Stress – what works and what doesn’t

Jan Maw
Lecturer, occupational health, University of Sheffield

In my research, I have looked at the psycho-educational aspects of mental health, at why hypnotherapy works, the biological process of imagery, and at laughter and how it affects the immune system. So I am interested in the emotional and physical side of stress – but that doesn’t mean you can ignore organisational aspects and the support staff receive, or the control they have over their work. These are all critical factors in managing stress, which the HSE guidelines have picked up.

But I am interested in the support base that an individual can have in terms of how they perceive the stressors. If you change someone’s perceptions of the stressor, the stressors won’t change, but their changed perceptions can help them. It can make the situation feel better, and so alleviate anxiety and depression.

The problem with some therapies is that they are so open-ended. But with cognitive behaviour therapy, we are normally looking at six or seven sessions. The sessions can also work with groups, and be run with staff who are not displaying stressful symptoms so they are a preventive measure. In this way, we can give people a toolkit to help them deal with stress, including positive imaging, assertiveness and laughter therapy, all of which can have a beneficial effect on the immune system and raise serotonin levels.

In cognitive behaviour therapy, the basic tenet is that you have an actual event – which could be a snide remark by a manager – and that there are consequences of that. If you believe your boss thinks you are useless at your job, or you think you are useless yourself, then the consequences will be difficult. But if you can change your negative belief, you change the consequence, even though the situation may still be the same.

Psychologist Robert Holden has looked at the way happiness can affect our health, and pointed out that while there is a huge amount of research into mental and physical ill health, there is very little into good health and happiness.

We don’t analyse what makes us feel good – and if you ask people what makes them unhappy, it’s like War and Peace. But if you ask what makes them happy, they hesitate. What this therapy is about is getting people to see there are positive things as well.

We aren’t ignoring the fact that the work situation may be bad, but we are trying to get them to see that there are positives as well, and not to go on ‘awfulising’ benders. Laughter therapy can remind people that there is a balance, and it is about the empowerment of the individual.

Cary Cooper
Professor of organisational psychology and health, Lancaster University Management School

There are a number of approaches that work. First, a stress audit should be conducted by OH and the HR department to determine the issues arising in the organisation. They need to establish a robust baseline measurement of the issues faced. Structural issues, job design and communication within the organisation may need to be addressed. There are software programmes that can help with this – Asset is the most advanced.

It is often helpful to have OH or HR carry out such audits. If line managers are delegated the responsibility for stress prevention, problems can arise as they are often the source of the pressure. These audits should measure staff perceptions and concerns in areas that are known to cause pressure, such as poor relationships at work and lack of control.

The primary approach should work – we have been looking at this issue for 20 years. We know what the factors are. Organisations need to ask: ‘What is it in the work environment that is causing people problems?’

If you have a problem with stress, you should assess every department of your organisation, and every level, looking at the management style from middle managers to senior management. And if you find that an autocratic or bullying management style exists, then you know that has to be changed.

There is also lots of good evidence that primary research works. Organisations such as Astra Zeneca have made dramatic changes. AstraZeneca’s CALM programme, for example, aims to promote employee well-being by providing a framework for ‘sensible living’, including life management skills and counselling.

Second, the issue of training and health promotion can be addressed, which may include specific training to identify and reduce bullying. Personal resilience is not about employers being uncaring, but OH can help individuals to protect themselves against the daily pressure they will continue to face.

And finally, workplace counselling and employee assistance programmes (EAPs) can help employees to cope with stress. However, too many employers are relying on this third approach exclusively. Dealing with the problem after the event using counselling or EAPs may help the individual to cope better. But if their job satisfaction levels or their commitment is damaged, it won’t help. And it won’t deal with the cause, whether this is an autocratic management style, or a long-hours culture.

If organisations take this three-pronged approach, then they should have a comprehensive strategic framework: primary prevention (tackling the root of the problem); secondary prevention (helping staff become more resilient) and tertiary prevention (using counselling and EAPs to counsel and rehabilitate staff).

