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Following news that the Welsh Government are tackling employee stress with the provision of a subsidised massage service, BBC Radio Nottingham’s Morning Show, hosted by Sarah Julien, invited me in to discuss the subject of work-related stress. (Wed 14th September 2011).

There are some obvious and clearly recognised sources of stress in the work place. For example, bullying/harassment/discrimination, job insecurity (threat of redundancy or dismissal due to disciplinary action), ‘missing’ out on promotion, and change of company culture/business model.

However, people may be less aware of the stressful consequences of extremes of perceived experience; that is, a sense of too much/an excess of something, or the opposite.

Perception of too much/over/an excess

1. Too much to do

2. Too many rules/restrictions

3. Too much (irrelevant) information/communications/meetings

4. Targets too difficult to achieve (eg in time available/with funding limits etc)

5. Too many bosses/hierarchical layers/too much ‘leadership’

6. Over-long working hours

7. Unrealistic self-other expectations (too high) = performance anxiety

8. Overqualified/skilled

Perception of Too little/ under/ a shortfall

1. Too little to do (boredom)

2. Too little structure/too few guidelines

3. Too little communication/ inadequate communication

4. Too few resources to do job adequately

5. Inadequate leadership/inaccessible leadership

6. Not enough time (eg full-time job in part-time hours)

7. Insufficient opportunity for initiative

8. Under-qualified/trained/skilled

Consequences

1. Health deterioration. Examples include headaches/ tiredness/loss of energy/ weakened resistance to colds and other infections. Tendency to rashes/respiratory difficulties/digestive problems and other aches (neck, back etc). Prolonged exposure to stress causes the para-sympathetic branch of the autonomic nervous system to over-ride the sympathetic branch; the long-term effect of this can bring on heart conditions, gastric ulcer problems and other serious illnesses. The tendency is for people to self-medicate with alcohol/ over-eating etc leading potentially to alcoholism and unhealthy weight gain.

2. Mood disorder. People may become noticeably more irritable, tearful, indecisive, forgetful, demotivated to engage with activities previously enjoyed, avoidant of social interaction, withdrawn. They may be diagnosed with depression or generalised anxiety.

Pathways

In each case, an individual approach to problem resolution is needed, but here are some suggestions that have been found by others to be helpful:

1. Communications: as early as possible, identifying what does not feel ok enough and assertively exploring this with someone who can make a difference.

2. Re-evaluating work/life balance. Maxing-up time outside work with fun and interest.

3. Making realistic adjustments in attitude/perspective on work, eg. this is a J.O.B. which pays for lifestyle needs, occupies x amount of daily time, and fulfils a function.

4. Reviewing options and possible changing job either within this organisation or outside.

5. Identifying and facing personal issues re specific extremes; learning self-soothing techniques eg calming breathing/relaxation exercises/strategies such as visualisations, letters/advice to self from a wise, warm, strong and encouraging Other self.

And finally……Prevention is always better than Cure! Check-out a company’s style if possible, before going on board. If, like the Welsh Government and Capital One (whose Head of HR also contributed to this debate), they seem to invest in looking after employees by providing a gym/ access to massage and other therapeutic body treatments/counselling etc, then this may be a good indicator of what to expect if you were to become stressed….

August 2011 may be remembered for scenes of violence and lawlessness in some of our cities which shocked many of us to the core. On Tues 16th August, BBC Radio Nottingham’s Morning Show with Mark Dennison, invited me to contribute to a discussion about the role of social networking media in society today, given some evidence that this was involved in orchestrating what took place. I have an interest in this contemporary phenomen, both in my role as a Magistrate on the Nottingham Bench, and also from the psychological perspective, in my work as a Psychotherapist.

By social networking, I mean, internet sites such as Facebook, MSN,  Chat Forums for special interest groups, dating websites, Twitter…….but also email and texting. 

There are a number of BIG PLUSSES with this instant form of communication; for example, at its most powerful best, the world-wide-web provides fast accurate information 24/7, with maximum convenience. This meets a demand we seem to have, in these times, for ‘answers NOW!’ ….. and then, the pressing desire to swiftly share what we have learned, with others.  With the press of a button, we can upload images to entertain others. Or indeed to sadden, and stimulate to action eg fundraise for disaster-stricken countries. The internet is a powerful lobbying resource for political and other change, via online petitions, for example.  

