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UK HSE statistics suggest stress-related costs to UK employers in the region of £700m every year. The cost of stress to society is estimated at £7bn pa. (These figures were respectively £350m and £3.7bn in 1995/6 when total days lost were half present levels.)

stress causes Stress is caused by various factors - not all of which are work-related of course, (which incidentally doesn’t reduce the employer’s obligation to protect against the causes of stress at work). Causes of stress - known as stressors - are in two categories: external stressors and internal stressors.

External stressors - physical conditions such as heat or cold, stressful psychological environments such as working conditions and abusive relationships, eg., bullying.

Internal stressors - physical ailments such as infection or inflammation, or psychological problems such as worrying about something.

From the above, it is easy to see that work can be a source of both external and internal stressors.

Stressors are also described as either short-term (acute) or long-term (chronic):

Short-term ‘acute’ stress is the reaction to immediate threat, also known as the fight or flight response. This is when the primitive part of the brain and certain chemicals within the brain cause a reaction to potentially harmful stressors or warnings (just as if preparing the body to run away or defend itself), such as noise, over-crowding, danger, bullying or harassment, or even an imagined or recalled threatening experience. When the threat subsides the body returns to normal, which is called the ‘relaxation response’. (NB The relaxation response among people varies; ie., people recover from acute stress at different rates.)

Long-term ‘chronic’ stressors are those pressures which are ongoing and continuous, when the urge to fight or flight has been suppressed. Examples of chronic stressors include: ongoing pressurised work, ongoing relationship problems, isolation, and persistent financial worries.

The working environment can generate both acute and chronic stressors, but is more likely to be a source of chronic stressors.

Stress effects on health and performance Stress is proven beyond doubt to make people ill, and evidence is increasing as to number of ailments and diseases caused by stress. Stress is now known to contribute to heart disease; it causes hypertension and high blood pressure, and impairs the immune system. Stress is also linked to strokes, IBS (irritable bowel syndrome), ulcers, diabetes, muscle and joint pain, miscarriage during pregnancy, allergies, alopecia and even premature tooth loss.

Various US studies have demonstrated that removing stress improves specific aspects of health: stress management was shown to be capable of reducing the risk of heart attack by up to 75% in people with heart disease; stress management techniques, along with methods for coping with anger, contributed to a reduction of high blood pressure, and; for chronic tension headache sufferers it was found that stress management techniques increased the effectiveness of prescribed drugs, and after six months actually equalled the effectiveness of anti-depressants. The clear implication for these ailments is that stress makes them worse.

Stress significantly reduces brain functions such as memory, concentration, and learning, all of which are central to effective performance at work. Certain tests have shown up to 50% loss of performance in cognitive tests performed by stress sufferers. Some health effects caused by stress are reversible and the body and mind reverts to normal when the stress is relieved. Other health effects caused by stress are so serious that they are irreversible, and at worse are terminal.

Stress is said by some to be a good thing, for themselves or others, that it promotes excitement and positive feelings. If these are the effects then it’s not stress as defined here. It’s the excitement and stimulus derived (by one who wants these feelings and can handle them) from working hard in a controlled and manageable way towards an achievable and realistic aim, which for sure can be very exciting, but it ain’t stress. Stress is bad for people and organisations, it’s a threat and a health risk, and it needs to be recognised and dealt with, not dismissed as something good, or welcomed as a badge of machismo - you might as well stick pins in your eyes.

Causes of stress at work

These are typical causes of stress at work:

Bullying or harassment, by anyone, not necessarily a person’s manager Feeling powerless and uninvolved in determining one’s own responsibilities Continuous unreasonable performance demands Lack of effective communication and conflict resolution Lack of job security Long working hours Excessive time away from home and family Office politics and conflict among staff A feeling that one’s reward is not commensurate with one’s responsibility

Factors influencing the effects of stress and stress susceptibility: A person’s susceptibility to stress can be affected by any or all of these factors, which means that everyone has a different tolerance to stressors. And in respect of certain of these factors, stress susceptibility is not fixed, so each person’s stress tolerance level changes over time:

Childhood experience (abuse can increase stress susceptibility) Personality (certain personalities are more stress-prone than others) Genetics (particularly inherited ‘relaxation response’, connected with serotonin levels, the brain’s ‘well-being chemical’) Immunity abnormality (as might cause certain diseases such as arthritis and eczema, which weaken stress resilience) Lifestyle (principally poor diet and lack of exercise) Duration and intensity of stressors (obviously…)

Signs of stress - stress test At a clinical level, stress in individuals can be be assessed scientifically by measuring the levels of two hormones produced by the adrenal glands: cortisol and DHEA (dehydroepiandrosterone), but managers do not have ready access to these methods. Managers must therefore rely on other signs. Some of these are not exclusively due to stress, nor are they certain proof of stress, but they are indicators to prompt investigation as to whether stress is present. You can use this list of ten key stress indicators as a simple initial stress test: tick the factors applicable. How did I do?

