Our NHS People

Supporting others to manage stress recovery

In this article we consider what elements of wellbeing leaders need to focus on to manage stress recovery and how to support colleagues by helping them feel psychologically safe at work. We also examine how senior leaders can role model wellbeing behaviours. 

Drs Emily and Amelia Nagoski describe our experience of stress as a biological cycle with a beginning, middle and an end, which we have to complete to recover. It is a process based on our human need to escape from danger which could be, for example, a lion or more frequently in the UK, a series of complex organisational challenges. They suggest that if we fail to complete the stress cycle the physiological effects of stress on our bodies will remain. If this happens repeatedly it can cause long term damage to our wellbeing and risks burnout, depression, and chronic ill health.  

In the past year there have been huge levels of stress and pressure made worse by any number of shifting horizons, meaning as leaders you have had to draw on all your inner resources to keep going while trying to keep everyone else safe too.  

How everyone completes their stress cycles is critical to the recovery for the whole organisation and crucial for, your colleagues and staff to be able to keep responding to the demands of their jobs.  

Through their research, Emily and Amelia Nagoski have identified that to complete the stress cycle we need to: 

  1. Remove the source of the stress and get into a safe space (physically or psychologically safe or both). 
  1. Care for each other, together.  

We should then use any or all of the following to de-stress further: engage in a physical activity you enjoy, in nature-based or spiritually nourishing activities, or make connection with other human. They also suggest finding time to be creative. In other words, focussing on positive activities which enhance your enjoyment of life and thus your wellbeing. 

Supporting others 

Business psychologist Dr Derek Mowbray describes four characteristics of positive workplace culture which go towards supporting staff to feel psychologically safe and so able to recover from stress at work: commitment, trust, engagement and crucially displays of leader behaviour that reflect and reinforce the previous three characteristics. In Emily and Amelia Nagoski’s words, care for each other together. 

A powerful example of ‘caring for each other together’ and of building commitment, trust and engagement for longer term positive workplace culture is sharing our own experience of a challenging situation and listening with real curiosity to others’ experience, i.e. with conversation turn taking and empathy. It shows leaders are human and authentic and allows others to feel safe to share their experiences.   

A two-year research project by Google into effective teams found that psychological safety, had more impact on effective teamwork than anything else. This suggests that staff who feel safe at work manage stress better and are therefore more resilient and productive as a team. They isolated the key behaviours that were involved for building and maintaining psychological safety as ‘conversation turn-taking and empathy’. The same behaviour we want in one-to-one relationships. 

At all levels of human interaction, the more authentic and honest the communication, the better the result for everyone involved at building trust, engagement, psychological safety and commitment. Whether these are micro communications, board meetings, team meetings or even lunch breaks. Psychologists suggest that leaders: 

  • Use and become comfortable with genuine, positive, caring and encouraging words and behaviours. The informal work communities within the NHS will be using this to maintain their individual and shared resilience.  
  • Encourage, recognise, and praise creativity and problem-solving behaviours in others. This will build trust and confidence.  Recognise your own achievements too. 
  • Make your own work and non-work life balance non-discretionary and guilt free, as it should be for everyone else. It is a long-term investment for prevention of distress and also for the restoration of wellbeing.  
  • Be prepared to trust your colleagues to listen to your concerns through describing your feelings, thoughts, and emotions. Do the same for them in pairs or groups. 

The last point is very important but it might be challenging for us to share and listen to concerns. We have suggested a possible way of addressing concerns through a structured sequence of questions, which you may wish to try with your colleagues. It is built around first responding to a concern and then reflecting on that response. 

In the model below participants are all able to share their emotional ‘gut reaction’ to a concern. They are also given protected time to explore what thoughts and feelings came from that response. The model starts with checking that the concern is real and not an assumption. It is then structured to ensure that those who are ‘think-talk-think’ communicators, have the same input into a discussion as those who are ‘talk-think-talk’ communicators as those often dominate conversations. 

In this scenario the concern might be an impending threat, a change, an incident, or more generalised worry. The aim is for everyone involved to learn and feel that they have as much control as they can have in the situation. Using the approach of listening first – without judgment, analysis or ‘fixing the situation’ – models respect and support for self-efficacy, an important element of emotional resilience. 

Work through these question in the suggested order either in one to one conversations or with a group. 

Responding to a concern (group or individual) 

  • What is the concern? (Be specific and check for evidence and that the concern is not an assumption.)  
  • What is the impact on you/us? (Include thoughts, feelings, emotions, and reactions so far.) 
  • What can you /we control regarding this concern? (Be specific include reactions. Check for evidence and assumptions.) 
  • What can’t you/we control?  (Check for evidence and assumptions.) 
  • What can you/we influence (indirect control)? (Include personal choices and systemic indirect control, i.e. sharing your experience retrospectively or writing to someone about it.) 
  • What do you/we know now? What would you/we like to have happened?  

Now allow time for reflection on the above and work through the following sequence.  

Reflection or review of the response to a concern (group or individual)  

  • What was the concern? (Be specific and check back. Was this based on evidence or assumption?)  
  • What was the impact on us/you? (Include thoughts, feelings, emotions, and immediate reactions.) 
  • What did we have control over regarding this concern? Did we/you check for evidence and assumptions? 
  • What couldn’t we/you control? (Check for evidence and assumptions.) 
  • What did we/you influence (indirect control) What was the impact of that for you/the team?  
  • What worked well (evidence)? What didn’t work well? What would have worked better? What do we/you know now? 

The above model can help senior leaders support others in stress recovery and create psychological safety by creating and protecting the space and time to explore thoughts and feelings about challenging situations. 

Although emotions are neurological events which happen not only in our brains but our whole nervous system, they are involuntary responses which often do not emerge fully formed and need time to be explored or identified. Once identified it is easier to decide what you want to happen next. If we don’t acknowledge and deal with our emotions and feelings, we risk burying them and not completing the stress cycle. 

References 

Lamb D, Greenburg N, Stevelink S A M, Wessley S (2020) Mixed Signals about the Mental Health of NHS Workforce. The Lancet Psychiatry: Vol 7 Issue 12, P1009-1011.  

Nagoski E and Nagoski A Burnout: The secret of solving the stress cycle with Drs Emily and Amelia Nagoski https://www.youtube.com/watch?v=H2vs84z_qpw (accessed 23.3.2021) 

Mowbray D. (2017) Let’s Talk about Health and Wellbeing at Work  www.mas.org.uk (April 2017) (accessed 22.3.2021)  

Mowbray D. Wellbeing Performance /Psychological Responsibility Psychological Responsibility (mas.org.uk) (accessed 22.3.2021) 

Support for leaders through COVID-19 – Our NHS People (accessed 23.3.2021)