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SECTION 4: MANAGING EMOTIONS AND STRESS
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Scenario 3: Sacha “I had been working for a certain team for a number of years and I knew that my work was good, as I had received excellent feedback from patients and colleagues and through the appraisal process. However, over the autumn when I was put in charge of a high profile but very stressful project, I could feel myself getting more and more remote from the two managers I worked for. I don't see them every day and found that contact with them was beginning to dry up. I can’t put my finger on it, but I felt that I was being side-lined or ignored. The project was probably the most challenging thing I had ever undertaken, and yet I felt I had no back up support. I tried to feed back issues we uncovered as the project moved forward but either had no reply or just a bland acknowledgement. My emails because more urgent, highlighting more issues we were uncovering. I really thought they were planning to get rid of me but could not understand that as I know I do good work. Finally, I was called into a meeting with them and was admittedly quite anxious. I prepared loads of figures about the success of the project, but also printed out all the email reports I had sent and the bland or non-existent replies. If they were going to get rid of me, I was not going to go down without a robust defence!” |
To deny that we are emotional beings or to say that emotions must not be brought to work is not helpful. When patients report positive experiences of healthcare, they often describe feeling cared for, being understood, and say small acts of kindness make a huge difference to them, showing that health care is an emotional job. Everyone has feelings about their work, about their colleagues and about the patients they care for. Most of the time these feelings are contained, and people can work without their emotions having to great a negative impact. We don't always acknowledge the positive impact of our emotions at work, and therefore feel we need to contain our negative emotions too. However, emotions can become problematic when they interfere with how someone is doing their job.
In scenario 1 we saw that Minna’s unacknowledged emotions about the patient she lost had led to a pattern of behaviour that adversely affected her ability to do her job. Once she was able to share those emotions, and process the case with a more experienced colleague, she regained her sense of perspective and returned to her former, effective self.
In scenario 3 Sacha talks about the way in which emotions coupled with a stressful role led to some strong emotions, and a high-stake meeting which brought matters to a head.
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What happens when we feel stressed? Stress often arises as a response to negative emotions. Our thinking, feeling and behaviour can often become altered as a result:
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Reflection 1 of 1:
This can be done individually or in small groups. If in small groups, please share thoughts. |
The role of emotional exhaustion has been well documented, and you can read about its impact in healthcare in the following articles:
- Lin & Chang (2015) Physician Emotional Labour and Job Performance: The Mediating Effects of Emotional Exhaustion. Journal of Health Management 17: 446-457
- Pandey & Singh (2015) Donning the mask: effects of emotional labour strategies on burnout and job satisfaction in community healthcare. Health Policy Plan.
How can we deal with the emotions we have about our work?
In their paper from 2004 John and Gross recognise the tendency of people to do one of two things to cope with their emotions, especially negative emotions. They claim that people either change how they think about the event that is causing negative feelings, or they refuse to let it affect them. They found that our choice of coping mechanism changes over time and that we are less likely to ignore the emotions as we get older and more likely to change how we view them. (John & Gross, 2004)
Subsequent work by Bassal, Czellar Kaiser & Dan-Glauser (2015) has found that neither one nor the other approach can be claimed to be the ‘cure’ for managing emotions and it is not difficult to foresee ways in which either approach might be helpful or damaging. However, it is useful for us to be aware of these tendencies, and to develop awareness around the ways in which we deal with our emotions.
A study of public sector workers in the USA by Hsieh (2012) found that emotional stress and burnout can be alleviated through encouraging appropriate expression of job-related emotions. They found that lack of resources and lack of colleague support was associated with emotional exhaustion. How far do our healthcare settings encourage the expression of emotions? How much colleague support is there especially at times of stress? Some areas of healthcare use debriefing models, but often only for extremely serious situations, and the small, everyday emotional demands are often not acknowledged but lead to a cumulative state of burnout.
You may also wish to view our module on Stress, Mental Health and Wellbeing: CLICK HERE
According to Fisher's (1997) research, the most common negative emotions experienced in the workplace are as follows:
- Frustration/irritation.
- Worry/nervousness.
- Anger/aggravation.
- Dislike.
- Disappointment/unhappiness.
Fisher recommends the following strategies to help deal with each of these negative emotions (click the tabs below to reveal the information):
Frustration usually occurs when you feel stuck or trapped, or unable to move forward in some way. It could be caused by a colleague blocking our favourite project, a boss who is too disorganized to get to our meeting on time, or simply being expected to wait longer than necessary for something. Whatever the reason, it's important to deal with feelings of frustration quickly, because they can easily lead to more negative emotions, such as anger.
Here are some suggestions for dealing with frustration:
- Stop and evaluate – Mentally stop yourself and look at the situation. Ask yourself why you feel frustrated. Think of one positive thing about your current situation. For instance, if your boss is late for your meeting, then you have more time to prepare. Or, you could use this time to relax a little.