1. sleep difficulties 2. loss of appetite 3. poor concentration or poor memory retention 4. performance dip 5. uncharacteristic errors or missed deadlines 6. anger or tantrums 7. violent or anti-social behaviour 8. emotional outbursts 9. alcohol or drug abuse 10. nervous habits

Methods of personal stress management and stress relief:

If you are suffering from work-related stress and it’s beginning to affect, or already affecting your health, stop to think: why are you taking this risk with your body and mind? Life’s short enough as it is; illness is all around us; why make matters worse? Commit to change before one day change is forced upon you.

If you recognise signs of stress in a staff member, especially if you are that person’s manager, don’t ignore it - do something about it. It is your duty to do so. If you do not feel capable of dealing with the situation, do not ignore it; you must refer it to someone who can deal with it. You must also look for signs of non-work-related stressors or factors that increase susceptibility to stress, because these will make a person more vulnerable to work-related stressors. These rules apply to yourself as well….

Stress relief methods are many and various. There is no single remedy that applies to every person suffering from stress, and most solutions involve a combination of remedies. Successful stress management frequently relies on reducing stress susceptibility and removing the stressors, and often factors will be both contributing to susceptibility and a direct cause. Here are some simple pointers for reducing stress susceptibility and stress itself, for yourself or to help others:

Stress relief pointers Think really seriously about and talk with others, to identify the causes of the stress and take steps to remove, reduce them or remove yourself (the stressed person) from the situation that causes the stress. Understand the type(s) of stressors affecting you (or the stressed person), and the contributors to the stress susceptibility - knowing what you’re dealing with is essential to developing the stress management approach. Improve diet - group B vitamins and magnesium are important, but potentially so are all the other vitamins and minerals: a balanced healthy diet is essential. Assess the current diet and identify where improvements should be made and commit to those improvements. Reduce toxin intake - obviously tobacco, alcohol especially - they might seem to Provide temporary relief but they are working against the balance of the body and contributing to stress susceptibility, and therefore increasing stress itself. Take more exercise - generally, and at times when feeling very stressed - exercise burns up adrenaline and produces helpful chemicals and positive feelings. Stressed people must try to be detached, step back, look from the outside at the issues that cause the stress. Don’t try to control things that are uncontrollable - instead adjust response, adapt. Share worries - talk to someone else - off-load, loneliness is a big ally of stress, so Sharing the burden is essential. increase self-awareness of personal moods and feelings - anticipate and take steps to avoid stress build-up before it becomes more serious. explore and use relaxation methods - they do work if given a chance - yoga, meditation, self-hypnosis, massage, a breath of fresh air, anything that works and can be done in the particular situation. Note also that managing stress does not cure medical problems. Relieving stress can alleviate and speed recovery from certain illnesses, particularly those caused by stress, (which depending on circumstances can disappear when the stress is relieved); ie., relieving stress is not a substitute for conventional treatments of illness, disease and injury.

Importantly, if the stress is causing serious health effects the sufferer must consult a doctor. Do not imagine that things will improve by soldiering on, or hoping that the sufferer will somehow become more resilient; things can and probably will get worse.

For less serious forms of stress, simply identify the cause(s) of stress, then to commit/agree to removing the cause(s). If appropriate this may involve removing the person from the situation that is causing the stress. Counselling may be necessary to identify the cause(s), particularly if the sufferer has any tendency to deny or ignore the stress problem.

Acceptance, cognisance and commitment on the part of the stressed person are essential. No-one can begin to manage their stress if they are still feeling acutely stressed - they’ll still be in ‘fight or flight’ mode. This is why a manager accused of causing stress though bullying or harassment must never be expected to resolve the problem. The situation must be handled by someone who will not perpetuate the stressful influence.

Removing the stressor(s) or the person from the stressful situation is only part of the solution; look also at the factors which affect stress susceptibility: where possible try to improve the factors that could be contributing to stress vulnerability. This particularly and frequently involves diet and exercise.

The two simplest ways to reduce stress susceptibility, and in many situations alleviate stress itself (although not removing the direct causes of stress itself) are available to everyone, cost nothing, and are guaranteed to produce virtually immediate improvements. They are diet and exercise.

Diet It’s widely accepted that nutritional deficiency impairs the health of the body, and it’s unrealistic not to expect the brain to be affected as well by poor diet. If the brain is affected, so are our thoughts, feelings and behaviour.

