Anxiety



Trainer Notes – Anxiety at WorkIntroductionWelcome participants and introduce yourself.Show slide – Course Introduction We’re going to take a good look at anxiety. As we progress, we will clarify what anxiety is, what it’s caused by and why it’s so important for us to know about it in the workplace.Underpinning our course is a crucial message – making anxiety normal.Ours will be a non-clinical approach – there’s no medical or scientific element to this course; we’ll take a common sense, practical and straightforward stand.This course is suitable for anyone at work. It’s been designed to assist us all with achieving an understanding of what anxiety is and how it might be handled whether as a sufferer, or as the manager or colleague of a sufferer.As we work through this course, there is no obligation upon anyone to disclose any private personal information. At no point will you be expected to share information about any medical condition that you – or anyone you know - may have suffered. You’re free to share your experiences as you choose, and you may participate to the extent that you’re comfortable and willing.Show slide – Objectives Know what anxiety is and what it isn’tBe able to discuss the impact of anxiety on colleagues, on productivity and working lifeKnow the role of the manager, employer and colleague of an anxious person – and the role of the suffererBe able to draw sensible comparisons between anxiety and physical illnessesProduce a plan to define the action you will take to address the stigma attached to anxiety with a view to improving productivityTalk participants through objectives and ask if they have any questions.Learning Log & Action PlanRefer participants to the learning log and action plan in their workbook. Advise them that throughout the session they should put down any actions that they’re going to take as well as the key learning points. You will also prompt them at key points to add items to their action plans (you will do this prior to every break in the programme).Show slide – QuotationTake a read of this quotation and reflect on your feelings about it before we get started.Activity – 10 minutesBefore we begin our learning, let’s take about 5 minutes to do a rapid survey of our feelings about anxiety.Anxiety at Work – Opening Questionnaire (this is a reflective exercise where the results are for discussion and comparison).Place participants into small groups and provide each with a questionnaire. Once both groups have put together their ideas, run through the questionnaire and pull out any similarities, differences and interesting points and review the activity with the following…Show slide – DefinitionFirstly, anxiety is a symptom. This means it occurs when someone has a medical condition. According to the NHS*:“Anxiety is an unpleasant feeling when you feel worried, uneasy or distressed about something that may or may not be about to happen. There are several conditions for which anxiety is the main symptom. Panic disorder, phobias, and post-traumatic syndrome can all cause severe anxiety.”* nhsonline.co.ukIn this definition, we see the term “disorder”. A person with an anxiety disorder experiences uncomfortably high levels of arousal in situations where you wouldn't normally expect to feel this level of fear. Anxiety is classed as a “mental illness” and a “neurotic disorder”.What do you think of these terms?Types of Anxiety DisorderCan you identify any examples of common anxiety disorders?Here are some:Show slide – Anxiety TypesPhobias Panic disorders / attacks Post-traumatic stress disorder Obsessive compulsive disorder (OCD).And here are some more that you may or may not have heard of:Anticipatory anxiety Separation anxiety Social anxiety disorder.Also, there is a condition known as general anxiety disorder (GAD) - possibly the most common anxiety disorder. Notes to help with explanations of anxiety conditionsPhobias, including claustrophobia and agoraphobia - very complex conditions usually manifesting themselves as a collection of inter-linked phobias. Panic disorders / attacks - sufferers often feel fine one minute, yet the next may feel totally out of control and in the grips of a panic attack. Panic attacks produce very real physical symptoms from a rapid increase in heartbeat to a churning stomach sensationPost-traumatic stress disorder – a disorder which may develop following exposure to any one of a variety of traumatic events that involve actual or threatened death, or serious injury. Obsessive compulsive disorder (OCD) - obsessions are repetitive, obtrusive, unwanted thoughts that are experienced and result in unreasonable fears, and compulsions are acts or rituals carried out in response to fears generated by obsessions.Anticipatory anxiety - where a person experiences increased levels of anxiety by thinking about an event or situation in the futureSeparation anxiety – this is a feeling of anxiety or stress when away from family or home. Social anxiety disorder - Social or public situations of any kind may induce this disorder which is often expressed as a fear of being the centre of attention, or of others noticing