From my work with clients, I am aware of the importance of special interest chat rooms/forums. They have become a valuable source of support for some people with, for example, disabilities or mental health conditions, and for those coping with other difficult experiences such as bereavement, trauma and addictions….not forgetting parents and carers.    

Another PLUS, for many, is access to Dating Websites; clients recovering from relationship loss, sometimes report finding this a helpful part of moving on; countering loneliness by making new friendships, even if not ‘replacing’ the original loved one. Dating sites, MSN, Facebook, Twitter etc all offer opportunities to engage with others at a distance – without the risks of face to face meeting. For clients experiencing generalised anxiety, and particularly social anxiety, this form of social interaction may provide a safe space for experimenting with meeting others and relationship building.    

Humans are a relating species: there are a range of evolutionary reasons for this, for example procreation and security.  Maslow (1954) identified a hierarchy of needs, with the most fundamental being biological needs. When these are met, our security needs are the next priority, followed by love and belongingness needs. This latter enhances our feeling of security also… And in some ways, a social networking site such as Facebook offers a tempting fusion of security and belongingness at our fingertips, as we accumulate ‘friends’ and, potentially receive a comforting volume of responses to the detail of our everyday experiences  of self, the world and others. ‘Friends are the family you choose’ …

No doubt, there are other PLUSSES too. However, many clients have shared with me more negative experiences of social networking in all its forms.

For example, are these, ‘real’ friends in whom you can place trust? One client told me that she had a sort of mind-picture of her closest friends (in a happy, calm mood), and did not really register the significance of the others picking up her messages – and also did not factor in that the close friends might be having a bad day… A misplaced sense of security can lead to confiding personal information, disclosing secrets, perhaps off-loading a ‘stream of consciousness’, private thoughts, or venting in the heat of the moment….or maybe uploading to U-Tube personally compromising photos.  Within seconds, this naivete can go global, as a ‘friend’ (for fun, or maybe, through malice), pings it onwards……with devastating consequences for the originator, who may be publicly ridiculed, experience shame and a sense of betrayal as personal vulnerabilities are published and available online for the foreseeable future. Some clients have also belatededly become aware that an ex-partner has been spying on their private Facebook account, well-aware of favourite passwords…. 

Bullying is another recognised negative aspect of social networking media.  This can take the form of overt threats or more subtle pressure. It is now thought that some of the participants in the violent lawlessness during August were ‘rallied’ by online or mobile messaging – no excuse for not being there, you must have got the message! (Equally, it is likely that the lure of being part of a powerful group and the stimulation of risking arrest, were factors in the appeal, particularly to young males). Cyber bullying is also, sadly, rapidly becoming one of the most common form amongst schoolchildren.

These experiences have an adverse effect on mental health conditions; for example, bullying can lead to a sense of isolation, which is associated with depression. If someone is already depressed and  ‘friends’ fail to respond as hoped to a text/email/Facebook message (or their responses are misinterpreted!), this can enhance the sense of rejection, and low self-esteem. The ongoing difficulty with all non face-to-face communications, is that we cannot always accurately interpret the senders intent; there is an absence of tone, pause, emphasis, and facial expression/mood indication.

In my observation, as reported from clients, for some people, these social networking systems become addictive; there is excitement as the mobile buzzes again, or the PC ‘pings’ to announce ‘incoming’. This reduces the need for face-to-face contact, and there is a risk that social interaction, eg ‘small talk’ skills will be lost. People experiencing social anxiety may never have the incentive to overcome their fears, and may continue to avoid real relationships. They are also vulnerable to a worsening of their anxiety because of the tendency to find evidence (eg through misinterpretation of non-verbal communciations) to justify and confirm their belief system about the personally threatening, judgemental world.

On Wednesday this week, I took part in a discussion about how best to treat depression, on BBC Radio Nottingham’s Morning Show.  News was just in of a fourfold increase in prescription medication for depression, compared with 5 years ago. Frances Finn, presenter of the Morning Show, wanted to challenge Dr Ian Campbell and me about these statistics – are people being prescribed medication by their GP almost automatically, after a quick consultation ?  Wouldn’t a talking therapy (counselling) be better than medication which might become a ‘crutch’ that people learn to depend on and struggle to give up ? And maybe some people are labelling themselves ‘depressed’ and seeking help when if they just ‘got a grip’ and got on with life they could overcome it by themselves.

