It's not black and white!

In the Challenge of Change Resilience training programme we emphasise that there is no 'good stress', and that all that stress offers is a life that may be shorter and will definitely be more miserable.  Once you define stress properly, as ruminating about emotional upset, the miserable part is self-evident to everyone.  We illustrate the 'short' part during the training by referring to the impact on your health of sustained high levels of adrenaline and cortisol, which are secreted when the system involving the hypothalamus and the pituitary and adrenal glands (the h-p-a axis) is activated.  The dramatic increase in adrenaline and cortisol in response to demand is called 'fight or flight', and these are not 'stress hormones' at all – they're doing exactly what they're designed to do, facilitate action, but they're adaptive only in the short term. 

In the longer term, adrenaline has the effect of unnecessarily prolonging cardiovascular strain, and continued elevations in cortisol secretion can compromise immunity by suppressing the production of white blood cells.  However, a recent paper in Nature Medicine appears to contradict these effects for cortisol, in showing that white blood cell production is increased during stress.  How are these findings to be reconciled?  They are in fact both correct.  This requires a lot more detail than is needed for the purposes of the training programme, but we need to put the findings into the perspective of the Challenge of Change.

First, the main findings were obtained by studying mice placed under laboratory stress.  Using mice doesn't negate the findings, but the effects may not necessarily generalise across species.  Second, the paper attributes the effects of enhanced white blood cell activity to chronic as opposed to acute stress, and to make sense of this we need a proper understanding of stress.   The CoC training programme is aimed at replacing misleading psychobabble with simple English, and 'stress' is reserved only for ruminating about emotional upset.  We distinguish between that and pressure, which is just a demand to perform.  It starts when you wake up: the demand is to get out of bed.  You get to work and something goes pear-shaped; this is just greater pressure, not stress.  It will involve an increase in adrenaline and cortisol – fight or flight – but that's appropriate: we need to act, and provided there is recovery afterwards it isn't a problem.  Pressure corresponds to 'acute stress'; rumination sustains activation inappropriately and corresponds to chronic stress.

Finally, we need to be wary of generalisations like 'white blood cells'.  There are in fact different kinds, and they have different functions.  The two types of white blood cell that increased under stress were monocytes and neutrophils, which are stimulated in chronic stress by noradrenaline.  Broadly speaking, adrenaline is associated with provocation to action and noradrenaline is associated with recovery, and the monocytes and neotrophils cluster around sites of inflammation to enhance healing.  In the cardiovascular system, inflammation is commonly at points where there is increased cardiovascular strain, for example, at bends and forks in arteries, particularly in the coronary artery system.  Cholesterol accumulates at the site of the inflammation, resulting in the formation of plaques, and the monocytes and neutrophils that also accumulate there serve to augment and exacerbate plaque formation.  Plaques lead to a narrowing of the arterial bore – atherosclerosis, which significantly restricts blood-flow to the heart, and the plaques can also break off and form life-threatening clots.

These effects have now been shown to be associated with the increase in monocytes and neutrophils, but elevated cortisol levels that are sustained can compromise the production of other white blood cells, especially lymphocytes called T-cells.  These regulate the immune response: helper T-cells facilitate it, while suppressor T-cells return the immune system to resting levels after infection, and sustained levels of cortisol compromises the helper-suppressor ratio.  Taken together, what the findings indicate is a double-whammy from ruminating.  Sustained levels of adrenaline increase cardiovascular strain and inflammation, leading to the formation of arterial plaques which are enhanced by some white blood cells that increase in the circulatory system as a result of sustained levels of noradrenaline.  At the same time, the action of other white blood cells is compromised by sustained levels of cortisol.  This is why stress, properly defined as rumination, will not only make you miserable but could indeed shorten your life.

Mind Full of What?

The new buzz-word is 'mindfulness'.  You might be forgiven for thinking this is some brand-new psychological construct, but it isn't – mindfulness is one of the central practices of Buddhism, and has been around for as long as people have asked the fundamental question of philosophy: 'what am I?'  As has so often happened, something profound and practical has been hijacked by psychobabblers, and has been completely misinterpreted along the way.

