Stress in the workplace is not only hobbling productivity, it’s seeping into our personal lives and making us sick. Donna Chisholm looks at the causes and hidden costs of chronic stress – and how to lighten the load.
The former secondary school biology and science teacher knew exactly what was going on physiologically that was causing her sleeplessness, anxiety, irritability and even, at times, rage and, given she was studying to qualify as a personal trainer, she knew exactly what she should be doing to counter it, too. “I knew exercise would relieve the thoughts and anxiety. I knew that to feel okay, I needed to move. But I just didn’t. I couldn’t. I didn’t know which thing to tackle first. I was totally lacking in energy.”
She was supervising group boot camps for local women in south Auckland, and studying two nights and one morning a week, while caring for toddler Lily and Elijah, then only a few months old. At one point, she admitted herself for three nights to a mothers’ support facility to help her cope, even though she says her husband, Josh, did everything he could to relieve her stress by sharing the parenting as much as possible with his own full-time job.
“He was very happy to do it; he’s wonderful. He said, ‘I’m trying to take away the stress from you’, but it made me feel a little guilty that he’s doing everything and I’m not doing anything – even though I’m keeping two small humans alive.”
She’d get to sleep at 10pm and wake at 1am “and that was me done. I was awake for the day. I was thinking about the [personal training] business,thinking about the children, thinking about the future. I have done many relaxation courses but I just could not switch off.” At the end of last year, she went to hospital with an irregular heart rhythm caused by something similar to a panic attack.
It was only when she was prescribed quetiapine last year to help her sleep and began stepping up her exercise as part of her studies that she started to break through the lethargy and fatigue. She began gentle workouts using bands and weights, increasing their intensity when her sleep was more settled.
When Baker, 34, spoke to North & South, she was only weeks away from packing up the household and moving to Switzerland for two years for her husband’s job but she already had strategies ready to deal with the stress of the shift and adapting to life, language and culture in a new country.
“One of the best pieces of advice I was ever given about parenting and life was to let things go and don’t ‘should’ on yourself by saying, ‘I should be doing this or that’. When I get there, I’m going to seek out a gym and make sure I move. I’m going to get out in the fresh air. Mindset is huge in the way you approach things. It’s going to be scary, but I’m going to treat it like a huge opportunity.”
Related article: How to break the anxiety cycle, according to an overachieving workaholic
Outside of the usual stresses of life – relationships, parenting and finances among them – pressure at work is a key culprit. Despite a law change in 2015, which spelled out that employers must provide a psychologically as well as physically healthy work environment, there is evidence that stress levels among workers are on the rise. In their biennial Wellness in the Workplace survey of nearly 100,000 workers released in 2017, Business NZ and the Southern Cross Health Society found stress and anxiety rising both in prevalence and severity, with the main cause reported as “general workload”, followed by family relationships, pressure to meet work targets and long hours. Larger businesses – those with more than 50 staff – were more stressful places to work than smaller firms.
“There is a grand canyon opening up between the nobility and the serfs, and if the nobility is putting pressure on the serfs to work harder for less – which is what I am seeing on a weekly basis – then the stress will build,” says self-described “Dr Stress”, Auckland counsellor John McEwan, who regularly treats burnt-out workers and managers. “There is a lot more ruthlessness and narcissism in management, where people are almost deliberately stressing out those beneath them so they won’t be attacked by them. The people I’m seeing are competent, pleasant, sensitive creatives, and nearly always they have a manager above them who is threatened by competence.”
This August, Massey University’s Healthy Work Group released the findings of the 2018 Workplace Barometer on the prevalence and impact of stress and mental ill-health in the workplace. The first national data set of stress-related outcomes and psychosocial risks in the workplace, it found more than a quarter of the 1400 respondents reported feeling depressed “much of the time”; a half said their lives were impacted to some extent by depression. Those in the top 25% of reported distress lost 3.5 times more work time than those in the lowest 25%. The mean level of job stress, rated between 1 (very stressful) and 7 (very unstressful), was a moderate 4. The researchers found no significant differences by industry sector, but said working remotely at least one day a week appeared to be beneficial.
