Stress and Leadership in Organizations

With Laura McGladrey; adapted from presentations for CU Nursing Doctor of Nursing Practice students and the AACN Business Officers of Nursing Schools (BONUS) annual meeting in April 2022.

In the wake of the COVID-19 pandemic, the U.S. Surgeon General's office released a first-ever report on workplace mental health and well-being. But many workplaces feel a long way from mentally healthy right now, as both employees and employers continue to struggle with changes ranging from infectious disease, to equity and inclusion, to remote work. In this blog, we will look at ways in which both employees and employers may be struggling with the lingering effects of trauma, and what kinds of small steps organizational leaders could take to help us all get back on track.

Stress and the Intuitive Mind

Stress is pernicious. It affects us in ways we might not even recognize, coloring our perceptions and our reactions to events. This is partly because stress tends to push our thinking out of the Narrative system and into the Intuitive mind, similar to the effects of sleep deprivation or taking opioid drugs. Stress also activates the fight-or-flight response: The amygdala neural structure deep in the brain tells the pituitary gland to secrete adrenaline, which produces the classic effects of sweaty palms, rapid heartbeat and breathing, etc. But the fight-or-flight reaction also has an unfortunate side effect: Under conditions of threat, the Intuitive mind gets tunnel vision. When under the influence of adrenaline, we pay more attention to information that might convey a threat, we pay less attention to other types of information, and we read threats into otherwise ambiguous stimuli. Because of these perception-altering effects stress has a way of being cumulative: The more of it you experience, the harder it is to recover from those experiences and get back to normal mental functioning. 

Although short-term stressors can feel invigorating or exciting, prolonged states of stress tend to be harmful. Besides setting things in motion via a fast release of adrenaline, the amygdala's threat response also triggers a slower release of glucocorticoid hormones from the adrenal gland that take longer to disperse from the body. These hormones help to break down complex sugars for fast energy, but they also tell the body to stop doing "nonessential" things like growth or memory formation, in order to focus on an immediate crisis. The evolutionary logic is that protein synthesis isn't essential in a life-and-death situation, which is great if the stressor is a tiger. But if it's something more chronic like office politics, these effects are counterproductive. Ongoing stress leads to negative physical consequences like inability to calm down due to hypervigilance, lack of motivation due to cortisol over-production, and depression due to serotonin downregulation in the brain. The effects of stress on the brain are particularly strong in the region of the hippocampus, which is involved in memory formation; neurons in this region lose their myelin coating under conditions of prolonged stress, resulting in behaviors in rats that look a lot like depression and anxiety do among humans. Demyelination in the hippocampus also likely interferes with the formation of new memories, which makes it harder to learn from new experiences that might mitigate the ongoing effects of stress. And long-term elevated cortisol levels inhibit the immune system and cause inflammation, so the body has more trouble fighting off infection and becomes more vulnerable to chronic conditions like heart disease, asthma, and arthritis. Besides its physical consequences, stress also damages relationships because stressed people are more likely to focus inward, to withdraw from others, and to have a harder time feeling trust. Eventually, these stress symptoms can add up to a syndrome of chronic depletion that is often called "burnout." After several years of COVID-19 pandemic living, burnout is at an all-time high, particularly in highly affected jobs like health care work.

Stress and Coping During the COVID-19 Pandemic

Stress has been a constant in most people's lives since at least the start of the COVID-19 pandemic in early 2020. Although the pandemic has had its ups and downs, we all have had at least one chronic stressor that didn't exist in 2019. The pandemic also exacerbated pre-existing problems like work-related stress, health disparities, family conflicts, political divisions, and road rage. And it had more serious effects for people who were already in vulnerable groups, like members of racial/ethnic minorities or people living in poverty. Many people are now living with long-term loss and grief, either due to the actual death of loved ones or the pandemic-related disruptions that might have cost them valued support networks or roles in society. A recent analysis in an APA journal found that people had the greatest pandemic-related distress because of (a) personal illness, (b) the death of a loved one, and (c) doomscrolling through news media. They were not adversely affected in any systematic way by prevention measures like masks, school and business closures, or even lockdowns -- instead, the most negative effects on people's mental health came from the pandemic itself. I have written previously about how traumatic experiences can lead to symptoms and affect the Intuitive mind; trauma makes it more likely that people will drink alcohol, use opioids, overeat, or engage in other behaviors that provide fast emotional relief but lead to long-term negative consequences of their own.

