STRESS: Will your job kill you in the future? - Dr. Nick Keca

stress is toxicIntroduction

Work plays a significant role in our lives and contributes to our economic, physical and mental health, both positively and negatively. Despite increasing awareness about mental health, reports show that much needs to be done for organisations to be able to demonstrate their duty of care. One of the challenges is the previous lack of understanding about the association between work related stress and long term physical and mental health. Consequently many of the work-place initiatives in evidence are aimed at avoiding productivity loss through sickness. While a number of studies have previously suggested a connection between stress and serious illnesses such as cancer, it is only very recently that researchers have finally confirmed a connection between activation of the stress hormone, Epinephrine, and the growth and spread of breast cancer stem cells through the increase in the enzyme lactate dehydrogenase – which happens to be an energy source for cancer cells. This breakthrough should be a game-changer in highlighting the need for a different approach to risk assessment, safeguarding, and improved organisation design. Though well intentioned, Mindfulness and Resilience training currently in vogue is not an adequate response, nor dies it diminish the significant future risks, be they financial or health related.

Work related Stress, Physical and Mental Wellbeing

Given REPORTS of increasing work related stress, associated (negative) health outcomes, emerging epidemics of ANXIETY and DEPRESSION, and the developing awareness of Mental ill-Health; it’s unlikely that the status quo can continue, i.e. where organisational practices negatively impact the mental and physical health of employees while The State Welfare System picks up the health and social-care bill, while those affected shoulder the long term impact to their lives, their savings and other assets.

In a previous LinkedIn article I noted that employers have a long standing Duty of Care to maintain a safe and healthy working environment. A duty to evidence appropriate risk assessment and management through work place audits. A duty to mitigate risks with improved job design, training and raising awareness through sympathetic psychological assessments that help to identify and support those individuals whose personality profiles make them especially susceptible to work related stress. Unfortunately, despite the best intentions, reports suggest that only 17% of organisations evaluate the impact of employee mental health and wellbeing in seeking to meet their duty of care to safeguard their employees. It’s unfortunate that…

We don’t recognise the seriousness of the problem because we can’t gauge how much stress we are coping with and the associated health issues often occur in the future, so we don’t immediately recognise there is a problem.

In my article, I outlined a wide range of sources that reported on the scale of the problem and the opportunities it presented. The following are a selection of examples indicating where we might focus attention…

How well are we managing stress and Mental Health?

