My article in the Conversation this week looking at the growing problem of work addiction in the neoliberal world. It really is time to address this and turn away from strategies pushing work intensification and individualism in the workplace. These provide the perfect environment to grow work addiction and the outcome is not good for mental health or for productivity in the workplace. Healthy, supportive workplaces can be a reality and not just a panacea. Let’s look at a positive work-life balance, support healthy working patterns e.g. send people home at end of working day; do not support or encourage working outside of working hours; kill off cultures of performance and presenteeism and lets create a place focused on building self esteem, encouraging satisfaction and fulfilment, sharing responsibilities rather than ascribing blame, and look for a more meaningful and integrated approach to everyday life. Work is only one a part of a balanced and meaningful life, it so let’s keep it in perspective. That way we can and will all keep afloat:
As we adjust to the ‘new normal’ of our everyday lives many people are experiencing stress, anxiety, fear and discomfort. Here I want to introduce a couple of techniques that might offer some relief to help you get through these challenging times.
Mindfulness is a method of focusing your attention on what you are thinking, feeling and doing as it happens; thus, it is about living in the moment as it unfolds. It is a powerful tool in the arsenal of skills that you can use to help yourself relax; because you can focus on what is happening around you and pay attention to how you are responding to that in the moment, rather than being caught up by your thoughts.
Thoughts are an interesting phenomenon; they tend to dominate our everyday thinking. Our heads can be full of incessant chatter or white noise, frequently worrying about things that have happened or catastrophizing about possible futures; and sometimes we are not even fully aware of doing this. Other times negative thoughts can dominate our thinking to such an extent that we can feel overwhelmed by them. This is when we can become stressed, anxious or depressed.
A very important part of mindfulness practice is to understand that thoughts are just thoughts; that is, they are something that you can ignore or let go of. When you see thoughts as merely thoughts, then you begin to understand that they do not have the power to control or dominate your life.
It does need practice to get to this point of understanding; but once you get the hang of it, you will find that you can learn to let your negative or disruptive thoughts go. There are some simple steps you can take to help with this.
The first step is to pay attention to your thoughts so you can begin to realise when you are thinking negatively or are thinking about things that are not relevant to the moment you are in.
When you become aware of these negative or distracting thoughts, register them, but then let them go; let them pass you by. To do this visualise them drifting away from you and melting into the distance. You might like to imagine them suspended in clouds or hot air balloons and see them passing you by; or maybe you imagine them floating away in the ripples of a gently flowing stream. Create an image that works for you and let those negative or distracting thoughts go; just let them pass you by; see them diminish into the distance.
Remember that mindfulness, like any other approach, needs practise so don’t expect immediate results; give it time. Once you have practised this, try some of these other simple techniques to help you break the negative cycle of thinking.
Three breaths to relaxation
This is simple exercise to help you feel more relaxed, centred and calm by focusing on your breath. Your breath is with you all of the time, wherever you are; so, if you can master this technique you can help yourself to feel more relaxed any time, any place, anywhere.
To achieve this, you will need to practise; but this is an easy technique that you can do frequently during the day, whenever you feel stressed, anxious or uncomfortable.
It is also a useful technique to break the cycle of worrying thoughts when you go to bed at night or wake in the early hours. You can also do it when you wake to start the day in a positive way.
Please click here to have an audio script that you can listen to. You can also find more details on my website here and in my book Challenging stress, burnout and rust-out: Finding balance in busy lives here.
Mindful body scan….a tool for self awareness
The mindful body scan is a way of learning to pay attention to your body and become more self aware in the moment. Self awareness and being present in the moment as it unfolds are essential elements of mindfulness practice. The mindful body scan works by helping you to tune into how your body is feeling in the moment, and faciliating you to identify where you hold tension and stress; most importantly it is about learning to let go of your tension and stress, to let it pass (like in the image of the clouds, hot air balloons or stream) in order to be fully present, relaxed and feel as comfortable and as calm as you can. Once you have learned this technique, you can apply it to most situations.
For an audio guide to the mindful body scan please click here.
You can find more on the mindful body scan on my website here or in my book Challengeing stress, burnout and rust-out: Finding balance in busy lives here.
Mindful walking…a tool for living in the moment
With the present restrictions on walking outdoors the mindful walking technique is a very important skill to learn to make the most of our time in the open air and achieve a deeper sense of wellbeing. This is because the mindful walking technique asks you to fully appreciate your walk as it unfolds, step by step, moment by moment. This is not our normal state; rather we worry about what we need to do; fill our minds with tasks or catastrophize future events; in essence we live in our heads, listening to the chatter or white noise within and responding emotionally to the often negative or worrying thoughts that it conveys. Consequently, we do not notice or fully appreciate what is happening around us, and yet this is where meaningful experience lies.