All interesting points….

Dr Campbell explained the medical origins of depression: it can be inherent in the person, a feature of their psychological/physiological make-up, or it can be caused by a specific event- such as relationship breakdown, redundancy or loss of some kind.

Medication can really help the person to be able to function enough – to keep going at work for example, when it is essential (as they might see it) that they do this. And it can also help them feel ready to tackle the cause of the depression, or underlying issues that have been triggered and have now come to the surface. Selective Serotonic Re-uptake Inhibitors (SSRIs) such as Fluoxetine (commonly known as Prozac) and Citalopram work on restoring the level of serotonin in the brain and maintaining adequate levels of this; serotonin seems to encourage a sense of calm and makes feelings of anxiety and distress less acute and raw. 

Although medication is very effective for many people, the ideal would probably be that those who want counselling as well, or prefer to avoid medication and just have counselling could be offered this ; sadly there are indeed long waiting lists eg 6 months, in some locations, despite the investment made by the previous government in the IAPS scheme (Improved Access to Psychological Therapies) which has seen a dramatic increase in numbers of trained counsellors (usually in Cognitive-Behavioural Therapy). It seems this has been more than matched by the numbers of people presenting with depression. Some reports suggest that 1 in 3 of us has or will have an episode of depression at some point in adult life.

Depression has been described as a Black Dog (eg Winston Churchill). The stigma surrounding it is diminishing due to various celebrities ‘coming out’ – Alastair Campbell, Ruby Wax, Stephen Fry and many others. Most people know that it is characterised by a dark negative mood, outburst of anger or general grumpiness, tearfulness, loss of energy and interest in activities that were previously enjoyed, appetite changes, sleep disturbance and a tendency to want to withdraw and isolate oneself.

In Cognitive- Behavioural therapy the emphasis is on identifying ,monitoring and encouraging activities that bring feelings of pleasure rather than effort and also in challenging Negative Automatic Thoughts.  In other therapies, we also work with underlying ongoing problems, often unfinished emotional business from the past, helping people to come to terms with these, accept the situation or take necessary action, and move on.

Depression certainly can be treated with counselling/psychotherapy, and this process can be supported by medication, which I particularly recommend when someone is in such a distressed state that they are unable to focus and engage.

If counselling waiting lists are too long, there are other local (Nottinghamshire) sources of possible support. Some of these agencies and charities may only ask for a small donation towards the cost of their service:

Nottingham counselling Service – 0115 950 1743

Nottingham Womens Counselling Service – 0115 978 2040

New Dawn  (Christian) – 0115 917 0500

Cruse (bereavement and loss) – 0115 924 4404

Relate (couples and relationship issues) – 0115 856 5205/0115 950 7836 /01623 636553

There also agencies which specialise in alcohol/drug related difficulties including depression/anxiety

For emergencies there is also Samaritans 08457 909090

There are some excellent self-help books available:

I Had a Black Dog – Matthew Johnstone

Living with a Black Dog – Ainsley and Matthew Johnstone

Overcoming Depression – Paul Gilbert

Depression The way out of your prison – Dorothy Rowe

Help online includes websites where you can download free leaflets like northumberland  tyne and wear nhs and various cognitive behavioural programmes.

You don’t have to just ‘get a grip’ – but you do need to reach out for support when you may least feel like doing so!

Some people would prefer to avoid medication of any kind and opt for counselling.

On Friday 1st April, I took part in a debate on Radio Nottingham’s Morning Show about the significance of mothers returning to work after baby is born, leaving fathers to do the nurturing.

My guiding text on this is Sue Gerhardt’s ‘Why Love Matters’ which explains how babies’ brains develop through the bonding with the primary caregiver, usually mother. The key to this is the emotional availability of the parent, expressed through caring touch, holding, eye contact and also verbally. The parent provides soothing for the infant, and he/she starts to internalise a model of how to do this, which becomes a template for life.

