The irony that as I sit here writing this article on stress, it is making me feel stressed is not lost on me… Stress is a word that we hear all too frequently and something we can probably all say we have experienced at some point in our lives. A question comes to mind, whether we should accept stress as part of life?
According to the Oxford English Dictionary, Stress is defined as “a state of mental or emotional strain or tension resulting from adverse or demanding circumstances”. These demanding circumstances can be resulting from work, home life or simply the pressures and expectations that we put on ourselves.
In 2019, stress was the leading cause of work absence and those working within healthcare are particularly vulnerable to stress related conditions. Stress accounted for 51% of all work-related ill health cases and 55% of all working days lost due to work-related ill health in 2019 (https://www.hse.gov.uk/statistics/causdis/stress.pdf). We know that 2020 has presented new challenges that have never been faced before, the PPE demands, short staffing levels, unprecedented high number of deaths to name but a few and that public service industries, such as education or health and social care showed higher levels of stress compared to positions in other industries. According to the Mental health Foundation 74% of UK adults say that they have felt so stressed at some point over the last year that they felt overwhelmed or unable to cope (https://www.mentalhealth.org.uk/news/stressed-nation-74-uk-overwhelmed-or-unable-cope-some-point-past-year). The statistic that really stands out is that 32% of adults said they had experienced suicidal feelings because of stress over the last year. It is clear that a better understanding of stress is required so we can all learn to manage stressful situations and environments better before they become problematic to our overall health.
So what is Stress?
This is a very difficult question. Stress will exhibit different effects on different people in different ways. Medically speaking Stress is a feeling of emotional or physical tension. The body reacts to Stress by releasing hormones, cortisol, which make the brain more alert, causing muscles to tense, and the heart rate to increase. In the short term, these reactions are positive because they can help us handle the situation causing the stress. For example in the past the stress response would heighten our alertness and preparedness to deal with predators, in the society of today stress can help us perform exceptionally to achieve deadlines we have in our work or social lives. In these contexts it is the way the body protects us or helps us perform at heightened levels. However, if the body stays alert for extended periods of time the effect becomes damaging rather than conducive to our survival. Emotionally, long term exposure to these hormones will cause us to feel fatigued and anxious. Physically we are at risk of heart attacks, stroke, diabetes due to the continually heightened blood pressure and heart rate and even death (www.nhs.uk).
As employers and managers we also need to understand that Stress can have a real damaging effect on our work force. It contributes significantly to absenteeism (as discussed above), increases staff turnover, poor time keeping and increased risk of procrastination resulting in poor performance and output, it can cause moral to deteriorate, increased employee and customer complaints due to poor service, and is highly contagious between teams (https://www.hr.admin.cam.ac.uk/policies-procedures/managing-stress-and-promoting-wellbeing-work-policy/policy-statement/effects).
We have to be able to recognise when we or others are Stressed so that we can control it and reduce the risk of over exposure. The more pertinent question becomes how can we recognize, manage and control the stress that we feel on a daily basis?
To address this question we need to consider stress from 3 different perspectives, and its as simple as ABC.
The A in ABC stands for AWARE, we have to be aware that we are stressed. Simply put, someone telling us we are stressed does nothing to help reduce it. An innate behaviour built into humans is to defend and deny negative feelings – we need to be able to acknowledge it in ourselves. Awareness is all about being in tune with how we are thinking, feeling, and being.
How do we recognize stress? We can check our thoughts, feelings and behaviours to give us the clues we need, it is all about knowing ourselves.
· Thoughts can present themselves in negative words and phrases that we use such as; ‘I am useless’, ‘I don’t want to..’ (avoidance language), ‘I have to..’ (obligatory language). In addition to the loss of concentration on a given topic or our inability to prioritize tasks as your mind keeps wandering from topic to topic.
· Feelings, at times of stress, can range from feeling down, depressed, sad, anger, scared, irritable, guilty, intolerance or simply overwhelmed with everything that is going on around us and the tasks we face. We may also be experiencing headaches (a firm favourite for my stress, particularly across the temples), stomachache, sweating, palpitations, insomnia or the inability to stay asleep, migraines, fatigue and exhaustion or a lack of energy to do your daily activities. We may feel one or a combination of these feelings and at different times and situations different combinations can present themselves.
· Behaviour can represent our personal feeling of stress. This can include shouting at another with no justified reason, fidgeting, engaging in destructive behaviour such as biting nails or picking and scratching at our skin, drinking more, smoking more or simply putting things off that we don’t want to do. Ceccato et al, 2016, identified that Stress is significantly correlated with individuals performing higher risk behaviors which can ultimately cause harm to themselves (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4732013/#:~:text=Chronic%20stress%20is%20associated%20with,actual%20behavior%20with%20real%20stakes.).