The image below represents this visually: the man is taking our usual, everyday approach to a walk; he is on his phone and his head is filled with worries about his next task, his next meeting; he has no sense of time as it passes and no attention is given to his immediate surroundings. He is living in his head; his thoughts dominate his self awareness. When we are stressed, anxious or overwhelmed this is what we do.
Man: …….I’m thinking about work……… : Girl …..I’m enjoying this walk…..
The girl, on the other hand, is noticing and paying attention to what is unfolding around her as she walks. She sees her surroundings as they appear to her; she is also using her other senses to experience the moment as it unfolds; so she hears, feels and smells what is happening around her. Her sense of time, space and place is focused on where she is, each and very step of her walk; thus she is seeing the world in all its beauty as it unfurls around her.
Mindful walking then, is about being fully present on your walk. It uses four key strategies to help you to do this, and if you have practised the techniques we have discussed previously you will have done all of these. These are letting negative or distracting thoughts go, self awareness, being present in the moment and focused attention.
These strategies are very important to the success of the technique because they require you to pay attention to your body as you are in motion on your walk; and yet, at the same time, to be fully aware of the environment around you: the noises, scents, colours, tastes and feelings you experience as you walk. So you can get the idea, let’s look at a basic script you can apply to any walk.
*For those who are in isolation please use the following script to support a visual journey in your minds eye; this is a meditative approach. There is some music in the audio version that you can listen to following the audio script in order to fully benefit for the mindful mediation. Please click here if you want to go straight there.
Mindful walking script
Pay attention to any preparations you may have to make e.g. putting on your jacket or tying your boots or shoes. For example, notice the colour and material of your jacket, how it feels when is slides over your arms. Feel the weight of your boots or shoes and pay attention to how your feet feel in those boots or shoes.
Before you leave the house, take a moment to centre yourself; try to let any negative thoughts go or practise the three breaths to relaxation technique. Alternatively, just focus your thoughts on your walk in a positive way. Breathe deeply and focus your attention on being calm and relaxed.
As you begin you walk, notice the temperature; is is cold or is it warm? Is it just right? Just notice how that feels. Breathe deeply and comfortably, and slowly move on. Think snail not hare.
Notice if there is a wind blowing, is there a breeze or is the wind just a whisper or a sigh? How does the wind feel on your skin, or in your hair?
Are there any scents in the air? Pay attention to any smells and breathe deeply. Register the scents around you and enjoy them …perhaps you can smell spring flowers or someone cooking lunch.
Listen; what can you hear? Can you hear the wind blowing or whispering in the trees or is it hushed and silenced? Is there birdsong ? If so, is there a chorus or a solitary singer in the trees? Gently breathe.
Observe your surroundings: what can you see? What is the colour of the sky? Is it azure blue? grey, hazy? Is it dusk or dawn? Is there sunlight? Moonlight or streetlight? Are there trees and green? Buildings and pavements? Is it bright or dark. Just notice these and gently breathe, feeling calm and comfortable in your surroundings.
Pay attention now to your own footfall as you gently progress on your walk. Notice how your feet peel up from the ground as one foot lifts and notice how the other falls; you are in motion, gently moving forward.
Stop if you can, and if you feel safe too, close your eyes; soak up the sensation of sounds or silence around you; breathe; smell the air and feel the sky; take time to just be and to be fully present in the moment as it unfolds. Become really self aware in of your moment and breathe deeply, drawing energy and calm into your body and your soul. Breathe.
As you continue on your walk see if you can maintain these levels of self awareness and remain present in the moment at is unfolds. Be at one with your walk and fully appreciate and experience each moment. It is, after all a beautiful world.
Mindful walking is about being fully present in the moment, moment by moment as the walk unfolds, so you can fully perceive and apprehend your journey. If you can apply these techniques to your next walk you will begin to enjoy it much, much more. Don’t forget to use it as a meditative walk if you are in isolation. Take a walk in your imagination with me.
For an audio guide to the mindful walking please click here.
You can find more on doing everyday activities mindfully on my website here or in my book Challenging stress, burnout and rust-out: Finding balance in busy lives here.
Worrying about things is extremely common. Worries are negative thoughts and negative thinking can both be a symptom of or a causal factor in stress and anxiety.
If you have done any mindfulness training you will know that seeing thoughts as just thoughts i.e. a product of your own mind, helps in making your thoughts feel less overwhelming. This is because you begin to realize that they are not controlling you and are thus manageable. Consequently you begin to feel a little more in control over your own mind.
Step 1: Understand thoughts as thoughts…….
So that’s all well and good, but how do I become aware of what I’m thinking and how do I address it?
Step 2: What am I thinking?
