Women at Work - The Essentials: Dealing with Stress

0:02You're listening to Women at Work from Harvard Business Review. I'm Amy Bernstein. This episode is part of our series, The Essentials. In it, women whose work is critical to all our well-being bring their perspectives, questions, and insights to conversations about key career topics, like stress. Sarah Rose Lamport, a nurse practitioner, knows a lot about dealing with stress.

0:28She practices palliative medicine at a large teaching hospital and specializes in caring for people with life-threatening illnesses. In this conversation, she's helping me and hopefully helping you better understand stress and manage it. The role of a palliative care provider, we go see.

0:48the patient and really try to get a sense for their needs. You know, develop a meaningful connection with them to provide them the best kind of care in what is almost always a really, really difficult time. It's an inherently stressful job any day. The pandemic heightened the mental and emotional strain. Sarah Rose made every effort to bond with her patients while cloaked in a mask, gown, and gloves.

1:16All the while, like so many of us, she worried about her family, how her five kids were holding up. At times she found herself feeling exhausted, overwhelmed and anxious, but also incredibly grateful to be able to go into work.

1:32I left my husband in the morning at home with all of these children ostensibly being schooled at home while he's trying to work. And then I got to go someplace and connect with my colleagues. And even though it was really difficult and challenging, I also got that support from that connection with my colleagues, which was really valuable. How people deal with stress at work is complicated. That's what makes studying it so interesting for Mandy O'Neill.

1:59Mandy's a management professor at George Mason University and a scientist at its center for the advancement of well-being. Healthcare is one of the industries she focuses on. The last time Mandy was a guest on the show, she explained burnout and gave us advice for managing it. And now she's back, this time to talk about stress. Sarah Rose, Mandy, thank you so much for joining us. Thanks for having us. Yeah, thanks so much. Sarah Rose.

2:28This has been an incredible year, particularly for someone in your line of work. What did you learn about how you experience and deal with stress? I think I learned that I needed to make space for being quiet and connecting with my body and feeling safe. A lot of it really came from a place of kind of everything breaking down.

2:56And when I say everything breaking down, I think I mean the stress level at work and specifically at the hospital going up so much. But then also in my home life, losing so much of the support, like an informal care network and friends coming over and all of those things. So I learned, I guess, how chaos feels.

3:22And out of necessity, I had to find things that grounded me and helped me keep going in a productive way. So are these sort of new coping mechanisms for you? Yeah. And what are they? So I'm very lucky to have my own office and my own space. And so I'm able to roll out a yoga mat and do two minutes of stretching and breathing. During the pandemic, the institution made a lot of effort to try to prevent burnout by trying to give space and time to people to try to process what was going on to avoid that. And I think it was really helpful. Mandy, when you were on with us talking about burnout, you made the distinction between burnout and stress. I wonder if you could talk us through that difference right now. It seems like an important one to keep in mind.

4:15Burnout and stress are very related, but stress has a different physiological profile. When people are burnt out, interestingly, they react in a way that allows them to keep going. Whereas stress, in a way, especially when it doesn't reach the extreme levels, can actually be our body's way of telling us that we need to slow down, that we need to cope with the threat or the stressor that's in front of us. So in that way, it serves a somewhat functional purpose. Even beyond this idea of emotions as signals, as information about the environment, we have this physiological response that's very adaptive, actually.

4:52To the extent that our body changes with stress, you know, there is some evidence that can actually improve performance in the short term and again in moderate amounts, you know, increased blood supply, the heart speeds up, it improves lung function. So there's this slight performance boost and it's good until it becomes unabated because when we get to that extreme response, the body actually weakens.

5:15from all this oversimulation and all these stress-related chemicals. So it's sort of interesting because if you talk to athletes, if you talk to performers, if you talk to creative spirits, if you talk to anybody preparing for a big exam, they might tell you that the stress actually motivated them to perform at their highest level and it got them through it and it really pushed the limits. But then that's just it. When we push the limits, that's when stress becomes problematic. And people don't often know where that line is. So Mandy, help us. How do we see this turning point? How do we keep stress from turning into something dangerous and unhealthy? I think emotional intelligence and at the most fundamental level, emotional intelligence is recognizing our own emotions and managing our own emotions. Part of recognizing our own emotions is recognizing our physiology. So we can feel our heart beating. We can feel our breathing increase.

