by John Page, Hackney TUC Secretary

Part one: What is work-related stress?

(You can read part two here)


We hear a lot about stress. People talk about being stressed out, how this or that situation is stressful. Stress affects us at home, work, and even on holidays.
We also hear too often that we should learn to ‘deal’ or ‘cope’ with stress at work. This implies that workplace stress is normal and that we need to ‘manage’ or ‘handle’ stress and just get on with the job. This view of stress is wrong.

Workplace stress is a serious health and safety hazard that can have devastating effects. Stress can lead to psychosocial illnesses, such as anxiety and depression. Stress can also contribute directly to physical illness; for example, tense muscles can worsen ergonomic injuries. Stress makes workers more susceptible to hazards, injury and disease.



While it is true that there are sources of stress other than the workplace, this does not mean that workplace stress is not a hazard or that it is the product of a worker’s imagination. The changing nature of work has increased the risk of workplace stress. Reorganisation, job insecurity, new technology, accelerated paces of work, along with many physical work hazards (eg. poor ergonomic design of workstations, poor ventilation, noise, etc.) can all contribute to stress. These causes of stress are all firmly rooted in the workplace. Also, stress that is experienced outside of work – for example within the family – often has a workplace component to it, or is in some way caused by workplace factors.



This guideline is focused on workplace stress – stress that is caused by and comes from the workplace. The word ‘stress’ is used with the phrase ‘workplace stress’ almost interchangeably, but it is used mostly as a more general term.



Stress is often related to control. Many workplaces have changed, resulting in less control for employees to direct their work. Less or low control over job tasks is often associated with high stress levels.



This guideline outlines the scope of the stress problem, assessing the issue, the causes, who is affected, and the hazards. It points members towards actions that can be taken, specifically outlining how to identify stress hazards, where solutions lie, and what strategies can deliver real change.



What is stress?


We know when we feel stress or stressed. It might seem the concept doesn’t need to be defined. It is also true that stress can affect people differently.
But part of the hurdle of addressing stress as a health and safety issue is to define the hazard:


Stress is a combination of physical and psychological reactions to events that challenge or threaten us. In normal circumstances, the stress response is a powerful protective mechanism that allows us to deal with sudden changes, dangers or immediate demands. In abnormal (i.e., highly stressful and/or prolonged stress) circumstances, stress overwhelms our protective mechanisms, leading to serious negative health outcomes.



This definition makes a key point that stress is often a result of combined factors – both physical and psychological. Similarly, the European Commission’s official definition of work-related stress is:


A pattern of emotional, cognitive, behavioural and physiological reactions to adverse and noxious aspects of work content, work organisation and work environment. Stress is caused by a poor match between us and our work, by conflicts between our roles at work and outside it and by not having a reasonable degree of control over our own work.



According to this definition, stress occurs when there is a poor match between workplace demands and a worker’s degree of control. We feel stress as a result of demands that are placed upon the mind and the body. Our reaction is called the Generalized Stress Response. Factors that cause this response and make us experience stress are called stressors.



Stress: a health and safety hazard



Stress is a health and safety hazard – plain and simple. Employers might like to believe that stress does not exist. They might argue that stress is ‘in your imagination’, a ‘personal problem’ or a result of workers’ ‘lifestyle choices’. Or they might regard stress as just part of the job. Those employers who do acknowledge stress on the job might argue that it should not be considered a health and safety hazard because stress is not visible, like more obvious hazards, such as exposure to chemicals, sharps, or confined space hazards. This is wrong. Like violence and overwork, stress is a significant health and safety hazard directly related to how work is organized. Workplace stress comes from how work is done.



The effects of workplace stress on employees are visible: illnesses and injuries negatively affecting members’ health and lives. Because workplace stress affects workers’ health, it must be seen as a workplace hazard and as a health and safety issue.