We know that certain vitamins and minerals are required to ensure healthy brain and neurological functionality. We know also that certain deficiencies relate directly to specific brain and nervous system weaknesses: The Vitamin B Group is particularly relevant to the brain, depression and stress susceptibility. Vitamin B1 deficiency is associated with depression, nervous system weakness and dementia. B2 deficiency is associated with nervous system disorders and depression. B3 is essential for protein synthesis, including the neurotransmitter serotonin, which is necessary for maintaining a healthy nervous system. Vitamin B6 is essential for neurotransmitter synthesis and maintaining healthy nervous system; B6 deficiency is associated with depression and dementia. B12 deficiency is associated with peripheral nerve degeneration, dementia, and depression.

Vitamin C is essential to protect against stress too: it maintains a healthy immune system, which is important for reducing stress susceptibility (we are more likely to suffer from stress when we are ill, and we are more prone to illness when our immune system is weak). Vitamin C speeds healing, which contributes to reducing stress susceptibility. Vitamin C is associate with improving post-traumatic stress disorders and chronic infections.

A 2003 UK 18 month study into violent and anti-social behaviour at a youth offenders institution provided remarkable evidence as to the link between diet and stress: Around 230 inmate volunteers were divided into two groups. Half were given a daily vitamin/fatty acid/mineral supplement; half were given a placebo. The group given the supplement showed a 25% reduction in recorded offences, and a 40% reduction in serious cases including violence towards others, behaviours that are directly attributable to stress.

Vitamin D helps maintain healthy body condition, particularly bones and speed of fracture healing, which are directly linked to stress susceptibility.

Adequate intake of minerals are also essential for a healthy body and brain, and so for reducing stress susceptibility.

A proper balanced diet is clearly essential, both to avoid direct physical stress causes via brain and nervous system, and to reduce stress susceptibility resulting from poor health and condition. Toxins such as alcohol, tobacco smoke, excessive salt, steroids, other drugs and other pollutants work against the balance between minerals, vitamins mind and body. Obviously then, excessive toxins from these sources will increase stress susceptibility and stress itself. (Useful information about salt and steroids.)

Some other simple (and to some, surprising) points about food, drink and diet:

Processed foods are not as good for you as fresh natural foods. Look at all the chemicals listed on the packaging to see what you are putting into your body. Generally speaking, and contrary to popular opinion, butter is better for you than margarine. This is because the fat in butter is natural and can be converted by the body more easily than the hydrogenated fat that occurs commonly in margarines. Fresh fruit and vegetables are good for you. Simple and true. Fish is good for you, especially oily fish like mackerel. Battered fish from the chip shop, cooked in hydrogenated cooking oil is not so good for you. Canned baked beans often have extremely high salt and sugar content. The beans are good for you, but the sauce isn’t if it contains too much salt and sugar. Look at the contents on the label. Canned and bottled fizzy ‘pop’ drinks are generally very bad for you. They contain various chemicals, including aspartame, which has been linked in several studies with nervous system disorders. Many squashes and cordials also contain aspartame. Too much coffee is bad for you. Interestingly expresso coffee contains less caffeine than filter and instant coffee, because it passes through the coffee grounds more quickly. Tea is good for you. Especially green tea. Pills and tablets are not good for you, avoid them if you can. For example, next time you have a headache, don’t take tablets, go for a run, or a walk in the fresh air to relax naturally. The rule is simple and inescapable: eat and drink healthily, and avoid excessive intake of toxins, to reduce stress susceptibility and stress itself. If you are suffering from stress and not obeying this simple rule you will continue to have be stressed, and moreover you will maintain a higher susceptibility to stress.

Irrespective of your tastes, it’s easy these days to have a balanced healthy diet if you want to - the challenge isn’t in knowing what’s good and bad, it’s simple a matter of commitment and personal resolve. You have one body for the whole of your life - look after it.

Exercise Physical exercise is immensely beneficial in managing stress. This is for several reasons:

Exercise releases helpful chemicals in our brain and body that are good for us. Exercise distracts us from the causes of stress. Exercise warms and relaxes cold, tight muscles and tissues which contribute to stress feelings. Exercise develops and maintains a healthy body which directly reduces stress susceptibility. Exercise increases blood flow to the brain which is good for us. Exercises also releases hormones, and stimulates the nervous system in ways that are good for us. Exercise produces chemicals in the body such as beta-endorphin, which is proven to have a positive effect on how we feel. For many people, serious exercise produces a kind of ‘high’. (It’s arguable that it has this effect on everyone, but not since so many people never get to do any serious exercise they’ll never know…….). Scientists still don’t fully understand how exactly these effects happen, but we do know that exercise produces powerful feelings of well-being and a physical glow, both of which directly reduce stress feelings.

