Combat job stress: does work make you sick? – includes related information

In our society, work underlies self-esteem and identity. Unemployment typically lowers the sense of self-worth, produces anxiety, depression and increased illness risks. On the other hand, monotonous, souless jobs can erode self-identity, stifle initiative and impair mental health, leading to injuries, absenteeism and unwanted staff turnover. Job satisfaction depends not only upon the task in had but also on the work culture or atmosphere. “In essence,” notes one expert from Toronto’s Addiction Research Foundation, “an organization that imposes superfluous stress, ignores employee needs and rides roughshod over their autonomy is likely to damage health andincrease alcohol and substance abuse.” The organization of work is a health issue in which employees “do better when they feel more in command.”

Stress-related worker complaints on the rise

In the past, workplace health concerns centred mainly on safety and physical working conditions — such as hazardous toxins, cleanliness, noise, cigarette smoke and work overload. But in recent years, complaints of job distress have skyrocketed. One U.S. survey found tht almost a quarter of the workforce aged 25-44 suffered from stress-induced nervous strain severe enough to “diminish performance.” The U.S. National Institute for Occupational Safety and Health reports that stress-related disorders are fast becoming the most prevalent reason for worker disability claims.

In Canada, as in the rest of the industrial world, absenteeism has tripled during the past 15 years, almost one third of it attributed to stress-linked disorders. Over 60 per cent of Canadians claim to have experienced “negative job stress” during the past year. Stressed employees are more likely to be involved in accidents, make mistakes and miss work.

Although hard to evaluate, stress-related disorders can arise from monotonous tasks, authoritarian supervision, time pressure, tight schedules, lack of stimulation, coercion, harassment and poor employee-to-employee interaction. The more stressful the work atmosphere, the greater the likelihood of stresslinked symptoms such as fatigue, anxiety, insomnia, headaches, dizziness, panic attacks, depression, cardiac disorders, backache and other muscular syndromes, and substance abuse — with a resultant rise in injuries and absenteeism.

“In addition,” notes one psychologist at the Toronto Hospital, “poor psychosocial work conditins can make employees with minor workplace injuries become incapacitated and take prolonged disability leave.” Even if there is no evidence of organic impairment, and employees are deemed physically fit enough to resume work, the injury may “take over their lives” so that they “can’t face going to work.”

Understanding the stress pathway

Evolution marvellously prepared human beings for danger through the “fight or flight” response. In the immediate, alarm stage of this reaction the adrenal glands release stimulatory hormones, the heartbeat accelerates, extra glucose is supplied for energy and blood is diverted to working muscles. But while very apt for fighting or fleeing tigers, the fight-or-flight response hardly equips us for the stresses of modern life. A little stress is a stimulus, making us more alert and “on the ball,” but although some stress can improve performance, too much is counterproductive.

Stress is a “state of arousal” provoked by specific stressors that call on the body’s physical and mental reserves, triggering physiological, psychological and biochemical changes — for instance, raising blood pressure and increasing secretion of catecholamine (stimulant) hormones such as adrenaline and noradrenaline. A stressor is any force, change or event that calls upon a person’s inner resources.

Stressors can be environmental (excess noise, bad fumes), job-related (a bullying boss) or personal (an abusive spouse). They can be acute (such as nuclear accidents, bereavement), developmental (such as marriage, job promotion) or ongoing (such as poverty, an alcoholic parent). Some stressors — for instance, a job switch or marriage — are welcome changes, but still produce stress. The more stressors people are exposed to, the greater the stress or distress.

Continued or frequent exposure to stressors can produce profound physical, emotional and psychological reactions. Skyrocketing levels of corticoid (steroid) hormones and other biochemical changes may lead to typical stress reactions: exhaustion, headaches, muscular aches, insomnia, anxiety disorders, depression, elevated blood pressure, increased risks of heart disease and weakened immune (white blood cell) defences. But stress reactions vary widely, depending on the way individuals perceive events or stressors — as a threat or a challenge — and their personal problem-solving skills. The long-term outcome of prolonged stess also varies from person to person: for example, some develop changes in blood lipids (fats) — with increased cardiovascular risks — or reduced immune defences with increased susceptibility to infection. Some overuse alcohol, tobacco and other substances. Substance abuse generally worsens rather than relieves the mental strain. (About 10 per cent of the workforce currently misuses alcohol and/or other drugs.)