I do not feel that only the mother can provide this. Indeed if mother experiences severe post-natal depression, which in rare cases can lead to hospitalisation and thus seperation from baby, it is really important that the other parent, or another consistent person fills this gap.

Instinctively I feel that mother and baby are the ideal unit, especially given the researched benefits of breast feeding. However, if necessary, the other parent can offer the conditions vital for healthy emotional development. The key point is that the parent(s) are content in themselves because this seems to be communicated (absorbed) by the baby.

At the beginning of the pre-Christmas week, I thought it might be helpful to reflect on the difficulties some families experience at Christmas time, and suggest some coping strategies. The Morning Show, on BBC Radio Nottingham, with Frances Finn, was the forum for this.

In Western cultures, Christmas is often promoted as a special time for families, when everyone must enjoy time together and have fun. This peaks on Christmas Day itself, which can become a steaming pressure- cooker of expectations: the perfect turkey, complete with all the trimmings served at the right time, in a festive environment, with each individual’s preferences accounted for….. This is often against an alcohol fuelled, noisy background, with over-tired children (and exhausted adults) trying to get their own needs met!  Small wonder that this is also a peak time for episodes of domestic violence, when tensions can boil over into verbal conflict and finally erupt into physical expressions of anger and distress.

The Christmas expectations are only a part of the problem; sometimes the family members assembled together may be present from a sense of duty – perhaps with little in common with each other other than this relationship. Or perhaps there is unfinished business – emotional conflict which is unresolved from the past, with the initially suppressed sense of unfairness and frustration re-ignited by the disinhibiting effect of alcohol…..and alcohol can also upset careful attempts to ‘say the right thing’ and walk on eggshells around known sensitivities of particular individuals….or cause people to misinterpret well-meant remarks and make apologies clumsy at best and futile at worst. 

Another factor in all this is the concept of Self-fulfilling Prophecy. This describes the tendency to anticipate an outcome with such intensity that we actually influence it by our behaviour – even without conscious awareness of doing so. If, for example, we really dread this Christmas being a repeat of a bad experience last year, we may start to ‘awfulise’ and ‘catastrophise’ – and these negative thoughts are expressed non-verbally in our body language and picked up by the people around us, creating a ‘bad (uncomfortable)  atmosphere’ …..which degenerates into awkward silences and abrupt remarks ….and then possibly hurtful comments….and replies…and finally full-on rows, plate throwing and physical assaults.

Violence is usually the final resort of the person whose anger exceeds their capacity to fully verbalise it, and is sometimes a pattern copied from the behaviour of a parent. Typically the person who becomes violent feels threatened by something or someone (past or present), and the circumstances of Christmas, especially the element of alcohol (ironically ‘Chrismas cheer’), enflame this and it is deflected onto an available victim – someone less powerful; or it may be that this victim is a reminder in some way of the original threat, or holds a different kind of power over the abuser – perhaps the power to abandon him or her. 

COPING STRATEGIES

1. Awareness: recogising the potency of Self-fulfilling Prophecy and the effect of carrying a sense of ‘it’s going to be awful, a DISASTER!’ Aim to keep an open mind and treat the situation as a fresh start.

2. Set BOUNDARIES:

– Limit the time you spend with family members, in an enclosed space. Try to mix things up, spend some time outdoors if possible, make full use of space.

– Prepare ‘safe subjects’ for general discussion; avoid the 3 Taboos of Sex, Religion and Politics

– Focus on ‘now’ and not ‘the past’ . Leave Unfinished Business outside and don’t try to get to the bottom of issues/make amends/ repair broken bridges  -about things that have gone wrong in the past.

3. Avoid or limit alcohol; as a rough guide, the more strongly you think ‘I need a drink’ the less advisable it is to have one…..

4.Ground and soothe yourself: take Time Out. You absolutely can absent yourself for a few minutes to do some soothing rhythmic breathing. (Inhale fully for 3 seconds, inflating your abdomen with air (fresh air if possible) – the hold for 3 seconds – and breathe out with a long exhale, 3 seconds).  Repeat to yourself a calming phrase such as ‘It’s ok, it’s just one day, all over soon…’

5. And finally, remember, Christmas Day is just one day of 24 hours (and some of those you will be asleep) made up of 60 minutes in each hour. You can get through this ….and you may even enjoy it.!!