The Essentials: Dealing with Stress
Stress affects everyone, but we all express and experience it differently. Hearing how a nurse practitioner responds to the various stressors of her job reveals how stress works at a fundamental level. Workplace well-being researcher Mandy O’Neill says that we’re more likely to feel stressed when there is an imbalance between the threat we’re facing and the resources we have to prevent damage or danger. When the current threat feels greater than our available resources, we become — understandably — mentally and emotionally strained.
The two of them join Amy B to discuss the constant challenge of managing stress, as well as actions that help control tension and anxiety — or, even better, the stressors themselves.
Sarah Rose Lamport is a nurse practitioner.
Olivia (Mandy) O’Neill is an associate professor of management in the George Mason University School of Business and a senior scientist at the university’s Center for the Advancement of Well-Being.
- HBR Guide to Managing Stress at Work, by Harvard Business Review
- “To Lead Better Under Stress, Understand Your Three Selves,” by Tony Schwartz et al.
- “5 Mistakes We Make When We’re Overwhelmed,” by Alice Boyes
- “Research: Why Breathing Is So Effective at Reducing Stress,” by Emma Seppälä et al.
- “Managing Burnout,” by Women at Work
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AMY BERNSTEIN: You’re listening to Women at Work from Harvard Business Review. I’m Amy Bernstein. This episode is part of our series, The Essentials. In it, women whose work is critical to all our well-being bring their perspectives, questions, and insights to conversations about key career topics, like stress. Sarah Rose Lamport, a nurse practitioner, knows a lot about dealing with stress. She practices palliative medicine at a large teaching hospital and specializes in caring for people with life threatening illnesses. In this conversation, she’s helping me and hopefully helping you better understand stress and manage it.
SARAH ROSE LAMPORT: The role of a palliative care provider, we go see the patient, and really try to get a sense for their needs, developing a meaningful connection with them to provide them the best kind of care in what is almost always a really, really difficult time.
AMY BERNSTEIN: It’s an inherently stressful job any day. The pandemic heightened the mental and emotional strain. Sarah Rose made every effort to bond with her patients while cloaked in a mask, gown, and gloves. All the while, like so many of us, she worried about her family, how her five kids were holding up. At times, she found herself feeling exhausted, overwhelmed, and anxious, but also incredibly grateful to be able to go into work.
SARAH ROSE LAMPORT: I left my husband in the morning at home with all of these children ostensibly being schooled at home, while he’s trying to work, and then I got to go someplace and connect with my colleagues. And even though it was really difficult and challenging, I also got that support from that connection with my colleagues, which was really valuable.
AMY BERNSTEIN: How people deal with stress at work is complicated. That’s what makes studying it so interesting for Mandy O’Neill. Mandy’s a management professor at George Mason University and a scientist at its Center for the Advancement of Well-being. Healthcare is one of the industries she focuses on. The last time Mandy was a guest on the show, she explained burnout and gave us advice for managing it. And now she’s back, this time to talk about stress. Sarah Rose, Mandy, thank you so much for joining us.
MANDY O’NEILL: Thanks for having us.
SARAH ROSE LAMPORT: Yeah, thanks so much.
AMY BERNSTEIN: Sarah Rose, this has been an incredible year, particularly for someone in your line of work. What did you learn about how you experience and deal with stress?
SARAH ROSE LAMPORT: I think I learned that I needed to make space for being quiet and connecting with my body and feeling safe. A lot of it really came from a place of kind of everything breaking down. And when I say everything breaking down, I think I mean the stress level at work, and specifically at the hospital, going up so much. But then also in my home life, losing so much of the support, like an informal care network and friends coming over and all of those things. So, I learned, I guess, how chaos feels. And out of necessity I had to find things that grounded me and helped me keep going in a productive way.
AMY BERNSTEIN: So, are these sort of new coping mechanisms for you?
SARAH ROSE LAMPORT: Yeah.
AMY BERNSTEIN: And what are they?
