Tag Archives: anxiety

Supporting sustainable return to work

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Dr Jo Yarker from the Department of Organizational Psychology shares her research into supporting employees who are returning to work following mental ill-health absence.

Around 15% of the working population suffer from common mental disorders (CMDs) such as depression, anxiety and adjustment disorder (OECD, 2014). For half of these, experience of mental ill-health will lead to a period of long-term sickness absence. In the UK alone, stress, anxiety or depression accounts for 57% of all working days lost to ill-health in 2017-2018 (HSE, 2018).

Sustainable return to work for workers with CMDs is therefore a major societal challenge in terms of scale and costs. A successful initial return to work is no guarantee for sustainable return to work, with research suggesting that approximately 19% of workers subsequently relapse and take further absence or exit the workforce (Koopmans, Bültmann, Roelen, Hoedeman, van der Klink, & Groothoff, 2011).

Relapse has significant consequences for sustaining work, with implications for employment prospects, productivity and wages (OECD, 2014). There is an urgent need to better understand how workers with CMDs can be better supported to return to, and stay in, productive work. Together with my colleague Professor Karina Nielsen from the University of Sheffield, I sought to find out how to support employees returning to work following mental ill-health absence.

Understanding the barriers to sustainable return to work

Our study was the first to our knowledge to follow workers post-return using a qualitative approach. We used the recently developed IGLOO framework in our research: examining the Individual, Group, Leader, Organisational and Overarching (IGLOO) contextual factors (Nielsen, Yarker, Munir & Bültmann, 2018) that influence workers with CMDs’ ability to remain in employment throughout working life.

We conducted interviews with 38 workers who had returned from long-term sick leave due to CMDs, the majority of whom we spoke to at multiple points following their return.  We’d originally planned to follow workers in the first months after return, however, after being contacted by workers who still experienced challenges long after return, we decided to include these too. We also spoke to twenty line managers with experience managing returning workers.

Our findings

Participants reported a number of resources, in and outside of work, that helped them stay and be productive at work.

Resources at work across the five IGLOO levels help employees stay and be productive at work:

  • Individual: Creating structure within their working day to help maintain focus and concentration.
  • Group: Gaining feedback on tasks from colleagues, help with challenging tasks and being treated as before, not as someone with a CMD.
  • Leader: Agreement of communication to colleagues, continued support and access to work adjustments, and signaling (and being) available but not intrusive.
  • Organisational: Flexible working practices and leave policies, accommodating absenteeism policies, work-focused counselling, and demonstrating care through support.
  • Overarching context: This level was not applicable as we only examined UK workplaces.

Resources at home across the five IGLOO levels help employees stay and be productive at work:

  • Individual: Prioritising self-care and the establishment of clear boundaries between work and leisure.
  • Group: Understanding and non-judgmental support from friends and family.
  • Links to services: Consistent point of contact and facilitation of links to external services and treatment.
  • Organisational: Access to work-focused counselling.
  • Overarching context: Those who were financially independent were able to make choices that better suited their needs; the majority reported the positive media attention around mental health enabled them to ask for help.

The main results of our study point to important avenues for future research and practice. Within the workplace, the findings highlight the need to:

  • Consider resources at all IGLOO levels and implement multi-level interventions.
  • Train returned workers in how to structure their day.
  • Train and support line managers, both in having difficult situations but also on how to support workers creating structure and support them manage their workload.
  • Develop more information about appropriate work adjustments that can be implemented and how these can be accessed.
  • Offer flexibility to the returning employee, in relation to work schedule, ad hoc flexibility when depleted to prevent further decline and aid recovery, and flexibility in tasks.
  • Adopt an individual approach as there is no off-shelf-style that works for all.
  • Adopt a long term approach, ensuring that employees are able to access adjustments in the months and years that follow.
  • Conduct further research to enable us to understand the contribution of these features and their synergistic effect on enabling returned employees to remain productive at work.

Outside the workplace, the findings highlight the need to:

  • Conduct further research to better model the impact of support received from friends and family, GP services and those within the voluntary sector.
  • Equip GP services with the skills and knowledge to support return to work.

We developed guidance for employees, colleagues, line managers and HR professionals to support returned workers to thrive at work. This and our full report can be found on the Affinity Health at Work website.

