For nearly 30 years, April has been set aside as Stress Awareness Month. In 2021, when the COVID-19 pandemic continues to pile on the strain and pressure, it seems more important than ever to acknowledge the huge role that stress plays in our lives. News & Views asked clinical psychologist Dr. Megan McMurray, PhD, ABPP, who is board-certified in rehabilitation psychology, to weigh in on this timely topic. An assistant professor at the University of Alabama at Birmingham School of Medicine, she explains how to recognize the warning signs that you or someone you care about is in trouble and offers direction on where to turn for help.

News & Views: What are some of the ways that stress manifests, particularly in the workplace?

Dr. McMurray: It goes without saying that we have all experienced times of increased stress. Stress impacts our bodies and minds at multiple levels. From a physiological perspective, the release of stress hormones (e.g., cortisol) can cause muscle tension, increased heart rate, fast breathing, sweaty palms, digestive issues and sleep disturbance, among other issues. From an emotional standpoint, stress can lead to an increase in difficult emotions such as anxiety, worry, anger and depression. Cognitively, people may notice impaired concentration, indecisiveness, forgetfulness, negative thinking and reduced confidence. Finally, when we experience times of high stress we tend to act in certain ways based on habit, which is our behavioral response to stress. Some popular behaviors in times of stress include increased alcohol or tobacco use, “snapping” at others or having anger outbursts, withdrawing from others, overeating or undereating or reducing enjoyable activities. While stress is a normal response to job demands in short bursts, persistently high levels of stress can dampen the immune system, promote inflammation, increase risk for disease (e.g., CVD, cancer, etc.), lead to premature aging and worsen mental health.

News & Views: What are some of the warning signs that a person is under too much pressure?

Dr. McMurray: If you notice that a coworker has an uncharacteristically short fuse lately, they might be experiencing a period of high stress. We can all be pressure cookers; agitation and irritability can build up inside without us realizing, and suddenly we’ve lashed out at a co-worker for no legitimate reason. Another warning sign might be the opposite – perhaps your coworker seems withdrawn and is isolating from everyone. Other signs of a troubled employee include physical signs (e.g., untidy appearance, exhaustion), absenteeism (including repeated absences and excessive tardiness), reduced job performance, worsened mood, poor relationships with coworkers and supervisor and unusual behavior (e.g., frequent tearfulness, outbursts).

News & Views: What steps can all working professionals, but specifically those in the CR/PR setting, take to address mounting levels of stress?

Dr. McMurray: First of all, it is important to recognize that we cannot always control the causes of our stress, but we can control the way we react to the stress. Next, keep in mind that stress is not always a bad thing. Stress motivates us to work toward solving our problems, and reframing your own thoughts to view stress as an acceptable emotion (as opposed to a “bad” thing) can lead to a reduction in negative symptoms. The goal is to manage the stress, not eliminate it entirely.

Conducting frequent self-assessment of our own emotional well-being is also critical. Perhaps you are having the typical “bad day” or perhaps a rough few weeks; but if feeling down, anxious or extremely stressed starts to become your new normal or your way of life, your emotions can serve as a signal to you to make some changes or seek help. Other practical tips include talking about your stress with friends and loved ones (even if this doesn’t solve the problems), prioritizing your to-do list, focusing on your basic needs (e.g., eating well, getting sufficient sleep), exercising regularly, setting boundaries (taking time off when needed, saying “no” to some things) and practicing mindfulness.

News & Views: What are some resources available to those who need help managing their stress?

Dr. McMurray: Most hospitals and medical centers have some type of employee assistance program, which is a great place to start. These programs often provide resources, counseling, referrals and other services to employees who are having personal and/or work-related problems. Reputable websites such as www.webmd.com and www.mayoclinic.com offer nice overviews of stress and provide a basic understanding of the causes and normal physical and psychological reactions to stress. The American Psychological Association offers information on topics such as common myths about stress, evidence-based strategies for managing stress and information on how to get help from a mental health provider for stress management. For those struggling with feelings of severe depression or thoughts of suicide, please reach out for help. Here are a few mental health resources:

• National Suicide Prevention Lifeline 24/7 at 1-800-273-TALK (8255)
• Text the Crisis Text Line 24/7 (text HELLO to 741741)
• SAMHSA’s National Helpline at 1-800-662-HELP (4357) for treatment referral and mental health information 24/7

News & Views: What can YOU do if notice a coworker or colleague who appears to be struggling under stress?

Dr. McMurray: The first step to normalizing mental health conversations is to realize that change starts with YOU! Big change starts with individual and seemingly tiny actions, but these actions can gradually change a culture. Here are a few practical tips for being a part of changing the mental health conversation and reducing stigma:

• Speak more openly about your own mental health challenges. While it’s difficult to be vulnerable, your willingness to disclose often opens the door for others to share.
• Check in with friends, coworkers and loved ones. This one requires digging a little deeper in our conversations with our social network. If you have not heard from a friend in a while or know a coworker is going through a particular difficult time, be proactive and ask open-ended questions about how he/she is doing.
• For those in leadership roles, create a culture where vulnerability is acceptable. You can start the conversation by sharing your own feelings and life stressors as a leader. You can also normalize things like therapy appointments by using this example as a perfectly acceptable reason to utilize employee or student sick leave. You can also encourage wellness activities in your department, office or friend group.

Sometimes it is difficult to know what to say to someone who is struggling with mental health concerns, but just having someone who listens without judgment is an extremely helpful form of support. If you are struggling to find the words, here are a few phrases you could try out as you try to find the comment that feels most genuine and appropriate for the situation:

• “You are not alone.”
• “How have you been doing lately?”
• “I am here if you ever want to talk.”
• “What can I do to help?”

Although it may seem like a good time to offer advice, try to avoid telling the colleague what they should be doing, since even helpful advice can feel judgmental when someone is struggling. And while sharing your own mental health experiences can make others feel less alone, this can backfire when someone is really struggling if the conversation is redirected to your own experiences (aka, try not to make it all about you). Just sit with your coworker, say something, and let him or her know you care.