JEA Q1 2020

Proactive Stress Management for EAP Clients

By James Porter

In his book, “A Clinical Guide to the Treatment of the Human Stress Response”, Professor George Everly of Johns Hopkins University, writes: “The history of stress management has been largely reactive. Stress management was initially conceived as a way to manage stress when it becomes excessive. More forward thinkers see that stress management can be proactive and preventative in nature.”
Dr. Everly is right. Most people apply what they learn about stress management like a bandage at the end of a bad day. If they do it at all, it’s usually reactive: “Maybe I’ll try to meditate or go for a walk tonight when I get home, because work today was really stressful.”  This is how the thinking goes for most people. But research tells us that people who practice yoga or meditate or who exercise regularly, are more productive, happier, healthier and less stressed than those who don’t.
Yet very few people ever make this proactive connection. Sure, a Band-Aid may help a person heal faster. But it doesn’t prevent the next injury from occurring. In the same way, it isn’t the occasional use of stress management that does the most good, it’s creating a resilience routine which can help EAP clients prevent stress rather than just manage it.
Following Dr. Everly’s lead, I developed a six-step stress prevention model – that can be used in the workplace – to help EA professionals teach employees how to manage stress proactively. These six steps can be applied to a whole host of stressful situations from dealing with a difficult boss, co-worker or client to managing a grueling commute or a growling customer.

Step 1: Raising awareness  
Recognize the symptoms of stress, including rapid heartbeat, cold hands, dry mouth, perspiring when you don’t expect it, and muscle tension and figure out, in real time, what is causing them.

Maria Ronda, CEAP, who works for an EAP provider in Maryland, recommends using a stress assessment tool like The Stress Profiler to help employees understand, exactly what their triggers are and what areas of their life are causing the most stress.
“Raising awareness is crucial for getting people on board with the idea that managing stress is important. The more they know about why they need to manage stress the more likely they are to establish a proactive routine.
“Encourage employees to connect the dots between their symptoms of stress and their sources of stress,” she continues. “When a certain supervisor walks into the room and the employee feels her heart beating out of her chest, she’s connected the dots between a symptom of stress and its apparent source. When a newly hired salesperson notices perspiration under his arms before a big presentation, he’s connected the dots between a source of stress and a symptom.”
Dr. Heidi Hanna, author of the book “Stressaholic”, puts it this way: “Most people try to cover up their stress symptoms, but they would be better served by paying close attention to them and doing something adaptive like breathing deeply or changing their perspective on the issue.”
IBH Population Health likes to use the instructional guide I authored, “Stop Stress This Minute.” Dr. Ryan Morgan of IBH explains: “I’m always surprised by how much people gravitate to the stress number system, which is described in the first chapter. Giving people a scale, from 0-10 on which to rate their stress, really helps them to raise their awareness of how their levels of stress fluctuate throughout the day.”
Here is how the scale works: 0 is the total absence of stress or tension and 10 is a panic attack. During their workday, most people fluctuate between a 2 and a 7. Although it’s entirely subjective, the scale is easily understood, and helps people realize when their stress levels are getting a little too high, thus encouraging them to take action to lower their stress.
Once a person develops an awareness about who or what is causing them stress, as well as their shifting levels of stress are throughout the day, then they know exactly how to apply the remaining five steps to cope with stress, on the fly while it’s happening. That’s the goal of proactive stress management.

Step 2: Problem-solving
Look at the problems identified in step one and do some creative problem-solving to eliminate, reduce or prevent them from happening.  

Maybe an employee with a difficult boss needs to talk to his or her supervisor, or to someone in HR or maybe even to a co-worker who isn’t bothered by this boss. Dr. Eric Gustafson, also of IBH, likes the problem-solving approach.
“I had a client who was dealing with a difficult commute. We explored her options: Working from home, requesting flex hours, moving closer to work or in the opposite direction of traffic, or making better use of her commuting time by taking public transit where she could work on a laptop while traveling.”
Dr. Gustafson explains: “A lot of times people have trouble doing problem-solving because they don’t see the big picture. They don’t realize how they can transform a stressor into a solution. In this particular case, the employee got permission to work from home for two days a week, and by requesting flex hours, was able to avoid peak traffic times on the other three days.”

