Motivation and emotion/Book/2020/Workplace mental health

Overview
"What are the changes ... that workplaces need to make ... it’s to be kind to those that we work with! ... Rather than jumping to ... an adversarial approach, instead, check in with them and find out whether there is something wrong and what might help."

- Patrice O'Brien, Beyond Blue

Globally, governments develop policies and practices for workplaces to be physically safe (Work Health and Safety Act) but is mental health (MH) being neglected? The social determinants of health require important recognition, including the need to work (Maslow’s hierarchy of needs). A focus on a positive work-life balance is required; assessing the relationship between individual and corporate practices. One in five Australians reported a MH or behavioural condition in 2017-2018 (AIHW, 2018). In 2014, research by PricewaterhouseCoopers equated that every $1 spent by an organisation on improving MH in the workplace, would reap a $2.30 return (PwC, 2014).

This chapter considers ways to foster MH in the workplace. 
 * What are the risk factors of ignoring workplace MH?
 * How can MH be improved?
 * What can an organisation do?
 * What part can an individual take?

 Ruth is ruminating about work and finds it difficult to sleep. During the journey to work, Ruth begins to experience panic attacks. Whilst at work she feels scrutinised and unsupported. Recently during meetings, she has started to forget what she was going to say. Ruth begins to feel angry and vulnerable and feels like a failure at work.  Peter has regular meetings with his workplace mentor. Through the "well-at-work" program, Peter began attending training and started using web-based resources. Peter liaised with his workplace health officer to amend any practices hindering his MH. He felt listened to and through this empathetic process, his apprehensions were reduced. Peter now sleeps better and feels a more valued part of the organisation.

Workplace mental health
Workplace mental health is a broad spectrum that includes developing workplaces with a strong culture of addressing mental health issues and developing strategies and programmes to intervene with mental health issues. Workplace mental health programmes attempt to create workplaces that foster resilience and create a supportive environment to maintain the employees' mental health. To improve workplace mental health, healthy workplace cultures can be established and maintained to stop tragedies from happening and to encourage those who are suffering to receive evidence-based interventions free from the stigma of seeking care.

Recognising workplace stressors
Occupational stress and psychosocial factors was examined by Nigatu and Wang (2018) through job demand and effort-reward-imbalance (EFI) to risks of depression (MDD). Their 4-year longitudinal study found high effort and low rewards the strongest predictor of emotional exhaustion, psychosomatic health complaints, high job strain, and low autonomy which may lead to MDD, family conflict and learned helplessness. This high-stress-low-reward dynamic may also indicate low salary or employment instability. The job demands-resources (JD-R) model has be used to describe work and personal characteristics, well-being and performance at work (van den Berg et al., 2017).  6 min. video



Risk factors
Occupational stress describes employment-related issues (stressor) that negatively affect workers leading to physiological and psychological changes (psychological stress) deviated from normal functioning (Newman & Beehr, 1978). Stressors include employment insecurity, bullying, psychological harassment, low social support and an effort-reward imbalance. These may be associated with anxiety, depression, burnout, alcohol dependence and suicide ideation. The physiological manifestations include panic attacks, lowered immune system, fatigue, change of appetite and sleep hygiene (Headsup.org.au, LaMontagne, 2014).

Workplace bullying, defined as ongoing, deliberate misuse or imbalance of power through repeated, persistent verbal, physical and social behaviour. This behaviour intends to cause physical, social and/or psychological harm. This is unpacked in video link figure 1. and behavioural signposts in figure 2. Experiencing bullying increases the risk of developing psychiatric disorders (Frizzo et al., 2013).

Organisations should consider the possible consequences if employees experience MH disorders: workers compensation claims, disability pension, long-term absenteeism, reduced productivity, staff turnover, lowered morale and HR costs (Frizzo et al., 2012; Giorgi et l., 2016). Workplaces should be mentally safe and healthy environments, Australian Disability Discrimination Act 1992. See Work Health and Safety Act for employment legislation and Health and Safety UK to protect and support physical safety at work.

DSM-V Definitions to frequently experienced psychological disorders

Anxiety. Anticipated future danger with feelings of worry, distress, and somatic symptoms of tension.

Panic attacks. Sudden onset of intense fear, often associated with physical symptoms including, shortness of breath, palpitations, choking, and feeling a loss of control.

Social exclusion. Imbalance of social power resulting in social exclusion or rejection. Examples include, bullying, teasing, intimidation, verbal abuse, humiliation, and excluded from workplace activities.

Stressor. Any emotional, physical, social, or economic factor that disrupts the normal physiological, cognitive, emotional or behaviour balance.

Worry. Unpleasant thoughts that cannot be controlled by altering attention to other things. It is often persistent and out of proportion to the subject.