the sufferer's anxious behaviour.GAD is characterised by chronic worry about all sorts of life problems and circumstances. It differs from normal worrying through the intensity, frequency and perceived uncontrollability of the worry thoughts. Some StatisticsLet’s take a look now at some statistics. There are lots of statistics on anxiety. According to Anxiety UK more than 1 in 10 people are likely to have a 'disabling anxiety disorder' at some stage in their life.Anxiety Care tells us that currently, GAD affects 5-6% of the population in the UK – that’s more than 3.5 million people. The Office for National Statistics report that 1 in 6 adults in Great Britain had a neurotic disorder (such as anxiety and depression).And according to the Mental Health Foundation, there are over 7 million people living with anxiety problems in the UK.Show slide – StatisticsAs an interesting contrast report that in the USA, anxiety disorders were the most common mental illness with 19.1 million (13.3%) of the adult population (ages 18-54) affected. Let’s put this into some context, taking a relatively common and familiar medical condition – diabetes.Diabetes UK report that 2.5 million people had been diagnosed with diabetes.The American Diabetes Associate reported that 7.8% of the US population suffer with diabetes.Open up the floor to these questions [PREPARE FLIP CHART IN ADVANCE]:Q: Do these statistics surprise you?Q: What can we conclude from them?A:Anxiety is incredibly common.Significantly more people suffer with anxiety than suffer with diabetes.Possibly, more people than we thought are anxious.Q: What can we say about the use of terminology when considering anxiety?A:The use of terms like mental illness and neurotic disorder gives anxiety a particular image.The terminology may, arguably, create a label or a stigma.Q: Would you handle a colleague with an anxiety disorder in the same way as a colleague with diabetes?A:Perhaps we feel a person with anxiety should pull themselves together and get a grip?Activity – 20 minutesPlace participants into small groups and give some the ‘Anxiety at Work Exercise 1’ handout and others the ‘Anxiety at Work – Exercise 2’ handout. Their task is to construct two reactions to the same scenario, according to whether a person is anxious or not. In review, bring the whole group together and discuss any important issues raised. The solution to the exercise can be used for reference and as a handout, if wished.A Little Bit of BiologyLet’s spend some time now considering what happens when anxiety occurs. What are the physical events that take place at times of anxiety? Well:Hormones called adrenalin and cortisol are releasedLevels of glucose in our blood increasePupils dilate to let in more lightWe breathe quickly to increase oxygen intake.Show slide – A Bit of BiologyAll of this makes us feel energised, charged and in evolutionary terms, ready for “fight or flight” in relation to a physical threat.Q: In a typical work situation, perhaps an office, a shop or a factory, what types of physical threats might call for this sort of reaction?A: Of course, there are very few. Q: So in reality, what kinds of modern events translate to our own work environments?A:Meeting a deadline?Delivering a presentation?Receiving or giving a reprimand?Ok, so we’ve established what happens to create anxiety and why we might become anxious. And by the way, it is normal for us to have a sporadic release of these hormones as they are essential to support our daily functionsThis doesn’t explain how someone might develop an anxiety disorder.We’ll look at this – and a bit more biology - in more detail soon, but for now, we can perhaps frame all of this by asking what happens if:Show slide – What Happens If…We don’t burn off anxious energy because we can’t take flight or fight?For some reason, we experience the physical events of anxiety when there is no need for fight or flight?Whether we like it or not, we can’t control how often or the exent to which we go into the sequence of anxious physical events?Please note, these are reflective questions only for the purposes of provoking thought.An Outline of Anxiety SymptomsMany of us experience anxiety, some of us quite regularly. Anxiety is a normal response to stress or danger. The problems arise when this response is out of proportion to the actual danger of the situation or is generated when there is no danger present. Activity – 5 minutesUsing the flip chart, throw open to the room a request for examples of physical and non-physical symptoms.Notes to help with feedback on anxiety symptomsPhysical symptomsNon-physical symptomsRacing heartbeat Inner Tension Shortness of breath Agitation Chest tightness Fear Muscle tensionDread that something catastrophic is going to happen Dry mouth Irritability Butterflies in stomach Feelings of detachment Nausea Worrying Urge to pass urine/empty bowels Loss of self-confidenceTremor NightmaresSweating Loss of interest / poor concentrationPins and needlesEasily embarrassedInsomniaEasily confused / flusteredFatigue Feeling self-consciousMind going blankEasily startled / on edgeInability to