- Find something positive about the situation – This can help you look at things in a different way. A small change in thinking can improve mood. People rarely cause your frustration deliberately. Systemic issues are certainly not personal and whilst frustrating, we can try to think of a way they might be altered or improved.
- Remember the last time you felt frustrated – The situation probably worked out in the end. Your feelings of frustration or irritation probably didn't do much to solve the problem then, which means they're probably not doing anything for you now.
In a time of economic uncertainty and rapid change, it is easy to understand why people are more worried than ever about their jobs and what they are required to do. However, worry can easily get out of control and impact not only on mental health, but on productivity, and willingness to try new things at work.
Try these tips to deal with worrying:
- Avoid amplifying worry and anxiety – Try to avoid colleague discussions which focus on developing worry and anxiety. Worrying tends to lead to more worrying, and if you know that you are someone who takes such worries home with them, it is best to avoid these situations.
- Try rhythmic breathing exercises – Dr Alan Watkins (2012) (click the text for the You Tube link) from Imperial College, London talks here about how to breathe rhythmically to regulate our physiological response to stress.
- Focus on how to improve the situation – Worry often comes from a feeling of helplessness and can therefore be reduced if we can develop a plan of action. Use the SMART questions earlier in the module to identify (see Section 1: Planning and Time Management) what you would like to do to change the situation and consider how you can begin.
- Write down your worries in a worry log – If you find that worries are circulating in your mind, write them down in a notebook or "worry log.” Decide to deal with them at a certain time in the next few days and banish them from your mind until that time. When it comes to the time you've decided on you can go through the list. Some of those worries will have resolved themselves since they occurred. Others will require a kind of ‘triage’ (prioritisation) approach. Decide what you can and cannot act upon first of all. You may wish to conduct a risk analysis (Mind Tools 1996-2016) or set some SMART goals.
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Example from a professional: Hal has established a habit of planning for the week ahead on a Sunday night, preparing for what can be prepared for and just thinking about the other elements of work. This alleviates some of the pressures of the week. Any worries that can be shelved are noted in a small book and on Friday early evening Hal spends a half hour just sorting through them to free up emotional space for the weekend. For shift workers these timescales may not apply but other can be adopted. |
Worrying can affect our self-confidence, self-esteem and behaviour. The resource on Building Self Confidence in Mind Tools 1996-2016 may be useful. Worrying can also affect our levels of self-esteem and behaviour. This link to assertive behaviour (Mind Tools 1996-2016) may also help.
Anger that gets out of control is perhaps the most destructive emotion experienced in the workplace. Few of us handle our anger well. Try the self-test in (Mind Tools Ltd, 1996-2016)
Try these suggestions to control anger:
- Watch for early signs of anger – Only you know the danger signs when anger is building, so learn to recognize them when they first appear. Stopping your anger early is key. Remember, you can choose how you react in a situation. Just because your first instinct is to become angry doesn't mean it's the correct response.
- If you start to get angry, stop what you're doing – Close your eyes, and practice the breathing exercise described by Alan Watkins (2012) earlier in this section of the module. This can help to calm down our physiological response, and it helps put us back on a more positive path.
- If you do keep a journal, use it to record your initial anger. Go back to it after a day or two and see what can be done productively, now that the ‘red mist’ has settled.
- If you are being treated unfairly, call it out. Say calmly, “I don’t think this is fair. I would like an opportunity to address this soon.”
Managing our anger should not mean that we do not react to mistreatment, undermining or unfairness. However, a calm and rational approach is more likely to be heard than an emotional one.
Developing your assertiveness skills can help you to state your case more rationally. See the link just above on assertiveness.
We've probably all had to work with someone we don't like. However, it is important to be professional, at all times. There are people we like and people we rate, and the ideal colleague is someone who scores highly on both. Many of us work with people we like but don't rate or rate but don't like and finding ways to deal with that effectively can be challenging.
If you are working with someone you dislike:
- Be respectful – If you must work with someone you don't get particularly like, then it's time to set aside your feelings about them. Treat the person with courtesy and respect, as you would treat anyone else. Sometimes we can grow to like someone, and even if we can’t it does not mean they cannot do their job.
- Try to gain some insight into why you don’t like them - Is it the way they treat you? Is it that they have different values and beliefs to you? Are you a little jealous of them? Are they perhaps jealous of you? Do they perhaps remind you of someone you have not had a good relationship with previously? Perhaps they remind you of yourself. Insight can lead to understanding which can take the heat out of the relationship.
