We all experience stress at work. But some stress can take a serious toll on our bodies. iMag spoke to Dr. Toni Love Johnson, MD (MetroHealth Medical Center, Cleveland, Ohio) to find out how stress can affect our health and what we can do about it.
Americans are working longer and harder compared to a generation ago and we are paying the physical and emotional price caused by work related stress. According to one international labor organization, Americans work almost one month more per year compared to Japanese workers and three months more per year compared to German workers and more than any other industrialized nation. Job stress is associated with health complaints, psychological problems, increased absenteeism, poor work productivity, as well as low job satisfaction. Stress originating in the work place negatively affects the personal and family relationships of workers and in certain situations is associated with aggression and violence both in the work place and at home.
A Gallup Poll in 2000 found 80% of American workers feel stress on the job and 50% stated they need help in learning how to manage stress. Today, many workers are facing more demanding work situations with cut-backs, lay-offs and hiring freezes that only add to the daily stress at work. We have become more attuned to the most devastating outcomes of work related stress over the recent years. In one survey, almost 30% of workers admitted to yelling at co-workers due to job stress and 14% admitted to thoughts of physically striking a co-worker. Ten percent reported working in an environment where physical violence has occurred.
So what is stress? The dictionary defines stress as a constraining force or influence; a physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation. Yet, stress is not always unhealthy. And certainly, life can not be lived without experiencing stress. In fact, the human body was designed to deal with certain types of short term stress. For example, sudden stress will temporarily increase the heart rate and divert blood flow from the digestive tract to the large muscles of the limbs. The stress hormones prepare the immune system for possible injury or infection as would likely occur in a physical struggle. The brain chemicals ready the brain for quick response and mental clarity. This is commonly known as a “fear response” and is meant to be short lived and followed by relief and relaxation. It is natural and can even be beneficial to face short-lived stress that motivates and energizes the body’s natural life-saving defenses. However, chronic, unrelenting daily stress, which is experienced in some work environments, can literally kill us.
Chronic stress can produce physical or psychological damage by overloading the “fear response” system. Today we are aware of the association between chronic stress and cardiovascular disease, irritable bowel syndrome and peptic ulcer disease and worsening of other medical conditions such as diabetes, autoimmune disorders, and chronic pain. Poor health behaviors including tobacco use, alcohol abuse, over-eating and sedentary lifestyles are also related to an inability to manage chronic stress. These poor health habits then, in turn, contribute to the same medical conditions or create new health problems. The stress response is regulated by the brain’s chemical messengers known as neurotransmitters and when these chemicals become depleted, the normal ability to concentrate, regulate emotions and experience pleasure may become impaired. Chronic stress, therefore, can lead to clinical depression.
Job stress is not so much related to the job itself as it is to the job-person match and an individual’s sense of control and the perception of their decision-making capacity. So, what may be a very stressful job for one person may suit another person very well and have totally different levels of experienced stress. Unfortunately, fluctuations in work environments may change the level of experienced stress that was once well-tolerated. Or one may have increased demands at home which may then drain one’s ability to tolerate work stress, or vice versa. Working parents, and in particular, working mothers, are under pressure by society to perform at work, manage household demands and tend to family responsibilities before addressing their own needs. Working mothers may feel guilty if they engage in “self-centered time-outs” for relief. Yet, these moments of self indulgence, brief as they may be, could be the exact remedy for stress-laden experiences at work. Working parents, especially working mothers, need to know that their ability to perform at work and nurture at home will be less effective if they are not being responsible by addressing and managing their stress.
Stress management is a popular topic promoted by employee managers and the medical community alike. Yet, no one stress reduction technique works for everyone. And because stress is experienced differently, even regular use of some techniques may have a limited impact. Some environments are just too toxic to remain in and still manage good health habits. Gaining a sense of control and/or a sense of balance in one’s life is key and can lead to the healthiest outcome even under very stressful work conditions.
So, in sum, we can effectively deal with stress in the following ways:
1. Take an inventory of what we have control over and what we do not.
2. Consider changing some of our stress-related activities, events and reactions. This may be a simple thing such as having your spouse take over math homework if that is a battle ground. Or it may mean re-evaluating your work hours.
3. With stress-related health conditions being so common, it would be reasonable to begin addressing stress management with a visit to a primary care physician for a general health screen.
4. Get regular sleep and exercise, which are basic health recommendations, yet very valuable. Adequate sleep and exercise enable us to garner more reserve to handle daily stress.
5. We should take time to recreate. This seems counter-productive in a busy life, but yet it is this slower, unstructured leisure time that can free us to be more creative and responsive. Even if we can not formally take a vacation, we can schedule healthy escapes.
6. There should be a place for music, art, dance and entertainment in our lives.
7. Laughter, remember releases the brain’s “feel good” chemicals and is therefore, good medicine.
8. Develop a sense of inner peace and balance through meditation and/ or spiritual nurturing from structured religious practice or personal devotion to relieve stress.
9. Spend more time alone or more time with positively focused people. Find what you need to protect your individual emotional balance.
Even with all of these suggestions, however, people can find themselves too overwhelmed or burned out to make positive life changes on their own. Good counseling may be necessary, which may come through a relationship with a friend, a member of the clergy or a mental health professional. Professional counseling can determine if the stress in one’s life is leading to other health problems, including clinical depression or anxiety. With help we can choose not to pay the physical and emotional price caused by work-related stress.
Dr. Toni Love Johnson, MD, enjoys educating medical students, residents, nursing staff, social workers and other physicians on psychiatric disorders and various mental health topics at MetroHeath Medical Center, Cleveland, Ohio. Areas of expertise include general adult psychiatric illness (depression, bipolar, schizophrenia) and women's mental health illnesses (post partum depression, psychiatric illness during pregnancy), mental illness in the African American Community and graduate medical education. Toni is Medical Director, Behavioral Medicine and Counseling, MetroHealth Broadway Health Center; Program Director, Psychiatry Residency Training, MetroHealth Medical Center; Assistant Professor, Case Western Reserve University.