Managing workplace anxiety

1. Ron Salomon MD
Faculty and Housestaff
Wellness Programs
Thanks to V. Flynn, MD
Managin
g
WorkplaceWorkplace
AnxietyAnxiety

2. Conflicts
• No conflicts of interest
related to this talk
• No IRB disclosures
• No IACUC involvement

3. Goals
Anxiety and stressAnxiety and stress, actually, ARE things to worry about.
Besides taking control of your energy and attitude,
it can affect your career and your general health.
There are ways to help
bring it under control.

4. Participants will be able to
- Recognize: stress and anxiety at work is common
- Understand: symptom severity changes with
- Challenges – number and intensity
- Internal and external support – availability and qualities
- Appreciate: psychological perspectives, separating
- Personal coping
- Pressures of managing illnesses in patients
- Find: resources for self-help and professional
assistance

5. Some stress is good.
Maslach Burnout Inventory*
7 point scale: “Never” to “Daily”
•“….emotionally drained…”
•“used up at the end of the day”
•“fatigued … have to face another
day”
•“… understand how my patients
feel about things …”
*Highly used and cited Burnout scale:
Maslach 1981, 2005
Nixon 1979 Transactional Model of Stress

6. Emotional Health
Personal Issues
• Stress, Depression, Anger, Anxiety
• Grief/Loss
• Conflict with S.O./Divorce
• Parenting/Emotional Health of
Child
• Child with challenges/illness
• Elder care
• Drugs/Alcohol
Work-Related Issues
• Professional Burnout
• No sense of personal
accomplishment
• Work/Life Balance
• Problems with supervisor
• Problems with supervisee

7. Prince William weighs in
Stressed the importance of emotional well-being to business leaders
-workplace stress can take a toll on a person’s overall mental health
-psychological conditions should be met with the same
compassion in the office as physical health.
“I’ve also seen how an employer can create
an environment where it is as unremarkable
to talk about feeling a bit down as it is to
admit to having a cold,” he said.
His experience as an air ambulance pilot
has shown him that employers can make
it OK to admit feeling down.

8. Even Leucocytes …
…get reactive when they
face challenges!!
Gras et al., J Leuoocyte Biol 2006

9. The LEAST Stressful
Income Growth Stress
Score
Diagnostic Medical
Sonographer
$64K 24% 4
Compliance Officer $66K 3% 5.7
Hair Stylist $23K 10% 5.8
Audiologist $24K 29% 7.3
University Professor $75K 13% 8.2
Medical Records Technician $37K 15% 8.6
Jeweler $37K 11% 8.9
Operations Research Analyst $78K 30% 9
Pharmacy Technician $30K 9% 9.1
Medical Laboratory
Technician
$50K 9% 10.3

10. ↑ Challenges  ↑ Symptom
Severity
Rating Factors:
• Travel
• Career Growth Potential
• Physical Demands
• Environmental Conditions
• Hazards Encountered
• Meeting the Public
• Competition
• Risk of Death or Grievous Injury
• Immediate Risk of Another’s Life
• Deadlines
• Working in the Public Eye
Top Five:
•Firefighter
•Industrial engineer
•Aerospace engineer
•Mechanic foreman
•Vehicle and railway equipment
repair worker
ADAA, 2016

11. It’s common.
By State:
Of the best
places to
practice –
Arkansas
is somewhere
in the lower
half.
Medscape, 2016
Paul Barrows

12. It’s common.
Especially in Healthcare and Public
sectors
• Workload
• Less managerial support
• Rapid organizational changes
• 50% of physicians
• Stress, depression, anxiety 
• 37% of work-related ill health
• 45% of days lost in 2015-16 (N=38,000 interviews)
• High stress, depression, anxiety
Prevalence: 1.5 per 1000
Incidence (2015-16): .7 per 1000
Work loss per case: 24 days
IsHak et al., 2009
Health and Safety Executive Report 2016

13. It’s common across occupations and age
groups.
But not equal by sex.
In men: Peak is at 45 – 54 years –
but not significantly higher than
for younger men
• Maslach Depersonalization
Scores:
• Teaching: 11.0
• Social Services: 7.5
• Medicine: 7.12
• Elevated stress is seen in the
first five years of practice for
physicians
Health and Safety Executive Report 2016
Maslach et al. 1996, 2005
Szigethy 2017

14. It’s common, but not equal by sex.
In women:
• Higher levels of work-related stress, anxiety, and
depression than men. Some suggested problems:
• Inequalities in pay
• Inadequate accommodations
• Sexist environments and sexism in hiring/promotion
• Age – differences in stress seen from 25 to 54
• Peak at 35 – 44 years, when juggling family issues
(children, parents)
Mohring J, Health and Safety Executive 2016
Priory’s Wellbeing Center in the City of London

15. “Burnout”
rated from
1 = no
interference
to
7 = I’m
thinking of
leaving
medicine
It’s common in Doctors.
By Specialty:
Medscape, 2016