The B in ABC stands for BE WELL. To be able to have our bodies in the best possible condition to manage the effects of the stress we will undergo. it is fair to say that for most people we will never eliminate all the stress life throws our way so we must manage it. Being Well has 6 different domains to consider:
1. Exercise. This word itself stresses me with the negatives images it generates of sweaty gyms and having to go running. So instead lets say ‘Get Moving’, whether this is going for a walk, doing some cleaning or getting outside in the sunshine to do some gardening. The government advocates we do 150 minutes (in 10 minute intervals) of movement to get our heart rate up each week (https://www.gov.uk/government/collections/physical-activity-guidelines). That is just 20 minutes a day and can fit perfectly into that lunch break
2. Diet. A healthy balanced diet with a little of what you fancy will always do you good! Don’t forget to keep hydrated too. As soon as you feel thirsty you are dehydrated.
3. Sleep. The National Sleep Foundation Guidelines suggest that adults need between 7 and 9 hours of sleep per night. To maximize our sleep it is suggested that we have a regular routine for when we go to bed and get up, limiting the amount of blue light (electronic devices) for 1 hour before going to sleep to maximize the amount of melatonin (sleep hormone) our body creates and to keep the bedroom space dedicated to sleep (Walker, 2018, Why we sleep: the new science of sleep and dreams)
4. Relaxation. Knowing how to relax and having techniques to help you relax can be pivotal in managing your stress levels. Two techniques that I have found to be particularly useful when I am in that stressful moment are square breathing (see Linked-In post https://www.linkedin.com/posts/helen-harland-106137172_whilst-out-walking-in-our-local-nature-reserve-activity-6790152546422972416-wLst) or grounding (See Linked-In post https://www.linkedin.com/posts/helen-harland-106137172_stressawarenessmonth-calming-activity-6788093998528573440-oXlg.) Relaxation can also be achieved by looking at your internal language (the voice inside your head) and turning the negative thoughts to positive ones – its not what you can’t do but what you can do or what you have got to do but what you get to do. Another trick is to give the negative voice in your head the voice of a silly character (mine is Mickey Mouse), just try it and then try to take the voice seriously! Challenge the negative thoughts that you have and replace them with helpful truths. Lets be honest with ourselves, how often do we work ourselves up into a state dreading a meeting or an interview and when the moment comes the experience is actually fine sometimes event enjoyable. This certainly has happened quite often to me in the past.
5. Perform activities that recharge you. Spend time to identify what it is that truly relaxes you. This could be a bath, a good book that allows you to step out of reality, taking a walk in nature or simply chatting with friends or family. There are lots of studies advocating the benefit of being in nature, one study found that a nature visit of 20 to 30 minutes three times a week was very effective for reducing levels of cortisol in the body (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6458297/).
6. Have a strong support network. Having someone that you can turn to and talk to at moments when you feel down or anxious, someone who will not judge or criticize but listens with a genuine interest to help and support you. This may be someone at home, a stranger or a professional. There are lots of options for support from organisations such as the Good Samaritans or Mind and many employers will offer free counselling services through employee benefit packages.
The C in ABC stands for COPE with the stress we cannot avoid. Take action in the moment and identify what we can do to reduce the same stress going forward. The HSE advocate that there are 6 main areas that can cause stress if they are not managed correctly. These are:
1. demands (including excessive work load),
2. control (or lack of),
3. support (or lack of),
4. relationships including isolation,
5. lack of meaning or purpose within our role and
6. change.
Employers have a legal duty to protect employees from stress at work by doing a risk assessment and acting on it (https://www.hse.gov.uk/stress/risk-assessment.htm). We can however take matters into our own hands to some extent and do our own risk assessment when it comes to the stress we face and see if we can gain more control and clarity of our tasks. Examples can include:
· Changing deadlines to provide more time to perform a task and reduce demands on our time, be realistic and improve estimates for how long it will take to complete a task.
· Rearrange our commitments to allow us to allocate dedicated time to one activity. A great book on time management is Brian Tracy’s “Eat That Frog”. If you haven’t read it and struggle with time management this is a great book.
· Avoid distractions, turn off notifications and emails. According to a University of California Irvine study, “it takes an average of 23 minutes and 15 seconds to get back to the task [when interrupted].” (https://lifehacker.com/how-long-it-takes-to-get-back-on-track-after-a-distract-1720708353)
· Reduce your standards – do you have to give 100% or would 80% do? We will never get to perfection and sometimes striving for it all the time simply provides stress we don’t need, be realistic with your expectations of yourself and other.
Managing stress and the release of cortisol in our bodies is not easy, and it is certainly a work in progress for myself. I promise you this though, if you do nothing nothing will change, but if each day you take small actions they will add up and eventually the tide does start to turn. The actions eventually become habits and part of your everyday life. At that point you will be conquering those negative feelings without even thinking consciously about them.
“The journey of a thousand miles begins with a single step”
Lao-Tzu
