Managing Stress at Work

1. Managing Stress at Work Westminster Talking Therapies Service

2. What is stress? Our emotional and physical response to pressure. Too many demands, too few resources

3. Stress – causes/triggers External demands • Loss of loved one • Illness • Relationship problems • Work • Housing • Finances • Family • Daily hassles Internal demands • Relentlessly high expectations of self/others • Perfectionism • Lack of assertiveness • Desire to be busy all the time

4. Stress in the workplace • Stress affects one in five of the working population from the newest recruit in the post room to the board of directors. • It is the single biggest cause of sickness in the UK. • In 2014/15 stress accounted for 35% of all work related ill health cases and 43% of all working days lost due to ill health. • More prevalent in public service industries • The main work factors cited as causing work stress, anxiety and depression were workload pressures, including tight deadlines, too much responsibility and lack of managerial support and organisational change (Health & Safety Executive)

5. Fight or flight response • Body’s physiological changes in response to a perceived threat is known as the ‘fight or flight’ response. Enables us to run fast and fight harder (e.g. if a lion is chasing us) • Modern civilisation generally protects us from predators, but our inherent fight or flight response remains, and is triggered by less life-threatening events that we can experience day-to-day e.g. job interview, difficult boss, demanding children, traffic jam, running late etc. • The more we are exposed to these stressors, the more active our fight or flight response becomes until we are constantly ‘preparing for battle’, perceiving potential threats everywhere. • We can then become ‘chronically stressed’, feeling constantly tense, on edge and prone to over-react

6. Signs of stress - physical • Headaches • Muscle tension • Digestive problems • Nausea • Sweaty • Dizzy • Breathless • Shaky • Heart palpitations • Blurred vision • Dry mouth • Freeze • Lump in throat • Tingling • Numb • Change in appetite • Aches • Pains

7. Signs of stress - emotional • Irritable • Anxious • Tense • Restless • Upset • Angry • Lonely • Overwhelmed • Demotivated • Unhappy • Stuck • Disinterested • Mood swings • Resentful

8. Signs of stress – cognitive (thoughts) Pattern • Racing thoughts • Worry (what if….) • Hopeless • Critical • Rumination Content • “This is too much” • “I can’t cope” • “They’ll think badly of me” • “This won’t change” • “I should be able to cope” • “I must get this done” • “I haven’t got time!”

9. Signs of stress – behaviour • Eating changes • Withdraw from others • Rush around • Clumsy, forgetful • Indecisive • Over checking • Not taking breaks • Reduced productivity • Alcohol/nicotine/caffeine • Working long hours • Temper outburst • Poor self-care • Procrastinating • Avoiding • Auto-pilot • Absenteeism • Presenteeism • Reduced focus

10. Long-term consequences of stress • Burnout • Heart disease • High blood pressure • Depression • Anxiety • Skin disorders • Migraines • Bowel Problems • Stomach problems • Ulcers • Fatigue • Insomnia • Low resistance to infection • Weight gain • Diabetes

11. How we think about stress matters! GOOD NEWS! • The harmful effects of stress on health are NOT INEVITABLE • Kelly McGonigal’s TED talk ‘How to make stress your friend’ tackles the problem from a new perspective, informed by recent psychological research

12. Thinking about stress differently • People who experienced a lot of stress in the previous year had a 43% increased risk of dying. But only true for the people who believed that stress is harmful for health. • People who experienced a lot of stress but did not view it as harmful were no more likely to die. In fact, they had the lowest risk of dying of anyone in the study, including people who had relatively little stress. • When you change your mind about stress, you can change your body's response to stress Kelly McGonigal (TED talk, 2013) TED Talk

13. Thinking about stress differently • Your heart might be pounding, you might be breathing faster, maybe breaking out into a sweat. And normally, we interpret these physical changes as anxiety or signs that we aren't coping very well with the pressure. • But what if you viewed them instead as signs that your body was energized, was preparing you to meet this challenge? What if you viewed your stress response as helpful? That pounding heart is preparing you for action. If you're breathing faster, it's no problem. It's getting more oxygen to your brain. Kelly McGonigal (TED talk, 2013)

14. Thinking about stress differently • Stress response has a built-in mechanism for stress resilience - human connection • Oxytocin (the ‘love’ or ‘cuddle’ hormone’) is also released as part of the stress response • While adrenaline makes your heart pound, oxytocin motivates you to seek support • When you reach out to others under stress, either to seek support or to help someone else, you release more oxytocin, your stress response becomes healthier, and you recover faster from stress Kelly McGonigal (TED talk, 2013)