Normal and toxic stress


The definition used earlier describes normal circumstances for stress: stress is dealt with and then it passes. Our instinctive reaction to stress is to combat or flee the source of stress – known as the fight or flight reaction. With normal stress we can fight or flee. The response occurs fairly quickly and then the stress ends. The three phases of normal stress are:

- Stress comes (facing an immediate threat/demand).

- Stress goes (dealing with the stress).

- Stress is over (the body relaxes, no longer feeling stressed).



An example of normal stress is short-term anxiety because you have lost something important (eg. keys), or feeling temporarily stressed because your bus is stuck in traffic and you are late for work. When the item is found, or the bus gets you to work on time, your stress drops away and is eliminated. There are many day-to-day occurrences like these that cause normal stress. Toxic stress is another matter. As the name suggests, toxic stress is like a poison. This form causes the most damage, as the human body is not equipped to deal with toxic stress. Unlike normal stress that comes and goes, toxic stress stays with you, building up the harmful effects. The three phases of toxic stress are:

- Stress comes (facing a demand or threat that does not stop).

- Stress stays with you (you have no way of dealing with the stress).

- Stress builds up (you can never relax and the stress is not eliminated).

Workers can experience toxic stress when they are exposed to staff shortages, harassment, bullying, noise, systematic discrimination and other hazards. This form of stress often leads to negative physical and psychosocial effects.



Physical reactions to stress



Both normal and toxic stress affect the body physically, but toxic stress effects are more severe. The Generalised Stress Response is the phrase used to describe a variety of physical reactions to stress, such as:

- An increased metabolism, for example, faster heartbeat and quicker breathing.

- Increased blood pressure.

- Increased cholesterol and fatty acids in the bloodstream.

- Decreased protein synthesis, impaired digestion and immune and allergic response systems.

- Faster blood clotting.

- Increased production of stomach acids.

- Increased production of blood sugar for energy.

- Localised inflammation (for example, swelling and pain in joints, muscles, and skin).

- Widened airways directing more oxygen into the muscles.

- Tensed up muscles.

- Increased sweating to cool muscles.



Stress can also cause workers to experience sensations such as a dry mouth and difficulty swallowing, shortness of breath, a racing heart, butterflies or knots in the stomach, and tension, aching, shaking, or pain in the muscles. These physical reactions are immediate, instinctive responses to stressors. Over time, as these reactions occur too often – as normal stress progresses to toxic stress – it can translate into more severe physical and/or psychological effects, such as:


- Sleep disruption and disorders.

- Fatigue, apathy and lack of energy.

- Chronic aches and pains in the chest, shoulders, back, neck and elsewhere in the body.

- Depression and a general decrease in enjoyment of life.

- Changes in sexual activity.

- Conflict with family, friends, and co-workers.

- Weight gain or weight loss.

- Greater susceptibility to injury.

- Immune system depression, greater vulnerability to illness and disease.

- Other stress-related health problems, such as, ulcers, heart disease, headaches, irritable bowel syndrome, diabetes, and menstrual disorders.



Any combination of these effects can be very harmful to a worker’s health and well-being.



Stress myths and clichés


Here is a quick look at some of the misinformation about stress. Don’t be misled by employers and consultants who use phrases and make claims such as these:

- Stress is not a workplace health and safety hazard.

- A little bit of stress is healthy.

- Stress is good for you; it makes you more productive at your job.

- Stress comes from your home life, not the job.

- All we need to do is learn to cope with our stress.

- To deal with stress, all workers need to do is take a stress management course.

- Stress can be solved with exercise, breathing deeply and learning to relax more.



Here are the realities – key points to remember about stress:

- Stress is a health and safety hazard.

- Stress can have serious health effects.

- On-the-job stressors cause workplace stress.

- Stress is largely caused by poor workplace organisation.

- Trade union health and safety reps have a role in eliminating stress hazards.

- Workers need control over their jobs to eliminate stress.