6:13But we can also feel when it starts to have an effect on our body in a dysfunctional way, but people are often very out of touch with their own bodies. And I think that being more in touch with our own bodies, recognizing those emotions is a key part of it. And also knowing that it has a short-term effect, but long-term is where it is the problem. And I think this is where people get so caught up in routines, they get caught up in their lifestyles, they don't take time to stop, you know, just to say stop.

6:43and really discharge, really focus, really engage in self-care. Sarah Rose, it sounds like you have some really good ways of recognizing that and yourself. I think they've definitely gotten better during the pandemic. But there's definitely also still that temptation to push through and keep going. And there are always more people that need help. And you always want to be the most helpful colleague.

7:11I think your advice really resonates that paying attention to your body and that there are specific signals you can look for and listen to is really helpful. Mandy, how do we release the stress when it builds up like that? This is going to sound like a very simple answer. And I'm sure everyone's physician has said the exact same thing, but exercise is one way.

7:36But exercise is challenging. And I speak to that from a very personal place. You know, you think, well, if I take time to exercise, then I don't have time to get done this one. Those 30 minutes I could spend doing something else. But it doesn't actually take all that much time to just incorporate exercise, especially in the mornings, especially when it's aerobic exercise. You know, there's some evidence that it actually improves brain function. So if I take my own advice, I would be out there exercising. But I would say that another important release of stress is connecting with others. So I think some of the most fascinating research is building on this idea of the fight or flight reaction. We used to think that there were only these two reactions to stress or to threats, which is fight or flight, but we now have this idea of

8:21tend and befriend. And I think that's just such a fascinating concept because it suggests that the old models we had really are sort of antiquated because we have this, and this is actually biological in origin, we have a tendency to also connect with others during times of stress and distress. And I think that that's an important lesson too. So maybe we go exercise a little bit in the morning, but then we take the time to really connect with people.

8:48And that could be friends, that could be coworkers, that could be family, but really prioritizing that interpersonal connection. And some of the emotions that come with it. So my own research has focused on joviality and laughter.

8:59Sarah Rose, I think that in healthcare, there's a big role played on humor and sort of laughing about some of the most stressful situations. Yeah, I feel like humor is really important in connecting, but also in just blowing off some steam and kind of resetting that stress. And we do a lot of debriefing together, and there is definitely some humor interjected that really helps kind of keep everything balanced. So, Sarah Rose.

9:30What does stress look like for you at work? Well, stress at work I think of in different ways in relation to the people that I'm interacting with and the kind of stressful situation. Specifically, I'm thinking of stress related to patients as being one thing that I feel like I have a pretty good toolkit of coping skills to handle versus stress related to institutional issues or issues with colleagues where I find I have a lot more unresolved stress and have more difficulty managing it. Sarah, can you describe how those different forms of stress manifest themselves? For example, when you're dealing with patients versus dealing with coworkers versus dealing with institutions, maybe in terms of the way you cope with it or just the way it manifests itself in your own reaction. Yeah, so

10:25I think stress with patients, it feels like an external kind of stress. It's something that I take into my heart because I care for my patients and I want to honor their stories. But I feel like I do have some boundaries around that in a way that I feel like I can kind of have peace with it even when it's very hard. Whereas stress with my colleagues, when there's a conflict, I often will start having these kind of negative thoughts about myself that I know aren't totally rational. And I find it much more distracting and harder to have boundaries with. That's interesting. I wonder how do you and your colleagues deal with conflict? Because that's another example of where there's a possible...

11:14remedy for some of the stress, which is having constructive ways to deal with conflict when it arises. You know, I feel like sometimes we handle it really well. And by well, I mean, from my perspective, sitting down and talking about it, talking about our perceptions and if somebody is feeling hurt, how we can help them feel better and work better together as a team. When I feel The conflict is more troubling is when that doesn't seem to be working. Sometimes it becomes this kind of thing that we all just sort of start living with and nobody really wants to deal with. And it's really easy to just kind of keep pushing through and ignoring it. When the collegial dynamics are working really well, they are the most amazing source of support in my work. Mandy.