Sometimes this is very clear to you; “I am worrying about XYZ”. Sometimes it harder to define because you are not so aware of your thoughts. In mindfulness you become aware of your thoughts and then you let them go in order to focus your attention in the present moment. With positive thinking techniques, for example, cognitive behaviour therapy (CBT) and thought stopping techniques, you focus on the thoughts a little more and explore the reactions that occur in response to them. This is usually best described as a negative thought cycle or spiral (see Figure 1).
Figure 1: Cycle of negative thinking:
Can you fit your own cycle of thoughts in this image? You may or may not be fully aware of what you are thinking:
Let’s try an exercise to become aware of your thinking……
Just sit comfortably for a moment. Somewhere you will not be disturbed is best.
Breathe deeply and slowly for a couple of breaths just to slow down and centre yourself.
Close your eyes and focus on your thoughts; become aware of what you are thinking about. If you are not aware of anything just let your mind drift.
Repeat the process of paying attention to your thoughts.
Don’t worry if you don’t get any sense from this first time; you can do this exercise any time, any place anywhere (for those old enough, the ‘Martini principle’). Eventually you will begin to become aware of your thinking. All of us, however self-aware when we start this will probably be surprised by how often we are thinking negatively; it’s usually quite a lot of the time.
Once you are aware of your thoughts start thinking about how they make you feel and then how you respond to them.
Because you can do this you can start to recognize trigger points or when you are worrying. Worrying thoughts can cause physical and emotional ill-health.
When you are thinking about a stressful event or worrying about something, those thoughts can cause the hypothalamus to activate the sympathetic nervous system instigating the stress response.
So your thinking, by provoking worrying can initiate and maintain the stress response over long periods. This can lead to chronic stress conditions and also impact on our memory (see Figure 2).
Figure 2: Chronic stress cycle
How can you use positive thinking to help?
First step is to learn to break the cycle of negative thinking (Figure 1). The second step is to learn to re-orientate your negative cycle of thinking to a positive one. Let’s look at step one first.…….
Step 1: Breaking the cycle of negative thinking
These are the thought stopping techniques; simply methods of breaking or interrupting the negative cycle of thinking and thus taking back control of your thoughts and stopping them running riot.
Get the right mind set. Don’t judge yourself or feel negative about the thoughts.
Find an image, word or action you can use to focus on and use to break the cycle. This can be anything that works for you. Let’s explore some ideas e.g. Visualize a stop sign; and/or visualize putting the thoughts in a box and locking it; see yourself on a train and visualize changing rail tracks from destination worry & stress to destination calm & relaxed (slower, more beautiful journey etc.)
Focus on your breathing and breathe deeply and slowly for a count of
Clench and relax your shoulders
Use a word or phrase that means something to you and repeat it……..?
You can use any combination of these you like to help you break that cycle.
Step 2: Re-orientate your negative cycle of thinking
This is where you start to repopulate your negative thought cycle with something more positive. This stage is not easy because you have to put things into perspective and you might have to make some changes or some difficult decisions as well. This depends on your particular situation and pattern of thought. However, if we review the example of a negative cycle (Figure 1), it might look something like this:
Figure 3: Positive thought cycle
Step 3: Practice!!
Practice does not make perfect but it does help. Remember these little bits of wisdom……….
“We are what we repeatedly do. Excellence then is not an act but a habit”. Aristotle
This is a workshop done with a community group on mindfulness. A second on thought stopping is available too as Im doing that this week! Remember its a workshop outline so image your engaged and fully present as you read through it and practice it.
How do I become more self-aware?
You pay attention to yourself; your thoughts and your feelings. A key way to do learn to pay attention to your ‘self’ is to focus on your breathing.
Exercise 1: Focus on the breath
Close your eyes if you can
Focus on the breath
Breathe in for count of three
Breathe out for count of three
Pause for one
Repeat until you have completed the cycle three times
You can use a little mantra if you like; something simple like “As I breathe in I breathe in calm; as I breathe out I breathe out stress”. Make an agreement or intention of practising this whenever you can during the day
Exercise 2: Body scan
Sit or lie down in a comfortable place and fully relax your body. Let your breathing slow down and breathe deeply through the NOSE. Feel you stomach rising and falling and follow the breath from the inhalation through your nose, down into your lungs and then on into your belly. Following the breath out in the same way but starting with the stomach to the lungs, throat, mouth and nose.
Be aware of your body position either sitting in the chair or lying on the floor/bed. Where is your body in contact with the chair? Where is it in contact with the floor? Just be aware of this then bring you focus back to your breath. Now we will focus on one part of the body at a time.
Starting with your head, pay attention to your body and notice any tension you’re feeling in that area. You might become aware of a feeling of tightness or pain. You might experience a feeling of heat, cold or energy around a certain area. If you do, focus on it for a minute and notice what you are feeling.