  1. 60% of professionals say their stress levels at work are higher than they were five years ago. 35% say their boss is their biggest source of stress at work. 80% say a change in leadership, such as a new direct manager or someone higher up the organisational chart, impacts their stress levels. Consequently, only 15% of workers globally say they are highly engaged in and enthusiastic about their work and workplace – Korn Ferry Survey 2018
  2. 526,000 workers suffer from work-related stress, depression or anxiety (new or long-standing) in the UK. This equates to 15.8 million working days lost due to work-related stress, depression or anxiety; and work-related stress accounts for 49% of all working days lost to ill health – Health and Safety Executive, 2017: Work related Stress, Anxiety and Depression Statistics in Great Britain; and Office for National Statistics, 2017: Sickness absence in the labour market: 2016.
  3. 60% of UK employees have experienced a mental health issue due to work, or where work was a significant contributing factor. 31% of UK employees have been ‘formally diagnosed’ with a mental health condition – Business in the Community, 2017: Mental Health at Work Report. Mental health at Work Report 2016, Business in the Community, 2016. Only 2 in 5 employees are working at peak performance. 84% of employees have experienced physical, psychological, or behavioural symptoms of poor mental health where work was a contributing factor – Deloitte Center For Health Solutions
  4. Mental ill-health costs UK employers an estimated £34.9 billion per year – Centre for Mental Health, 2017: Mental health at work: The business costs ten years on. Mental health (not specific to workplace wellbeing) costs the UK £70 billion each year, equivalent to 4.5% of GDP. 33% people with long term physical conditions also experience mental health problems, increasing treatment costs by around £8 billion to £13 billion a year – Deloitte Center For Health Solutions
  5. Workload and Interpersonal Relationships (conflict) are the largest single contributors to workplace stress – Health and Safety Executive, 2017: Work related Stress, Anxiety and Depression Statistics in Great Britain.
  6. 75% of people with a diagnosable mental illness receive no treatment at all – Department of Health, 2014: Chief Medical Officer annual report: public mental health. Of those that do receive treatment, 1 in 10 people wait more than 12 months for access to talking therapies – Deloitte Center For Health Solutions
  7. 64% of senior business leaders have suffered from mental health issues, including anxiety, stress and depression, with work often cited as the contributing factor. 58% of senior business leaders said that they felt it was harder for them to talk about mental health. 25% said they felt less supported around the issue of mental health since becoming more senior – BUPA Report on Mental Health in Leadership
  8. 91% of managers agree that what they do as a manager affects the wellbeing of their staff, but only 58% of employees feel that their line manager is genuinely concerned about their mental health and wellbeing. 84% of managers feel that employee wellbeing is their responsibility, but only 24% have received training in managing an employee with a mental health issues. 35% reported having no workplace facilities or services that could help mental health and wellbeing. 75% believe there are barriers to supporting their staff, and 25% feel ‘not very confident’ or ‘not at all confident’ in recognising mental health issues – Business in the Community: Mental Health at Work Report 2017.
  9. 3 in 5 (60%) of Company board members feel their organisation does ‘very well’ in supporting employees with mental health issues. BUT 27% of employees say their organisation does not support employees with mental health issues at all; and only 11%felt able to tell their line manager about their mental health issue – Business in the Community, 2017: Mental Health at Work Report.
  10. 9% of employees who experienced symptoms of poor mental health experienced disciplinary action up to and including dismissal – Deloitte Center For Health Solutions.

This is daunting whatever your organisational perspective. For example, the scale of the problem, causes and effects, present a significant financial risk for organisations and their shareholder’s. It will spur regulation and policy changes as the Government mitigates the impact to the public purse. In turn, this will provide individuals and their families with a pathway to seek redress in recompense of suffering and financial loss.

In my experience, organisations tend to be reactive about such matters, doing the necessary minimum needed to keep abreast of regulatory obligations. However, the scale of this necessitates a change in behaviour, whatever the drivers. Addressing the safeguarding needs of existing employees is already a challenge but a recent research by the American Psychological Association helpfully points out that there was no significant increase in the percentage of older adults experiencing depression or psychological distress during the period 2008 to 2017. In fact, researchers saw a slight decline in psychological distress in individuals over 65 – perhaps coinciding with retirement age. However, the study found that Gen Z / I-Gen are considerably more susceptible to psychological distress (i.e. 52% to 71% increase in young adults experiencing serious psychological distress from 2008 to 2017). Further, the rate of young adults with suicidal thoughts or other suicide-related outcomes increased 47% in the same time frame, suggesting that…

trends in the last 10 years may have had a larger effect on mood disorders and suicide-related outcomes among younger generations compared with older generations.

Are we taking stress seriously enough?

Unequivocally NO. This applies to the corporations in which we work, and who are responsible for the health and wellbeing of their workforce. It also applies to each of us as individuals as we are similarly responsible for our own safeguarding.

There’s considerably more awareness of mental health today. It’s unsurprising, given mental ill-health costs UK employers £35 billion per year, that they are motivated to take actions and promote initiatives like World Mental Health Day. BUT…these largely focus on raising awareness, or addressing the short term issues of keeping people healthy enough to work. They do little to address the problem of Presenteeism, which costs the UK economy £21 billion each year because 1.8Xs as much productivity/working time is lost through presenteeism as through sickness absence. Interestingly, Presenteeism is most prevalent among senior staff due to the continuing stigma of mental health and strong behavioural norms that prevent them from taking time off work.