Robert Westlake
Clinical head of psychiatric services, BUPA Wellness

As stress isn’t a medically accepted term, at BUPA we talk about ‘dis-stress’, in which people present certain symptoms that show they aren’t coping with pressure. These are typically sleeplessness, irritability and headaches.

There a two ways of addressing this – at organisational level, or at individual level. Both have a part to play, but if you aren’t looking at the organisational causes, you are not tackling the right issue. Once you have identified the causes, you can also look at ways of training individuals to cope better. Both of these measure are preventive, while schemes to help staff like EAPs are reactive, a way of managing stress once it presents itself.

All these methods are important, but we do find that companies tend to jump straight to the third option, sometimes offering staff EAPs because their competitors are and they feel they need to keep up. I think this is caused by a lack of understanding rather than a lack of will. Employers aren’t sure how to improve their organisational procedures in order to cut stress, and they find it much easier to install a gym, or to offer employees private medical insurance.

Problems start when employers are trying to drive costs down too far. They need to understand that these services are provided by professionals – they shouldn’t be brought in via internet auctions, where people are saying: ‘How much will you do this for?’ A lot of people may be offering counselling services, but you will only help your staff if you employ the best professionals.

The role of OH nurses is very important. They can give employees an alternative person to go to when they are feeling stressed. Ideally, staff should feel able to talk to their line managers about this, but often people don’t. And this means that – while respecting individual confidentiality – OH nurses can be a source of vital information to employers, and let them know where the trouble spots are likely to be. They can give a good, objective picture of the organisation. Identifying the problem in the first place is the key, so this is of enormous value to organisations.

Carole Spiers
Occupational stress management consultant

The first thing you need to do tackle work-related stress is carry out a risk assessment to highlight problem areas. There are also general measures you should introduce, including a stress management policy, recruitment, counselling teams, management style and mediation and negotiation.

Commitment to a staff management policy should begin at the most senior level and be cascaded downwards. There’s little point in introducing stress management training for line managers if senior managers have little or no commitment to minimising excessive pressure within the organisation.

And when recruiting, it is important that both the organisation and applicant understand the requirements of the post and potential pressures involved. One conclusion of the Court of Appeal case in February 2002 was that ‘there are no occupations that should be regarded as intrinsically dangerous to mental health’. It’s therefore essential to combine an appropriate selection policy with job-specific and practical training.

A first contact counselling team should be made up of volunteer employees trained in basic counselling skills. They can provide an active listening service and help to deal with work-related problems such as stress, bullying and change.

Effective communication is often neglected in management training, yet it is essential to good management – by reducing misunderstanding and the opportunity for discontent. This includes active listening skills – engaging with the person you’re listening to and responding appropriately. Access to mediation and negotiation are also vital in enabling workplace disputes to be resolved before they escalate into stress-inducing or bullying behaviours.

For stress management to become integral to corporate culture, initiatives must be introduced that will raise awareness of work-related stress. Recognising the early warning signs and symptoms should become integral to management strategy. This can be achieved by monitoring sickness absence, carrying out confidential staff surveys, observing working relationships, and questioning changes in attitude and behaviour.

Stress management training can then build on this by teaching employees about the nature and sources of stress, its effects on health, and the personal skills needed to reduce it. Training may also help reduce stress symptoms such as anxiety and sleep disturbances, and is also relatively inexpensive.

Depending on the nature of your organisation, complementary therapies like reflexology, yoga and massage may also be useful. But they should be incorporated into a holistic approach to work-related stress.

If an organisation introduces these types of ‘stress-busting’ initiatives without a solid foundation of stress management training and employee counselling support, they risk adding to problems of work-related stress, through frustration, disillusion, and a belief among employees that the causes of stress aren’t being taken seriously, and the organisation is simply paying lip service to the problem.


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