Be wary of employers who claim stress is normal and unavoidable. Also be sceptical of employers who claim stress problems can be solved with stress management schemes, team-building exercises, and anything else that sounds warm and fuzzy. These are ‘sticking plaster’ solutions that do nothing to eliminate stress hazards. Stress management techniques only deal with the symptoms of workplace stress. They do not get rid of stressors. These programs do not prevent injuries or diseases. They are not a solution to workplace stress. Relaxation techniques, counselling and coping mechanisms offer only temporary relief from stress; they can assist those already damaged by stress, but unless the stressors are eliminated from the workplace they will have no long term success. Workplace stress hazards must be dealt with at their source through primary prevention – not after the fact. Preventing exposure to the causes of stress is the only way to eliminate the hazard.



What causes stress?



What are these stressors and how do we pinpoint them? Here are a few causes of stress:


- Too many demands at one time.

- Deadline pressures.

- Uncertainty.

- Office politics and hostile management.

- Lack of training and direction.

- Racism and other systematic discrimination

- Lack of windows and natural lighting.

- Violence, threats and bullying.

- Too many bosses.

- Working alone.

- Low morale among workers.

- Risk of injury and disease.



Work organisation, lack of control and excessive demands



Work organisation factors cause stress or make stress worse. How jobs are designed, carried out, and the degree to which workers participate in the decision-making process at their workplace can result in stress.



Work organisation has been defined as the “work process and the organisational practices that influence job design.”



Work organisation also includes broader considerations, such as the economic, social, political and legal environment. These are important elements as they can affect new work organisational practices. The following are among the many work organisation factors that can cause stress:

- Lack of control and conflicting work demands.

- Lack of participation in decision-making and lack of autonomy (ie. independence and ability to self-direct) at work.

- Lack of training and direction, and changes in work organization.

- Lack of recognition of work done and lack of respect from supervisors.

- Repetitive, boring and meaningless work.

- Unclear and conflicting work responsibilities.

- Low pay, lack of career development opportunities and job instability.

- Too much or too little work, overwork or under-use of skills.

- Poor communication, new technologies and time pressures.

- Outsourcing, downsizing, mergers, staff cutbacks, restructuring, and other large-scale work reorganisation schemes.

- Repressive ‘blame’ management styles and techniques.



Control is a central work organisation factor linked to stress. Lack of control at work can make workers sick. It comes from not having the ability to decide how a job is done. Examples include not being able to decide the pace of work, or what tasks get done in what order. If a worker cannot control these elements, if they do not have the leeway of action to make decisions about their job tasks, then they will have higher stress levels. Control is different from power. Control concerns factors within the job – how the job and its tasks are carried out. Power is broader than control and concerns decisions such as when work is scheduled, whether a worker will have or retain a job, which workers will get advancement within an organisation, and other larger scale decisions. Uncertainty over these broader power factors can also cause stress.



If workers have excessive demands placed upon them, they will suffer stress. For example, if workers are given unreasonable deadlines, are bullied by their employer to work overtime, and are forced to work through breaks, then they are facing excessive work demands that can cause stress.



When lack of control is combined with high demands, a worker will almost certainly suffer high stress levels. These factors can create toxic workplace stress, causing increased heart disease and possibly death, depression, exhaustion, low self-esteem, and increased upper extremity musculoskeletal disorders.



Overwork



Overwork – like stress – is a work organisation health and safety issue. It is characterized by:


- Long and difficult hours.

- Unreasonable work demands.

- Multi-tasking.

- Pressure to work overtime (paid and unpaid).

- Fewer rest breaks, days off, holidays and vacation.

- Faster, more pressured work pace.

- Performance monitoring.

- Unrealistic management expectations.

- Additional, often inappropriate, tasks piled on top of ‘core’ duties (eg. doing more than one job).

- No replacement during sick leave, holidays and vacations.



