Taking a different approach

Stress is surrounded by a kind of mystique. It seems to be caused by a multitude of factors, is poorly understood by professionals, and not at all by managers. Really progressive organisations smugly import yoga trainers or reflexologists on a Friday afternoon, and while that is better than nothing, it is only just better than nothing.

But although stress is seen as a complex problem, it is, in fact, extremely simple. There is no stigma about stress, or at least there shouldn’t be. We are all subject to it; we all have to manage it at some time. Some of us are more susceptible to stress than others, and some deal with it more efficiently than others.

The causes of stress

In a work situation, the causes of stress are to do with factors in the employee’s situation, such as overwork, an inability to manage his or her workload, bullying, discrimination and all the rest.

Work-related stress (WRS) is caused by poor management and by an inadequate response to the problems stress causes. Of course, there are other causes of stress such as domestic and financial difficulties, and there may be a combination of causes.

The management of stress

The problems caused by stress are psychological, physical and behavioural. These are inter-linked. The psychological symptoms include anxiety and apprehension. The physical effects are entirely physiological, caused for the most part by in increase in autonomic activity and by hyperventilation. These effects are for the most part reversible, but long-term stress can produce long-term problems such as hypertension.

The effects of stress

Stress is a treatable condition. It can be prevented by enlightened managers, but if it is present, it can be managed by informed stress management techniques which are logical, simple, and effective.

How do you manage stress?

Stress as a syndrome is psychological, physiological and reversible if treated early and well. Clients can be kept at work with minimum cost to the employer and minimum distress to the employee.

Ideally, it should be managed by an occupational health nurse but nurses in primary care also treat the condition. The basis of treatment is logical and straightforward:

– Give a clear explanation and information about the condition

– Do something about the causes of stress if possible

– Teach the client how to cushion the effects of stress

– Change how the client thinks about the situation.

Note that this is not stress counselling – it is giving plain, unambiguous stress advice. This advice is tailored to the client and given over five sessions. It is research-based and ethical, and it works. Hundreds of nurses in occupational health and across the divide in primary care use the system and find it to be of benefit. It gives early results and keeps the employee at work.

Give a clear explanation

This can be remarkably effective. Clients with somatic symptoms may think they are very ill. It helps them greatly if they know what is actually going on.

Doing something about the causes

This isn’t easy. Managers may need to be educated. Sometimes the causes of the stress are obvious, and useful, effective advice can be given.

Teach the client how to cushion the effects of stress

This is about teaching relaxation and breathing exercises with advice about managing panic attacks and the like. Again, it is very effective if done properly.

Change the way the client sees the situation

Many people have inappropriate thought processes, both about themselves and about their situation, or both. They have unreal expectations. They constantly talk of things they ‘ought’ or ‘should’ do. They may have irrational beliefs, which can be challenged.

How do you use this approach?

This essentially logical method of managing the stressed client was the subject of a research project carried out in primary care in 1994/5 by myself, a GP, and Alice Muir, a psychologist – both of us having a long-term interest in stress.

Stress is apparently diverse, but when stripped to its fundamentals, it is surprisingly consistent in its presentation.
The treatment method is based on the use of a manual, which if followed, guides the stress adviser through the steps needed to effect a change.

Stress adviser courses to university level 2 and 3 (Glasgow Caledonian University), or recognised by the Royal College of Nursing (for personal develop- ment), are available for distance learning from Stress Education Services.

Using an essentially logical system which is work based can be very satisfying as the results are immediately apparent, as are the long term benefits to the client and the employer.

Dr Kenneth Hambly is the medical director of Stress Education Services



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