relaxForgetfulnessSelf-criticismAll of these are good examples of anxiety mon Anxious ThoughtsAnxiety is very much concerned with fear.What kind of fears do you think are common for a person with an anxiety disorder in a work situation?Notes to help with examples of fear:Fear of making a fool of yourself, meeting people or of being criticisedFear of being rejected, of losing control or of challengesFear of facing the day, of failure or of making mistakesRemember, it is perfectly normal for us all to experience these fears but for anxious people, these fears are present even when they are not called for and they are usually disproportionate.Distinguish Anxiety from Stress and DepressionIt’s important that we distinguish anxiety from stress and depression. Can anyone give us their thoughts on this?Show slide – What’s the Difference?Stress is a reaction to a situation that you perceive is something that you cannot cope with successfully and which could result in defeat, negative results, emotional and physical ill health.Anxiety is an unpleasant feeling when you feel worried, uneasy or distressed about something that may or may not be about to happen. Depression is a mood disorder characterised by low mood and a wide range of other possible symptoms, which will vary from person to person. Notes to help with reference to distinguishing stress, anxiety and depressionStress is a reaction to a situation that you perceive is something that you cannot cope with successfully and which could result in defeat, negative results, emotional and physical ill health.Stress at work can therefore occur for perfectly legitimate and normal reasons, such as workload or bullying.Anxiety is an unpleasant feeling when you feel worried, uneasy or distressed about something that may or may not be about to happen. A person with an anxiety disorder experiences uncomfortably high levels of arousal in situations where you wouldn't normally expect to feel this level of fear. So, anxiety at work can therefore occur for irrational reasons, even when someone’s workload is managed, and they are well liked and respected.Stress can be the trigger or even the cause of anxiety but in fact, many people with anxiety disorders do not suffer from stress at all.Depression is a mood disorder characterised by low mood and a wide range of other possible symptoms, which will vary from person to person. People who are depressed are often very anxious. It's not clear whether the anxiety leads into the depression or whether the depression causes the anxiety. What are the Effects of Anxiety?In every piece of stress management material, you will see words like “a bit of stress can be good for you.” Whilst it’s possible to argue that a bit of adrenaline or concern and focus can be constructive, if you have ever suffered with an anxiety disorder you will know that it is never, ever a positive condition.If anxiety occurs over a prolonged period, our brain chemicals become conditioned, giving a sensation that there is perpetually something wrong. Imagine living in that kind of state and the possible implications:Show slide – EffectsAnxiety may cause problems in relationships with others, since people are often preoccupied and withdrawn. It can affect a person's ability to concentrate, which may prevent them from working to their full potential or enjoying favorite activities. Perhaps their attention to detail and performance will be reduced?The Mental Health Foundation says that high levels of fear and anxiety also linked to serious physical health problems.The Causes of Anxiety DisordersWe need to ask the question: “Why do people get anxiety disorders?” There are lots of theories and explanations – including some controversial arguments.It is widely thought that anxiety is usually caused by a mix of things so it can be hard to see why it started. Show slide – CausesSome people believe it is caused by our reaction to external events and that our life experiences cause us to be anxious. From a work perspective, it’s important to remember that anxiety may or may not be job related.Others believe that some of us are born more likely to develop anxiety due to our genetic make-up. There is research into cortisol underway at the moment which is predicated on the basis that anxiety during pregnancy is linked with the subsequent anxiety of the baby.It is said that stimulants such as tea and coffee can make us feel anxious as they increase levels of these hormones. In addition excessive sugar consumption has also been implicated in anxiety.What Is Our Reaction to Anxiety?If you have never experienced severe anxiety it can be difficult to understand what all the fuss is about.If you have ever experienced severe anxiety, it is sometimes difficult to explain, discuss or admit to it.Why is this? Where do our feelings about anxiety come from?Essentially, our response towards anxiety is often much the same as with any mental illness. We judge those people within the context of the social stigmas that are attached to mental illnesses.What’s more, if we have an anxiety disorder, we are aware of the stigma attached to it and we’re unlikely to be able to discuss