SARAH ROSE LAMPORT: So, I’m very lucky to have my own office and my own space. And so, I’m able to roll out a yoga mat and do two minutes of stretching and breathing. During the pandemic, the institution made a lot of effort to try to prevent burnout by trying to give space and time to people to try to process what was going on to avoid that, and I think it was really helpful.
AMY BERNSTEIN: Mandy, when you were on with us talking about burnout, you made the distinction between burnout and stress. I wonder if you could talk us through that difference right now. It seems like an important one to keep in mind.
MANDY O’NEILL: Yeah, burnout and stress are very related, but stress has a different physiological profile. So, when people are burnt out, interestingly, they react in a way that allows them to keep going, whereas stress in a way, especially when it doesn’t reach the extreme levels, can actually be our body’s way of telling us that we need to slow down, that we need to cope with the threat or the stressor that’s in front of us. So, in that way it serves a somewhat functional purpose, even beyond this idea of emotions as signals, as information about the environment. We have this physiological response that’s very adaptive, actually. So, the extent that our body changes with stress, there is some evidence that can actually improve performance in the short term, and again, in moderate amounts – increased blood supply, the heart speeds up. It improves lung function. So, there’s this slight performance boost. And it’s good until it becomes unabated. Because when we get to that extreme response, the body actually weakens from all this overstimulation and all these stress related chemicals. So, it’s sort of interesting, because if you talk to athletes, if you talk to performers, if you talk to creative spirits, if you talk to anybody preparing for a big exam, they might tell you that the stress actually motivated them to perform at their highest level, and it got them through it, and you know, it really pushed the limits. But then that’s just it. When we push the limits, that’s when stress becomes problematic. And people don’t often know where that line is.
AMY BERNSTEIN: So, Mandy, help us. How do we see this turning point? How do we keep stress from turning into something dangerous and unhealthy?
MANDY O’NEILL: I think emotional intelligence, and at the most fundamental level, emotional intelligence is recognizing our own emotions and managing our own emotions. Part of recognizing our own emotions is recognizing our physiology. So, we can feel our heart beating. We can feel our breathing increase. But we can also feel when it starts to have an effect on our body in a dysfunctional way. But people are often very out of touch with their own bodies. And I think that being more in touch with our own bodies, recognizing those emotions is a key part of it. And also knowing that it has a short-term effect, but long term is where it is the problem. And I think this is where people get so caught up in routines, they get caught up in their lifestyles, they don’t get time to stop, just say stop, and really de-charge, really focus, really engage in self-care. Sarah Rose, it sounds like you have some really good ways of recognizing that in yourself.
SARAH ROSE LAMPORT: I think they’ve definitely gotten better during the pandemic. But there’s definitely also still that temptation to push through and keep going, and there are always more people that need help, and you always want to be the most helpful colleague. So, I think your advice really resonates that paying attention to your body and that there are specific signals you can look for and listen to is really helpful.
AMY BERNSTEIN: Mandy, how do we release the stress when it builds up like that?
MANDY O’NEILL: This is going to sound like a very simple answer, and I’m sure everyone’s physician has said the exact same thing. But exercise is one way. But exercise is challenging, and I speak to that from a very personal place. You know, you think, well, if I take time to exercise, then I don’t have time to get done. Those 30 minutes I could spend doing something else. But it doesn’t actually take all that much time to just incorporate exercise, especially in the mornings. Especially when it’s aerobic exercise. You know, there’s some evidence that it actually improves brain function. So, if I take my own advice, I would be out there exercising. But I would say that another important release of stress is connecting with others. So, I think some of the most fascinating research is building on this idea of the fight or flight reaction. We used to think that there were only these two reactions to stress or to threats, which is fight or flight. But we now have this idea of tend and befriend. And I think that’s just a fascinating concept, because it suggests that the old models we had really are sort of antiquated, because we have this, and it’s actually biological in origin, we have a tendency to also connect with others during times of stress and distress. And I think that that’s an important lesson, too. So, maybe we go exercise a little bit in the morning, but then we take the time to really connect with people. And that could be friends. That could be coworkers. That could be family. But really prioritizing that interpersonal connection. And some of the emotions that come with it, so my own research has focused on joviality and laughter. Sarah Rose, I think that in healthcare, there’s a big role played on humor, and sort of laughing about some of the most stressful situations.
