Managing workplace anxiety3
Transcript of Managing workplace anxiety3
Ron Salomon MD
Faculty and Housestaff Wellness Programs
Thanks to V. Flynn, MD
Managing
Workplace Workplace AnxietyAnxiety
Conflicts • No conflicts of interest
related to this talk • No IRB disclosures • No IACUC involvement
Goals Anxiety and stressAnxiety and stress, actually, ARE things to worry about.
Besides taking control of your energy and attitude, it can affect your career and your general health.
There are ways to help bring it under control .
Participants will be able to- Recognize: stress and anxiety at work is common - Understand: symptom severity changes with
- Challenges – number and intensity - Internal and external support – availability and qualities
- Appreciate: psychological perspectives, separating - Personal coping
- Pressures of managing illnesses in patients
- Find: resources for self-help and professional assistance
Some stress is good.
Maslach Burnout Inventory*
7 point scale: “Never” to “Daily” •“….emotionally drained…”•“used up at the end of the day”•“fatigued … have to face another day”•“… understand how my patients feel about things …”
*Highly used and cited Burnout scale: Maslach 1981, 2005 Nixon 1979 Transactional Model of Stress
Emotional Health
Personal Issues• Stress, Depression, Anger, Anxiety• Grief/Loss• Conflict with S.O./Divorce • Parenting/Emotional Health of
Child • Child with challenges/illness• Elder care• Drugs/Alcohol
Work-Related Issues • Professional Burnout• No sense of personal
accomplishment • Work/Life Balance • Problems with supervisor• Problems with supervisee
Prince William weighs inStressed the importance of emotional well-being to business leaders
-workplace stress can take a toll on a person’s overall mental health
-psychological conditions should be met with the same compassion in the office as physical health.
“I’ve also seen how an employer can createan environment where it is as unremarkableto talk about feeling a bit down as it is to admit to having a cold,” he said.
His experience as an air ambulance pilot has shown him that employers can make it OK to admit feeling down.
The LEAST Stressful Income Growth Stress
Score
Diagnostic Medical Sonographer
$64K 24% 4
Compliance Officer $66K 3% 5.7
Hair Stylist $23K 10% 5.8
Audiologist $24K 29% 7.3
University Professor $75K 13% 8.2
Medical Records Technician $37K 15% 8.6
Jeweler $37K 11% 8.9
Operations Research Analyst $78K 30% 9
Pharmacy Technician $30K 9% 9.1
Medical Laboratory Technician
$50K 9% 10.3
↑ Challenges ↑ Symptom Severity
Rating Factors:• Travel • Career Growth Potential • Physical Demands• Environmental Conditions • Hazards Encountered • Meeting the Public• Competition • Risk of Death or Grievous Injury • Immediate Risk of Another’s Life
• Deadlines• Working in the Public Eye
Top Five: •Firefighter•Industrial engineer•Aerospace engineer •Mechanic foreman •Vehicle and railway equipment repair worker
ADAA, 2016
It’s common. By State:Of the best places to practice –
Arkansas
is somewhere in the lower half.
Medscape, 2016Paul Barrows
It’s common. Especially in Healthcare and Public sectors• Workload• Less managerial support • Rapid organizational changes • 50% of physicians • Stress, depression, anxiety • 37% of work-related ill health • 45% of days lost in 2015-16 (N=38,000 interviews)
• High stress, depression, anxiety Prevalence: 1.5 per 1000 Incidence (2015-16): .7 per 1000 Work loss per case: 24 days
IsHak et al., 2009Health and Safety Executive Report 2016
It’s common across occupations and age groups. But not equal by sex. In men: Peak is at 45 – 54 years – but not significantly higher than for younger men
• Maslach Depersonalization Scores: • Teaching: 11.0 • Social Services: 7.5 • Medicine: 7.12
• Elevated stress is seen in the first five years of practice for physicians
Health and Safety Executive Report 2016Maslach et al. 1996, 2005 Szigethy 2017
It’s common, but not equal by sex. In women:
• Higher levels of work-related stress, anxiety, and depression than men. Some suggested problems:• Inequalities in pay• Inadequate accommodations • Sexist environments and sexism in hiring/promotion
• Age – differences in stress seen from 25 to 54 • Peak at 35 – 44 years, when juggling family issues
(children, parents)
Mohring J, Health and Safety Executive 2016Priory’s Wellbeing Center in the City of London
“Burnout” rated from
1 = no interference
to
7 = I’m thinking of
leaving medicine
It’s common in Doctors. By Specialty:
Medscape, 2016
ED work: Mental and physical health of doctors is critical to patient care
ProblemsHigh job stress and work volume
Quick decisions under pressure
Limited prospect for improvement
Limited stress interventions
High burden of responsibility
↓↓
↓ ↓ Physical and psychological health
Loss of job satisfaction
Lower productivity
More staff turnover
Data25 studies reviewed. Confirmed: -High work volume and long hours,-Little control over work, -Poor support at work, -Low pay -Inadequate recognition-Compassion fatigue
Work “targets,” e.g. requirements to see patients within four hours, could add greatly to job stress.