Step 3: Cognitive Restructuring
Teach employees how their thinking can be a major source of stress.

Cognitive Restructuring is a term borrowed from Cognitive Behavioral Therapy (CBT). Dr. Albert Ellis, one of the cofounders of CBT, changed the whole field of psychology by moving it away from Freudian Psychoanalysis and into the cognitive behavioral model, which could produce results in as little as five sessions.
Ellis was inspired to create this new form of “cognitive” therapy when he realized how often his clients’ thinking was “faulty, irrational and muddled.” He reasoned that if he could get them to recognize when their thinking was irrational, then they could easily change it.
As an EAP counselor, you can use this same approach by getting people to notice their negative self-talk.  If the client says “I’ve got the world’s worst boss,” that’s an overly negative self-statement that only makes their stress worse. Encourage them to change that self-talk to be more accurate.
“My boss isn’t always bothering me, last week, she let me go home early when I wasn’t feeling well.” Employees don’t have to sugar coat their self-talk, as long as they continually modify and correct thoughts that are overly negative.  
Dr. Rae Hadley of IBH teaches her clients cognitive restructuring because it’s such an effective technique to use. “Employees quickly see how often their distorted thinking plays a major role in creating stress.” For step 3 they use the first two articles from The Thinking Person’s Stress Management Workbook. This book describes Dr. Albert Ellis’s A+B=C equation. In this equation, A stands for the Activating event, which could be any source of stress. B stands for your Beliefs about that event, and C stands for the Consequence of A+B which is what you feel inside as the result of what has just happened.

Hans Selye, the Canadian scientist whose research in the 1930s put stress on the map once said: “It’s not so much what happens to you but how you take it.” Selye’s quote confirms the fact that a lot of the control over how stress affects us occurs as the result of our interpretations, thoughts and beliefs at point B.
As Dr. Gustafson explains, “This is an incredibly empowering idea. The whole world believes that A=C. That any stressor automatically leads to stress. When you introduce the idea that a client can control his or her stress by controlling their reaction at B, it can be life-changing.”

Step 4: Mindfulness
Understand the therapeutic value of staying in the present moment.

When a person leaves the present moment, and allows his/her mind to wander off into the future, they may get anxious. And when they go back into the past to dig up old hurts, people may get angry and resentful. So, staying in the present moment has therapeutic value. It can be a refuge from both anxiety and anger.
Remind your clients not to let a minor incident that occurs on a Monday, affect how they feel about someone (like their boss or a co-worker) on a Friday.  By adopting this stay-in-the-moment approach (rather than a narrative view of life where one bad moment taints how they see a person in the next moment) employees soon realize that their boss (or their co-worker) is not “bad” all the time.
Bud Wassell, MS, CEAP, LPC Coordinator, Employee and Family Resources (EFR) Program, Yale New Haven Health System, practices mindfulness himself and teaches it to his clients. He has a regular meditation group that meets for a half-hour, once a week, for six weeks, at the hospital.
Wassell gradually built up a demand for his mindfulness meditation classes, by inserting short mindfulness meditations into other programs he was offering on stress and resilience.
“I’d do a short session at the beginning of meetings, on retreats or at any event in the hospital where it might work. Employees started requesting it more and more and that’s when I started my six-week classes.
“I’ve tested the participants in these classes with a perceived stress and burnout scale and have seen significant reductions of up to 25% in their scores pre and post,” Wassell adds.
One client of Wassell’s in particular typifies their experience. “After your meditation class I had mental clarity and I was more productive all day. I was able to get a lot done and I felt good doing it.’”

Step 5: Resilience
Establish a resilience routine.  