15. Thinking about stress differently • In a study, people were asked “How much stress have you experienced in the last year?" and "How much time have you spent helping out friends, neighbours, people in your community?" • For every major stressful life experience, like financial difficulties or family crisis, the risk of dying increased by 30 percent. • But - people who spent time caring for others showed absolutely no stress-related increase in dying. • Caring created resilience. Kelly McGonigal (TED talk, 2013)

16. Thinking about stress differently • The harmful effects of stress on your health are not inevitable. • How you think and how you act can transform your experience of stress. • When you choose to view your stress response as helpful, you create the biology of courage. • And when you choose to connect with others under stress, you can create resilience. Kelly McGonigal (TED talk, 2013)

17. Cognitive Behavioural Therapy (CBT) • Evidence-based treatment for stress, anxiety, low mood • Making links between the environment, thoughts, emotions and behaviour • Identifying unhelpful patterns that exacerbate and prolong emotional distress • Aims to help us make positive change through altering how we think and act

18. TRIGGER CBT MODEL Writing presentation which is due soon THOUGHTS I’m not going to get this done on time BEHAVIOURS EMOTIONS Anxious Withdraw, isolateProcrastinate PHYSICALSYMPTOMS Heart racingHot, sweaty, can’t think clearly

19. Breaking out of cycle of stress • Situation 1 – (specific stressor) Given deadline from boss to complete a piece of work and present to team • See handout for response a) and b) • Situation 2 – (general stressor) accumulation of stress at work – busy, lots of competing demands, difficult relationship with some colleagues • See handout for response a) and b) • Think about any other alternative responses

20. What can we do about it? • All employers have legal responsibility to ensure the health, safety and welfare at work of their employees. This includes minimising the risk of stress-related illness or injury to employees. • As individuals, we can also protect ourselves with skills and tools to manage personal stress and limit its harmful effects. • Explore your triggers & CBT cycle • Change the environment (e.g. working hours, work load, physical space, equipment) • Change our own response (e.g. address unhelpful thinking patterns and behavioural reactions)

21. What can we do to reduce stress? Reduce external demands • Take control of the problem: Problem solve - is there something you can change? Develop a plan and do it vs continuing to worry • Assert yourself: Get your needs met in the workplace as best you can. Say no, take on less, request changes to working environment/ hours, address bullying issues • Set boundaries: Take breaks, time to eat, limit working hours, leave on time, limit use of e-mail/phone, turn off push-notifications, avoid ‘grazing’ • Time management: Prioritise what is most important, avoid multitasking, take one step at a time, be realistic about how much can do

22. What can we do to reduce stress? Reduce internal demands • Write down thoughts and feelings: Get some distance • Challenge unhelpful thinking • Tackle perfectionistic thinking • Tackle procrastination: 5 minute rule • Physical relaxation, controlled breathing • Mindfulness: Stay present, focus on one task at a time rather than flitting between tasks • Accept what is beyond your control, and focus on the changes that you can make.

23. What can we do to reduce stress? Acceptance of what we cannot control • If you cannot change the situation, deal positively with the stress that remains, rather than allow worry and resentment to further compound difficulties. Practice good self-care, make time for nurturing and enjoyable things in your life. • “Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference”

24. Setting good foundations to reduce stress • Healthy eating • Exercise • Healthy sleep habits • Rest and recreation • Be open to others and share how you feel • Reduce alcohol, caffeine, nicotine

25. Don’t trust us – experiment – try a few What happens if you…. • Tell someone trusted how you feel • Say no to taking an additional piece of work as too busy • Stop checking e-mails after 7pm • Spend 5 minutes on a task you have been avoiding • Take a lunch break and go for a walk • Send an e-mail you haven’t triple checked • Hand in a job that’s 80% ok by your standards • Talk to HR about being bullied • Practice a breathing exercise for 5 minutes a day

26. Stigma at work • How would you describe your work culture? • How acceptable is it to admit to feeling stressed, vulnerable, overwhelmed? • How supportive do you find your colleagues and managers? • How do you respond to others if they say they are feeling stressed? • Connection creates resilience – create a healthy work environment where it’s okay to talk about it • www.time-to-change.org.uk Campaign to end mental health stigma

27. Seeking extra help If you are feeling stuck, overwhelmed, low and less able to get along with daily life, it can be helpful to seek extra help and support. • We offer CBT for those who are resident in Westminster, or with a Westminster GP: • Call 030 3333 0000 • Email Westminster.iapt@nhs.net • Via our website www.westminsteriapt.org.uk • If you’re not in Westminster, your GP can signpost you to your local service Counselling also available for a more open-ended, exploratory approach

28. Useful websites • Living life to the full – free online CBT self-help programme www.llttf.com • Get Self Help – CBT self-help information and resources www.getselfhelp.co.uk • Centre for Clinical Interventions – Self-help workbooks across a range of problems www.cci.health.wa.gov.au

29. Any questions?