SARAH ROSE LAMPORT: Yeah, I feel like humor is really important in connecting, but also in just blowing off some steam and kind of resetting that stress, and we do a lot of debriefing together, and there is definitely some humor interjected that really helps kind of keep everything balanced.
AMY BERNSTEIN: So, Sarah Rose, what does stress look like for you at work?
SARAH ROSE LAMPORT: Well, stress at work I think of in different ways in relation to the people that I’m interacting with and the kind of stressful situation. Specifically, I’m thinking of stress related to patients as being one thing that I feel like I have a pretty good toolkit of coping skills to handle, versus stress related to institutional issues or issues with colleagues where I find I have a lot more unresolved stress and have more difficulty managing it.
MANDY O’NEILL: Sarah, can describe how those different forms of stress manifest themselves? For example, when you’re dealing with patients, versus dealing with coworkers, versus dealing with institutions. Maybe in terms of the way you cope with it, or just the way it manifests itself in your own reaction.
SARAH ROSE LAMPORT: Yeah, so I think stress with patients, it feels like an external kind of stress. It’s something that I take into my heart because I care for my patients, and I want to honor their stories. But I feel like I do have some boundaries around that in a way that I feel like I can kind of have peace with it, even when it’s very hard. Whereas stress with my colleagues, when there’s a conflict, I often will start having these kinds of negative thoughts about myself that I know aren’t totally rational. And I find it much more distracting and harder to have boundaries left.
MANDY O’NEILL: That’s interesting. I wonder, how do you and your colleagues deal with conflict? Because that’s another example of where there’s a possible remedy for some of the stress, which is having constructive ways to deal with conflict when it arises.
SARAH ROSE LAMPORT: You know, I feel like sometimes we handle it really well, and by well, I mean from my perspective, sitting down and talking about it, talking about our perceptions, and if somebody is feeling hurt, how we can help them feel better and work better together as a team. When I feel the conflict is more troubling is when that doesn’t seem to be working. Sometimes it becomes this kind of thing that we all just sort of start living with, and nobody really wants to deal with. And it’s really easy to just kind of keep pushing through and ignoring it. When the collegial dynamics are working really well, they are the most amazing source of support in my work.
AMY BERNSTEIN: Mandy, when you listen to Sarah Rose, what are your thoughts about workplace relationships?
MANDY O’NEILL: I’m hearing a couple of themes, one of which is the importance of workplace relationships. So, there’s some ambivalence around workplace relationships. There’s this notion that friendships at work are sometimes problematic. You know, you don’t want to get too close to colleagues, because at the end of the day, they’re colleagues, and you might leave the organization, or you have work to get done, and friendships can get in the way and can cloud your judgment. But I think what this brings up is the importance of relationships at work, including managing them when they become problematic. So that’s part of building strong relationships is managing the conflict. And some of that has to deal with individual conflict styles. So, if you have two people who are very conflict avoidant, versus two people who are very confrontative, that can cause difference sorts of problems. But I think recognizing our conflict styles and dealing with conflict in a productive way is a big part of that relationship, particularly when things are not going well, when the stressors at work are putting strain on our relationships due to the pandemic.
SARAH ROSE LAMPORT: Talking about the conflict between colleagues or just not working as well as we’d want to together, versus, for me, I have this separate struggle with setting boundaries with work entities and home entities, meaning my family, and I think I struggle with that specifically because I don’t want to disappoint anyone. But I also am really cognizant of needing to take care of myself. And I feel like the pandemic has made that even more clear to me the importance of that. And I wonder if Mandy has any advice for how to do that better.