One of the barriers to developing meaningful approaches to work related stress is recognising the seriousness of the long term impacts that protracted periods of chronic stress have for our physical health. This is because, falling short of a crisis, the effects of prolonged periods of chronic stress, while leaving us feeling exhausted, may not be immediately apparent. It’s more likely to manifest as a problem as we age, like smoking. This is a reason why many of the initiatives intended to address work related stress are ineffective. They only address the tip of the ice-berg.

What about the longer-term effects of Stress?

Unmanaged stress is a pervasive part of our lives and self-reported stress has increased in nearly every demographic since 1983. how we handle it impacts our health, creates issues like anxiety attacks, and depression. High levels of chronic stress are associated with numerous diseases and conditions, including obesity and abdominal fat deposition, metabolic syndrome, respiratory infection, immune compromise, cardiovascular disease, systemic inflammation, respiratory impairment, cancerous tumour growth, dendritic shortening in the hippocampus and prefrontal cortex, and systemic damage to chromosomes through hormonal effects. Medical science is progressively explaining the dramatic effects that stress has on our bodies and minds – read more.

Stress response is one of the body’s natural defence mechanisms. When danger threatens, the body produces chemical substances called hormones which physically prepare people for rapid action in response to threats. These hormones, such as adrenaline, are released into the bloodstream and circulated throughout the entire body. This increases muscle tone preparation of the need to burst into action. They raise heart rate so blood flows more rapidly throughout the body tissues. They increase respiration so sufficient amounts of oxygen are available to supply the entire body in its crisis mode. They even increase the speed of our thoughts by raising the frequency of brain waves and helping us to rapidly plan and solve challenging problems to escape threats. While these physical and psychological changes are helpful when we are threatened by danger, they are unhelpful when we experience them all of the time as it is difficult for the body to maintain a state of continuous high alert. If this occurs, we become physically and mentally fatigued, anxious, and/or depressed.

Until recently, there was little evidence of how stress was directly related to serious illnesses like cancer, although suggestions of a link between stress and certain kinds of cancer and other illnesses has been accumulating for some time. The National Cancer Institute has reported that…

Although studies have shown that stress factors alter the way the immune system functions, they have not provided evidence of a direct cause-and-effect relationship between immune system changes and the development of cancer.

…arguably if stress decreases the body’s ability to fight disease by depressing the immune system, which diminishes the body’s ability to kill cancer cells – that IS the direct link between cancer and stress.

However, there has been progress. A recent study has demonstrated the link between stress hormone and cancer. [Alternatively you can follow This link for a more easily readable summary.]

Although there are well established associations between long term exposure to the stress hormone Cortisol and suppression of the immune system, this most recent study has established a direct link between chronic stress and the growth and spread (metastasis) of breast cancer stem cells through the activation of a receptor of the stress hormone Epinephrine, which raises levels of an enzyme called lactate dehydrogenase. In normal situations this enzyme supports the rapid release of energy to muscles through the sympathetic nervous system, more commonly referred to as the fight-or-flight mechanism. This biochemical process produces lactate as a byproduct and cancer cells need lactate for energy. So it is that excessive amounts of lactate dehydrogenase in chronically stressed individuals results in the activation of cancer-causing genes that in turn results in cancer cells growing and spreading via cancer stem cells in bone structures. This leads to two conclusions: –

  1. Now the connection has been made, the scale of the problem and financial risks associated with culpability should be significant enough to motivate a change in organisational policies and leadership practices; and
  2. Since the future work force (represented by Gen-Z and those that follow) is even more susceptible to the negative consequences of psychological distress, the current approach to resilience will not be enough to avoid the threats posed.

It’s harsh and we may not like it but we will have to acknowledge that…

Our actions and omissions today will result in serious negative life outcomes for our children and their friends as they join the work force.

This is neither effective or socially acceptable.

In Summary

Intense stress over prolonged periods has profoundly negative health outcomes for individuals whose genetic profile predisposes them to particular serious illnesses, such as heart disease and certain types of cancer. Because work is a major factor in all of our lives, our jobs present a unique and significant risk factor to our physical and mental health through the accumulating effect of repeated and prolonged episodes of intense stress.