{Do you have problems concentrating at work?}


 * type=""}

- Sometimes + Yes, I find work very stressful - Never

{Do you worry about work during the weekend?}


 * type=""}

- Sometimes + Yes, I think about work on and off all the time - Never

{Do you have problems sleeping?}


 * type=""}

+ Yes, I regularly have trouble sleeping - Sometimes - Never

How can workplace mental health be improved?
"Emotion is what sets people and organisations in motion."

- Anat Rafaeli

Essential to enhancing MH within the workplace is to create a workplace environment that cultivates health, safety and well-being. Well-being has been defined as the “presence of positive feelings and functioning,” (LaMontagne et al. 2014). A psychosocial safety climate (PSC) is joint confidence that employees and employers have a commitment to promoting and enhancing well-being through organisational policies and practices including shaping a climate of inclusion and protection. Through their longitudinal research, Bond and colleagues examined PSC in 1,700 South Australian police officers through anonymous questionnaires during two-time periods. Stations with low (negative) PSC reported elevated workplace bullying and post-traumatic stress symptoms. Conversely, high (positive) PSC officers felt appreciated and content. Bond and colleagues concluded that stations that followed protocol, and articulated a no-tolerance to workplace bullying resulted in a positive PSC (Bond et al., 2010).

Italian research of 326 adults from factory and office-based private workplaces studied the relationship between emotional intelligence (EI) and workplace bullying. EI was found to be an aid in avoiding the experience of bullying. The converse was also found; if there was a deficit in EI either due to a lack of skills set or workplace burn-out or stress then this may lead to experiencing workplace bullying, or other negative workplace relationships because of the lack of self-management ability. Namely, suffering from MH issues (that may arise from workplace bullying or elsewhere) have shown to reduce emotional regulation. Their findings suggest that EI is paramount for manoeuvring through life’s stressful experiences and the partnership of organisations to provide a non-bullying safe environment to enable individuals to continue to develop their coping skills (Giorgi et al., 2016).

Primary interventions are processes that act as early detection to protect and reduce workplace risk factors. An employer may partner with the employee to modify a job description, which may increase their autonomy and adapt the working environment to better meet needs.

Secondary interventions are strategies or programs endeavour to reduce stressors or perceptions of a stressful situation before the issue develops into psychological distress with an employee-directed response.

Tertiary interventions react to issues or challenges. For example, the individual who has a health condition. This could include assessing their physical working conditions, reducing working hours or working from home. There will also be liaisons with other stakeholders to manage a return-to-work program.

Authors suggest an integrated approach to improving workplace MH has more utility than individual interventions. Promoting MH in the workplace, identifying employee strengths and positive capacities which will in turn generate a shared view with positive engagement and a supportive culture. Without leadership promotion, there will not be employee uptake. Authors also suggest addressing MH issues regardless of origin, introducing psychoeducation to improve MH literacy and promoting early help-seeking to avoid long-term interventions.

(LaMontagne et al. 2014; Richardson & Rothstein, 2008).

Stress management intervention
Stress management intervention (SMI) programs or activities are designed to reduce stressors. These programs are usually constructed for the individual to use as an aid to minimise negative outcomes from exposure to stressors, reduce intensity or perception thereof and improve general coping abilities. They may also be group based with a therapist, web, book or tape based. Programs will generally last for several weeks, vary in length and contain several techniques. Richards and Rothstein (2008) carried out a meta-analysis of 36 studies and 55 interventions and reviewed the previous 45 study meta-analysis from van der Klink et al. (2001) and found that cognitive behavioural therapy (CBT) was more successful (d = 1.16) than any other intervention. When comparing each SMI objective, CBT as a single-mode SMI was found to be an active process whereby negative thoughts were acknowledged, challenged and maladaptive behaviour modified. The relaxation and meditation SMI were often favoured but due to the passive nature of the interventions stress was found to only be temporarily refocused.

These include:
 * Stress management interventions are often categorised as being secondary and tool-based (Giorgi et al., 2016; Richardson & Rothstein, 2008).


 * Stress management
 * Goal setting
 * Time management
 * Assertiveness training
 * Social interactions and support groups
 * Meditation and relaxation
 * EMG biofeedback programs
 * Mindfulness
 * Journaling
 * CBT
 * Enhancing EI and regulation

Stress and coping


Emotions are a complex challenge. Emotional regulation is when processes of experiencing feelings, body responses and expressing reactions are combined. Self-regulating emotions instead of being led by emotions. Early detection and prevention of issues relating to emotional regulation, for example, anxiety, should be utilised by employing primary interventions of modifying workplace environments and strategies to improve coping (Giorgi et al., 2016, flow state).