MANDY O’NEILL: Boundaries need to be set with colleagues and with family members. So, I think that sometimes the boundaries are with colleagues who, for example, might be causing additional stress due to their emotions. So, one of the concepts that we talk about is emotion contagion, so catching other people’s emotions. So, for example, if you have a colleague who is extremely anxious all the time, you might catch their anxiety, and it increases yours. So, one of the remedies for that is what we call situation selection. So for example, if you know that going into the break room is going to mean running into this person, and they’re going to start talking about everything that’s going on, and this and that, and you know yourself, and you know that you’re susceptible to catching their anxiety, then the remedy is, well, maybe don’t go in the break room. If you know they’re on shift, or you know that they’re off at the same time as you, maybe that’s the time you go into the meditation room instead. So, engaging in situation selection.
But sometimes it involves having a conversation with those people because you just can’t avoid them. So, think about a family member. I mean, one of the things that has come up in the pandemic is the centrality of family or whoever you’re cohabitating with. So, you can’t get away from them. I mean, you could go in your room, and you could close the door. But they can find you there sometimes. And so that’s at a time when situation selection might not work, that you may actually need to engage in meaningful conversations around setting those boundaries. And I think that the key here is how to have those difficult conversations. In my experience, it’s important to speak from a place in which you can elicit compassion, both compassion for what they’re going through, if they’re causing a source of stress, but also have them engage in perspective taking for what you’re going through, so that they can notice and respond to pain that you have. I find that much more productive than, for example, “You’re stressing me out. You know, you need to stay away from me.” Or “I need some space from you.” I mean, that’s sort elicits a defensive mechanism, whereas with a little bit of emotional intelligence, we can sort of recognize what are the sources of their stress and anxiety, but also get them to recognize the impact they have, and from a place of compassion.
SARAH ROSE LAMPORT: What I’m hearing you say in some ways is how important it is to you to have that awkward conversation when you can’t realistically avoid something. And I tend to avoid things when I’m worried about disappointing people. So, I think maybe this is a good nudge for me to kind of be aware of when that’s happening. And just try to make peace with that feeling and move through it.
AMY BERNSTEIN: So, Sarah Rose, I wonder if you could talk about some of the other sources of stress in your work.
SARAH ROSE LAMPORT: Yeah, I also feel like I struggle with stress in prioritizing competing demands when I’m at work. And specifically, when there are multiple things that feel really important, and I know that I don’t have the time or emotional energy or physical energy to take care of all of them, I struggle with prioritizing it, but then I also struggle with letting go and making peace with not being able to do all of those things. And I find that’s definitely a source of stress for me, and I wonder if you have any thoughts about that, Mandy.
MANDY O’NEILL: Role conflict and job demands are common across all jobs. So, your experience is not alone. It’s absolutely the case that multiple types of requirements for our job are competing for our attention, and it’s hard to prioritize, and it’s hard to disappoint people, as you said. It’s hard to let people down. It’s hard to let yourself down. So sometimes we can engage in a triage system, where, and I use this kind of knowing that this is very meaningful in your work, but what are the most important demands?
I also think it’s important to think about our own values, because at some level, we’re not going to be able to do everything at work, and our own values might compete with what our workplace is telling us to prioritize. And so that’s a really important opportunity for us to think about, what are my values? What’s important to me? What do I think is the best way to achieve certain ends? And am I living according to my values? And then secondarily, it’s important to think about, what’s valued in the culture? And sometimes there’s not a fit. And I think that’s where the real challenges happen, where for example, you know, you might think that spending the extra time on one of the priorities is more important than what the organization thinks is important. And that’s, I think, where it gets into a different kind of stress, where interestingly, I think there’s an opportunity for coping with it that’s a little bigger than just us. So far, we’ve talked a lot about how individuals manage stress, how stress is an individual experience that is dealt with differently, depending on your own coping skills, depending on your perceptions. But I think there are opportunities for deciding, is this a widespread or a common reaction to a stressor in the environment? If so, then maybe our own coping strategies aren’t necessarily not only not going to be able to change it, but maybe there’s a shift to focusing on the work environment that might need to come up with a more collective solution, you know, a stressor reduction that not only benefits one person, but benefits everybody, because it may be, for example, the organization is completely unaware that while it says one thing is important, like, you know, let’s say patient care, it might actually be putting pressure to reduce costs, or to increase efficiency. And there’s a conflict there. So, it may be that the organization is completely unaware of the ways in which some of this is transmitted. And so, I think in that case, it’s important to think about what happens when the stress is widespread? How can we mobilize others to change the environment rather than just assuming that it’s our job as individuals to fix the problem?