Massey Business School’s director of research, Professor Tim Bentley, says the most powerful predictor of the mental health outcomes for staff was how much of a priority the issue was for management in creating a company’s “psychosocial safety environment”.
And that didn’t mean organising the ubiquitous feel-good “wellness initiatives” such as mindfulness, stress management and resilience training, free massages, and lunchtime yoga and step groups. “To have someone come in and fix you instead of fixing the organisation is a blame-the-worker approach,” says Bentley. “You’re not removing the cause [of stress], you’re just treating the symptoms and deflecting attention from your organisational obligation to remove the risk.”
The “wellness” industry is large and growing. “I think they are a lousy cop-out. Their job is fixing people, but they need sick people in order to fix them. Organisations like them, because they don’t challenge them. People like that they get a free gym membership and they enjoy the walking club and the bowl of fruit at the watercooler. It’s all nice to have, but none of it makes any difference to the pressures they face at work. They do help us become more resilient in the short term, but they are only a Band-Aid that diverts the focus from the true causes of stress-related illness.”
One worker whose firm regularly offers wellbeing initiatives agrees. “I’m sure it’s well intentioned, but we’re having a wellness week we don’t have time to attend.”
“Spot on!” says Bentley. “Let’s control those stresses in the first place. What’s fundamental is how the leadership of the organisation is committed to and supports people.” A big part of that means controlling workload and giving workers flexibility and autonomy.
Government agency WorkSafe is funding further research for the next three years that aims to discover how much in dollar terms it would mean to companies to improve psycho-social safety in their organisation. ”Everyone is asking how we can push up productivity. We have this impasse; we are working long hours and not producing any more. It’s an intractable problem in New Zealand, but here is one way to overcome it – by committing to people’s psychological wellbeing.”
Wellington psychologist Gaynor Parkin has spent 26 years working with employers who want to improve their workers’ wellbeing. “Some organisations are doing better at spotting signs of distress and proactively following up and in those companies it might seem as though the problem is getting worse, but they are identifying and addressing it.”
In assessments her company, Umbrella Health, has done of 2500 employees, around 20% report high psychological distress. Like Bentley, she says it’s vital company leaders “walk the talk” rather than pay lip service to improving company culture. Some companies say they offer flexibility, then schedule lunchtime meetings or 8am team get-togethers so parents can’t drop their children at school before work. Others worry that employees will take advantage of flexible hours or working from home and start “slacking off”.
Naturally, employees will bring stresses from their daily lives into the workplace. “The demographic I’m in, the sandwich generation managing dependent children and dependent parents, we’re not doing so great,” says Parkin. “And at the other end, data is showing young professionals with young children who are probably under some financial load may not be doing so well, either.” A stressful home life can increase stress in the job, and stress at work can make people feel overwhelmed at home, “so there is a horrible feedback loop”.
In Umbrella’s data, 43% reported finding money stresses at least “somewhat” stressful, followed by family problems (32%), commuting (22%), children/parenthood (22%), relationships (16%), caregiving (16%) and ill health (14%). The top four “challenges” at work are failing to be consulted about change (60%), high workload (50%), unclear roles (23%) and lack of manager support (22%). Workers commonly point to flexible hours, the ability to work from home – particularly in Auckland – and “better work-life balance” as keys to reducing stress. The results aren’t all bleak news, however, with 25% of employees classified as “thriving” and 55% as “managing well”; 15% were “surviving” and 5% were “finding it tough”.
“The best way to get organisations on board is to help them know the business case for doing it,” says Parkin. “The research is overwhelmingly clear that if organisations prioritise wellbeing, everything else follows. But the litmus test is in the doing rather than the saying.” Her background, in frontline adult mental health for a district health board, meant working under pressure with limited resources. “We had more people being referred than we could physically see, so you either waitlist, prioritise or try to work more efficiently, but it was still more work than the team could manage and that’s incredibly stressful because then you don’t have autonomy.”