12:09When you listen to Sarah Rose, what are your thoughts about workplace relationships? I'm hearing a couple of themes, one of which is the importance of workplace relationships.

12:22there's some ambivalence around workplace relationships. There's this notion that friendships at work are sometimes problematic. You don't want to get too close to colleagues because at the end of the day, they're colleagues and you might leave the organization or you have work to get done and friendships can get in the way and can cloud your judgment. But I think what this brings up is the importance of relationships at work, including managing them when they become problematic.

12:49That's part of building strong relationships is managing the conflict and some of that has to deal with individual conflict styles So if you have two people who are very conflict avoid versus two people who are very Confrontative you know that can cause different sets of problems, but I think recognizing our conflict styles and dealing with conflict in a productive way is a big part of that relationships, particularly when things are not going well, when the stressors at work are putting strain on our relationships due to the pandemic. Talking about the conflict between colleagues or just not working as well as we want to together versus, for me, I have this separate struggle with setting boundaries with work.

13:36entities and home entities, meaning my family. And I think I struggle with that specifically because I don't want to disappoint anyone. But I also am really cognizant of needing to take care of myself. And I feel like the pandemic has made that even more clear to me the importance of that. And I wonder if Mandy has any advice for how to do that better. Boundaries need to be set with colleagues.

14:02and with family members. So I think that sometimes the boundaries are with colleagues who, for example, might be causing additional stress due to their emotions. One of the concepts that we talk about is emotion contagion. So catching other people's emotions. So for example, if you have a colleague who is extremely anxious all the time, you might catch their anxiety and it increases yours. So One of the remedies for that is what we call situation selection. So for example, if you know that going into the break room is going to mean running into this person and they're going to start talking about everything that's going on and this and that and you know yourself and you know that you're susceptible to catching their anxiety.

14:46then the remedy is, well, maybe don't go in the break room. If you know they're on shift or you know they're at the office at the same time as you, maybe that's the time you go into the meditation room instead. So engaging in situation selection. But sometimes it involves having a conversation with those people because you just can't avoid them. So think about a family member. I mean, one of the things that has come up in the pandemic is the centrality of family or whoever you're cohabitating with.

15:12you can't get away from them. I mean, you could go in your room and you could close the door, but they can find you there sometimes. And so that's at a time when situation selection might not work, that you may actually need to engage in meaningful conversations around setting those boundaries. And I think that the key here is how to have those difficult conversations. In my experience, it's important to speak from a place in which you can elicit compassion, both compassion for what they're going through, if they're causing a source of stress, but also have them engage in perspective taking for what you're going through so that they can notice and respond to pain that you have. I find that much more productive than, for example,

15:54you're stressing me out you know i need to stay away from me or i need some space from you i mean that you know that sort of elises a defensive mechanism whereas with a little bit of emotional intelligence we can sort of recognize what are the sources of their stress and anxiety but also get them to recognize you know the impact they have and from a place of compassion.

16:15What I'm hearing you say in some ways is how important it is to have that awkward conversation when you can't realistically avoid something. And I tend to avoid things when I'm worried about disappointing people. So I think maybe this is a good nudge for me to kind of be aware of when that's happening and just try to make peace with that feeling and move through it.

16:44if you could talk about some of the other sources of stress in your work? Yeah, I also feel like I struggle with stress in prioritizing competing demands when I'm at work. And specifically, when there are multiple things that feel really important, and I know that I don't have the time or emotional energy or physical energy to take care of all of them, I struggle with prioritizing it, but then I also struggle with, you know, letting go and making peace with not being able to do all of those things. And I find like that's definitely a source of stress for me. And I wonder if you have any thoughts about that, Mandy. Roll conflict and job demands are common across all jobs. So your experience is not alone. It's absolutely the case that multiple

17:38Types of requirements for our job or competing for our attention and it's hard to prioritize and it's hard to disappoint people as you said It's hard to let people down. It's hard to let yourself down So sometimes we can engage in a triage system where you know I use this kind of knowing that this is very meaningful on your work But what are the most important demands? I also think it's important to think about our own values because at some level We're not going to be able to do everything at work and our own values might compete with what our workplace is telling us to prioritize. And so that's a really important opportunity for us to think about what are my values? What's important to me? What do I think is the best way to achieve certain ends? And am I living according to my values?