or admit to it within the workplace for fear of a loss of credibility and all the other negative associations of a mental illness.Even though over 7 million people in the UK suffer with an anxiety problem we still see anxiety as a weakness. We still do not seem to regard it in the same way as a medical condition like diabetes.But herein lies the very core of how to deal with anxiety in the workplace. Show slide – The SpiralThis is the self-perpetuating, downward spiral of anxiety in the workplace.If there are literally millions of people feeling anxious every day of their working lives, what a difference could we make to the UK economy and peoples’ lives if we could accept anxiety as a medical condition like any other and give anxiety sufferers the opportunity to perform even better than they do at present?Activity – 15 minutesPlace participants into pairs and give each the ‘Anxiety at Work Exercise 3’ handout. Their task is to consider the two scenarios and discuss their feelings towards the individuals described. In review, bring the whole group together and explain that the two people are one and the same and that this is the way that many people with anxiety live their lives.Discuss any important issues raised. Treatments - Their Effects and Their ShortfallsActivity – 10 minutesPrepare a flip chart with two columns:TreatmentShortfallTranquillisersAnti-depressants and anxiolyticsCounselling, Cognitive Behavioural Therapy etcNon-prescribed treatments and complementary therapiesDrink and drugsOpen up the floor to ask for completion of the empty column:TreatmentShortfallTranquillisersHighly addictiveAnti-depressants and anxiolyticsMay not provide a cureCounselling, Cognitive Behavioural Therapy etcMental health service on the NHS is patchy and sometimes non-existent, so it is either necessary to pay for such treatment privately or go withoutNon-prescribed treatments and complementary therapiesInconsistent and unprovenDrink and drugsIn the long run, makes you more anxious not less. Notes to help with feedback on exercise:In extreme circumstances doctors may prescribe tranquillisers such as Valium, to help control anxiety. Unfortunately, these drugs are highly addictive and the more often you take them, the more often you need them to get the same effect and without them you can get rebound anxiety.There is a range of different anti-depressant and anxiolytic treatments available on prescription and many of these are effective in controlling the symptoms of anxiety, although of course, where someone has a severe disorder, these drugs may not cure it. This is a bit like treating diabetes with insulin – you get things under control, but the condition never actually goes away.Many clinicians believe that the best approach to managing anxiety is to blend medication with some sort of therapy, like counselling, Cognitive Behavioural Therapy or similar. Unfortunately, though, the provision of mental health services on the NHS is patchy and sometimes non-existent, so it is either necessary to pay for such treatment privately or go without.There are also a number of non-prescribed treatments and complementary therapies that have varying degrees of effect. These include herbal remedies, hypnotherapy, massage etc. Often people turn to drink and drugs such as cannabis to help them relax. These drugs promote the body's natural “peacemaker” hormones, helping to turn off excess cortisol and adrenalin and calm you down.The problem with alcohol and cannabis is that although these substances temporarily raise the peacemaker hormone levels, they have the effect of lowering them over time, so that after a session of drinking, hormone levels become very low and you wake up feeling mentally tired, grumpy and irritable. The net effect is that in the long run, alcohol makes you more anxious not less. The same is essentially true for cannabis, which if habitually smoked reduces drive and motivation.The Avoidance DebateThere are two strong – and conflicting – schools of thought on avoidance. Activity – 15 minutesProvide the group with the ‘Anxiety at Work – Exercise 4’ handout and ask them to consider Viewpoint 1 and Viewpoint 2. Facilitate a discussion about which is the correct approach to management of anxiety.There is no right or wrong, of course. Anxiety is an individual experience and what works well for one may not work well for another.What Can We Do About Anxiety? BusinessA report called ‘Returning to work, the role of depression’ detailed the findings of a study by Loughborough University. It compared the return to work experiences of individuals with heart disease, back pain and cancer to individuals with depression and anxiety.?The report makes a number of recommendations and calls for:Managers, occupational health and employees to work together both before and after an employee returns to work to develop individually tailored and efficient plans. A longer period of monitoring, communication and support for returning employees following absence. Employers to provide mental health training in order to promote understanding of depression and anxiety. Do you think we can extrapolate these