Ford and Gross in their meta-analysis of 2019 on “why beliefs about emotions matter” found that believing emotions are controllable will generally predict greater cognitive reappraisal and eventual success of ER, although people may be less empathetic because of this expectation. Conversely, believing events are negative and cannot be changed may indicate a risk of MDD, particularly in youth. Cultural norms were highlighted as a distinct difference and require further research. This modern research links with Ryff’s (1995) 6-factor model of psychological well-being representing strong findings that well-being could be measured through autonomy, environmental mastery, personal growth, positive relations, life purpose and self-acceptance. Hebere et al. (2016) developed a web-based stress management training that was implemented in a German workplace. The program was based on Lazarus’ transactional model of stress (figure 3.). The program was enacted through guided interventions, text messages to promote engagement and motivation, interactive exercises and human support for goal setting, a 6-step procedure to problem-solving, ER strategies and relaxation training. Positive results were found at 6- and 12-month evaluations for stress reduction (Hebere et al. 2016). Sweeny and Dooley (2017) found that worry can be beneficial if used as a prompt to action. They established that levels of worry can be utilised as useful only when the ratio of arousal to autonomy is satisfied. Namely, if the worry is enough to encourage action but not so large that it is paralysing. When worry is inevitable (waiting for a result) then a coping mechanism is enacted to diminish negative results, make plans for alternatives or feel increased positivity if the outcome was positive.

Emotion regulation
Affective events theory describes everyday ups and downs reflected at work. It is the frequency and accumulation of events rather than the intensity of one particular event that determines outcomes. “Uplifting events” more frequent positive feedback and supportive colleagues after a negative event appears to be more important and may “reverse negative consequences” (Charmine et al., 2016. p.7). Autonomous emotional labour may be summarised as the emotions an individual reflected and controls whilst at work. Namely, an employee’s positive emotion for their employment may be reflected in their general positive affect and attitude directed to their colleagues and work. Authors suggest that this could be further encouraged by providing a break area for freely expressing emotions or elevating positive affect (Charmine et al., 2016, p.228). Emotional intelligence (EI) is the process enabling assessment and evaluation of emotional information accurately, individually and in others, and to adapt emotions correctly to be able to function in an ideal manner in complex situations (Charmine et al., 2016, p.175). Emotional regulation (ER) is the process and evaluation of emotion in relation to individual goals and the decision to modify a response and monitor success. A belief that emotions are controllable predicts greater cognitive reappraisal and eventual success of ER. Extrinsic regulation may be represented as rumination. Team leaders should be explicit and intentional, implicit reactions are automatic and not useful (Ford & Gross, 2018). Affect control theory details evaluation, activity and strength of emotion which are suggested to affect the events that follow and whether this is congruent with self-identity. This may be linked with ER as part of culture (Strongman, 2003. p.279).

Transformational leaders is an example of ER by breaking norms, engaging staff intellectually, sharing goals, and giving feedback. These leaders are emotionally stable, show empathy, seem in touch with their feelings, able to encourage employees through less aggressive and altruistic methods. Employees need to feel they are effective team members in a productive workplace. This will only occur with an “emotional commitment from employees, innovation and conflict-free decision making towards achievement” (Strongman, 2003. p.243). Charmine et al. (2016) summarise their management strategies for team-building: conflict resolution skills, teaching leadership development to understand and regulate emotions, stress management and wellness programs, creating an environment to express and accept emotions and an area for employees to unwind from events. Shame and powerlessness should be considered important emotions. Employees have to surrender power and control to their employer. Shame may be experienced through not gaining a positive evaluation or promotion, redundancy or losing their job. Shame may be experienced within the workplace leading to lower self-esteem, psychological illness, bullying, and disadvantage from a lack of diversity: gender, sexual, faith or physical characteristics (Strongman, 2003. p.243).

Tools for ER at work include promoting positive emotions, and increasing arousal through mood playlists, videos, and digital nature soundscapes. Currently, video games are used for stress relief, and social media for reflection; mobile applications could track mood and prompt mindfulness training. Digital ER may be beneficial or harmful, for example, benefits may include sharing resources, enabling engagement with immediate access or harmful through binge-watching media. (Gross, 1998 & 2015). Wadley et al. (2020) ask questions such as, is ER different in a digit environment? Does digital technology assist in modulating emotion? Ashoori et al. (2015) shaped these ideas to manipulate lighting, music and images (wall displaying a Zen garden) at a workplace which resulted in assisted decision-making. Failure tolerance should be encouraged with an openness to revise and update knowledge and ask for advice, namely learn from mistakes (Strongman, 2003. p243). Mark Rober explains this re-framing process in his YouTube video.