18:23And then, secondarily, it's important to think about what's valued in the culture. And sometimes there's not a fit. And I think that's where the real challenges happen, where, for example, you might think that spending the extra time on one of the priorities is more important than what the organization thinks is important. And that's, I think, where it gets into a different kind of stress where, interestingly, I think there's an opportunity for coping with it that's a little bigger than just us. So far, We've talked a lot about how individuals manage stress, how stress is an individual experience that is dealt with differently depending on your own coping skills, depending on your perceptions. But I think there are opportunities for deciding, is this a widespread or a common reaction to a stressor in the environment? If so, then maybe our own coping strategies aren't necessarily not only not going to be able to change it, but maybe there's a shift to focusing on

19:19the work environment that might need to come up with a more collective solution, a stressor reduction that not only benefits. one person but benefits everybody because it may be for example the organization is completely unaware that you know while it says one thing is important like you know let's say patient care it might actually be putting pressure to reduce costs or to increase efficiency and there's a conflict there so it may be that you know the organization is completely unaware of the ways in which some of this is transmitted and so I think in that case it's important to think about what happens when the stress is widespread.

19:55how can we mobilize others to change the environment rather than just assuming that it's our job as individuals to fix the problem? That makes so much sense to me and I feel like specifically talking about when our values come into conflict with institutional values and I find myself thinking about being in the hospital and wanting to get the best care for my patients and having it not be something that I can actually do in that moment or even in that admission or maybe ever and because of institutional roadblocks that feel like they're in place to save money. That conflict is so, is so stressful but it definitely is not just me and it's definitely kind of a shared stress among staff because I think most people if not all people who go into healthcare go in because they want to help people and everyone understands that you can't help all people in all situations but when it becomes this

21:00frequent situation where you're not able to provide the help that seems like it's appropriate and reasonable and it starts to feel really unmanageable. It's really important to recognize when your stress is shared and when it's not just your own stress and I think in those situations it's helpful to mobilize people but also for the organization to have outlets to let that voice be heard. And not just in the form of complaints, by the way, because sometimes we have this distinction between, you know, promoted voice and prohibitive voice, which is the idea that sometimes when we're bringing up ideas and suggestions, they can be helpful. And my sense is that organizations are generally...

21:43very open to that. But if it ends up being a mechanism just for complaints and management tear downs, I think that's less helpful. So pushing the issue toward more promotive voice, speaking up about ideas and suggestions.

21:57rather than just complaining. But I think on the institution, it's important to have mechanisms to let this voice be heard. So sometimes institutions create roadblocks and barriers to listening to people. And it may have to do with the difference between when you're in a management role, when you're in a supervisory role, when you're in the role of top decision maker, you've got your own set of stressors and you're dealing with them every day. But it can allow a little bit of a disconnect between what's happening at the top and what's happening on the front line. And if there are no institutional mechanisms for that communication, I think that's where the problems start to rise, because there's just simply a lack of awareness. It's not necessarily a resistance to it as much as a lack of awareness. And by the same token, I think sometimes it's difficult to empathize with what's going on with the boss or with management too, because there are stressors that

22:48You know, absolutely important. I mean, fundamentally, we need the organization to run and to function and to be funded and to survive. So that's an incredible stressor. But I think there's a sweet spot where at the front line, there are ways of suggesting helpful.

23:04mechanisms for improving upon some of the stressors that may actually be compatible. So there's a congruence there between some of the problems experienced and some of the solutions that may be very interesting to management, but they're just simply unaware. Yeah. When you are dealing with that clash of values between the institution and individuals, let me ask this of you, Mandy, how do you make that decision about when to take on the added stress of trying to effect change as an individual. It's important to think about doing a self-assessment before taking on stress. Are you in a position to take on the stress relative to maybe some other time in your life? So for example, if we think about our resources, you know, stress is a little bit of an equation around the threats or the

24:01the potential harms that we're facing, and the resources that we have to deal with it. So I think the first step is an assessment of, do I have the resources to deal with it? And if the assessment comes up, no, then probably it's not a good idea to take on that stress versus, yes, I have the resources to take this on, that has a secondary assessment of, is this important enough for me to take on? If this is an incremental change that isn't going to be worth the time, worth the effort, or might introduce other bigger problems, then maybe it's not worth taking on. But if it's something where it'll be painful for a little bit, but the consequences of it could be potentially beneficial.