Although stress itself may be inevitable, people respond to it in different ways. People's stress responses can be described using a continuum that ranges from normal and healthy responding to a complete breakdown in the face of difficulties. The more severe and prolonged a stressor is, the more likely it is that people will begin to have negative responses to it; the cumulative impact of many stressors over time can also have the same effect. Importantly, the fact that responses occur along a continuum makes it possible to identify early warning signs of stress before they become serious. Several recent projects at our College of Nursing have been designed to help people notice those early signs of stress and make healthier "green" choices that reduce stress, improve overall health, and help to prevent progression to a higher level on the stress continuum. The tool is best used in groups where people can serve as natural supports to one another, which makes it valuable for use within organizations. These programs have resulted in improvements for nursing students and for rescue workers in the community.

Organizational Stress

Besides being a stressor on its own, the COVID-19 pandemic has also highlighted some of the ways in which organizations affect their members' stress. Just as stressed individuals tend to neglect their social connections, being embedded in a social context can help people to resist the toxic effects of stress. Organizations can be a source of social support, even if only because nothing seems quite so bad when other people are going through it with you. An alternative to the fight-or-flight reaction is the "tend and befriend" or "broaden and build" approach to handling problems. This problem-solving strategy relies on the social resources of the Narrative mind and helps to reduce stress and counteract defensiveness. A longstanding "buffering hypothesis" suggests that stress is less harmful when it occurs in the presence of social support. Besides feeling better than going it alone, connecting with other people can also result in instrumental social support -- contributions of time, money, or other resources that help us to "get by with a little help from our friends." Finally, organizations can provide a sense of purpose, mission, or belonging, which is helpful in counteracting the effects of stress. Like social support, a sense of meaning has a buffering effect that reduces the negative effects of stress on health outcomes. These factors may be part of the reason why people who belong to religious organizations tend to live longer and stay healthier than their non-religiously-affiliated peers. Civic organizations and workplaces can serve similar purposes for many people.

Although organizations can help to alleviate the effects of chronic stress, they unfortunately can also make stressors worse. Traumatic stress involves an acute stress reaction to a specific incident, like an unexpected sudden change or crisis. Depletion stress is the chronic condition of feeling unable to handle new challenges because one's resources are too low, and is more likely after multiple traumatic stressors. But worst of all for many people is the experience of mission stress, which occurs when people lose faith in the group that they are ostensibly a part of. This might happen when people feel that they are being asked to do too much with too little resources, when there are conflicting or unclear directions on what is expected, or when an organization's observable behavior seems out of line with the individual member's values and goals (and sometimes also out of line with its own publicly stated values). As you might imagine, mission stress (also sometimes called "moral distress") has also become an increasing problem during the COVID-19 pandemic. In a 2022 national survey of higher education institutions (unpublished data), we found that 30% of faculty and staff had mild stress injuries, another 15% had moderate to severe signs of burnout, and nearly 40% had some symptoms and were at-risk for burnout; only 15% said that they were relatively burnout-free. In a different survey this past spring, 45% of university presidents said that they were worried about being unable to meet employees' mental health needs. Among graduate students in our programs at CU Nursing, a 2020 study by our colleagues found that 25% had moderate to severe levels of self-reported stress, and that nearly as many reported actual symptoms of post-traumatic stress disorder like agitation, avoidance, or disturbing dreams. And in a 2021 statewide survey, we found high levels of traumatic stress symptoms, burnout, and especially alcohol overuse among back country search and rescue workers in Colorado. 