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Example from a professional: Ren was attending a small conference event and had some knowledge of one of the speakers prior to the day. Admitting the prejudice to a friend also attending, Ren said she was sure she would not like this speaker. She expressed curiosity at this feeling. It seemed irrational, but maybe the day would shed light on it. After the speaker had presented, Ren turned to her friend with a big smile and said she had changed her mind, but she felt she knew what had given her the initial prejudice. The speaker had reminded her previously of a former colleague who was difficult. She could now see this was irrational, that the speaker was a very different person. It was useful however to recognise how we can be subliminally influenced by memories of previous relationships. |
If you are working with someone you don't rate:
- Ask yourself why you don't rate them - Are they genuinely performing consistently below an acceptable level? If this is the case, you need to raise this with an appropriate person if you have concerns about their work. If, however they are working effectively but in a very different way to you, try to understand and accept their way of working.
- Be assertive – If the other person is rude and unprofessional, firmly explain that you refuse to be treated that way, and calmly leave the situation. It is important not to operate on their level but to set an example.
Dealing with disappointment or unhappiness at work can be difficult. Of all the emotions we might feel at work, these are the most likely to impact on productivity. Disappointment can reduce our energy levels and make us risk averse.
How can we deal with disappointment and unhappiness?
- Look at your mindset – it is a normal human expectation that once we overcome the current hurdle, we will be free of worry and can lead a more enjoyable and rewarding life. Those who show most resilience are often those who have accepted that life is a steeplechase, with constant hurdles to overcome, but that without these challenges’ life would possibly be less interesting. As for every action there is a reaction, so for every disappointment there is often a success, it’s just that sometimes they don't come neatly alternate, but like buses, often come three at once. Accepting this can help us view our disappointments with more perspective.
- Adjust your goal – If you're disappointed that you didn't reach a goal, that doesn't mean the goal is no longer reachable. Keep the goal, but make a small change – for example, delay the deadline or identify what you really wanted from that goal and find another way to achieve that part of it.
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Example from a professional: He wanted to work in Paediatrics but when he did not get the hospital job, he evaluated which aspect of the job he was really attracted to and decided to go for a community role which put him in touch with as many children, albeit in a different setting. |
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Activity 1 of 2: Record your thoughts – Write down exactly what is making you unhappy.
Once you identify the specific nature of the problem, use the SMART questions to find a way to address that. Remember, you always have the power to change some aspect of your situation.
This can be done individually or in small groups. If in small groups, please share thoughts. |
In the following powerful clip “How to practise emotional hygiene” Guy Winch offers ways in which we can manage our psychological health. https://www.youtube.com/watch?v=rni41c9iq54
This clip provides an interesting insight into the sense of failure, helplessness, loneliness and rejection that many people feel from time to time. Rumination is a costly habit we develop when we feel stressed. Guy makes a case for the development of better emotional habits, and says:
“Treat yourself with the same compassion you would expect from a truly good friend.”
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Activity 2 of 2: Please watch this clip and note down ways in which you can adopt some different emotional habits. |
Sacha’s story, at the start if this section, shows us how quickly emotions can lead to negative thinking and erratic behaviour.
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Scenario 3: Sacha’s outcome So, what happened to Sacha at the meeting? Sacha finishes the story: “I was very apprehensive when I walked into that meeting. Both managers looked serious and I hoped they could not see my hands shaking or hear my heart thumping. But I got a real shock. They asked me how things were going. I said fine, well, it was a tough role but that we were really making progress. They looked at each other. So, I passed over the figures I had prepared, and they barely looked at them. They asked if I would like to reduce some of the workload, scale it back a bit. I was horrified and said not at all. Then one of them leaned over the table and said, ‘Sacha, we know how hard you have been working on this,’ and I thought, here it comes, the demotion or dismissal. I could feel the back of my eyes prickling and my throat going even more dry. She continued, ‘We are a little concerned about you burning out.’ ‘You are giving so much, ‘said the other manager, ‘And from some of your recent emails it seems that some of the pressure is getting to you.’”
After the meeting, where various issues were discussed including Sacha’s angry emails, and the managers’ lack of communication, Sacha realised that the situation had been allowed to happen from a lack of connection. An earlier meeting between the three of them would have perhaps allowed some sharing of the specific issues of the project, which would have made Sacha feel more supported and less emotional. The emotions had led the managers to believe that Sacha was burning out, whereas their poor communication and distance meant that Sacha felt unsupported and that the work was not acknowledged. |
What can we learn from this scenario to manage these situations?
- Awareness of self – knowing our emotional responses and trigger points can make us aware of them at an early stage.
- Understanding of others – seeing that people are rarely intent on hurting us can help us to look at the situation more objectively.
- Perspectival exploration – a friend or colleague can help us to explore other possible viewpoints before we confront them. Both Sacha and the managers jumped to conclusions about each other without seeking information first.
- Feedback – is very important so that people know how they are doing. If the managers had let Sacha know what a good job was being done, maybe the emotional response would have been averted.
- Communication – is almost always at the heart of personal and professional issues. Regular and relatively informal communication is more often effective than infrequent formal communication.
- Action planning – can help us to work out how to progress when we do find ourselves in an emotionally sensitive situation, not least because it focuses us on tasks and not people.