In that situation, Parkin says, the most important thing managers can do is to acknowledge and validate how their staff feel. “Staff need to feel their leader or manager has their back. Giving people autonomy as much as possible over how they work and when they work is really important, but at an individual level, so is learning how to leave the job behind and to switch off so you can then turn around and do it again the next day without burning out.”
Gilbert had been a high-performing staffer, reducing recidivism rates among the hundreds of violent criminals and sex offenders in his caseload. Staff at the Ōtāhuhu probation office had been nearly halved in the years before he was forced to retire on medical grounds in 1996. He has been unable to work since. The Employment Court found the department acted “outrageously and flagrantly” in returning him to full work after a hospital admission for heart problems caused by his acute stress. He was admitted to hospital eight times with arterial spasm causing severe chest pain, but says his bosses did nothing to help.
“It was the opposite,” he told North & South. “One of the bosses’ solutions was to just stick your case files in the drawer and forget them. The decent staff were trying to do the job well and the management couldn’t have given a stuff about that.”
What would have made a difference, Gilbert says, was the ability to limit workload “and there really wasn’t that ability. If you tried, they would say, ‘Are you refusing a lawful order?’ They’d storm around because they had reports to allocate and if judges didn’t get them they would leap up and down, but there was no acknowledgement of staff efforts. There was nothing; no support. They expected you to drop everything to make it easier for them but harder for you, and do it immediately regardless of what you had on. It was ridiculous. A good manager comes along and puts a hand on someone’s shoulder and says you did a good job on that case, or I read your report on this.
“I knew the [Employment Court] process would be a pain in the arse, but I determined it had to be done, or in effect you were condoning and saying you can do whatever you like – and what had been done was actually pretty bloody offensive.”
One of Gilbert’s legal team, Hugh Rennie, QC, says the Crown’s opposition to his claim was extraordinary. “Every resource was thrown at it – legal, medical, actuarial. I could not believe it would act the way that it did. There appeared to be… an agenda to fight to the end.”
He says the case happened after stress was removed from ACC coverage.
White, who stood for Labour in Auckland Central at the last general election, is also concerned about the disclosures some employees have to make about their mental health history, including anxiety and depression. Someone might be expected to disclose if they are on antidepressants, for example.
“The worst would be if something goes wrong in the workplace that is then used as a weapon if you haven’t [disclosed] it. It’s really important our workplaces are flexible enough that we can cope with the ordinary nature of human beings, and the norm is not this vanilla person who is bulletproof and infallible.”
It’s also an issue that worries John McEwan, who destroys his counselling notes within six months for privacy reasons, and is often asked by patients not to let their doctor know about their stress and anxiety for fear it will reduce their ability to get medical or life insurance or increase its cost.
“If we are stressed for good, normal reasons – in other words, we’ve had a whole heap of demands placed on us and we are squished… we are depressed – pressed down by normal demands… it’s not a psychiatric illness. It’s not a precursor to suicidality and it doesn’t mean we are a risk to anyone or anything or at risk of anything. It just means we are normal.”
Records of workers who seek counselling through Employee Assistance Programmes (EAP) are always confidential.
In McEwan’s experience, companies with a good culture can be identified by “the intelligence of the management”, who can spot the risks and realise that staff who are well looked after will be more productive. “Others have very narcissistic managers in critical places. It starts coincidentally but once a bad egg gets in and they burn out the people below them, they replace them with more bad eggs. A company that doesn’t address the really self-centred manager destroys itself over time.”
Although this results in workers leaving, and a high staff churn, managers themselves often move on every two years or so, staying ahead of the “tsunami of carnage” they cause.