SARAH ROSE LAMPORT: That makes so much sense to me. And I feel like specifically you’re talking about when our values come into conflict with institutional values. And I find myself thinking about being in the hospital and wanting to get the best care for my patients, and having it not be something that I can actually do in that moment, or even in that admission, or maybe ever. And because of institutional roadblocks that feel like they’re in place to save money, that conflict is so stressful. But it definitely is not just me, and it’s definitely kind of a shared stress among staff, because I think most people, if not all people, who go into healthcare go in because they want to help people, and everyone understands that you can’t help all people in all situations. But when it becomes this frequent situation where you’re not able to provide the help that seems like it’s appropriate and reasonable, it starts to feel really unmanageable.
MANDY O’NEILL: It’s really important to recognize when your stress is shared and when it’s not just your own stress. And I think in those situations, it’s helpful to mobilize people, but also for the organization to have outlets to let that voice be heard. And not just in the form of complaints, be the way. Because sometimes we have this distinction between promotive voice and prohibitive voice, which is the idea that sometimes when we’re bringing up ideas and suggestions, they could be helpful. And my sense of it is that organizations are generally very open to that. But if it ends up being a mechanism just for complaints and management tear downs, I think that’s less helpful. So, the first is, I think, recognizing when the stressor is not just an individual stressor, but is actually a collective stressor. And then I think pushing the issue towards more a promotive voice, speaking up about ideas and suggestions, rather than just complaining. But I think on the institution it’s important to have mechanisms to let this voice be heard. So sometimes institutions create roadblocks and barriers to listening to people. And it may have to do with the difference between when you’re in a management role, or when you’re in a supervisory role, when you’re in the role of the top decision maker, you’ve got your own set of stressors, and you’re dealing with them every day. But it can allow a little bit of a disconnect between what’s happening at the top and what’s happening on the front line. And if there are no institutional mechanisms for that communication, I think that’s where the problems start to rise, because there’s just simply a lack of awareness. It’s not necessarily a resistance to it as much as a lack of awareness. And by the same token, I think sometimes it’s difficult with empathize with what’s going on with the boss or with management, too, because there are stressors that absolutely are important. I mean, fundamentally, we need the organization to run and to function and to be funded and to survive, so that’s an incredible stressor. But I think there’s a sweet spot where at the front line, there are ways of suggesting helpful mechanisms for improving upon some of the stressors that may actually be compatible. So, there’s a congruence there between some of the problems experienced and some of the solutions that may be very interesting to management. But they’re just simply unaware.
SARAH ROSE LAMPORT: Yeah.
AMY BERNSTEIN: When you are dealing with that clash of values between the institution and individuals, let me ask this of you, Mandy, how do you make that decision about when to take on the added stress of trying to affect change as an individual?
MANDY O’NEILL: It’s important to think about doing a self-assessment before taking on the stress. Are you in a position to take on the stress relative to maybe some other time in your life? So, for example, if we think about our resources, you know, stress is a little bit of an equation around the threats or the potential harms that we’re facing, and the resources that we have to deal with it. So, I think the first step is an assessment of, do I have the resources to deal with it? And if the assessment comes up no, then probably it’s not a good idea to take on that stress. Versus, yes, I have the resources to take this on. That has a secondary assessment of, is this important enough for me to take on? If this is an incremental change that isn’t going to be worth the time, worth the effort, or might introduce other bigger problems, then maybe it’s not worth taking on. But if it’s something where it will be painful for a little bit, but the consequences of it could be potentially beneficial, much more so than the stress involved, you know, a little bit of that calculation involved. Sometimes people even come up with decision matrices, you know, if/then scenarios. Like, if I do this, what will happen? What are the consequences? What do I have right now? And I will say that for people in the pandemic, a lot of the resources that they had went away, and that includes the sort of help, the kind of support that they had, that they relied on, myself included. And then the demands and the stressors went up. So that sort of ratio of the demands and the stressors and the resources that we have got a little skewed. So, people were less able to take it on.