If you notice any uncomfortable sensations, focus on them and breathe into them. Notice what happens; the feeling may become more intense at first, then as you continue the body scan meditation and keep your focus, the feeling may dissipate. Keep your awareness on whatever that feeling for a little while, just staying present in the moment. Give yourself a little massage in that area if you want to.
Next, move down to your neck, and repeat the body scan meditation steps. Notice if there is any tightness, pain or pressure. Breathe into the areas where you notice and discomfort; stay with the feelings. Gently massage your neck if you wish. Let your body and mind relax.
Continue this practice with each area of your body, moving from head to toe. Notice how you feel, where you are holding your stress, and what sensations you are experiencing as a result.
Breathe, meditate, massage and relax. This can help you release tension in your body now; and be more aware of it in the future so you can release it then, too.
Give yourself a goal or plan (intention) to do this regularly and actually do it; start small and build to up to once a day if you can. Be positive about it. Make it part of your routine.
How can I be more present in the moment?
Exercise 3: Mindful activities: Making a cup of tea
Buy yourself some loose-leaf tea if you do not have any and take down your teapot and dust if off.
Fill the kettle. Turn the tap on and listen to the running water. Be aware of the weight of the kettle changing as you fill it, creating torsion in your arm. Breathe deeply and breathe in calm; as you breathe out, let stress leave your body.
Boil the water in the kettle and do not do anything else whilst you are doing that. Focus on the kettle. See it, hear it and sense its presence; it is sharing your space and it is singing, slowly building to a crescendo. Listen to its song.
When the kettle has boiled pour a small amount of water into the teapot to warm the pot. Place your hands on the teapot and experience the warmth seeping through into your palms and fingers. Smell the hot water; it has a scent all of its own and sense the heat in your nostrils. Breathe out through your mouth and let your tension go.
Gently swill the water around in the bottom of the teapot and hear its gentle swishing. Pour the warm water out and watch as it tumbles down and disappears into the sink. Listen to the tinkle of the water as it dissipates.
Place a teaspoon or more of the tealeaves into the warmed pot. Smell the aroma of the leaf and study the color. Breathe.
Re-boil the kettle and when it is ready carefully pour the boiling water into the waiting pot. You need about one cup of boiling water to each teaspoon of tea. Watch the steam wafting up and note the aroma of the tea as is infuses.
Stir the brew gently and hear the tinkling of the teaspoon on the china of the pot.
Place the lid on the pot and allow the tea to stand for a minute. Imagine the leaves dancing in the water and notice the smell and feel the calmness.
Pour your tea into your cup and watch the strainer fill; add milk, lemon or sugar to taste. Look at the color of the tea: is it amber, russet, green or black? Smell its aroma; is it earthy, grassy or floral? If you take sugar, smell the sugar as it dissolves; it has a very distinct but almost lucent scent, both there and yet not.
Sip your tea slowly; savour the taste and pay attention to the temperature of the liquid in your mouth. Is it hot, warm, or cool? Notice the taste of the tea and roll it on your tongue. Feel the body of the tea in your mouth and consider its qualities. Is it creamy, full, dry, thin, heavy or light? Swallow and feel the warmth of the liquid infuse you with light.
How do you feel?
Think of an activity you do regularly (everyday if possible) and begin to do it mindfully.
Time is an interesting concept. In contemporary neoliberal Western economies, it tends to be understood as chronological i.e. passing in a sequential and linear manner. Like the image of an arrow, this sense of time is absolute and deterministic; it tends to be goal directed and is used to measure the effectiveness or performativity of what we ‘do’ every day. This is clock time and it dominates how we organise our lives ‘by shifting the emphasis of everyday living and working patterns from variable rhythms to invariant ones’ (Adam, 1995: 47).
In neoliberal economies in particular, time has become associated with money because what we ‘do’ in time, especially in terms of paid work, measures productivity and sustains market growth. In this sense time, has a palpable performance orientation, because using or spending time efficiently and effectively is considered integral to profit and growth (Clouston, 2014; 2015).
Time does however have other meanings, both within the modern Western context and within the fabric of other cultures. Time, for example has temporal dimensions like past, present and future; it has tempo that creates the pace of life; time can hold a sense of place or belonging and can have mythic or spiritual significance. This concept of time is embedded in human unconscious, represented in folklore, creation myths, and legends (Adam, 1995). Yalmambirra (2000) for example, articulated the difference between Western clock time and his own Australian aboriginal peoples, by describing how they, as a community, marked time as events in the year, celebrating connections between people and planet. In this sense, time is an aspect of self-identity, a form of connection with others, so relational in nature and so is a meaningful experience rather than merely a tool for performativity.