One person’s threat is another’s challenge

Individual differences explain why — faced with events such as war, hijacking, job demotion or relocation — people react differently. Some hide and give up, others rise to the challenge and develop new skills. The same situation can seem challenging (“the spice of life”) or terrifying (“the kiss of death”), depending on how it’s interpreted. The amount of stress people can handle depends on past experiences, individual “hardiness,” inner resources, upbringing, coping mechanisms and social support. What one person finds devastating can stimulate another. Thus, a new supervisor, democratization of the workplace or computerization may present an intriguing challenge to some, while in others it provokes anxiety. A noon fitness class might relieve tension in some but prove stressful to those who dislike group activities or hate wearing shorts.

The “psychotoxic workplace”: Tracking job stressors

A hierarchical, nonparticipatory, authoritarian organization that gives employees little decision-making influence over the execution of their work increases job distress. Arbitrary changes made without consulting employees can engender great anxiety. Conflicts or disagreement with a boss or workmates, and uncertainty about responsibilities are also powerful stressors. Some stressors are an inescapable part of the job. For example, telephone operators feel stressed by being monitored for their voice and client approach, while also being bombarded with consumer questions they can’t answer — about weather conditions, road reports, restaurants or movies. Teachers experience high stress when, in addition to uninterested pupils, they face extra administrative chores and meal duties. The latest trend to total quality management, emphasizing “customer satisfaction” and “zero defects,” can exert enormous pressure on employees.

Worldwide, bus drivers are particularly stressed by the simultaneous need to meet schedules, be polite to passengers and deal with traffic. Scandinavian studies show they are plagued by gastrointestinal disorders, hypertension (high blood pressure) and heart problems. Bus schedules are often arranged without considering road conditions. No sooner do drivers sit in the bus than they are already behind schedule. Social isolation can add to the strain. Most drivers work long shifts and some stay at the bus depot to “wind down.” By the time they get home, many have little time to socialize with spouse, children or friends. Besides improving posture and seat design, overcoming “the tyranny of the schedule” might do wonders for driver stress-reduction. But changes should involve the drivers themselves. One expert describes how a transit company allowed bus drivers input into new seat designs, bringing more comfort and greater satisfaction.

Specific workplace stressors include:

* Unrelieved task overload, high pressure;

* Needlessly intimidating supervision — “rule by fear”;

* Bullying, discrimination, harassment;

* Monotony, boredom, underused capabilities;

* Little control and low decision-making influence;

* Changes — even those meant to “humanize” and improve conditons — being “shunted around”;

* Ambiguous roles, blurred lines of authority;

* Conflicts, not getting along with supervisors, workmates;

* Social isolation, lack of support, poor communication;

* No feedback, lack of encouragement;

* Few learning, career or promotional opportunities;

* Competition and job insecurity.

High pressure and low control the deadliest twin stressors

Unremitting job demands, coupled with little or no control, can grind people into the ground. The combination is a deadly duo that produces not only mental strain, but can also elevate blood pressure and increase heart disease risks. Authoritarian practices that allow employees little or no influence over the pace and execution of tasks produce great distress.

It’s a fallacy to think that high-level positions carry the most stress. Although executives, bureau chiefs and medical officers bear heavy responsibilities, they also possess the authority to carry through their plans. Bosses who “run the ship” tend to be less stressed than subordinates who lack control. Assistants, secretaries and nurses, who often take the brunt of making things run smoothly but without authority to make decisions, are highly prone to job distress.

Employees who feel more in command of their work are likelier to gain mastery over other aspects of life, including their health. Jobs that give workers at least a modicum of control over the work method and pace generally increase self-esteem and, while demanding, produce efficacious employees who are “energetic, assertive and self-reliant.” Employees who take part in the decision-making are gnerally more cooperative, less prone to sabotage, errors and illness. Supportive relationships can help to mute the ill effects of job distress. Sharing and discussing problems may lessen the strain.

“Learned helplessness” can carry over into everyday life

While some react to stress by trying to alter circumstances, many adopt a helpless, passive attitude, withdraw, stop trying and take sick leave. Lack of decision-making influence induces a depressed attitude aptly called “learned helplessness.” Learned helplessness may be the cumulative end-point of master-servant relationships and being endlessly treated as a subordinate. The learned helplessness may spill over into everyday life, undrmining the will to make decisions, causing apathy and lack of interest in community affairs. Feeling helpless at work, people come to believe they cannot alter any aspect of their lives.