Why does mission stress occur? First, even well-intentioned leaders are not doing as well as they might, because they are stressed themselves. Their own amygdalas are working overtime, and they are pushing through their own symptoms of anxiety and depression. One common response to stress is to retreat into authoritarianism: It helps to ameliorate the feeling of being under threat, and goes along with the perception that others are hostile. Unfortunately when leaders use a more authoritarian style, followers are more likely to feel cynical about their organization, to feel that a "psychological contract" has been violated, and to behave in ways that don't support organizational goals. Another explanation for increased mission stress is that organizations have had to confront many unexpected challenges over the past 2 and a half years, on topics like remote work, new health precautions in the workplace, unstable economic conditions, and unprecedented levels of turnover or retirement. Just one of these issues would have challenged organizations in good times, and all of them at once provide ample opportunities for a mis-step. Finally, changes in organizations have been happening fast and with little warning. Just like individuals, organizations don't do their best decision-making under those conditions. Even the CDC, whose mission centers on containing and preventing health emergencies, recently noted that it had not done very well during the pandemic, in many cases ignoring its own best-practice recommendations on how to communicate and encourage science-based decision making. In another analysis from our survey of higher education leaders, we found that employees in 2022 were experiencing organizational culture more directly than they had been in early 2020, with higher-level organizational culture affecting employees' job satisfaction with less mediation through the employees' immediate supervisors. In general this was not a good thing: Employees felt uncertain, unsupported, and unprotected.

How Leaders Can Help

What can leaders do to reduce mission stress going forward, and to help the members of their organizations thrive? Here's a list of some possibilities:

• Leaders can consider their own stress levels, and work to reduce them.
• Leaders can set a good example by being honest about their own stress and what they are doing to manage it. They can ask peers or supervisors to help them monitor their own behavior, and to let them know if they seem to be behaving erratically because of stress.
• Leaders can re-focus on core goals and values of their organization, which they share with other members of the group. Consistent discussion of values and overarching goals can help a group to guard against snap decisions that are likely to be wrong.
• Leaders can support their employees' continued professional growth, for example by providing time and money, by meeting one-to-one with employees to develop a plan, by writing down the plan and checking in about it later, by modeling their own continued development, and by providing opportunities for employees to share what they learn.
• Leaders can take a critical view of policies and procedures that increase members' stress, in particular any new policies that have been put in place in response to emergency conditions during the pandemic. Some changes may be needed, but how can they be minimized, or rolled out in a way that maximizes member satisfaction?
• Leaders can also seek extensive input and dialogue before making policy changes, which not only helps to make policies the best they can be, but also enhances buy-in by empowering everyone in the organization.
• Leaders can take a deep breath and be thoughtful before responding to problems or requests. This can help to avoid snap decisions, and can also allow time for creative problem-solving -- e.g., by resisting false either/or dichotomies and looking for outside-the-box solutions.
• Leaders can facilitate an explicit discussion of stress and coping with their teams, including naming stress injuries when these occur, encouraging and supporting members to take steps to reduce their stress, and asking team members to look out for one another as well.
• Leaders can be clear and consistent in their communication with members, for example using a weekly communique with a set format, a biweekly meeting, or other routine methods to put out the latest information.
• Leaders should actively solicit feedback from other members of the organization, with an explicit request for honesty even if the member thinks that it is something the leader might not want to hear.
• Leaders can be proactive in planning for future stressors, and in responding thoughtfully as new challenges arise.
• Leaders can be honest about the problems their organization is facing, and seek the "wisdom of the group" for collaborative solutions rather than trying to solve all problems on their own.
• Leaders should be there for other organization members as people, just listening to their ups and downs and supporting them through changing life circumstances.

If you are a leader and would like to help your employees manage stress, try this free online tool: https://bit.ly/stresslead. It will list some potential strategies that you can try, and help you to create a plan that you can use going forward. Life is difficult enough; we can all benefit if our organizations become a source of support rather than an additional source of stress.