Intriguingly, this notion of time resonates with the history of my own Welsh culture, where history suggests the Brythonic Celts embodied a more interconnected and relational sense of time, marked by seasonal cycles and the circle of life (King, 1995). This was a slower sense of time, marked by spring, summer, autumn and winter, light and dark linked to planting, growing harvesting and resting, evincing the agrarian nature of life.
Celtic seasonal cycles of time
In a similar way, Greek mythology identifies how time was marked by the passage of the seasons and the sun, moon and constellations across the sky (Alis et al., 2006). It is interesting in this context to note that chronological time originally takes its name from the Greek myths of Cronus, the King of the Titans, who created time when he separated Uranus (the sky) from Gaia (the earth). As King of the Titans, Cronus represented dominance and control over time and was an omnipotent and destructive force. He was eventually subdued by his own son Zeus, who, with his three daughters, the Horai, worked with natural the cycles of the sun, the moon and the seasons to create a world of interconnections, marked by a more meaningful, harmonious and relational concept of time focused on events and meaning in life as opposed to performativity (Alis et al., 2006). Kairos, Zeus’s brother was also influential in this sense of an interconnected, relational and meaningful concept of time. He represented the ability to be spontaneous and experience the moment; thus perhaps an allegory for the mindful use of time in the moment as it unfolds. The lessons to learn is that Kairos and Horai offer the opportunity of a more meaningful and interconnected use of time in which we can live in the moment and regain a sense of wellbeing and connection in life.
This myth is an interesting allegory of our time; a moral and political tale asking us to challenge how we allow Cronus (chronological time) to control and dominate our lives and drive and measure human performance. This concept of time not only subsumes the notion of a more meaningful orientated use of time, but the autonomy and free will that accompanies choice in how we use our time.
This suggests we need to move to a more meaningful concept of time, one in which we, as the metaphorical Zeus, and the Horai did, engenders a sense of autonomy over the temporal experience and meaning of our own everyday life. This requires a revolution, or at least an evolution in our thinking to engender and value greater meaning in our daily lives rather than performativity. As Kairos would attest, perhaps the time to act is now.
References
Adam B. 1995. Timewatch: The social analysis of time. Cambridge: Polity Press.
Alis D, Karsten L, & Leoplod J. 2006. From gods to goddesses: Horai management as an approach to coordinating working hours. Time & Society, 15(1), 81-104. doi: 10.1177/0961463X06062280.
Clouston TJ. 2014. Whose occupational balance is it anyway? The challenge of neoliberal capitalism and work-life imbalance. British Journal of Occupational Therapy, 77(10), 507-515. doi: 10.4276/030802214X14122630932430
Clouston TJ. 2015. Challenging stress, burnout and rust-out: Finding balance in busy lives, London, Jessica Kingsley.
King, J. 1995. The Celtic druids’ year: Seasonal cycles of the ancient Celts. London: Bandford.
Yalmambirra. 2000. Black time … white time: my time … your time. Journal of Occupational Science, 7(3), 133-37. doi:10.1080/14427591.2000.9686476.
As the organizing committee of the 4th Conference of Occupational Science Europe, we are very happy to inform you that there will be a free live stream of some sessions of the upcoming conference in Hildesheim next week. Even though you might not be able to participate as one of the 200 on-site participants from 24 countries, you are warmly invited to participate virtually via a free live stream. It is the first time that a live stream from an OSE-Conference has been organised, and we hope to expand discussions about occupation across geographical and disciplinary borders as well as with those who cannot be with us in Hildesheim. 4 out of 30 sessions will be streamed live on Friday and Saturday September 8th and 9th 2017 as well as the Igniter Talk of the 2nd Think Tank on Occupation-Based Social Transformation on Thursday, September 7th.
Timetable: Thursday, 07.09.2017
Igniter Talk
of the Think Tank
9:20 – 10:00
“Social transformation through occupation: Moving beyond intentions for enhancing justice?” Lisette Farias
Friday, 08.09.2017
Session 1.5
Panel Session
11:00 – 12:30
The Development of Occupational Science Outside the Anglophone Sphere: Challenges and Opportunities for Enacting Global Collaboration
Lilian Magalhães, Lisette Farias, Natalia Rivas-Quarneti, Liliana Alvarez, Ana Paula Malfitano
Session 2.5
Panel Session
14:00 – 15:30
From Raising Awareness to Stimulating Legislative and Policy Reform: Occupational Science’s Political Agenda Gail Elizabeth Whiteford, Clare Hocking, Hanneke van Bruggen, Valerie Wright St Clair
Session 3.5
Panel Session
16:15 – 17:50
Mobilizing Critical Theoretical Perspectives to Enact Occupation-Based Social Transformative Work Debbie Laliberte Rudman, Lisette Farias, Roshan Galvaan, Beccy Aldrich, Alison Gerlach, Lilian Magalhaes, Nic Pollard, Ben Sellar
Saturday, 09.09.2017
Session 4.4
Tandem Papers
11:00 – 11:45
Gender Aspects of Palliative Care for People with Dementia Elisabeth Reitinger, Verena Tatzer
“Doing Gender” – Intersectional and Occupational Aspects of Cognitive Disability, Gender and Age Verena C. Tatzer, Elisabeth Reitinger
11:45 – 12:30
People with Intellectual Disabilities work as Teachers at Universities: the Project ‘Inclusive Education’ Fabian van Essen
Employment: Occupational Choices for People with Intellectual Disabilities Ina Roosen
You are warmly invited to join and also to leave comments or give feedback on social media or via e-mail during or after the streaming.