While being far from ideal in general, this is especially problematic for individuals who have a high level of the personality trait Neuroticism, as these individuals are particularly sensitive to psychological distress. A large number of studies have confirmed that these individuals present with complex negative long term health outcomes, and create significant pressure on the health service that supports them.

Bookstores are replete with advice on how to become more resilient and such advice is well intentioned, we must recognise that increasing resilience is not the solution to this problem. It’s a sticking plaster and, for many, it’s akin to learning how to become a safer/better smoker, i.e. it’s not appropriate as it superficially alleviates some of the symptoms but ignores the causes.

We can’t and shouldn’t try to avoid stress completely. We need some stress in our lives, because a moderate amounts have a positive impact for our physical and mental wellbeing. Naturally, what is moderate for one person may be extreme for another and everyone has different genetic and biochemical underpinnings. It is this variability that makes it especially important for organisations to undertake appropriate risk assessments and address issues with organisational design. This latest study reinforces that importance in confirming the link between stress hormone and particular forms of cancer. No doubt future studies will expose the relationship with a variety of other serious illnesses.

Things that can help…

The risks and serious nature of illnesses associated with work related stress, and stress in general, require everyone to take their responsibilities seriously. Organisations must not only assess and mitigate risks appropriately, but they must provide learning so that their employees are able to recognise the risks and take responsibility for their own safeguarding. Conversely, individuals also need to share the safeguarding burden. For example, those that have a stressful job that also suffer a traumatic event in their personal lives, like a relationship breakdowns, house move, serious illness or bereavement, should avoid compounding the stress load by trying to work through it. Minimising or avoiding periods of intense stress is the best approach but if that’s impossible then seek the support of a qualified professional. The sooner you are able to do this, the easier the issues are to fix.