recommendations and apply them to the workplace before a period of absence has begun?Additional notes for feedback and backgroundIt shows that almost half (45%) of those with a physical condition experienced mild to moderate depression but were more worried about telling their employer about their mental health issues than their cancer or heart disease. Despite the fact that depression impacted on their well-being and ability to function at work, most felt unable to tell their line managers about the difficulties they were facing.?The study found that while most line managers were initially supportive when a person returned to work, they were not aware of the long-term effects of a serious physical illness or condition upon an employee’s ability to work and mental health. There was a consistent lack of follow-up by occupational health, line managers and human resources on employees’ general health and psychological well-being after returning to work.? The report also revealed that those returning to work after an episode of mental ill health find it more difficult to adjust than those with a physical condition, largely because line managers and colleagues have little understanding about depression and anxiety, and inadvertently the support provided to employees is poor. Neither occupational health, human resources or line managers are adequately trained in how to deal with these issues.?The study found that gradual returns and reduced workloads were more commonly offered to those with physical conditions and illnesses than with mental health conditions. What Can We Do About Anxiety? Employers The Legal Issue – Health & Safety at WorkFor many years, employers have been concerned about stress and how to manage it because the causes of it may be work related and they could have a responsibility in causing it. Does the same apply to anxiety do you think? It really depends on the employer, of course. The high profile of stress and the perceived need for stress management training is often linked with the concern of employers for protecting themselves against expensive health and safety claims.Anxiety is a different type of condition, less known and understood, often confused with stress and often not caused by a workplace issue, but the “legal” argument in favour of understanding anxiety is as strong for an employer as it is in the case of stress.The Other Legal Issue – Disability DiscriminationThe Disability Discrimination Act defines a disabled person as someone who has a physical or mental impairment that has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities.Q: Does this mean that anxiety could be deemed a disability?A: Potentially, yes.It is unlawful for employers to discriminate against disabled people for a reason related to their disability, in all aspects of employment, unless this can be justified. The Act covers things like application forms, promotion, transfer or training opportunities etc.Reasonable Adjustments in the WorkplaceAn employer has a duty to?make 'reasonable adjustments' to ensure a disabled person is not put at a substantial disadvantage by employment arrangements or any physical feature of the workplace. Q: Can you think of some examples of the sort of adjustments an employer should consider, in consultation with the employee?Record ideas on flip chart.Some notes to help with feedbackThe Disability Discrimination Act (DDA) defines a disabled person as someone who has a physical or mental impairment that has a substantial (neither minor nor trivial) and long-term (likely to last for at least 12 months) adverse effect on his or her ability to carry out normal day-to-day activities (eg everyday things like eating, washing, walking and going shopping).Allocating some work to someone else Transferring the employee to another post or another place of work Making adjustments to the buildings where the employee works Being flexible about hours - allowing an employee to have different core working hours and to be away from the office for assessment, treatment or rehabilitation Providing training or retraining if an employee cannot do their current job any longer Providing modified equipment Making instructions and manuals more accessible Providing a reader or interpreter.What Can We Do About Anxiety? Employers The Culture IssueOrganisations are more than simply an organisation chart; they are living, changing entities and they are made up of human beings and the interactions between them. Culture means “the way we do things around here”. Think about words to describe organisational culture and you may come up with terms like paternalistic, blame, sales focused etc.Q: What’s the culture here?It follows that an organisation’s culture will determine whether those employees with an anxiety disorder progress or struggle. A positive, open and supportive culture will accommodate all kinds of people – anxious and otherwise. The Time is Money IssueThere is much in the way of compelling evidence to demonstrate that employers should be interested in anxiety disorders. People with an anxiety disorder are three-to-five times more likely to go to the doctor. Anxiety