We’ve all heard of the two key players in the body’s stress response: the hormones adrenalin and cortisol, both of which are released by the pyramid-shaped adrenal glands on top of our kidneys in response to signals from the brain. Superficially at least, we understand the body’s fight-flight response, the evolutionary mechanism to help us survive threats to our life. The adrenal not only generates the response, but then, after the threat has passed, also works to adjust the body to “homeostasis”, its original state. The adrenal consists of an inner medulla and an outer cortex; the medulla regulates the fight-flight response, while the cortex produces the cortisol.
When you lose patience with your computer because it’s frozen one more time, adrenalin is the hormone that makes you pick it up and throw it out the window. It’ll be the culprit if you’re in a road-rage incident and you storm out of your car and threaten to punch the other driver. It raises your heart rate and your breathing. It redirects your blood supply to the muscles to help you run away or fight, and shuts it off to places such as your digestion and reproductive system – those, says the adrenalin, can wait.
It also increases blood supply to the brain, so you can think your way out of a situation. “Ask anyone who’s had a near-death experience, say a car accident, to tell you what happened,” says Otago University’s Stephen Bunn. “They will almost always tell you that things slowed down, and the reason is that your brain is sampling the environment much more rapidly than it would normally do. When nothing is going on around you, you don’t take much notice, but when lots of things are going on, you take a hell of a lot of notice.”
Cortisol is adrenalin’s more restrained cousin. It’s the hormone that nags at you constantly when you’re stuck in traffic, you’re stressed and you’re running late but you can’t do a thing about it – running away isn’t going to help you.
“The sabre-toothed tiger runs at you, so you need to get the hell out of there. You produce the adrenalin that will either say you will stay and fight it or run away. In either of those strategies, you’re probably going to get injured doing it. Either you’ll get physically hurt, or exhausted running away. The adrenalin will turn itself off when you are out of that situation, but you’re still stressed because you have used up a lot of energy running away and you need a recovery phase.”
That’s where cortisol comes in. Its main job is to increase the amount of glucose in your blood to help return your energy balance and repair your tissues. When its job is done, it needs to tell the brain to switch it [the cortisol] off, but sometimes this doesn’t happen, either because the brain can still detect a persistent threat or the stress response is dysfunctional.
In Neolithic times, our stress response was built-for-purpose, but it’s far less useful to us now, when we worry not about sabre-toothed tigers but our jobs, our relationships and our finances – even about driving in peak-hour traffic.
“Cortisol doesn’t really help with those at all in any meaningful way but it’s still being produced to deal with something your physiology recognises as stress. And you don’t want cortisol to remain too high for too long or you will end up with all sorts of problems.”
In Cushing’s disease, which causes chronically raised cortisol levels, patients are at increased risk of hypertension and diabetes, infections, anxiety and depression, and weight gain.
Cortisol has an important role in the regulation of the immune system, damping it down in a delicate balancing act so that it doesn’t over-react and cause more damage by destroying the good cells along with the bad. It’s why cortisol is a common treatment for immune-related conditions such as eczema and asthma, and to prevent the body rejecting organ transplants.
It’s also why highly stressed people often take longer to heal after injuries or operations, says Auckland University professor of health psychology Dr Elizabeth Broadbent, who’s been researching how stress affects health for more than 15 years since writing a master’s thesis on wound healing after surgery.
Broadbent’s work has since been featured in the New York Times, Scientific American, the Guardian and Time magazine.
Inflammation promotes healing and is the body’s natural response to trauma, but Broadbent’s work has shown that people who are more stressed have a poorer inflammatory response. In her more recent research, however, she’s demonstrated how relaxation techniques before surgery can improve wound healing. In one study, she recruited 65 people from retirement villages who each underwent a punch biopsy in their upper arm – purely for the research.
Before the biopsy, half went into a control group and half into an “emotional writing” group, in which they were asked to write about their deepest thoughts and feelings on any topic, for 20 minutes at a time, on four occasions, typically consecutive days, prior to the op. The biopsy wounds were photographed on day 7, 10, 14 and 20 post-surgery. Everyone had healed by day 20, but there was a greater proportion of people in the writing group who’d healed by day 10.