The covid crises has created a huge amount of stress in frontline workers; and not least in the healthcare workforce who have dealt with trauma, death and dying on a daily basis.
As we (hopefully) come through the worst of this, it is of no doubt the impact of the Covid crisis will leave its mark on many. But this is not just in terms of the loss of loved ones, the loss of jobs and livelihoods, long covid or even the ongoing fears over the economy or an insecure future. No – it leaves a more far less recognised and more hidden shadow, especially for those who carried the responsibility of caring during the crisis and that is the real possibility post traumatic stress.
Post traumatic stress disorder (PTSD) is now a well known condition recognised by several key factors including: the presence of one or more extreme stressors or traumatic incidents; flashbacks to the event; intrusive thoughts, often accompanied by imagery or sounds; intense distress and anxiety; disassociation or other avoidance behaviours.
This high state of arousal can result in incapacitating symptoms, such as panic attacks; irritability and aggressive or overly sensitive behaviours; disturbed sleep patterns marked by ruminations and/or nightmares and, unsurprisingly, a lack of concentration.
Such a complex picture does have profound impacts on the individual’s ability to function in everyday activities; strategies to support this incorporate a comprehensive range of person-centred approaches, including cognitive and dialectical behavioural therapies, hypnosis, the building of personal resilience and the strengthening of relational (family, friends, colleagues) networks.
Interestingly, whilst much of the research around the area of PTSD highlights the presence of specific traumatic events as the causal factor, a study by Mealer et al (2009) has identified how PTSD in health workers can emerge as a result of recurring daily events, like dealing with death and dying, excessive psychological demands and feelings of helplessness. Crucially, the study also identified that in this context, the diagnosis of PTSD always coexists with burnout, marked by psychological exhaustion and de-personalisation. When PTSD and burnout were found together, people described lower levels of trust with both colleagues and clients/patients. They also described higher levels of psychological symptoms, like stress, anxiety and depression, and lower levels of functional abilities, like performance and effectiveness at work and home environments to those individuals suffering from burnout or PTSD alone.
These factors of course, impact not only the individual worker’s health and wellbeing and the efficacy of the outcomes for the employing organisation, but the ability to work effectively with others and to sustain the practical and emotional energy needed to care for clients/patients effectively. This is because it is not just the physical, emotional and psychological dimensions of the individual’s wellbeing that are disrupted, but also the spiritual (Clouston 2015), reflecting a breakdown in the core elements of the person’s existential essence or ‘being’ and thus their ability to connect meaningfully to self or others (McBride 2013; Shaw, Joseph & Linley 2005).
In terms of health care workers, this is a notable loss in an environment that now requires the abilities to be caring and compassionate as a prior skills to working in the health and social care sector (Francis 2013) and promotes the emotional use of the self as part of the therapeutic encounter (Solman & Clouston 2016).
To address this requires a pragmatic approach that not only requires the organisation to support the individual employee psychologically, emotionally and physically, but also at a spiritual level; only by working with this frequently overlooked dimension of human nature can health and social care organisations hope to support their staff to practice healthy and compassionate care for others.
This, of course is not easy and requires these organisations to tackle the roots of the problem, which includes an ‘illness model’ that indirectly enables them to place the fault of PTSD (and burnout) firmly at the feet of the employee, rather than as an outcome of the pressures and cultural context of the workplace. To confront this necessitates a reorientation of the organisation’s values, systems and practice at the most fundamental level in order to move from a performance orientation to a more caring and compassionate one; that in turn, requires a social structure and political and public mindset will that will support it.
This means a government that invests in its staff, values them, supports them and pays them fairly for the work they do and the public service they offer everyday. Only then can we address the growing problem of stress, burnout and PTSD in health and social care workers and give these staff the sense of value and worth they really need and deserve.
References
Clouston TJ. 2015. Challenging stress, burnout and rust-out: Finding balance in busy lives. London: Jessica Kingsley.
