licensed mental health professional such as a psychologist. Psychologists are trained to help people address emotional reactions to disaster such as disbelief, stress, anxiety and grief and make a plan for moving forward.

Post Traumatic Stress DisorderPTSD

PTSD

PTSD, or Posttraumatic Stress Disorder, is a mental health condition or a psychiatric disorder that can occur following the experience or witnessing of a life-threatening traumatic events such as military combat, natural disasters, terrorist incidents, serious accidents, or physical or sexual assault in adult or childhood.

Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.

Post-traumatic stress disorder symptoms may start within three months of a traumatic event, but sometimes symptoms may not appear until years after the event. These symptoms cause significant problems in social or work situations and in relationships.

PTSD symptoms are generally grouped into four types: intrusive memories, avoidance,

negative changes in thinking and mood, or changes in emotional reactions.

Intrusive memories

Symptoms of intrusive memories may include:

Recurrent, unwanted distressing memories of the traumatic eventReliving the traumatic event as if it were happening again (flashbacks)Upsetting dreams about the traumatic eventSevere emotional distress or physical reactions to something that reminds you of the event

Avoidance

Symptoms of avoidance may include:

Trying to avoid thinking or talking about the traumatic eventAvoiding places, activities or people that remind you of the traumatic event

Negative changes in thinking and mood

Symptoms of negative changes in thinking and mood may include:

Negative feelings about yourself or other peopleInability to experience positive emotionsFeeling emotionally numbLack of interest in activities you once enjoyedHopelessness about the futureMemory problems, including not remembering important aspects of the traumatic eventDifficulty maintaining close relationship

Changes in emotional reactions

Symptoms of changes in emotional reactions (also called arousal symptoms) may include:

Irritability, angry outbursts or aggressive behaviorAlways being on guard for dangerOverwhelming guilt or shameSelf-destructive behavior, such as drinking too much or driving too fastTrouble concentratingTrouble sleepingBeing easily startled or frightened

Intensity of symptoms

PTSD symptoms can vary in intensity over time. You may have more PTSD symptoms when you're stressed in general, or when you run into reminders of what you went through. For example, you may hear a car backfire and relive combat experiences. Or you may see a report on the news about a sexual assault and feel overcome by memories of your own assault.

When to see a doctor

If you have disturbing thoughts and feelings about a traumatic event for more than a month, if they're severe, or if you feel you're having trouble getting your life back under control, talk to your health care professional. Get treatment as soon as possible to help prevent PTSD symptoms from getting worse.

If you have suicidal thoughts

If you or someone you know is having suicidal thoughts, get help right away through one or more of these resources:

Reach out to a close friend or loved one.Contact a minister, a spiritual leader or someone in your faith community.Call a suicide hotline) to reach a trained counselor. Make an appointment with your doctor, mental health provider or other health care professional.When to get emergency help

If you think you may hurt yourself or attempt suicide, or your local emergency number immediately.

If you know someone who's in danger of committing suicide or has made a suicide attempt, make sure someone stays with that person. Call your local emergency number immediately. Or, if you can do so safely, take the person to the nearest hospital emergency room.

Treatments and DrugsPost-traumatic stress disorder treatment can help you regain a sense of control over your life. The primary treatment is psychotherapy, but often includes medication. Combining these treatments can help improve your symptoms, teach you skills to address your symptoms, help you feel better about yourself and learn ways to cope if any symptoms arise again.

Psychotherapy and medications can also help you if you've developed other problems related to your traumatic experience, such as depression, anxiety, or misuse of alcohol or drugs. You don't have to try to handle the burden of PTSD on your own.

Psychotherapy

Several types of psychotherapy, also called talk therapy, may be used to treat children and adults with PTSD. Some types of psychotherapy used in PTSD treatment include:

Cognitive therapy. This type of talk therapy helps you recognize the ways of thinking (cognitive patterns) that are keeping you stuck — for example, negative or inaccurate ways of perceiving normal situations. For PTSD, cognitive therapy often is used along with exposure therapy.Exposure therapy. This behavioral therapy helps you safely face what you find frightening so that you can learn to cope with it effectively. One approach to exposure therapy uses "virtual reality" programs that allow you to re-enter the setting in which you experienced trauma.Eye movement desensitization and reprocessing (EMDR). EMDR combines exposure therapy with a series of guided eye movements that help you process traumatic memories and change how you react to traumatic memories.All these approaches can help you gain control of lasting fear after a traumatic event. You and your health care professional can discuss what type of therapy or combination of therapies may best meet your needs.

You may try individual therapy, group therapy or both. Group therapy can offer a way to connect with others going through similar experiences.

Medications

Several types of medications can help improve symptoms of PTSD:Antidepressants. These medications can help symptoms of depression and anxiety. They can also help improve sleep problems and concentration. The selective serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) and paroxetine (Paxil) are approved by the Food and Drug Administration (FDA) for PTSD treatment.

Anti-anxiety medications. These drugs also can improve feelings of anxiety and stress for a short time to relieve severe anxiety and related problems. Because these medications have the potential for abuse, they are not usually taken long term.

Prazosin. If symptoms include insomnia or recurrent nightmares, a drug called prazosin (Minipress) may help. Although not specifically FDA-approved for PTSD treatment, prazosin may reduce or suppress nightmares in many people with PTSD.You and your doctor can work together to figure out the best treatment, with the fewest side effects, for your symptoms and situation. You may see an improvement in your mood and other symptoms within a few weeks.

Tell your health care professional about any side effects or problems with medications. You may need to try more than one or a combination of medications, or your doctor may need to adjust your dosage or medication schedule before finding the right fit for you.

epilogue

• Stress is everywhere and anywhere, you can have small stresses, big stresses, or extreme life-threatening stresses. Whatever it is at any level, you should be able to recognize and accept that you are under such duress to be able to do something about it as a response.

• The important thing is to know that there are ways to avoid it or to minimize its impact, and that there are ways to cope with it and treatments for it are available if needed.

-Fin-

May Flerida Martinez-Culango, RGC, MACTU-San Francisco Campus

February 8, 2015