Overwork affects our quality of work. When workers can’t get the job done the way they want it done, they will experience stress. In overwork conditions, the protective mechanism of the stress response breaks down due to fatigue, overexertion and other factors. The stress that results is not given enough time for release and instead builds up, leading to toxic stress. Stress and overwork go together. These two health and safety hazards are both consequences of poor work organisation. Long hours, shift work, and night work are stressors related to overwork. These stressors can disrupt workers’ family and social life, increase fatigue, create sleep deficits, affect concentration, increase exposure to chemical hazards, and make workers more susceptible to workplace injuries and illnesses. All of these factors can also contribute to higher stress levels.



Flexible working patterns



Flexible working, when it is agreed between the worker and their employer, can be a method of reducing stress and increasing work/life balance. However, when flexible work patterns are imposed on workers without their agreement, it can dramatically increase stress.



Casual, reduced-hours, temporary and split shift work can also cause stress. Short notice for fulfilling work commitments can create stress for casual and temporary workers. Split shift workers experience job stress due to constantly juggling work, family and social commitments, often putting family and social lives second to work demands.



Physical working conditions



Physical work conditions can also be stressors, such as:

- Noise and vibration.

- Poor and inadequate lighting.

- Temperature extremes – too hot or too cold, or too much variation in temperature.

- Overcrowding, poor spacing and work area layout.

- Exposure to toxic substances.

- Ill-fitting and poorly designed work tools, furniture and workspaces.

- Poorly maintained work environment.

- Poor indoor air quality.

- Bad building design.

- Working with hazardous equipment.

- Lack of outside amenities and bad site planning – such as no parking, no access to public transit, no proximity to green space and recreational facilities.



Any of the above can cause or compound stress. Many of these stressors are also linked to work organisation. For example, studies have correlated high, ongoing noise disturbance and low speech privacy at work resulting from poor work organisation, with elevated stress and reduced job satisfaction. Other physical factors, such as the absence of windows and natural light in a workplace, have likewise been linked to higher stress levels for workers.



Job insecurity, cutbacks and reorganisation



Many workplaces have changed in recent years. Cutbacks, privatisation, reorganisations, and downsizing have contributed to a heightened sense of job insecurity. There have been huge cutbacks and downsizing in the public sector, along with a massive shift towards privatisation. At the same time, public needs and expectations have not decreased. If anything, they have become greater. Cuts in staffing levels have imposed higher demands on workers and can be a significant cause of stress.



Bullying, discrimination, harassment and violence



These three hazards can cause stress and are again linked to work organisation. Bullying has become a more widely-recognized hazard in recent years. The public sector union UNISON defines bullying as:

Offensive, intimidating, malicious, insulting or humiliating behaviour, abuse of power or authority which attempts to undermine an individual or group of employees and which may cause them to suffer stress. Bullying can create a dangerous, debilitating and negative workplace climate that elevates workers’ stress levels. As a result, workers may suffer headaches, back pain, stomach ailments, insomnia, depression, fatigue, anxiety and even suicidal thoughts.



It is specifically unlawful to discriminate against people because of their race or ethnicity, their religious or similar beliefs, their gender, marital status, disability or sexuality. It will soon be unlawful to discriminate on the basis of age. Despite the law, discrimination is widespread and is a major factor in stress.



Harassment includes physical or verbal abuse; threats; slurs; insults and deliberately creating a hostile environment. Harassment has been defined as behaviour in the form of repeated and hostile or unwanted conduct, verbal comments, actions, or gestures, that affects an employee’s dignity or psychological or physical integrity and that results in a harmful work environment for the employee. Sexual harassment is a widespread problem that can cause major psychological damage.



Employers are obligated to prevent harassment.



Harassment like bullying, creates a workplace climate hazardous to workers’ health and safety. Harassment is also linked to physical symptoms, such as stomach ailments, headaches, nausea, over and under eating, sexual problems, and deteriorated interpersonal relations. Violence is still a significant hazard workplaces. The presence and/or threat of violence at work can contribute to elevated stress levels. Violent incidents at work make a deep impression, leaving workers on edge and stressed for long periods. This can include violence or the threat of violence from service users.