disorders cost the U.S. more than $42 billion a year. Statistics for New Zealand show that anxiety is the single largest contributor to absenteeism from work.Just think about the impact on working time that anxiety has. This shows us how an employer interested in productivity must develop a proactive approach to managing anxiety. Employers have a real interest in assisting those who suffer from anxiety so that their chances of developing serious physical illness, taking time off sick and for GP appointments are also reduced.Show slide – Reactions to AnxietyAsk learners to read and reflect.What Can We Do About Anxiety? Managers Show slide – ManagersAnxiety is a challenge that calls for managers to show real leadership. Managers must show their people that it doesn’t matter if they have an anxiety disorder, that it’s ok to be open about it and that in doing so, no one is risking their reputation or career potential.Getting rid of stigma really rests in the hands of managers. If you are a manager, ask yourself honestly whether you feel more or less supportive towards a team member with diabetes or a team member with an anxiety disorder. Challenge your thinking and analyse your mindset.We can begin to remove the stigma attached to anxiety and stop thinking about anxiety as a weakness or a failing, but instead as a condition that affects millions of people and which, if it were normalised, could potentially improve the experience of those that suffer with it.Q: Can you suggest any practical ideas that managers might implement?Record ideas on flip chart.Some notes to help with feedbackFor employees who have been absent due to a mental health condition, returning to work is made easier by good communication with their line manager. Creating individual return to work plans, and a positive manager attitude towards the condition is effective. Shorter working hours, fewer job tasks or reduced workload can be beneficial and there is evidence that those who do not receive these types of adjustments feel this is detrimental to their mental health and well-being.What Can We Do About Anxiety? Employee Colleagues As colleagues, we have a part to play in being proactive about anxiety at work.We can act positively to show that it doesn’t matter to us that a colleague has an anxiety disorder. This doesn’t need to be patronising – it need only be supportive and genuine.It may be appropriate to assist with some adjustments in the workplace to accommodate the rehabilitation of a colleague or to assist on an ongoing basis. Offering a shoulder or lending an ear can be invaluable, but it’s also important to remember that some anxiety sufferers are not open about their conditions, so it’s necessary to respect privacy and act with discretion.Support from colleagues is instrumental in improving a person’s mental well-being. Those who have support from their colleagues find it easier to admit to having bouts of mental ill health. And as we have begun to see, admission is a vital part of normalising.The Anxious Be realistic and reasonable – you have a contract of employment to fulfil, and you have a duty of fairness to your employer in the same way that they owe a duty to you.Decide on your strategy – face up or avoidance – then act on it.If you can be open at work, then do it.Get help if you need it – whether from a friend or colleague, from a GP or another professional.An employee can play an active role in discussing with their employer reasonable adjusments at work. What kind of positive action can an employee take?Record ideas on flip chart.Some notes to help with feedbackThey might want to encourage their employer to speak to someone with expertise such as an occupational health adviser.They could suggest an adjustment at work (examples could be discussed here, including cost, practicality, affordability etc)They may want to make sure that their employer is aware of the Access to Work programme run by Jobcentre Plus. Through this programme, employers can get advice on appropriate adjustments and possibly some financial help towards the cost of the adjustments.Activity – 20 minutesDivide the learners into 3 groups and hand each a different scenario from the Anxiety at Work Exercise 5 handout.The objective is to consider and discuss a celebrity with an anxiety condition, to examine sentiments towards them and to then consider how each has dealt with his own condition.Discuss any interesting points and ask the learners to reflect on just how many high profiles, household name individuals work through their anxiety on a daily basis.Show slide – Food for ThoughtIntroduce slide show as a closing thought.Final reflection and invitation for comments and discussion.Ask delegates to refer to the learning logs and action plans. They should spend 10 minutes completing these.Show slide – ObjectivesReview objectives and ensure that all points have been covered. Mention that there are a number of Help sheets available should anyone wish to have copies. Also, there are several useful website addresses in the plete evaluation and close. ................
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