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Managing the ‘always on’ culture – a myth buster and agenda for better practice

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Professor Almuth McDowall (Department of Organizational Psychology) shares her research into worklife balance and calls on employers to take responsibility for their organisation’s culture.

Break, Business, Business People, Businesswoman, Cafe

There is much being written and said about the ‘always on culture’ and how we are increasingly glued to our digital devices – whether at work or at home. Some of my own research has also concerned itself with this topic. My colleague and friend Gail Kinman and I had the results from a practice survey published in 2018 as we wanted to know what organisations are doing about the changing world of work, and the use of information and computer technology.

Well, precious little is the answer. Over half of our respondents said that their organisations don’t have a relevant policy in place and don’t offer any guidance or training. Somewhat worryingly over 40% thought that it should be up to individuals to manage the issue, rather than their line managers or human resources.

Why would people choose to be ‘always on’ outside formal working hours?

Working unpaid during leisure time does not make logical sense! We gift the UK economy billions in unpaid overtime year on year, as research by the Trade Unions Congress has revealed. Our systematic review with colleagues Svenja Schlachter, Ilke Inceoglu and Mark Cropley pointed to a complex picture.

People have different motivations, influenced by issues such as what everyone else does (social norms), what the expectations in the job are, how committed people feel to their job, how they value ‘switching off’ and recovery and whether this is supported in their environment. One key issue which came out of this review is the ‘empowerment enslavement paradox’. Our digital devices are both an enabler, as they afford flexibility, but also ‘digital leash’ as it’s difficult to say ‘enough is enough’ and switch off. As we all know, screen-time can be very seductive.

Is there any evidence that being ‘always on’ is bad for our health?

A recent econometric analysis shows that ICT infrastructure has a positive impact on population health (the authors measured general health outcomes such as infant mortality etc.). Regarding the impact of social media use, there is evidence that high use is linked to poor sleep quality, anxiety depression and low self-esteem. Of course, such studies cannot tell us whether teenagers who are highly anxious to start off with are more likely to be prolific users.

There is far less robust evidence on the exact effects from the world of work – what happens to you if you are on your phone, tablet or laptop near 24/7? We lack good research to tell us what the exact effects are.

What we do know though is that we need recovery and respite, our systems are simply not programmed to be on continuous overdrive. We also know that leisure activities which are quite different from our work tasks are better for our recovery than doing more of the same. I take this to heart. For instance, I find that reading at night doesn’t help me switch off as academics read rather a lot at work, so I take ballet classes online (and am known to teach the odd one myself!), knit and crochet.

What can organisations do?

Employers have a duty of care and should ensure that people are not overworked and can switch off. Worklife balance research tells us that those who live ‘enriched’ lives have better mental and physical health, important for them, and important for their employer. We should actively support employees by ensuring that:

  • A worklife balance policy is in place as a point of reference; then check processes and structures against this policy
  • Employers review job design and ensure that digital tasks (checking and responding to emails, synchronising devices, remote calls and conferences) are actually captured in people’s workload and tasks – these often fall off the radar
  • There is consultation to ask employees what they need – mutually negotiated boundaries and solutions work much better. Think creatively about flexible solutions!
  • Everyone, including senior leaders and managers, role models good behaviours. People need time to switch off, so don’t expect your staff to be available outside normal working hours
  • Staff are offered training and development. Managing in an increasingly digital workspace requires up-to-date management and leadership skills
  • Employees look out for implicit expectations and ‘rumours’. “I check my emails on holiday because this is what is expected of me”. Really? Question such assumptions as they can often take on a life of their own

Finally, if in doubt, ask a psychologist. The Department of Organizational Psychology is keen to work with organisations to establish, consolidate and evaluate best practice.

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Improving attentional control to reduce anxiety

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This post was contributed by Prof Nazanin Derakhshan of Birkbeck’s Department of Psychological Sciences. Here, Prof Derakhshan describes her most recent study into how our cognitive flexibility can be trained and boosted to protect against the effects of anxiety

Anxiety-webAnxiety can be a debilitative emotion that can adversely affect our performance. For example, it is common for individuals with high levels of anxiety to worry excessively about a variety of issues ranging from their performance on upcoming examinations, job interviews, attending meetings, and giving talks to multi-tasking and managing everyday activities efficiently.