Francis R. 2013. Final report. London: The Stationary Office.
McBride JL. 2013. Spiritual crises: Surviving trauma to the Soul. Abingdon, Oxon: Routledge.
Mealer M; Burnham EL; Goode CJ; Rothbaum B & Moss M. 2009. The prevalence of PTSD and burnout syndrome in nurses. Depression & Anxiety, 26,12, 1118-1126.
Shaw A; Joseph S & Linley A. 2005. Religion, spirituality, and posttraumatic growth: a systematic review. Mental Health, Religion and Culture. 8,1, 1-11
Solmon B, Clouston TJ. 2016. Occupational therapy and the therapeutic use of self. British Journal of Occupational Therapy, 79,8, 514-516.
I have just spent a week in West Wales on a watercolour painting course. I do this every year if I can get the annual leave but I’m not an artist. Why do I do it then you may well ask? The simple answer is, I go to support my husband who is a professional artist and takes the course (if you’re interested in sublime watercolours and oils capturing the beauty of both the natural and built environment see his work here http://www.petercronin.org/).
I make lots of tea, smile a lot and am generally helpful; but I also go because it’s held in a beautiful spot and I catch up on writing, usually either a book or an article, depending on what’s on the agenda at the time.
But this year was qualitatively different. I could not settle into my writing routine; I could not focus on the article I was hoping to tackle, even though I was, and still am, burning to finish it in order to start another. Why was this, I pondered? And this is where it got interesting.
Those of you who have read the ‘Challenging stress… Finding balance book’ (you can buy it here https://goo.gl/ALsTiw) will know I believe that wellbeing is found in a personally meaningful life. My work as a Reader (associate professor) in Cardiff university is certainly part of my passion and writing one of the aspects of my job I find most satisfying; yet the workplace provides quite limited time to do this. It’s there on the schedules but it tends to become filled by meetings, developing new materials or strategies, marking and placement visits etc. You know the kind of stuff…Plagiarising Shakespeare a bit, it’s not the stuff that dreams are made of, or rounded with a kiss….it’s the hidden tasks and clutter we all have to clear off the desk as the next lot builds up behind it. Thus, my annual leave becomes a quiet and focused time for writing ‘catch-up’.
So what had happened to my ‘zen’ moment to write away from the constant interruptions of the workplace this year? Well, even though writing is a meaningful occupation, so something I inherently enjoy, I was reflecting on the fact that this year I didn’t have to write in my personal time. In previous years it’s been necessary to cope with the workload; but this year I had adjusted my role and my thinking to accommodate that (an important stage of getting a more balanced and satisfied life). I also felt I needed and wanted a little break from my annual leave writing routine; so I made an active decision not to write. The problem then was what do I do? Returning to the book, variety is the spice of life and does engender a more interesting existence (Clouston 2015) but when all around you have a purpose and you do not, you begin to feel a little out on a limb.
The rest of the group were all experienced painters and were industrious in their efforts to improve; they were focused and absorbed on their work, sometimes tussling with a challenging subject or technique. I could see their engagement and and feel their mindfulness as they lived each and every moment of producing their artistic endeavours; several were also clearly ‘in the zone’ or experiencing ‘flow’.
Flow is reached through focused attention and full absorption in an activity. It’s usually (although not exclusively) something you really enjoy doing; it’s something you need to concentrate on but also to have some skill or mastery in. Csikszentmihalyi (1997) describes flow as meaningful engagement, a sense of being in which people become fully absorbed and focused on the activity they are doing, because it is both challenging and satisfying. When in this sense of flow, people can often find time slows down; this is because you are so involved with the activity you experience it fully absorbs your attention and other issues become forgotten. This is a great way to manage stress and anxiety because you break the cycle, become more mindful and meditative and in the resulting relaxed state, can begin to put things into perspective.
Experiencing flow is a critical part of living a balanced lifestyle and whilst we may all experience this in varying degrees of depth, it is a state of being that will bring greater satisfaction and meaning to life. It was inspiring to see this happening first hand in the artists, and I could see how they benefited from their engagement and mindful attention.
Now I do experience flow in writing, but this year, at this point in time, I was seeing it as a task, driven by the outcomes I’d been given at work rather than a self motivated task. Letting go of the work driven agenda when it’s dominating life is another very important step to getting a balanced life (Clouston 2015); but because I didn’t engage in it, I was feeling a bit lost. So what to do? Well as I note in the book, variety is the spice of life and engagement in something positive in life other than work is good karma; so I did a couple of things I have always wanted to: I visited Skomer and saw puffins, fulmars, gannets, guillemots, black backed gulls, herring gulls, razorbills, peregrines and huge seals; the evidence of elusive manx shearwaters was everywhere. It was awe inspiring and I really enjoyed the experience. I got my pencils out and started to draw (I used to draw at school) and this is one of my etchings. I’m going to work on it a bit more for next year….my landscapes were not quite so successful! He is fondly known as Donald….this is nothing to do with his Scottish heritage…..it’s something to do with that hair cut……Any ideas?