Exercise of all types (muscle-building and stamina-building) relaxes tense muscles and tight connective tissues in the body, which directly contribute to stress feelings and symptoms (particularly headaches). Try this next time you get a stress headache - one that comes up the back of your neck into the back of your head: stand up, leave whatever you are doing, walk outside, take a few deep breaths, roll your shoulders backwards gently, slowly at first, then gradually speed up to about one rotation per second and keep it going for one minute. You can actually feel your shoulders warming and loosening, then feel your neck muscles warming up and relaxing, and then feel the relaxing feel beginning to take the edge of the pain in the back of your head. And that’s after just sixty seconds of exercise! Imagine what 15 minutes brisk walking or jogging can do. Ask anyone who’s just finished a game of tennis or squash or soccer if they feel at all stressed. Of course they don’t. It’s actually impossible to stay stressed if you do a serious bit of exercise.

Exercise is wonderfully distracting - especially something very competitive which makes you push yourself further than you might do by yourself. When your body is involved with exercise it’s very absorbing - it’s actually very difficult to think about your problems when you are puffing and panting. Something terrific happens to the brain when the body works out, especially aerobic exercise - cardiovascular exercise that gets the heart pumping.

We all evolved over millions of years with bodies that were built to exercise, it’s no wonder that avoiding it creates all kinds of tensions.

Exercise, like a better diet, isn’t difficult to adopt - the answer is simple, the opportunity is there - it’s the personal commitment that make the difference.

And a final point about ‘anger management’….

Anger management and stress The term ‘anger management’ is widely use now as if the subject stands alone. However, ‘anger management’ is simply an aspect of managing stress, since anger in the workplace is a symptom of stress. Anger is often stress in denial, and as such is best approached via one-to-one counselling. Training courses can convey anger management and stress reduction theory and ideas, but one-to-one counselling is necessary to turn theory into practice. Management of anger (and any other unreasonable emotional behaviour for that matter) and the stress that causes it, can only be improved if the person wants to change - acceptance, cognisance, commitment - so awareness is the first requirement. Some angry people take pride in their anger and don’t want to change; others fail to appreciate the effect on self and others. Without a commitment to change there’s not a lot that a manager or employer can do to help; anger management is only possible when the angry person accepts and commits to the need to change.

A big factor in persuading someone of the need to commit to change is to look objectively and sensitively with the other person at the consequences (for themselves and others) of their anger. Often angry people are in denial (”my temper is okay, people understand it’s just me and my moods….”), so removing this denial is essential. Helping angry people to realise that their behaviour is destructive and negative is an important first step. Discuss the effects on their health and their family. Get the person to see things from outside themselves.

As with stress, the next anger management step is for the angry person to understand the cause of their angry tendency, which will be a combination of stressors and stress susceptibility factors. Angry people need help in gaining this understanding - the counsellor often won’t know the reason either until rapport is established. If the problem is a temporary tendency then short-term acute stress may be the direct cause. Use one-to-one counselling to discover the causes and then agree necessary action to deal with them. Where the anger is persistent, frequent and ongoing, long-term chronic stress is more likely to be the cause. Again, counselling is required to get to the root causes. Exposing these issues can be very difficult, so great sensitivity is required. The counsellor may need several sessions in order to build sufficient trust and rapport.

The situation must be referred to a suitably qualified person whenever necessary, ie when the counsellor is unable to establish a rapport, analyse the causes, or agree a way forward. In any event if you spot the need for anger management in a person be aware that serious anger, and especially violence, is a clinical problem and so must be referred to a suitably qualified advisor or support group - under no circumstances attempt to deal with seriously or violently angry people via workplace counselling; these cases require expert professional help.

Establishing commitment to change and identifying the causes is sufficient for many people to make changes and improve - the will to change, combined with awareness of causes, then leads to a solution.

lakshman@lbdh.co.uk

Author’s URL: http://www.lbdh.co.uk

Dr. L Balasubramanyam is a Senior Consultant. He has a doctorate in Dynamic Simulation Modelling for Staffing in projects and Companies. He is also a keen researcher in the Use of Fine chemicals and natural extracts for various industries and contributes articles. He has been instrumental in setting up start up organisations in the Systems Integration field for services and has vast experience in handling issues of trust and public affairs. Dr. Balasubramanyam also is a Sr. Human Resources Professional practising the science and management of HR over the last 10 years and is now writing on the subject for very many publications.