For most people, the answer to what 'I am' is limited to being this body or mind that I appear to be.  How can you be what you observe?  A better question is what observes?  The observer is what the Buddha said 'I am' is.  What I am not is the conditioned idea I have about myself which, fuelled by emotion, turns into attachments.  The sum of these attachments is what ego is, and ego is another idea distorted by psychobabble.  Psychologists argue that we need to have a balanced ego; Buddhism – and indeed all of the familiar teachings – says ego needs to be dispensed with altogether.  Don't take my word for it.  Here's a quote from perhaps one of the greatest Buddhist teachers of the last century:

'When suffering arises, we attach to the suffering and thereby must really suffer.  In the same way, when happiness arises, we attach to the happiness and consequently experience pleasure.  Attachment to these feelings gives rise to the concept of self or ego, and thoughts of 'we and 'they' continually manifest.  Here is where it all begins, and then it carries us around in its never-ending cycle.' (Ajahn Chah – Food For the Heart)

Ajahn Chah is describing what Shakespeare called the tale told by an idiot, signifying nothing. Here's another description of ego from one of the great teachers of the Vedic tradition, Ramana Maharshi, who was asked what ego is and why it gives us so much trouble:

'The ego-self does not exist at all.  To whom is the trouble?  The trouble is also imagined.  Trouble and pleasure are only for the ego'. (Be As You Are: The Teachings Of Ramana Maharshi)

If you are suffering from feelings of low self-worth, anger, fear, or any other emotional state, we might describe that as being psychologically 'below the line'.  Therapy and counselling can certainly help to get you to or even above the line, and you might well feel much happier.  Whether that happens and how long it might last is a moot point, and very much questioned by the evidence, but if you're going to try to commandeer a Buddhist idea like mindfulness you can't stop there.  Happiness is no more desirable than unhappiness.  Ajahn Chah again:

"Even though you may be unhappy, it doesn't matter.  Is that unhappiness your 'self'?  Is there any substance to it?  Is it real? Unhappiness is a mere flash of feeling that appears and then vanishes.  Happiness is the same.  Is there any consistency to happiness?  Is it truly an entity?  It's simply a feeling that flashes suddenly and is gone. Where is the consistency in love, hate, resentment?   The Buddha knew that because both happiness and unhappiness are unsatisfactory, they have the same value.  Once born, they die." (Ajahn Chah – Food For The Heart)

The purpose of mindfulness is not to make you happy, it is to transcend becoming attached to either happiness or unhappiness.  This is enlightenment, and no-one ever became enlightened through therapy.  Happier maybe, enlightened, no.  You don't consult a psychologist for wisdom.  What does mindfulness actually mean?  That your mind is full.  To be miserable, fill it with unhappy thoughts.  If you want to be happy, fill it with happy thoughts.  If you want to be truly mindful, fill it with consciousness.  That's what mindful means: being in the now, attending to everything with detachment (or using Buddhist terminology, non-attachment).

Unfortunately, 'consciousness' provokes much empty philosophical debate.  Since it is what observes, it can't be observed.  It is also described as absolute, which we can't really comprehend with ordinary thinking.  We need to be more practical if it's to be of any use.  The Challenge of Change Resilience programme is about mindfulness, adapted so that people who have no interest in Buddhism can relate to it and use it practically.  It is also couched in familiar language: consciousness can be known and used practically as attention, and the first two steps in the training programme are to wake up out of the dream world of what we call 'waking sleep' – lights on, nobody at home – and to maintain control of attention, which you can then give intentionally to what's there.  Waking sleep is attention snatched away.  

Giving your attention intentionally to the past or future, drawing on experience and making plans, we call reflection, and you're awake when you do it.  If you add negative emotion to waking sleep, that's all that stress is: ruminating about emotional upset.  Once awake and controlling attention, you can become detached, which we describe as keeping perspective: knowing that the ruminative thoughts are just thoughts, what Mark Twain called the worst things in his life that never happened.  You can then let go of those thoughts, surrender them, coming back into the present by connecting with your senses.  This is presence of mind (your mind in the present) by literally coming to your senses.

I'm not a Buddhist, but my personal view is that Buddhism isn't a religion, just a very practical way of living your life.  The principles of the training came from the research, asking ordinary people to talk about how they would think, act and feel in a series of pressured scenarios, and the simple English terms we use reflect exactly those of Buddhism but placed into a contemporary way of life: waking up, controlling attention, becoming detached and letting go.  This is what mindfulness is.

The Conundrum of Engagement

One of Cynthia's abiding interests is employee engagement, which HR people have long known is highly correlated with a variety of measures such as productivity, absenteeism, retention, and customer satisfaction.  Some excellent work has been done by organisations to lift employee engagement, which has resulted in improved organisational outcomes, but Cynthia noticed that this work was mostly organisationally driven. This makes sense when you consider that most of the models of engagement put the responsibility for employee engagement not on the individual themselves, but on either the organisation (for example, 'I feel I am working for a successful company'), or the manager ('my immediate manager provides the support I need to succeed'), or on other people ('my co-workers are committed to quality work').