What are the symptoms of stress?


The following is a list of some of the symptoms arising from workplace stress:

- Headaches and tension.

- Chest and stomach pains.

- Joint and muscle pains; arthritis.

- Increased use of alcohol and drugs.

- Lower interest in sex.

- Feeling angry and aggressive more often.

- Weight gain and weight loss.

- Feeling anti-social and idle.



Psychological disease and social and behavioral changes



Stress is a known cause of many psychological diseases and disorders, as well as many social and behavioral changes, such as:


- Depression, feelings of apathy and low self-worth, crying spells.

- Anxiety, increased tension, fearfulness.

- Changes in eating habits.

- Sleep disorders, insomnia, fatigue and exhaustion.

- Irritability, mood changes, constant negativity, over-reaction and irrational behaviour.

- Inability to concentrate and see tasks through to their conclusion.

- Burnout.

- Sexual dysfunction.

- Increased use of drugs, alcohol and tobacco.

- Paranoia and social isolation and withdrawal.

- Suicidal thoughts.



Many of these outcomes can severely affect workers’ lives. Descent into acute depression, for example, can cause workers to be off the job for years and end careers prematurely. The effects of stress can also devastate workers’ family and social lives.



Studies have connected stress and psychological diseases. For example, high job demands among male power-plant workers have been associated with depressive disorders. Depression has also been linked with specific workplace stressors such as lack of job satisfaction, workplace role conflict and ambiguity (not knowing what your job is).



Heart disease and other physiological outcomes



Exposure to job stress increases the risk of heart disease and other physiological problems. The physiological reactions to stress described earlier with the Generalized Stress Response can be early triggers of more severe heart problems to come. Heart disease is the leading cause of death in the UK. It includes coronary heart disease, hypertensive disease, heart and circulatory system disorders, and other conditions. Stress in the workplace has been directly linked to many of these diseases. High stress can make the heart beat faster, which can lead to excessive oxygen intake in the heart muscle. This can increase the possibility of heart attack. Stress can also upset the heart’s cardiac rhythm. Numerous studies correlate stress and higher rates of heart disease. Stress can also make workers vulnerable to other diseases, including:


- High blood pressure.

- Headaches and migraines.

- Impaired digestion – due to a decrease in intestinal movement.

- Menstrual disorders – there is some evidence of an association with stress.

- Ulcers – from lowered blood flow.

- Irritable bowel syndrome – there is some evidence of a link with stress.

- Diabetes – from excessive levels of fats and glucose released into the bloodstream.

- Various illnesses – from lowered immune function due to stress.



Personal and family-life conflict



Like any workplace hazard, the effects of stress can spill over from work and have an impact on workers’ lives with their family and friends. With stress – especially with toxic stress – workers continue to suffer outside their working hours. Family and personal relationships suffer. The deterioration reveals itself in relationship problems, family breakdowns, domestic violence, increased use of drugs and alcohol, isolation and withdrawal from personal relationships, reduced interest in sex, and other psychological outcomes. Stress can contribute to exhaustion and fatigue, causing workers to lose interest in or feel too tired for personal or family hobbies and recreational activities. This can intensify the negative effects of stress, creating a vicious circle. Striking a balance between work and life/family can be a difficult task. Juggling childcare arrangements, sick family members, elder care, and extended family responsibilities are difficult on their own. When stress is added to these responsibilities, workers’ ability to meet all of their commitments becomes harder. Something has to give. Workers’ and their families’ wellbeing are typically what suffer most.



Workers divided



Stress can create conflict in the workplace that shows up as anger, frustration, envy and mistrust. These can be destructive forces in a workplace, especially if directed at fellow workers – someone to blame other than the employer. Co-workers, stewards, staff representatives, and other union workers might become targets. Conflict can isolate workers from one another. Some may even blame themselves for their stress, compounding the problem. These circumstances divide workers and harm union solidarity.



