Chilling effect

A range of therapies available to tackle stress and mental health issues are playing an increasingly important role in workplace wellness. Edmund Tirbutt reports 

Stress at work is on the rise
Stress at work is on the rise

The treatment of workplace stress and mental health issues will undergo significant change during the next five years. But this is likely to be due more to greater employer understanding of methods and strategies that are already available than to the emergence of any revolutionary new drugs or treatments.

Experts predict the three main types of existing talking therapy – psychodynamic psychotherapy, humanistic psychotherapy and cognitive behavioural therapy (CBT) – will figure prominently in employers’ drive to tackle employees’ mental health.

Each school has its own starting point and the therapeutic approaches differ accordingly. Psychodynamic psychotherapy believes that present problems relate to family and childhood; humanistic or ‘person-centred’ psychotherapy believes that individuals have the answers to their problems within themselves and just need the space to unload and explore them; CBT challenges irrational thoughts and aims to move towards more rational thinking and behaviour.

CBT, the preferred first line of treatment of the National Institute for Health and Clinical Excellence (Nice), continues to produce impressive shortterm results. For example, Legal & General reports that 74 per cent of those who undergo it return to work within six months – up from only 30 per cent before it introduced CBT in 2004.

CBT is also the banner under which a number of new developments are occurring. The term is now being used to include solution-focused CBT, which involves talking about solutions, rather than problems, eye movement desensitisation and reprocessing (EMDR), which helps people who are repeatedly going over traumatic situations; and mindfulness, which uses meditation techniques to clear the mind of clutter (see panel, p35). Even traditional CBT is increasingly being supported with computer-based technology. But none of these variations is likely to become the universal choice.

Dr Wolfgang Seidl, head of health management consulting at Mercer, says: “CBT is at risk of being seen as a panacea as the research behind it is quite supportive but not as supportive as proponents would like to think. It has the best short-term outcomes on anxiety and depression but, for longterm outcomes, new variables tend to come into play, such as the quality of the therapists being used. Psychodynamic psychotherapy and various forms of humanistic psychotherapy are also producing good long-term results and are very commonly used in the UK by insurers.

In five years’ time, attitudes towards these methods won’t be significantly different. Rather, the big change I predict is in the way psychotherapy will be administered, structured and accessed. There will be more biofeedback gadgets to help people de-stress and I expect most companies to have adopted a meaningful psychological pathway, providing systematic assessment and then referring to the most appropriate resource. At the moment, resources are often administered in silos, so people often don’t get the most appropriate treatment.”

When it comes to preventing employees from developing stress and mental health problems in the first place, the most widespread approach is for employers to take more responsibility for preventing stress by creating the right working environment. But only a minority of organisations currently do this.

Cary Cooper, distinguished professor of organisational psychology and health at Lancaster University Management School, says: “The problem is that when it comes to mental health, GPs can’t possibly know the most appropriate treatment. They may tell the patient to avoid stressful work when it is the way they are managed that is actually causing the problem, and a GP won’t know that someone has a bullying manager when they issue a fit note. So we need occupational psychologists, not medics, to work with those who are affected.

Research shows that line managers are the central cause of mental illhealth, and it can result from anything from bullying and not recognising symptoms to imposing unreasonable deadlines or not engaging. A good line manager manages by praise and reward and not by finding fault. We must focus on line managers and, if we get it right, we could eliminate around 20 to 25 per cent of stress.”

Feedback from Canada Life lends weight to this line of thought. When intervening early, the insurer has found that 15 to 20 per cent of absences were nothing to do with clinical scenarios but resulted from interpersonal conflict, management conflict and promotion to levels at which individuals were not comfortable.

Conversely, however, there is also increasing focus on tackling stress by looking beyond the workplace. During the past year, occupational risk management consultancy Healthcare RM has been focusing primarily on lifestyle behaviours such as lack of appropriate exercise, sleep, nutrition and smoking and drinking habits.

Pamela Gellatly, chief executive of Healthcare RM, says: “For a number of years, people have been blaming work and looking to treat symptoms as opposed to the underlying causes, but we have been looking at causative and contributory risk factors to stress, which could be physical but could lead to psychological problems. These can be addressed and, in some cases, CBT may be used to help understand them.”

Training line managers to spot the signs of stress is on the increase and it would be no surprise if in five years’ time it was standard practice for group risk insurers to offer such a service. Legal & General has just launched a line manager training programme via a tie-up with charity Rethink Mental Illness. It is available to all employers, whether clients or not, but some of the insurer’s larger clients can access it free of charge.

Also growing in popularity is the idea of educating the workforce in spotting the signs of stress and introducing resilience training to teach people to only worry about those things they can control. Towers Watson estimates that around 40 per cent of its clients are looking at the former and around five per cent at the latter. But in five years’ time it is expecting the vast majority of clients to be using both methods.

A primary driver behind the shift is a greater appreciation of the fact that the vast majority of people with mental health problems will recover with the right kind of support.

Andrea Woodside, director of training and consultancy at workplace wellbeing consultancy Minding Work, says: “The fact that people like me are doing recovery courses for employers is one of the big new developments of the past couple of years. Previously all employers tended to think everyone suffering from stress and depression was at the end of the road but I expect the recovery model to become much more important in the next five years.”

Other developments that pundits predict could assume a whole new dimension in years to come include research into the links between musculoskeletal problems and stress, cancer and stress, greater use of psychological screening via executive employee assistance programmes (EAPs) and the availability of tax relief.

Nick Homer, proposition development manager at Zurich Corporate Risk, says: “Government proposals to give tax relief for employer-funded interventions of up to £500 could be very helpful in getting employers more engaged with supporting rehabilitation – £500 could pay for a decent course of CBT.”

But, all these factors apart, the single biggest improvement in workplace stress is likely to result from a sustained economic recovery.

Dr Jenny Leeser, clinical director for occupational health at Bupa Health Clinics, says: “There is no substitute for good management and knowing when your people are not behaving normally. That will be the same in five years’ time but what will change is the recession situation.

There is no getting away from the fact that job insecurity and financial hardships are currently major factors in the stress equation.”

Stress at work is on the rise
Stress at work is on the rise

Being mindful of mindfulness

Mindfulness, based on meditation techniques used in the far east, is the fastest expanding form of CBT. It teaches people to calmly anticipate the inevitable coming and going of thoughts and emotions so that they can be released without feeling attached to them. Participants grow in self-awareness and the realisation that these are not permanent fixtures of their mind or identity.

Andrew Kinder, chief psychologist at Atos Healthcare and chair of the Employee Assistance Professionals Association (EAPA), says: “Mindfulness is important in the workplace as we are so time-urgent with deadlines and being under pressure. You can be so focused on the

end-game that you miss things, but mindfulness slows you down, increases awareness of what’s around you and boosts creativity. The NHS has been using mindfulness for several years and some EAP providers are beginning to incorporate it. I would expect this to be more mainstream in five years’ time.”

Nevertheless, many insurers feel it is still early days for mindfulness and are adopting a watching brief.

Kirsty Jagielko, head of product management at Cigna UK HealthCare Benefits, says: ”We are looking at it to see if we can incorporate it into our online CBT model but there must be sufficient clinical evidence for us to do so.”