Perhaps the only clear exception to the top down approach is David Rock's 2008 SCARF model (Status; Certainty; Autonomy; Relatedness and Fairness), in which he argues that it's people's perceptions of threat or reward which drives them either to engage or to withdraw.  For example, if we perceive our status is under threat we may withdraw by withholding our ideas, and if we feel our work environment is an uncertain one we might resist the mental effort of decision making.  Worse still, if you know there's a planned restructure but have no idea when it will happen or who will be affected, motivation may be entirely sapped.  By contrast, if we feel relatively autonomous in our role,   or that we have been treated fairly, we're likely to respond in a much more resilient way when there are significant organisational changes.

The question that follows from the SCARF model is what determines people's perceptions, and does it have anything to do with resilience?  Curious about how resilience and engagement are related and what could be done to put tools and techniques into the hands of employees when they feel disengaged or ambivalent, we surveyed 160 employees, 61 men and 99 women, across eight NZ organisations.  They were all participating in Challenge of Change Resilience programmes being implemented in their organisations, and in addition to providing their age and gender they were asked to respond anonymously to four engagement questions on a 6-point Likert scale ranging from strongly agree to strongly disagree: 

• 'I think my present job makes good use of my skills'  
• 'There are opportunities for career advancement in my present organization' 
• 'It is very clear to me what I am meant to be achieving in my present job' 
• 'I think I will stay with my employer for the next few years at least'.   

The correlations amongst the four questions were modest, which means that they access slightly different facets of engagement and can be analysed independently.  However, the correlations were all significant, indicating that they nonetheless have enough in common to also be pooled into a single summed score; indeed, the correlations between each of the questions and the summed score ranged from .768 to .803.  To explore the relationship between engagement and individual behaviours, the employees were also asked to provide their scores on the eight Challenge of Change Profile scales: Rumination, Emotional Inhibition, Toxic Achieving, Avoidance Coping, Perfect Control, Detached Coping, Sensitivity, and Flexibility.  Our research has shown that the lower the score on the first five, and the higher the score on the last three, the more resilient people are, and controlled case studies have shown equally clearly that these are all trainable skills.   

When the scores from the engagement questions were correlated with the Profile, the results indicated that low engagement was associated with ruminative, toxic achieving behaviour, but these results were at best only trends.  By contrast, the relationship with Perfect Control was substantial and consistent across all of the questions, and applied equally to men and women.  People high on this Profile scale are perfectionists who are unable to see the threshold of added value: anything you work on has a threshold beyond which it doesn't matter how much you keep working at it, you're adding nothing. 

What seems to drive these individuals beyond the threshold is anxiety about not producing the perfect piece of work, which doesn't actually exist.  Everything can be improved upon.  What's more, with the workloads people generally have there isn't the time to spend trying to perfect things. Perfectionism is not just unrealistically trying to meet others' expectations either – perfectionists set standards for themselves and others so high that they can never be achieved.  Perfectionists also tend to be controllers of the universe, and unfortunately for them there's a lot that happens over which we have no control.   

For these people, work only gets done properly if they do it themselves, or it's done their way.  They may feel that they are the only ones who are doing quality work and that others can't be trusted to do it properly, and in addition to low engagement the cost of perfect control is spending a disproportionate amount of time on projects.  They are also likely to feel frustrated with the organisation, its policies and practices.  They want the organisation to be perfect, which of course is impossible.  All of this thinking and behaviour builds disengagement.  Part of being resilient is being able to accept that there are degrees of autonomy and certainty: change, dependency and limits on time and resources are inevitable features of working life.  Individual employees and the organisation itself endeavour to do their best, but neither will always be perfect.  

So how can their sense of engagement be enhanced?  It can be difficult to achieve, but perfect controllers need to learn perspective, to view their work with distance, and this is something they can explicitly be encouraged to do.  They can be helped by clearly defining what the standard is, what falls within scope and what falls outside of it, and how much time should be spent on a task. Perfect controllers also need to be encouraged to seriously review how much they actually need to do, by introducing them to the concept of added value. They may need to learn to delegate and to remind themselves that it is the outcome that matters most – people may have other ways of approaching a task that are just as effective. They need to let go of the need to be right and to let go of the 'what if' anxiety that comes with perfectionism.  To help with this, they can be coached with questions like: 

• "What is the best use of your time right now?"  
• "How much do you think someone would pay for this?"
• "Is what you are proposing going to add momentum or a noticeable difference to the end user?"  
• "Will this add simplicity or complexity?"