New, as yet unpublished work is looking at how environmental factors pre-surgery – such as social support, music or reading, or the comfort of surroundings – influence healing. People who healed more slowly didn’t have worse outcomes in other ways – for example, increased complications or infection rates, but Broadbent says the sample size was too small to measure those.
In the book’s foreword, former All Blacks captain Richie McCaw says Evans was a big part of the team’s mental turnaround between the disastrous 2007 World Cup quarterfinal and their successive victories in 2011 and 2015.
“We completely changed the way we dealt with pressure. In the last 20 minutes of the 2011 final, when we really got tested, I realised how important that was. The match was touch and go… but I thought, ‘This is the moment I have pictured and prepared for’. I felt calm. I could see what I needed to do and I felt myself getting stronger. I wanted to be there.”
The essence of Evans’ book is his red-blue mind model, which roughly equates to the right-left hemisphere functions of the brain. “Right hemisphere processes are automatic, fast and largely unconscious,” Evans writes. The left are deliberate, slower and conscious. The feeling vs thinking axis is at the core of the model, with the red system the primary driver of our psychological reaction to stress and pressure. “Trying to ignore or suppress our red mind is a weak strategy, because it has evolved to never be snubbed or shut down.
“When you face that stress, the physiological responses are fight-flight or freeze – aggression, escape or freezing, which is about going passive,” he told North & South. “In performance terms, that’s a massive drain on performance, when we are just a bit slow to do things, because we are not fully engaged and involved. If you look at pressure moments as something to get out of all the time, that sets up a certain dynamic and a relationship with pressure from the outset.”
He points out that as children, when we become uncomfortable, our instinct is to seek refuge with our caregiver to be soothed. “But in a tough moment, because performance is about those tough moments, do you go forward, explore them and stay in them, or do you look to get out of them as quickly as possible? I’m suggesting that if we view those tough moments in a certain way, they don’t have to be inherently unhealthy.”
Evans says it’s not that the red in his model is necessarily bad or blue good. We need the energy of red and the clarity of blue to perform at our peak. And, while we can talk about some sportsmen and women being “confidence players”, Evans says it’s not about feeling you’re bulletproof. “Imagine if we had that same approach for the people who keep us safe, like doctors and pilots. ‘I’m not confident therefore my performance is allowed to drop off.’”
We have to see tough moments not just as something to survive, but as healthy. “The implicit assumption is that we have to get out of these moments to recover from them when we’ve left them. I’m saying there is a different approach. Instead of fight or flight, you face the moment. Instead of getting out of it, you stay in it and find your way through it.”
If we use the techniques frequently enough, says Evans, our brains will rewire and remodel themselves. “Under pressure, two minds are better than one. So start putting them both to work.”
Life-saving strategies from stress and anxiety experts.
With mental health being historically under-resourced, it has always been a challenge for people suffering stress, anxiety or depression to get timely help. But some of the $455 million set aside in this year’s Budget for frontline support services is expected to be spent on increasing patient access to workers like Cindy Sharon, a health improvement practitioner (HIP) attached to the Māngere Health Centre, a general practice in one of the most socio-economically deprived parts of Auckland.
When patients go to their GP with mental or social health problems, they can be referred on the spot to Sharon, a health psychologist who started her career as a practice nurse. Sharon’s appointment seven months ago was part of Te Tumu Waiora, a pilot programme launched by primary health organisation ProCare in 2017 to embed mental health and addiction services in general practice. Preliminary data from the pilot, running in eight practices across Auckland, shows two-thirds of patients are seen on the same day that they disclose distress to their GP, compared to 5% for conventional “talking therapy” services. It’s recently been expanded to practices in Northland, the Lakes District, Midlands, Wellington and Christchurch. There are now 22 full-time-equivalent HIPs in 22 practices, along with 31 health coaches.