As Wassell’s story and further research confirms, a regular practice of yoga, exercise and/or meditation helps employees to better handle the ups and downs of their day.  This is how stress management morphs into stress prevention.
Eileen Hodiak, LCSW, CEAP, Director of the FirstHealth of the Carolinas EAP, encourages her clients to start small. “Just suggesting that someone walk for 30 minutes a day is a big request. In so doing, you could be setting them up for failure. That’s why I tell each person to start small when setting up a resilience routine. Whether it’s meditation, walking or stretching, start with just 5-10 minutes a day. Once that tiny habit is WELL in place, then they can build on it.”
Dr. Ryan Morgan of IBH uses “Stop Stress This Minute” to reinforce the lessons of step 5. “There are ten quick 2-minute exercises and relaxation techniques that people can practice to build their resilience to every-day stressors. I tell people to try all ten and choose the one they like best and do that for 5 minutes every day. The technique people choose most is abdominal breathing.”
From the psychometric data they have gathered, it’s clear that IBH has created a highly effective resilience program. In this program, state employees can have up to ten coaching sessions over the course of 4-6 months. Each participant agrees beforehand to do some sort of skill practice for 10 minutes each day.
“We’ve seen significant changes in all ten areas that are tested on the Stress Profiler assessment, including how well people cope with anger, worry, time pressure, financial stress, change, and stress symptoms,” Gustafson explain. “Overall, participants’ scores on The Profiler have gone from an average of 212 before the intervention down to 168 afterwards, a drop of over 42 points on the scale.”

Step 6: Social Support
Seek out social support as a hedge against all kinds of stress.

As an EA professional, you are supplying some of this much needed support. Help employees to see, if they are dealing with a toxic boss, a difficult coworker or a long commute, that finding someone to talk to about it, can really help. David Mitchell of Employee Assistance of the Pacific tries to make it easy for his clients to reach their EAP in a time of need.
“I want our phone number to be riding around in their wallet or purse, 24/7/365. That’s why we hand out our contact information on a stress-testing card. It’s the size of a business card, but they are much more likely to keep it with them than a regular business card. People use it repeatedly to test their stress levels but more importantly, it reminds them that we are there whenever they need a helping hand with their stress or any other mental health problem.”

Using the Six Steps with Clients
Whenever I put on a presentation on stress prevention, I leave my audiences with these six simple ideas for incorporating each of the six steps:
* Use a 0-10 stress number scale to monitor stress levels throughout the day.
* Make a list of the top ten sources of stress and use creative problem-solving to eliminate at least 3 problems on the list.
* Recognize an A when it occurs and choose how to respond at B.
* When feeling frazzled, take one deep breath to bring yourself back into the present moment.
* Establish a resilience routine and make it a habit. Start with just five minutes a day.
* Connect with at least one person every day.

As an EA professional, don’t think you have to walk through all six steps with every client. Dr. David Hunnicutt, former president and CEO of WELCOA explains: “The beauty of this model is that your clients can use it at whatever step works for them in whatever situation they find themselves in.” And there is a growing interest in this type pf approach. When I lectured at MIT, I noticed that, as a group, they were very interested in cognitive restructuring. When I have spoken at Army bases, there’s definitely a greater interest in resilience.”

Summary
As you work with individual clients, you will get a sense of which steps they are ready for. Whatever steps you choose to teach them, always emphasize the proactive and preventative nature of this approach.
When they learn they can detect tress early on– by becoming aware of stress symptoms and fluctuating levels of stress – and learn to deal with them in real time, they can prevent day-to-day issues from becoming chronic problems with stress, requiring more in depth intervention.  

Jim Porter, CEO of StressStop, is author of “The Stress Profiler,” “Stop Stress This Minute” and “The Thinking Person’s Guide to Managing Stress,” which together have sold over 400,000 copies. Mr. Porter has presented programs on stress at MIT, BYU, the FBI, CIA, and others. He has presented at numerous professional conferences including EAPA, WELCOA, IRAE, National Wellness and NCEAPA. He may be reached at jim@stressstop.com.


References

Brusman, M., Porter, J., (2018). The stress profiler. Retrieved from  https://stressstop.com/collections/workbook/products/the-stress-profiler

Ellis, Dr. A., Lange, Dr. A. (1994). Carol Publishing: How to keep people from pushing your buttons.

Everly, G. Jr., Lating, J., (2012). Springer: A clinical guide to the human stress response, 3rd Edition.

Hanna, Dr. H., (2014). Wiley: Stressaholic.

Porter, J., (2017). Stop stress this minute, (WELCOA), https://stressstop.com/collections/workbook/products/stop-stress-this-minute

Porter, J., MALS, Rosch, P., M.D. (2015). StressStop. https://stressstop.com/collections/workbook/products/the-thinking-persons-stress-management-workbook