New approaches to promoting resilience at work
Systems approaches to the prevention and management of work-related stress was the theme of a recent London conference, William Payne reports.
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Systems approach to
workplace health
Quality of leisure improves
productivity
Stress-related sickness halved.
A conference at the Royal Free Hospital, Hampstead in September - "Promoting Resilience and Protecting Mental Health at Work" - considered new approaches in dealing with stress in the workplace. These included: the development of systems approaches to workplace mental health based on "positive psychology"; the key role of leisure in improving workplace productivity; and how a CBT-based acceptance and commitment therapy led to sick days being halved and stress levels reduced to sub-clinical levels at Cardiff and Vale NHS Trust.
Systems approach to workplace health
Problems with mental health are responsible for 30% to 40% of all referrals to occupational health practitioners, Barbara Wren, consultant lead psychologist at the Royal Free Hospital, Hampstead, told the conference. Mental health issues are the second largest cause of occupational health referrals, with one in six adults affected at any one time.
Ms Wren spoke of the potential of "positive psychology" to build resilience and aid recovery from stress. Positive psychology helps promote a systems approach to workplace stress and staff mental health. The systems-based, "positive psychology" approach provides a framework to identify and manage workplace stressors, reduce the anxiety and stigma associated with mental health problems, and support the development of resilient individuals and organisations that are healthier and more productive in a modern business environment.
Wren defined resilience as the ability to withstand or recover quickly from difficult conditions, and described it as an essential component in maintaining mental health in a stressful environment. A transactional model such as this provides a framework for understanding the interactional processes with which people cope with stressful environments through a series of mediated appraisals. It has the advantage over more conventional linear models of understanding stress - used in occupational health practice - of helping promote greater mental health in currently well, but at risk, sections of the workforce, and in providing pointers to those sections of the workforce that might be more at risk.
A transactional model of stress incorporates not only the direct effects of the stressor on the individual, but also the nature of the environment, the individual's assessment of the stress's impact, their social and cultural resources for managing stress, and their coping mechanism. The transactional approach would look at the workplace environment first, and the individual second. The HSE Management Standards approach has much to commend it in managing workplace stressors, it was suggested. How an individual responds to stress will also be strongly affected by familial and cultural influences.
Quality of leisure improves productivity
The quality of activity in leisure time is emerging as a key determinant of employee recovery and resilience to workplace stressors, argued Dr Paul Flaxman of City University, London.
Recent developments in cognitive behavioural therapy (CBT) have placed greater emphasis on "acceptance" and "mindfulness" approaches, in contrast to the more conventional change-oriented model associated with CBT. Acceptance and commitment therapy (ACT) promotes acceptance rather than change, aiming to enhance an individual's ability to experience thoughts and feelings, including those that are unpleasant, without any attempt to alter or block them.
As part of its research programme into employee resilience and acceptance-based approaches, City University is studying the value of leisure-time activity in promoting employee recovery. The leisure activities of a cohort of NHS staff members is being tracked, together with any subsequent alterations and improvements in mood and wellbeing. These activities include people's evening, weekend and holiday experiences.
The key to whether an activity represents a positive or negative experience lies in its cognitive dissimilarity to workplace activities - leisure-time activities that mimic or appear cognitively similar to workplace activities do not promote employee recovery. Leisure-time activities can be "resource-replenishing" or "resource-draining". For an employee who uses computers extensively at work, for example, using the internet or watching television in leisure time are not only unlikely to aid recovery, but will likely prove to be resource-draining. Likewise, an employee who works on phone lines for much of their working day will experience any leisure-time phone calls as resource-draining, irrespective of the caller or the content of the conversation.
The study has identified five types of leisure-time "recovery" activities that individuals typically engage in:
- work-related activity - finishing or preparing work during leisure time;
- household and childcare activities, including cooking, washing up, running errands, maintaining the car;
- low-effort activities, such as watching television, reading a book, napping, taking a bath;
- social activities, such as meeting with friends and family, going to the pub, speaking to friends on the phone, or going out with a partner; and
- physical activity as a deliberate exercise, such as swimming, jogging, sports, gym, cycling or yoga.
Psychological detachment from work during leisure time leads to improved wellbeing, sleep quality and recovery. The work-related activity, therefore, does not aid recovery and can be expected to be resource draining. Studies of the recovery benefits of the remaining types of activities shows one stand-out winner: physical activity, which has a clear and lasting recovery benefit that is shown in all studies. Household activities do not appear to have any recovery benefit, nor do low-effort activities such as watching television or reading books (although one study did show a weak benefit for low-effort activities). Social activities present a mixed picture, with two of the studies reporting a positive recovery effect, with one of the studies reporting a negative effect.
Without adequate recovery activities during leisure time, employee initial load reactions, such as fatigue and low mood, may develop into damaging chronic conditions such as depression and burnout.
Stress-related sickness halved
A paper detailing a programme that achieved a 50% reduction in stress-related sickness absence at Cardiff and Vale NHS Trust was delivered by Dr Jane Boyd and Julie Devlin. The programme aimed to increase workplace resilience through the use of ACT. Sixty-six employees attended all three programme sessions - a high rate of programme completion compared to similar intervention programmes - most attendees were nurses or occupational therapists, but a wide range of other professions and disciplines also used the service.
A 12-item scale based on the general health questionnaire (GHQ) was used before and after programme attendance to measure general mental health. A score of 3 or more on the GHQ-12 is considered to be in the clinical range. Mean score before the programmes was 4.35. Post programme, the mean score was 1.64.
Also, in the three months prior to programme attendance, employees reported a mean of 2.3 sick days. In the three months following programme attendance, employees reported a mean of 1.1 sick days. The ACT intervention had no impact on the number of employee sickness days that were attributable to a physical cause, demonstrating, the team argues, that the intervention is potentially effective at alleviating stress.