Prime Minister Jacinda Ardern and Director-General of Health Ashley Bloomfield visited the Māngere centre to discuss the HIP programme in March, and Ardern visited a second time, with Health Minister David Clark, the day after the Budget, on 31 May.
Consultations last less than 30 minutes each and HIPs see around 600 individual patients a year – about three times as many as are seen with traditional talking-based services. Sharon uses Focused Acceptance and Commitment Therapy (FACT), a shorter version of the well-established, but longer-term, ACT therapy, which might include mindfulness, breathing and relaxation training. She comes up with a two- or three-point plan for the patient to take home that can often feature a prescription for exercise.
Sharon says many patients aren’t comfortable with being referred to other counselling services but trust their GPs and those who work with them. A “warm handover” is integral. “When they introduce me, they are handing over that trust. I’ll go to their office and they’ll say, ‘Here’s Mrs Bloggs, she’s having trouble sleeping and things are stressful at home, can you see her right now?’”
GPs see that HIPs can “add something”, says Sharon. “Doctors have a lot that they need to know about. Some have real interest and experience in mental health care, others have less. The feedback I’ve got is that they find it tremendously helpful in managing their patients. The more they understand the model, the more it gets used – it’s a very different way of working.”
The ProCare-funded pilot service is free to patients, but it’s hoped the Budget moves will mean the scheme earns central-government support.
Seven-point survival guide
Source: John McEwan, stress counsellor
- Win the battle for the mind. In psychology, it’s called “cognitive reframing” – to take something from the “demands” side of the stress ledger and place it on the “recharge” side. Humour, and relaxation of the neck, shoulders and face muscles will help anxiety.
- Use dynamic physicality four times a week, such as gym, yoga, pilates or swimming in the morning and upper-body weights after dinner.
- Draw tension from the neck, shoulders, forearms/hands and jaw every hour. Take 15 seconds to pull your shoulders down, stretch your fingers wide apart, yawn for four seconds, then do three shoulder rolls forward and backwards.
- Eat a good breakfast – on a busy day, it may be the only meal you have. Tea and toast will simply leave you “fuzzy” later on.
- Pee your way through the day. Drink plenty of water to keep up your fluid intake between meals.
- Take breaks away from your desk or screen regularly, and try to have one day each week that’s tech-free.
- Rest-recharge your serotonin batteries with activities and/or people you love. Create, celebrate, show love, worship, yahoo, affirm values and purpose, and focus forward into the next meaningful activity on your list.
New science on stress
Research into stress often makes the headlines. Here are some of the latest findings:
- Researchers from RMIT University in Melbourne say high levels of the hormone ghrelin, which stimulates appetite and is also released during stress, could cause reproductive problems. They found that by blocking the ghrelin receptor in female mice, they could reduce the negative effect of chronic stress on ovarian function.
- Rats immunised weekly for three weeks with beneficial bacteria showed increased anti-inflammatory proteins in the brain and more resilience to the physical effects of stress in research at the University of Colorado at Boulder. Researchers say the findings could lead to novel, microbiome-based immunisations for mood disorders such as anxiety and PTSD.
- In a mouse study, neuroscientists from the École Polytechnique Fédérale de Lausanne in Switzerland located neurons that help reprogramme long-lasting memories of trauma towards feelings of safety.
- The severity of daily stress is correlated to the intensity of engagement on Facebook and the tendency to develop a pathological addiction to the social media site, say researchers at the Mental Health Research and Treatment Centre at Ruhr-University Bochum in Germany. The effect was reduced in people who were receiving offline support.
- Taking at least 20 minutes a day to stroll or sit in a place that makes you feel in contact with nature will significantly lower your stress hormone levels, say the authors of a study at the University of Michigan. They said the “nature pill” should be taken in daylight, with no aerobic exercise, social media, internet, phone calls, conversations or reading.
This article was first published in the September 2019 issue of North & South. Follow North & South on Twitter, Facebook, Instagram and sign up to the fortnightly email for more in-depth health stories.