24:42much more so than the stress involved, a little bit of that calculation involves. Sometimes people even come up with decision matrices, if then scenarios, like if I do this, what will happen? What are the consequences? What do I have right now? And I will say that for people in the pandemic, a lot of the resources that they had went away. And that includes the sort of help, the kind of support that they had that they relied on, myself included. And then the demands and the stressors went up. So that sort of ratio of the demands and the stressors and the resources that we have got a little skewed so people were less able to take it on. I want to flip that scenario a little bit. What advice do you have, Mandy, for not taking on other people's stress? For not, you know...

25:30absorbing it all yourself. We talked about boundaries. I think setting boundaries is an important part of not taking on other people's stress. Sometimes removing ourselves from the situation. So we talked about if there are certain people for whom the stress is just so potent and the anxiety is so contagious, we may actually need to separate ourselves a little bit from some of those people and some of those situations to the extent that we can. If we can't, so if we can't actually change the situation, then we have to think about how we engage in coping with this. So there's a distinction between problem-focused coping and emotion-focused coping. Problem-focused coping is changing the behavior in the environment and eliminating the stressor or the harm.

26:16Emotion focus is if we make the assessment that we can't change the environment, then we need to regulate our own distress. Even breathing exercises, there are some individual strategies that we can engage in that has been shown and proven to reduce our stress. And this is not the panacea. We tend to put too much emphasis on these individual strategies. But certainly, if we've decided that we can't change the environment, we can certainly engage in some of these self-care.

26:44mechanisms to help reduce the stress physiologically. I also want to point out the important role of managers in recognizing this in employees. Again, we put a lot of emphasis on us fixing our own problems, but I think it's a good opportunity for managers to recognize stress in their direct reports and to say, you know, you really need to take some time off. Again, it's interesting, but people are so reluctant to take time off that sometimes it actually takes the manager, takes the organization to say, you actually have to take some time off. Oh, and by the way, you're not allowed to check email or you can only check email once a day. And it's in those times that people recognize the effect of stress on their own body. So sometimes people just, they cannot recognize it. They're so in the routines that it might actually take really supportive supervisors or colleagues to recognize this in others. Yeah. So Mandy, what you just said resonates.

27:43really deeply with me. I have found over the last year that people's diligence has kicked in in a really big way. And reminding them that they have to take their vacation. It's for their own good. It's for everyone's good. Has become sort of a regular conversation for me with my team. And also just being a little extra sensitive to a shift in mood, a change in the tone of voice because the kind of stuff people are dealing with right now, we would never have thought about it before, but because there are no boundaries between home and work, we're forced to think about them all the time, right?

28:30Yeah, sometimes the clues are on people's faces and sometimes it's in the silence. So I had a time, a really stressful time and usually I was really prompt at responding to emails to this one colleague.

28:43And suddenly, my email response time went down. This colleague knew me really well and knew something's up. She's just not responding as quickly. And that started a conversation in which she said, hey, is everything OK? And actually, things weren't OK. And it was extraordinarily helpful. And I appreciated so much that she recognized that invisible signal, as it was, that maybe something wasn't OK. And having that close relationship helped to make it better.

29:13That makes a lot of sense and that people can send signals of distress that aren't always, you know, verbal or they can be behavioral or they can be quiet. I do want to thank you both. Mandy, thank you so much for helping us figure out what's going on here and how to manage it ourselves and Sarah Rose for everything that you do every single day and for sharing your story with us. Thank you so much for having me.

29:46Thank you so much for having me, too. That's our show. I'm Amy Bernstein. Stress is a topic that HBR covers extensively. You'll find plenty of insight about it on our website, hbr.org. We also published a really useful book, The HBR Guide to Managing Stress at Work. Our editorial and production team is Amanda Cursey, Maureen Hoek, Adam Buchholz, Tina Toby Mack, Erica Truxler, and Rob Eckhart.

30:18Robin Moore composed our theme music. Get in touch with us by emailing women at work at hbr.org. Thanks for listening and take good care.