Stress

 

• One in five workers report feeling extremely stressed at work
• The American Psychological Association’s 2007 “Stress in America” poll found that one-third of people in the U.S. report experiencing extreme levels of stress
• Nearly one-in-five report that they are experiencing high levels of stress 15 or more days per month

Dr. Habke says:

There are two words that seem to come up with almost any client I meet with – in particular, everyone has something to say about stress.  (The other word is “issues” but that’s another topic).  They are feeling stressed, see things as stressful, or see stress as part of the context of other things they are dealing with – at home or at work.  

As psychologists, we know that the whole area of stress is complicated – both in theory and in the research.  On the whole, we want to put stress into a defined category, and if I can get technical, I would call “stress” the response we have when we are placed under a demand or threat.

We know that it can be either good or bad and that we can either feel up to the challenge or not.  But, whenever someone sits in front of me (almost), stress is bad and they are feeling overwhelmed.

The common areas of stress that we hear about are work (be it workload, demand for learning new areas or tasks, or …), interpersonal relationships (at work, with family or friends), or multiple demands. This happens when someone is trying to juggle too many roles at once. Regardless of the cause, there are a few things that I always need to understand.

First of course, it is necessary to explore the nature of the stressors.

Not everyone feels stressed by the same thing, or even by the same piece of the same situation.  I have met people dealing with the illness of a family member who are stressed by the logistics of getting to the hospital, and others that are stressed by seeing their loved one in distress (and others who would say both are stressful).

Part of understanding stress is the need to understand the meaning of the stressor itself – what is at risk.  If we are going along feeling perfectly competent with all the things we have to do, we are likely to feel busy but not stressed.  It is when we are anxious that we can’t get it all done, or that we are falling short of what we need to do, or what others are expecting of us, that we start to feel stressed.  So, we need to understand the fears.

Second, I need to ask about how the individual is experiencing the stress.  Stress typically has a number of symptoms.  They are physical (often sleep is impacted), emotional (anxiety and feelings of being overwhelmed), and behavioural. However, not everyone has the same symptoms.

Thirdly, I need to understand the individual’s resources. There are a number of things that help when an individual is under stress, such as social support, previous experience, and knowledge (however acquired). Coping style is also important, as it speaks to the ways an individual generally tackles stress, although it does interact with the type of stressor.  For example, it is generally a good strategy to focus on the problem and get really practical about what might be done to address it; however, some stressors have no practical solutions and so this style could be problematic.

Finally, it is necessary to look at the possibility of other issues being involved.  Stress can often lead to depression, but depression can also make stress worse. So, we need to assess for this, as well as for problems with anxiety, etc.  If it seems that depression is a significant issue, then we need to look at treating that as well (see Section on Depression).  Because it is not uncommon for stress to spill over into relationships, I also ask about the condition of marriages in particular. 

We need to talk briefly about the condition of burnout. This is typically considered an end result of stress that has gone on for too long.  The primary feature of this is a sense of disconnectedness – individuals get to the point where they stop caring about the job that they are doing.  This is dangerous for everyone, as it is a real risk factor for errors that can have significant consequences, depending on the nature of the individual’s job.  This is one we take very seriously.

So, when I have someone who is clearly stressed, I will often talk with him or her about a multi-pronged approach to treatment.  Because stress is so physical, we need to address the physical side of it.  Exercise is critical as a way for the body to overcome stress.  It does not have to be strenuous – I often get folks started on walking, sometimes as little as a block at a time.  Nutrition is also important, as it is an important part of how our bodies handle the biochemicals it produces under stress. Finally, rest is critical. When we have a lot of adrenaline in our systems, it can be hard to come down to rest or sleep.

From an emotional perspective, I will start people examining the thoughts and assumptions that create some of their stress.  One of these is around control (can you control it or not), some of it is around consequences (what will happen if you change something you are doing), a lot of it is around managing the “shoulds” and the “have to's” that have people overextending themselves. Behavioural change around stress is a big area, as it can include some adjustments to time management or assertiveness.

From a practical perspective, sometimes, we need to give the individual some time to regroup because they are not able to function at work.  This was called “stress leave” but we find this term to be really misleading.  Stress is not a reason to be off work and will not be covered by any insurance company as a recognized disability.  Time off work comes when you are not able to function at work, and only lasts until you are able to function.  Often, we can work with companies around a graduated return to work, and sometimes modified duties, to make this possible. 

What seems to make the biggest difference for people who are dealing with stress, in my opinion, is how seriously they are taking what they are feeling – do they truly accept the need to change what is happening to them.   I think a lot of people want to talk about their stress but don’t really want to work towards changing it.  I also think we sometimes struggle with a connection between being stressed and feeling ‘important.’ Sometimes, getting rid of stress means giving up - on being all things to all people (or even all things to a few people), on being the ‘perfect’ employee or mother or spouse.  Unfortunately, too many people won’t look at this until they hit a wall of burnout, depression, or physical illness.