If the distress is not recognized and alleviated, the sense of helplessness may become entrenched and lead to ill health. “Instead of facing and dealing with mental health problems,” explains one therapist, “ailing workers who feel helpless may become disabled, dependent persons, unable to work.” Anxiety, depression or other stress-related disorders often express themselves or “somatize” as physical ailments, such as muscular pain, headaches, digestive upsets, sleeplessness and cardiovascular (heart) symptoms. People may unconsciously deny the underlying reasons for distress, labelling mental and emotional problems as physical ailments that call for medical treatment, thus avoiding the stigma of mental illness. Taking on the sick role because of organic ailments, they seek medical instead of the needed psychological therapy.

Links between stress and heart disease

Many studies now link job stress to elevated blood pressure and cardiovascular risks. Workers who describe their jobs as “overly demanding,” especially with a low levels of “decisionlatitude” (little say in what they do) are likelier than others to develop cardiovascular disease. A Swedish study showed that young men working in “non-learning” occupations that underutilized their abilities were more susceptible than others to physical signs of stress — high levels of blood adrenaline and elevated blood pressure. Other investigators found that men who had heart attacks before age 45 described less influence over their tasks than men without heart problems. Job monotony was a significant discriminator between “cases” (men with heart attack) and “controls” (those without heart attack).

The renowned British “Whitehall” study, which tracked 10,000 civil servants for nearly 20 years, found a striking difference in heart disease rates between those at the top and bottom of the job ladder. Lower-rank civil servants (mainly unskilled manual workers) had coronary disease rates almost four times greater than those in top (administrative) grades. The higher illness rates of lower-rank employees cannot simply be attributed to poverty, as those studied were far from impoverished or deprived and included people with substantial incomes. One explanation is that because low job status is also associated with poor workplace support, those in lower-rank jobs might be short on all three stress-reducing factors: a sense of control, decision-making influence and social interaction.

Humanizing workplace design and organization

Work stress can be reduced by changing people or altering the work situation. “To be effective,” states one psychologist, “stress-reduction strategies must include organizational changes.” Although stress often stems from poor work conditions, many organizations still focus on changing individual behaviour by education, training and lifestyle improvement. “Yet,” notes one corporate health consultant, “trying to combat job stress by changing individual behaviour without correcting workplace flaws is a lost cause.” Modern experts believe the real solution to job stress lies in humanizing and democratizing the workplace, identifying stressors and targetting what needs to be changed. It can mean restructuring jobs to give workers more control over the tasks performed, better incentives and a voice in planning changes. “Yet,” bemoans one corporate consultant, “the current system, and especially labour laws, are set up to hinder rather than encourage a collaborative process.” Much remains to be done.

Therapy can alleviate stress-linked disorders

Appropriate counselling can ferret out sources of stress and help to relieve it. “It’s crucial,” notes one psychotherapist, “to emphasize the normalcy and frequency of emotional and psychological problems, which afflict over half the workforce at some time.” Even brief counselling by a professional can do wonders and markedly diminish stress, perhaps short-circuiting “illness behaviour,” getting workers back to work.

Employee assistance programs, available in many companies, offer confidential advice and assistance for mental, emotional or other problems that disrupt family and work lives. Many programs are run off-site, and are available at no cost to employees and their families, offering assistance not only with relationship, anxiety and other problems, but also for legal, financial, child and eldercare concerns. Some have a 1-800 number and many also offer trauma response services around the clock.

Personal stress-coping tips

* Dialogue and share problems with others.

* Remember that everyone has some personal problems; you’re not alone. Share worries with others.

* Sort out the stressors in your life, assess which are avoidable, which are not. Try to avoid the avoidable.

* Do a reality check. Step back and appraise reality.

* Take stock of priorities — decide what’s a “must” and what can be deferred. Improve time management.

* Try to gain control and take charge of your life.

* Don’t condemn yourself for failure.

* Expect uncertainty and be adaptable. Try to avoid rigid anticipation or expectations.

* Emphasize strengths rather than weaknesses. Admit imperfection — just do your best.

* Incorporate rest periods into everyday schedules, making time for yourself. Be good to yourself — at least once a day.

* Take regular exercise — which helps to reduce tension and can provide friendly camaraderie.