AMY BERNSTEIN: I want to flip that scenario a little bit. What advice do you have, Mandy, for not taking on other people’s stress, not, you know, absorbing it all yourself?
MANDY O’NEILL: We talked about boundaries. I think setting boundaries is an important part of not taking on other people’s stress. Sometimes removing ourselves from the situation. So, we talked about if there are certain people for whom the stress is just so potent, and the anxiety is so contagious, we may actually need to separate ourselves a little bit from some of those people on some of those situations to the extent that we can. If we can’t, so if we can’t actually change the situation, then we have to think about how we engage in coping with this. So, there’s a distinction between problem focused coping and emotion focused coping. Problem focused coping is changing the behavior and the environment and eliminating the stressor or the harm. Emotion focus is, if we make the assessment that we can’t change the environment, then we need to regulate our own distress. Even breathing exercises. There are some individual strategies that we can engage in that has been shown and proven to reduce our stress. And this is not the panacea. We tend to put too much emphasis on the individual strategies. But certainly, if we’ve decided that we can’t change the environment, we can certainly engage in some of these self-care mechanisms to help reduce the stress physiologically.
I also want to point out the important role of managers in recognizing this in employees. Again, we put a lot of emphasis on us fixing our own problems, But I think it’s a good opportunity for managers to recognize stress in their direct reports and say, “you know, you really need to take some time off.” And again, it’s interesting, but people are so reluctant to take time off that sometimes it actually takes the manager, takes the organization to say, “You actually have to take some time off. Oh, and by the way, you’re not allowed to check email, or you can only check email once a day.” And it’s in those times that people recognize the effect of stress in their own body. So sometimes people just, they cannot recognize it. They’re so in the routines that it might actually take really supportive supervisors or colleagues to recognize this in others.
AMY BERNSTEIN: Yeah. So, Mandy, what you just said resonates really deeply with me. I have found over the last year that people’s diligence has kicked in in a really big way and reminding them that they have to take their vacations for their own good, it’s for everyone’s good, has become sort of a regular conversation for me with my team. And also, just being a little extra sensitive to a shift in mood, a change in the tone of voice, because the kind of stuff people are dealing with right now, we would never have thought about it before. But because there are no boundaries between home and work, we’re forced to think about them all the time. Right?
MANDY O’NEILL: Sometimes the clues are on people’s faces, and sometimes it’s in the silence. So, I had a time, a really stressful time, and usually I was really prompt at responding to emails to this one colleague. And, suddenly my email response time went down. And you know, this colleague knew me really well and knew something’s up. She’s just not responding as quickly. And that started a conversation in which she said, hey, is everything OK? And actually, things weren’t OK. And it was extraordinarily helpful, and I appreciated so much that she recognized that invisible signal as it was, that maybe something wasn’t OK, and having that close relationship helped to make it better.
SARAH ROSE LAMPORT: That makes a lot of sense in that people can send signals of distress that aren’t always verbal, or they can be behavioral, or they can be quiet.
AMY BERNSTEIN: I do want to thank you both. Mandy, thank you so much for helping us figure out what’s going on here and how to manage it ourselves. And Sarah Rose for everything you do every single day, and for sharing your story with us.
SARAH ROSE LAMPORT: Thank you so much for having me.
MANDY O’NEILL: Thank you so much for having me, too.
AMY BERNSTEIN: That’s our show. I’m Amy Bernstein. Stress is a topic that HBR covers extensively. You’ll find plenty of insight about it on our website, HBR.org. We also published a really useful book, the HBR Guide To Managing Stress At Work. Our editorial and production team is Amanda Kersey, Maureen Hoch, Adam Buchholz, Tina Tobey Mac, Erica Truxler, and Rob Eckhardt. Get in touch with us by emailing [email protected] Thanks for listening, and take good care.