Goals Intervention studies (only 2)
-aromatherapy and massage sessions reduced anxiety.
-Mindfulness and other emotional skills didn’t reduce job stress.
Proposed but unstudied: -“buddy system,” -exercise programs -increasing workers’ contact with their families
Emergency Medicine Journal, 2014
Consequences: • Stroke? • Holmes&Rahe>150 OR=3.84
• Cancer? (weak evidence)• Sleep disruption faster tumor
growth• Bmal1, Per2 KO’s faster tumor
growth
• Neurotoxic? • Loss of dendritic spines, poor
function in mPFC, amygdala, anterior cingulate ctx
http://dx.doi.org/10.1136/jnnp-2012-302420 Hunter et al., 2009 Roozendall et al., 2014 Papagiannoakopoulos et al., 2017
↑Support ↓Symptoms• Family • Friends• Coworkers • Religious affiliation or spirituality • Therapist • Leisure activity peers • Hobby enthusiasts• Peer support group (AA, …)
Stress Solutions
• Therapies • Mindfulness • CBT
• Exercise • Yoga • Walking
• Skills • Relaxation• Positive Psychology • Communication • Time management • Team building • Setting and achieving goals
Kilpatrick, et al., 2011, NeuroImage Salyers, et al., 2011Quoidbach et al., 2010, Personality and Individual Differences Krasner, et al., 2009 Davidson, McEwen, 2012, Nature Neuroscience Hayes et al., 2004
Stress relievers
115 men surveyed •27% - Sex •29% - Playing video games•31% - Comfort eating•74% - Talking with friends•Male bonding •Therapy for work issues
250 women surveyed•11% - Sex •>50% - Comfort eating •Read self-help book •Talk to friends •Arts and Crafts •Therapy for relationship issues
Russoniello et al., 2009Barry, J, 2017
Video games: $25bn in the United States in 2016
Interventions• Enhance sense of capacity to influence organizational policies
• Personalized responses • Stressors tend to be individual, and relatively unique • Burnout reduction programs with universal solutions generally don’t work.
• SLEEP!! Leiter et al., 2014Halbesleben et al., 2006
Timing is everything
• It’s all about YOU! • Be mindful of yourself and your environment• Decide when to send that email – will the recipient be likely to have
• Time to respond – is it the end of the day? • A weekend coming up – is it Friday before a long
weekend?
DECIDE WHEN AND HOW TO GET HELP!
Burnout Reduction Resources: ACGME
• ACGME Symposium on Physician Well-Being: Commitment to ACGME Symposium on Physician Well-Being: Commitment to Change :Change :– SMART (Stress Management And Resiliency Training)SMART (Stress Management And Resiliency Training)• Protected time for mindfulness meditation, stress awareness, and Protected time for mindfulness meditation, stress awareness, and
opportunity for experience sharingopportunity for experience sharing
– Positive Psychology CoachingPositive Psychology Coaching• Focus on positives, self reflection, and guidance led personal and professional Focus on positives, self reflection, and guidance led personal and professional
growthgrowth
ACGME, 2016: http://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being/2016-ACGME-Symposium-on-Physician-Well-Being
Resources: Employee Assistance Program – Therapy focus • Anger management• Eldercare• Grief/bereavement• Individual life skills training• Life/Career coaching• Personal/emotional concerns• Referral/resource assistance
http://eap.uams.edu/ 686-2588
• Relationships• Short-term, individual and family
counseling• Stress management• Substance Abuse• Wellness training• Work-related issues
Resources: Employee Assistance Program – Therapy focus • Free and confidential • Email a counselor at
www.uams.edu/eap• Appointments in 72 hrs• 24 h crisis counseling • Group assistance for workgroups
http://eap.uams.edu/ 686-2588
Resources: Wellness Programs• Urgent and Rapid Evaluation and Diagnosis• Treatment planning
FACULTY: http://faculty.uams.edu/wellness/ 526 – 8140
HOUSE STAFF: http://medicine.uams.edu/current-residents/resident-handbook/
526 – 8286
STUDENTS: http://studentwellness.uams.edu/ 686 – 8408
• Initial medication management • Referral/resource assistance
Goals
This introductory talk should have helped to:
-Identify workplace stress and anxiety issues, -Recognize signs of excessive anxiety, and-Understand helpful ways to cope with stress, -Obtain information on how and where to seek additional help.