According to the WHO (World Health Organisation) anxiety (and depression) will be the biggest cause of disability worldwide by 2025. People with high anxiety frequently report that they have difficulty concentrating on tasks that need undivided attention and are easily distracted. It goes without saying that the implications of anxiety’s effects on our everyday activities as well as on the challenging tasks demanding our attention are vast.

Unfortunately, anxious individuals remain at a disadvantage of getting stuck in a viral chain of worries and over-thinking, consequently needing to invest more effort as compensation to their worries in getting tasks done (see Berggren & Derakshan, 2013, for a review).

How can we explain the nature of the relationship between anxiety and performance?

In a theoretical breakthrough, we have proposed earlier (see Eysenck, Derakshan, Santos & Calvo, 2007; Derakshan & Eysenck, 2009) that a central mechanism by which anxiety impairs performance is via its adverse effects on attentional control. Attentional control is an important function of our working memory, a system that regulates incoming information and helps with temporary storage of information.

Attentional control or cognitive flexibility directs our attention towards what is relevant and away from what is irrelevant. Attentional control is thus a vital ingredient of our lives, it helps us be cognitively flexible, concentrate on tasks and resist distracting thoughts/information when we need to. When we have poor attentional control we become inefficient and can do badly in tasks; we can’t keep worries at bay, and get trapped in cycles of over-thinking that can hold us back from performing well. There is now substantial evidence to support the prediction that anxiety impairs performance via its impact on attentional control (see Berggren et al., 2013).

How can we reduce the effects of anxiety on performance?

If attentional control is a causal mechanism that can explain anxiety’s effects on performance then it can be trained and boosted to protect against the effects of anxiety on performance. In the current study, which will be published in the journal Biological Psychology, we asked participants with a high anxiety disposition to train on an adaptive cognitive task for a period of 15 days over three weeks, for half an hour every day, and all training was performed online.

The special thing about the training protocol is the adaptive nature of the task that increases and decreases in difficulty based on participant performance levels. Elsewhere, we have shown that training on this task improves attentional control in subclinical depression (see Owens, Koster & Derakshan, 2013; see also our BBCR4 programme on How to Have a Better Brain.

In the current study, we assessed participants’ levels of attentional control using a number of tasks measuring distractibility (e.g. a flanker task that was performed under stressful and non-stressful conditions), an antisaccade task measuring inhibition of threatening faces and resting state attentional control using electrophysiological measures. Participants completed these tasks before and after the intervention. We also had a control group who performed a non-adaptive version of the training.

Did training improve attentional control?

Graph from Prof Derakhshan's current study showing changes in anxiety as a function of engagement with training

Graph from Prof Derakhshan’s current study showing changes in anxiety as a function of engagement with training

Our results showed that those undergoing adaptive training compared with the control group showed greater transferability of training related gains onto attentional control measures. Specifically, they were better at inhibiting distractors in the flanker task, and this superiority was especially apparent when stressed, i.e. they could exercise attentional control much better than the control group when they were under stress.

The training group also had better resting state attentional control compared with the control group. Importantly, engagement with training as shown by improvement on the training task, from first to last day of training, correlated with reductions in anxiety levels after the intervention relative to before the intervention. This meant that those who improved more on the training task had lower levels of anxiety vulnerability after training.

Why are the results of the current study important?

The most important message here is that attentional control can be trained with transferrable effects on unrelated tasks measuring relevant cognitive functions such as distractibility, inhibition, and concentration in individuals suffering from high levels of anxiety. Furthermore, our findings showed that improving attentional control can reduce anxiety in individuals with an anxious predisposition.

They also attest to the causal mechanism of attentional control protecting against anxiety vulnerability especially under stress. The implications of improving attentional control are enormous in education and clinical science. Targeting and training working memory using adaptive tasks that exercise attentional control holds the potential to protect against longer term under-achievement in anxious pupils. It can also protect against the development of clinical anxiety which can be debilitative to the individual.

How can the current study be extended?

There are a few ways in which future research can build upon the current findings. First, if attentional control training shows promise to increase processing efficiency then it can be used as an adjunct to traditional therapies such as mindfulness and CBT that rely on pre-frontal functions such as concentration and attention focus.

Second, it is essential to examine the sustainability of the effects of adaptive cognitive training on performance and anxiety vulnerability and get an indication of how training effects consolidate with the environment over time. How are behaviours changed? Finally, it seems essential from a clinical point of view to look at how training can impact on a person’s quality of life and levels of resilience throughout time.

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