* Try relaxation, biofeedback, meditation, soothing tapes — whatever works for you.

For more information, consult your local health and safety committee, employee assistance programs (if available), or private corporate health consultants.

Some reasons for the rise in work stress

Part of the increase in stress-linked illness is blamed on computerization, monotony, restrictive supervision, under-utilized abilities and “deskilling.” Deskilling, fragmentation and separation of “conceivers” from “executors” are blamed for much modern job distress. While the new technology has abolished the traditional assembly line, the routine computerized office is rather like a “mental assembly line,” with boring jobs in which workers spend much of the day feeding data into a computer. Workplace stress can be fuelled by home stressors. An estimated 40 per cent or more of the population have serious enough personal and family problems (e.g., homemaking duties, conflicts, financial worries, caring for children or elderly relatives), which, added to job distress, can seriously undermine health.

Psychosocial contributors to work stress

* Environmental aggravation such as noise, fumes, cigarette smoke, inadequate safety precautions, can cause much distress.

* Job content: Fragmented, monotonous, repetitive, short-cycle tasks that underuse skills may produce profound stress.

* Work load and pace: Machine-paced or computer-monitored work often creates relentless pressure with clear signs of stress such as anxiety, headaches and muscular ailments.

* Role, responsibilities, and amount of control/influence over the job in hand is a key factor — lack of control produces stress.

* Change — even if it’s meant to “democratize” conditions and increase worker participation — can cause distress especially if employees are not prepared for and trained to deal with it. (People may feel “out of their depth.”)

* Family roles and competing responsibilities — such as homemaking, childcare, eldercare — often cause stress, particularly in women.

* Role ambiguity — fuzzy job delineation, uncertainty about lines of authority to those “above” and “below” is very stressful.

* Troubled social relationships with colleagues, supervisors and subordinates are frequent stressors — for instance fellow workers with whom one “doesn’t get along,” sexual harassment, bullying, not daring to voice personal problems (for fear of dismissal).

* Shiftwork, especially rotating shifts and permanent night work that disturb the body’s circadian rhythm (biological clock) and interfere with social life can be stressful to some.

* Job insecurity, fear of job loss, obsolescence and unemployment lower self-esteem, erode health and threaten financial security.

* Personality traits. “Type-A” personalities (typified by competitiveness, time-urgency and over-commitment) are extra prone to stress and may even be stress-transmitters who pressure others. (Type-A, driven personalities might “self-select” demanding jobs.)

Some signs of stress-linked distress

* Memory lapses, distracted, “daydreaming”

* Diminished concentration, wandering attention

* Withdrawal, avoidance of peers, supervisors

* Inability to do job, declining performance, tasks undone

* Unexplained lateness, long lunch hours, absences, quitting work early, frequent sick-leave

* Sloppy appearance, change in attire

* Borrowing money from colleagues

* Waning interest in workmates, family, friends

* Perpetual fatigue

* Agitated, nervously restless, emotional outbursts

* Thought preoccupation (over-riding usual interests, sociability)

* Unexplained anxiety, “jitters,” irrational fears

* Unusual sensitivity to criticism, expressed sense of helplessness

* Complaints of “heart pounding,” sweating, dizziness

* Sleep disturbances, insomnia

* Dismal outlook, negative thoughts — nothing working out “as it should,” expressions of “unworthiness,” guilts

* Increased accidents, injuries, illness, absenteeism

* Disciplinary/corrective action

* Disturbing to colleagues

* Medical attention needed for stress-related symptoms

Stress-management courses can offer:

* Strategies to bolster the sense of control;

* Relaxation techniques, which can include special tricks such as “power-naps,” taking 10 minutes off for an exercise bout or visualizing a soothing activity to attain tranquility;

* Deep-breathing to improve muscle relaxation;

* Exercise and fitness programs, dietary advice;

* Tuition in meditation skills;

* Self-help manuals, group therapy;

* Training togain a positive outlook and improve self-image;

* Mind-focussing strategies, repetition of personally meaningful words or phrases that help people calm down;

* Altering thinking styles and positive “visualization”;

* Music therapy, special sound tapes and soothing imagery;

* Advice on managing leisure time and vacations — perhaps taking several small holidays, rathe than one long one (which brings its own stresses).

COPYRIGHT 1994 Strategic Inc. Communications Ltd.

COPYRIGHT 2004 Gale Group

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