Clouston TJ. 2015. Challenging stress, burnout and rustout: Finding balance in busy lives, London: Jessica Kingsley
Well at this point (like a lot of things) we can only imagine; but the EU has brought in legislation that has improved work-life balance for employees in Britain.
The working time directive (WTD) is probably the most well known and perhaps controversial of these. Introduced in 1998 the WTD has reduced the paid working week for employees in the UK to a maximum of 48 hours. There is a lot of flexibility around this, and it can be averaged out over 17 weeks, meaning some weeks can be much longer than others. Some jobs are exempt and there still remains an opt out clause in the UK that working people can chose to take if they want to work more hours. The WTD also legislates for the right to a day off each week, a right to a rest break if the working day is longer than six hours, and 5.6 weeks paid leave each year.
Now when you think that the whole amount of hours we have available to us in any 7 day week is 168 hours, you can begin to see why 48 hours is more than enough for paid work. Think about it. If you work the full complement of your 48 hours, you will have 120 hours left for everything else. You sleep (or you should sleep) 7-8 hours per night; more if you are a young adult. Well, working on 8 hours (let’s be kind to ourselves) that’s 56 hours you are asleep. Together then, paid work and sleep equate to 104 hours, leaving 64 hours for everything else. Depending on your perspective, your first thought might be “Well that’s more that enough. In fact it’s loads…..”. But in reality is it? In essence it depends on what you do in your life outside of paid work and how much control you have over how you manage both that and your workload; this sense of control is a critical factor.
So what do we do in the rest of life? Well of course, there are the basics we all have to do to survive: eating, toileting and self-care; these are essential and need time to be done well, if we are to maintain a healthy lifestyle. If we are to be happy as well as healthy, we also need to have strong loving relationships and social friendships. To create these takes an investment in time and energy; moreover this use of time and energy needs to be sustained across the lifespan, so that these relationships are resilient, strong and reciprocally caring. How many of you reading this can honestly say your family, friendships or both have not suffered because of the hours of time and energy you have freely given, or conversely have been taken, by paid work? On top of the demands of paid employment, we also have unpaid work to contend with. The latter includes the things you have to do in life, like housework, home maintenance, food shopping and other aspects of everyday drudge. For some people, this on its own, is a full time occupation!
Finally, but far from least, if we are to have personal meaning and a sense of fulfilment in life, we need a little time and energy left for those activities that are personally fulfilling; things we choose or want to do because they give use satisfaction, pleasure and joy. These personally chosen activities are frequently lost in the milieu of having to do paid work and meet the demands of everyday tasks we have to do at home (this is the unpaid work I mentioned earlier).
When you look at this complexity of life activity, it’s clear that 64 hours may not be enough to all these things well. Yet it is necessary to do them if we are to maintain our health and wellbeing.
Interestingly the UK rallied against the WDT when it was first introduced and did not want to implement it. Whilst we were unable to refuse, many people still work much longer than their maximum 48 hours, and are either coerced or feel they have to do so in order to get through their workload. Some of you might want to work longer hours and get satisfaction from that, and I’m not judging that; but we still have the longest working hours in the EU and remain less productive in our longer hours culture than our European colleagues.
In essence working longer does not mean working stronger or more productively; quite the contrary. Levels of work related stress remain excessively high in the UK, specifically in the public sector workforce. High workloads, lack of control, insecurity and limited support by management remain the causative factors.
Worse still, we now have an underclass of working people in Britain, whose human rights are being exploited, their wages driven down to the lowest common denominator by the use of employment agencies and unscrupulous employers. The recent reports about Sports Direct are tantamount to this and the Radio 4 report here is a shocking indictment of the market versus caring perspective. http://www.bbc.co.uk/programmes/p03xjyzn
So what will happen when we leave the EU in terms of work and life balance? With the instability of the market and the insecurity and fear that will create, the loss of unions fighting for workers rights, the lack of public support for mistreated workers and a limited, rather lack lustre approach to care and compassion for others, I am not so sure it’s going to be good.
For ideas and practical examples on how to live a more balanced lifestyle read: Clouston TJ (2015) Challenging stress burnout and rust-out: Finding balance in busy lives. London. Jessica Kingsley Publishers available here: https://goo.gl/BEupm4 and here: http://www.jkp.com/uk/catalogsearch/result/?q=Clouston
Living Life in Balance: Professor Teena J Clouston 