Self-Determination Theory
How do we create environments that support others to flourish? Self-determination theory (SDT) may be viewed across cultures as the process of work being labelled as 'just a job', the only reason for attending this employment is the extrinsic motivation of earning a salary. With this view dissatisfaction and potential psychological distress may occur. When an intrinsic motivational choice is made, namely the person and environment is viewed together, then employment may be regarded as enjoyable with good workplace relationships that increase well-being and foster good psychological health. Through the sub-theory of Cognitive Evaluation, autonomy can be improved with perceived competence which employers can illustrate through positive feedback. Positive emotionality is the absence of negative emotion, having a sense of purpose and satisfaction with life (Ryan & Deci, 2000).

What can organisations do?
Organisational culture should be fostered to encourage active participation in their employees’ psychological life journey. When organisations are encouraged to participate in MH literacy there is an increased culture of MH awareness and general uptake of interventions than without any positive encouragement or contact as illustrated in figure 4 (Kristman et al., 2019).



This could include:

(Beehr & Newman, 1978; Kristman et al., 2019; Richardson & Rothstein, 2008; Safet Work Australia, 2016).
 * Organisational documentation and training to know psychological and physical health requirements as set out in law. MH awareness training to encourage organisations to continue fostering their workplace environment and to implement a system of workplace psychological health assessments (CSA, 2014).
 * Organisational health checks - structured assessments that relate the organisation's perceptions of workplace MH with corresponding policies in relation to the reality of how employees perceive the situation and preferred practical support to be implemented (NHS.org).
 * Implement a stress management and intervention (SMI) program (Roohafza et al., 2012).
 * Mental Health First Aid for all employees.
 * Psychological and physical health promotion and awareness. Asking, “How do you feel at work?” “Are you aware of your MH?” “How do you care for others at work?”
 * Autonomy, encouraging personal engagement in a role.
 * Training to recognise psychological stressors and ways to limit them.
 * Flexible working arrangements

The National Standard of Canada for Psychological Health and Safety in the Workplace actively seeks to encourage organisations to prevent physical and psychological harm in a workplace through worker conditions, management practices, decisions and communication processes. This standard has detailed 13 items for an organisation to attend to, see table 1. (Kristman et al., 2019). This would be suitable for implementation in workplaces to encourage a psychologically and physically safe environment.

Table 1.

Workplace factors for organisations to implement a psychologically and physically safe workplace adapted from Kristman et al. 2019 

{Would you consider using a web application-based SMI?}


 * type=""}

- Perhaps - No + Yes, I would find that useful

{Would you participate in workplace wellness activities (for example, mindfulness, yoga, walking groups, support groups)?}


 * type=""}

- No - I like the thought of them, but probably not + I may consider attending if my friends were also participating



What can individuals do?
It is important to consider work and home environments (biophilic design figure 5 and 6). Physical workplace strategies to consider
 * Reflect on Ryff's (1995) 6 facets of well-being: self-acceptance, interpersonal relations, autonomy, environmental mastery, purpose in life and personal growth.
 * Team morning teas: how is everyone tracking?
 * Creating an open environment for team conversations. What are our challenges?  How can we support each other? Being engaged and using well-being resources leads to resilience.
 * Re-evaluate joy at work by decluttering and organising a more efficient workspace (Kondo & Sonenshein, 2020).
 * Scheduling pleasant activities: group activities (organising a pleasant activity builds anticipation and triggers a dopamine release)
 * Building a psychologically safe workplace, Amy Edmondson TEDx

Virtual workplace strategies (apa.org)
 * Decide on a working space that is separate from your general living space, where you can close the door.
 * Set working time boundaries.
 * Maintaining ongoing communication via the workplace chat facility.
 * Creating schedules for exercise: stretches and walks.

Taking time out (Beehr & Newman, 1978; van den Berg et al., 2017)
 * Exercise: walking, yoga and tai chi.
 * Sleep and hygiene.
 * Scheduling pleasant activities: organising activities that through the process of anticipation will enhance your MH. Meeting friends at a botanical garden (avoiding social isolation and loneliness).
 * Talking over challenges with a psychologist, visiting positive psychology information, Australian Psychological Society, or Beyond Blue pages.

Conclusion
 Enhancing workplace MH requires a partnership and belief between all stakeholders. A cultural change is necessary to create and continue to develop a workplace environment that enhances health, safety and well-being by fostering autonomous motivation. Full integration of the working environment, workplace practices, psychological interventions and psychoeducation is required with a move from viewing work as an extrinsic motivator. As workplace environments diversify between the office and home base the challenges continue. The activation of four basic strategies should be considered. Planning through discussions with all employees, engaging and implementing the waterfall change from leadership down, checking that the plans are effective and adjusting as necessary for a cohesive workplace, and congruence.

More multidisciplinary research and development between psychology, public health, business and information technology are essential to understand the challenges and implement change. Technology can enable individual support and psychoeducation to avoid interventions and promote workplace strategies to enable people to live more congruent lives.