It is vital to understand that workplace stressors – such as how work is organised by your employer – cause the stress, not co-workers or the union. Don’t let employer techniques such as performance monitoring and surveillance devices create competition and resentment. In a divided workplace, the employer gains and workers lose. There is strength in numbers. When confronted by stress hazards, workers need to remember that solutions and strategies for change depend on worker solidarity.



Work-related upper limb disorders



Stress can contribute to work-related upper limb disorders (WRULDs), also known as Repetitive Strain Injuries (RSI) and Musculoskeletal Injuries (MSI). WRULD is a catch-all phrase for various injuries (eg. carpal tunnel syndrome, epicondylitis). These injuries usually involve repeated trauma to muscles, tendons, and peripheral nerves. WRULDs have a work organisation component. Ergonomic injuries do not only result from manual working techniques, for example, how a worker holds a mop when mopping, or how a worker lifts materials. The effects of stress due to poor workplace organisation can also contribute to an ergonomic injury. Specific stress risk factors that have been linked to WRULDs include:


- Job dissatisfaction.

- Intensified workload.

- Monotonous and repetitive work.

- Low job control.

- Role uncertainty.

- Inadequate work-rest cycles.

- Limited social support from supervisors.



Workers are more vulnerable to WRULDs when suffering specific physiological reactions to stress. Stressors stimulate the autonomic nervous system, triggering the release of adrenalin and noradrenalin. Muscles and tendons then tighten, reducing the flow of nutrients to the tendons. These tendons will not self-heal if there are microlesions (small injuries) to the tendon fibres caused by ergonomic strain. The result: chronic muscle fatigue and muscle pain. An activated central nervous system (brought on by stress) can also cause corticosteroids to be released. This has been linked to tunnel syndromes. The central nervous system also releases cytokines that can cause tendon inflammation, contributing to or causing WRULDs.



Burnout



Working under continually stressful conditions can lead to burnout – the end result of physical and mental exhaustion caused by exposure to toxic stressors. Some symptoms of burnout are:


- Emotional exhaustion, feeling emotionally overextended and nearly depleted of emotional resources.

- Negative feelings, irritability, and a deteriorated sense of self-image.

- A decline in feelings of competence and a decrease in work performance, feeling helpless and hopeless.



Specific workplace stressors that cause burnout include role conflict at work, lack of control over one’s job, and lack of social support on the job. Sufferers of burnout can be ill and away from work for long periods. Burnout is directly linked to stressors at work. Stress often results in increased absenteeism and extended leave to recover from burnout and other negative health outcomes.



Combining effects of stress and other diseases



The effects of stress can work ‘synergistically’, combining with other illnesses and diseases to make worse those illnesses and diseases. Workers who suffer toxic stress levels at work are more likely to catch a cold. Their stress levels make them more vulnerable to viral infection. In Finland, researchers studied the synergistic effects of stress and heart disease among manufacturing sector workers. The study found that workers suffering high stress levels had twice the risk of death from heart disease than workers in the same jobs that had low stress levels. A study of telecommunications workers looking at ergonomic injuries found higher rates of upper extremity musculoskeletal disorders among those with high stress levels caused by job pressures and low decision-making control at work.



If workers suffer the effects of stress, they are at greater risk of other illnesses and injuries.

Critical incident stress



This condition – sometimes known as post-traumatic stress – can occur when workers are exposed to a single, severely stressful circumstance, such as a natural disaster, road accident, murder or assault. Critical incident stress is a serious condition that requires professional treatment and care. It is a serious health and safety hazard that must be prevented. In workplaces where there is the chance of critical incident stress affecting workers, programs to respond to workers’ needs must be in place. All steps should be taken to prevent critical incident stress. Critical incident stress is beyond the scope of this guideline, which focuses on normal and toxic stress.



This introduction to stress is based on ‘Enough Workplace Stress: Organizing for Change’ produced by the Canadian public service union CUPE.