16. ED work:
Mental and physical health of doctors is critical to patient care
Problems
High job stress and work volume
Quick decisions under pressure
Limited prospect for improvement
Limited stress interventions
High burden of responsibility
↓↓
↓↓ Physical and psychological health
Loss of job satisfaction
Lower productivity
More staff turnover
Data
25 studies reviewed.
Confirmed:
-High work volume and
long hours,
-Little control over work,
-Poor support at work,
-Low pay
-Inadequate recognition
-Compassion fatigue
Work “targets,” e.g.
requirements to see
patients within four hours,
could add greatly to job
stress.
Goals
Intervention studies (only 2)
-aromatherapy and massage
sessions reduced anxiety.
-Mindfulness and other
emotional skills didn’t reduce
job stress.
Proposed but unstudied:
-“buddy system,”
-exercise programs
-increasing workers’ contact
with their families
Emergency Medicine Journal, 2014

17. Burnout!!
Shanafelt and Noseworth, 2017

18. Consequences: • Stroke?
• Holmes&Rahe>150  OR=3.84
• Cancer? (weak evidence)
• Sleep disruption  faster tumor
growth
• Bmal1, Per2 KO’s  faster tumor
growth
• Neurotoxic?
• Loss of dendritic spines, poor
function in mPFC, amygdala,
anterior cingulate ctx
http://dx.doi.org/10.1136/jnnp-2012-302420
Hunter et al., 2009
Roozendall et al., 2014
Papagiannoakopoulos et al., 2017

19. Wrong
Solution!!

20. ↑Support 
↓Symptoms
• Family
• Friends
• Coworkers
• Religious affiliation or spirituality
• Therapist
• Leisure activity peers
• Hobby enthusiasts
• Peer support group (AA, …)

21. Stress Solutions
• Therapies
• Mindfulness
• CBT
• Exercise
• Yoga
• Walking
• Skills
• Relaxation
• Positive Psychology
• Communication
• Time management
• Team building
• Setting and achieving goals
Kilpatrick, et al., 2011, NeuroImage Salyers, et al., 2011
Quoidbach et al., 2010, Personality and Individual Differences Krasner, et al., 2009
Davidson, McEwen, 2012, Nature Neuroscience Hayes et al., 2004

22. Stress relievers
115 men surveyed
•27% - Sex
•29% - Playing video games
•31% - Comfort eating
•74% - Talking with friends
•Male bonding
•Therapy for work issues
250 women surveyed
•11% - Sex
•>50% - Comfort eating
•Read self-help book
•Talk to friends
•Arts and Crafts
•Therapy for relationship issues
Russoniello et al., 2009
Barry, J, 2017
Video games: $25bn in the United States in 2016

23. Interventions
• Enhance sense of
capacity to influence
organizational policies
• Personalized responses
• Stressors tend to be individual, and relatively unique
• Burnout reduction programs with universal solutions generally don’t work.
• SLEEP!!
Leiter et al., 2014
Halbesleben et al., 2006

24. Timing is everything
• It’s all about YOU!
• Be mindful of yourself and your environment
• Decide when to send that email
– will the recipient be likely to have
• Time to respond – is it the end of the day?
• A weekend coming up – is it Friday before a long
weekend?
DECIDE WHEN AND HOW
TO GET HELP!

25. Burnout Reduction Resources: ACGME
• ACGME Symposium on Physician Well-Being: Commitment toACGME Symposium on Physician Well-Being: Commitment to
Change :Change :
– SMART (Stress Management And Resiliency Training)SMART (Stress Management And Resiliency Training)
• Protected time for mindfulness meditation, stress awareness, andProtected time for mindfulness meditation, stress awareness, and
opportunity for experience sharingopportunity for experience sharing
– Positive Psychology CoachingPositive Psychology Coaching
• Focus on positives, self reflection, and guidance led personal and professionalFocus on positives, self reflection, and guidance led personal and professional
growthgrowth
ACGME, 2016: http://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being/2016-ACGME-Symposium-on-Physician-Well-Being

26. Resources:
Employee Assistance Program –
Therapy focus
• Anger management
• Eldercare
• Grief/bereavement
• Individual life skills training
• Life/Career coaching
• Personal/emotional concerns
• Referral/resource assistance
http://eap.uams.edu/ 686-2588
• Relationships
• Short-term, individual and family
counseling
• Stress management
• Substance Abuse
• Wellness training
• Work-related issues

27. Resources:
Employee Assistance Program –
Therapy focus
• Free and confidential
• Email a counselor at
www.uams.edu/eap
• Appointments in 72 hrs
• 24 h crisis counseling
• Group assistance for workgroups
http://eap.uams.edu/ 686-2588

28. Resources: Wellness Programs
• Urgent and Rapid Evaluation and Diagnosis
• Treatment planning
FACULTY: http://faculty.uams.edu/wellness/
526 – 8140
HOUSE STAFF: http://medicine.uams.edu/current-residents/resident-
handbook/
526 – 8286
STUDENTS: http://studentwellness.uams.edu/
686 – 8408
• Initial medication management
• Referral/resource assistance

29. Goals
This introductory talk should have helped to:
-Identify workplace stress and anxiety issues,
-Recognize signs of excessive anxiety, and
-Understand helpful ways to cope with stress,
-Obtain information on how and where to seek additional help.

30. Questions
?