There are also a number of other things you can do to help yourself…

  • Talk openly to your employer about the challenges you are facing. It will give them an opportunity to help and it will help to explain any atypical/uncharacteristic behaviours you may have during periods of intense stress as it can be difficult regulating emotions during these times.
  • Share constructive ideas about how your work might be made less stressful with your boss. The chances are they will appreciate the insight of your expertise and it is likely that what you are proposing will be more efficient. Ineffective processes that cause frustration are a significant work stressor. This is particularly the case for individuals that are highly Conscientious!
  • Learn to recognise the signs of Depression.
  • Take Vitamin C. The research study referred to above found that Vitamin C suppressed lactate dehydrogenase production and shrank developing tumours. Scientists have suspected Vitamin C’s cancer-fighting potential for decades, and several clinical trials have demonstrated positive results. NOTE – not all Vitamin C supplements are equal so avoid the poor quality types that have lots of fillers – see the linked article for advice on this.
  • Learn to Breathe properly and Teach your Children. We can consciously use breathing to influence the involuntary (sympathetic nervous system) that regulates blood pressure, heart rate, circulation, digestion and many other bodily functions. This is something that young children up to the age of around 8 years old do naturally but it’s something that we all lose as we progress into adolescence. If there was one important parenting skill you can instils in your children to help them manage their anxiety and stresses – it is reminding them how to breathe properly and helping them to establish it as a habit when they feel anxious. Breathing exercises act as a bridge into those functions of the body of which we generally do not have conscious control over. During times of emotional stress our sympathetic nervous system is stimulated and this effects a number of physical and neurological responses. For example, our brain frequency increases, our heart rate and blood pressure rises, we perspire more, our muscles tense and our breathing becomes rapid and shallow. If this process continues over a long period of time, the sympathetic nervous system becomes over stimulated leading to an imbalance that can effect our physical health, resulting in inflammation, high blood pressure and muscle pain, to name a few of the issues. Trying to consciously slow our heart rate, decrease perspiration and relax muscles is much more difficult than simply slowing and deepening our breathing. Breathing properly directly influences these stress responses that direct stimulate the parasympathetic nervous system. This results in relaxation and a reversal of the stress response. Best of all, it’s easy to learn how to do it. We can do it any time and anywhere. It costs nothing and we don’t need any equipment or complex technical understanding.
  • Consider using Binaural Beat Machine to entrain the brain, lower brain frequency and aid relaxation – aim for THETA and ALPHA wavelengths. You can either visit a web page and listen on your laptop; or, download a free Binaural Beat Machine to your phone from the App Store relevant to your phone’s OS – MyNoiseIOSor Android. NOTE: You must wear ear/headphones to listen to Binaural Sounds. The links in this section will inform you about this subject. If you’re interested please take the time to review the pages to learn more about this subject as the different frequency ranges have different effects. Here are 3 helpful YouTube videos to teach you how to use the Beat Machine. Binaural Meditation is an ancient practice that is found to be very effective. However, in a small number of cases people using modern Binaural Beat machines have experienced unwanted effects. Don’t overdo it. Start with short sessions until you feel confident it has the effect you are expecting. If you have any unwanted effects stop using immediately.
  • Use Imagery techniques.
  • Learn Muscle Relaxation and Meditation Techniques.
  • Avoid repetitive high stress situations in your personal life.
  • Get enough good quality sleep – that’s when your body and mind repair themselves.
  • Join a Stress Support Group. Talk to people with whom you have trusted relationships and remember that NOT TALKING is a problem but, NOT LISTENING just as bad – and it damages those important trusted friendships!
  • Take a reputable Personality Assessment like the Five Factor Model of Personality, and get qualified feedback about your profile so you better understand yourself. It is well established that environmental factors like work and life-style choices that don’t activate your inherent personality traits result in dissatisfaction, demotivation, stress, anxiety and depression. If you are aware of your personality profile, and understand how your personality traits interact with the situations that you find yourself, you can make informed decisions about how you manage yourself and avoid risks that might be self-sabotaging or create a stress risk. For example, a pale skinned person would avoid exposing their skin to strong sun light for long periods or they’d expect to suffer a sunburn. In the same way, individuals that score highly on the Neuroticismscale should do what they can to minimise exposure to prolonged periods of intense stress, or high stress situations, otherwise risk short, medium and long term consequences to their mental and physical health.
  • Don’t smoke or use psychoactive drugs, like cannabis.
  • Avoid drinking alcohol too regularly, or to excess.
  • Try to have a balanced nutritious diet that is low in sugar (glucoses converts to lactate which is an energy source for cancer cells) and aim to maintain a healthy body mass below BMI 30 as a guide – seek your doctors advice before starting a diet.
  • Consider adopting an Intermittent Fasting regime to help manage Insulinlevels and reduce inflammation generally. A positive side-effect of Intermittent Fasting is the body’s natural response, known as Autophagy. NOTE – Intermittent Fasting is not suitable for diabetics. Do your own research and check with your Doctor to see if intermittent fasting may be an appropriate life-style choice for you.
  • Maintain a healthy gut microbiome with good quality probiotics since many hormones are related to gut health.
  • Exercise moderately for at least 4 hours each week. Regular moderate exercise activates happy hormones that are beneficial to your mental health and wellbeing (i.e. endorphin, dopamine, serotonin, oxytocin, GABA) – remembering that repeated long periods of intense exercise increases stress and blood lactate serum. If you can’t manage that much, do what you can as just 10 minutes moderate exercise a week will have a positive impact on your health.
  • Socialise and spend time doing the stuff you enjoy with the people you like being with.
  • Make a habit of regularly doing something nice for other peoplewithout expecting anything in return. you’ll get your reward through the increased activation of the happy hormones.

If you’re really struggling to cope, don’t try to tough it out. It just makes a bad situation worse. Go and see your Doctor and talk to them about what you’ve tried and how you’re feeling. They are the gateway to getting you the support that you need and the sooner you seek help, the easier it is to help you get back to being your usual self.

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