Of course, the ideal employee engagement programme is neither solely a function of the organisation/manager/other people emphasised in much of the work on engagement, nor is it solely the individual employee's attitudes and behaviour, but rather the interaction between them.  Responsibility has too often rested at the organisational/manager level, and this research begins to redress the balance and point the way to how employees' thinking and response to pressure can help or hinder their engagement.

Note: A version of this blog has been published elsewhere: Johnson, C. & Roger, D. (2014) The conundrum of engagement.  Human Resources 19 (1), March/April, 14-16.

Where's TED?

A recent TED talk by Kelly McGonigal was an opportunity to demonstrate that the earth is not after all flat.  It was an opportunity missed – instead the talk ended up merely adding to the accumulated misinformation about stress. 

A critique of the two studies the talk relies on would require a blog in its own right, but suffice to say that measuring stress with a single question asking whether people had subjectively experienced a little, a moderate amount or a lot over the past 12 months is about as unscientific as you can get.  The first issue in the talk itself, though, is the revival of the old chestnut about 'good' vs. 'bad' stress.  As usual no clear definition of stress is provided, but the speaker concludes with the new bit of psychobabble, 'making stress your friend'.  What eventually becomes clear is that she's actually talking about pressure.  In the Challenge of Change Resilience programme, the most important distinction we make is between stress and pressure, with pressure being simply a demand to perform.  There is no training programme that will remove it, and it is pressure that gets you out of bed in the morning. 

Pressure you can certainly use, since it is always accompanied by an increase in the physiological arousal that's needed to get things done.  What increases to facilitate the arousal is adrenaline, which is not a 'stress hormone', just a hormone doing what it's designed to do – get you going.  Cortisol increases at the same time, but cortisol is also not a stress hormone.  Amongst other things, it helps to regulate energy as well as having a longer-term impact on immune function.  The  fight-or-flight reaction is normal and needed, but the problem is when it is sustained beyond being useful.  What sustains it is rumination.  Something goes pear-shaped at work, adrenaline and cortisol increase to deal with it.  This isn't stress, provided you return to a resting level afterwards.  If instead you go on and on thinking about the what-ifs and if-onlys, the things that Mark Twain described as the worst things in our lives that never happen, that's what stress is.  Hence our unambiguous one-line definition of stress as ruminating about emotional upset.  All of this only becomes clear by using simple English.

In the TED talk yet another hormone has been added the list of so-called 'stress hormones' – oxytocin.  The main and well established role of oxytocin has nothing to do with 'stress': it is involved in facilitating natal and post-natal adaptation (oxytocin is Greek for quick birth).  It plays a role in regulating inflammation and healing, which it does in interaction with cortisol, and there is some evidence that it regulates emotional bonding – it increases during affection.  It is this last function that the speaker focused on, using the conventional phrase 'social support'.  Oxytocin increases when we feel supported and loved, but the question is, what constitutes social support?  It isn't how many people you know or whether you subjectively feel you've been generous towards someone.  The real issue is whether you can use the available support.  We found in our research at the University of York that this depends on whether or not you can express emotion, which is why emotional inhibition is one of the key measures in our pre-training Profile.  What also contributes to social support is having empathy, which we describe in the programme as detached compassion: having high scores on both detachment and sensitivity.   

Unfortunately oxytocin also regulates pair bonding by ensuring exclusivity, and it increases envy as well as love!  This is the danger of misusing hormones and neurotransmitters to draw often unwarranted conclusions – our physiological systems regulate evolutionary processes that are not necessarily warm and fuzzy.  The problem with psychology is that it is so dilettante, selecting what suits the argument whether or not there really is a genuine biogenetic justification.  So we've ended up with yet more myth-making.  Pressure can certainly be used strategically and effectively ('made your friend', if you prefer psychobabble).  Stress properly defined as rumination is self-evidently and demonstrably not good for you, and the distinction between pressure and stress is not just semantics: the TED talk acknowledged the effect that thinking in a particular way will have on your behaviour. 

Here's how to think and act differently: what you have to deal with in your day-to-day life is pressure, so instead of saying how stressed you are, say how much pressure you're dealing with.  That gives you the opportunity to wake up out of the nightmare of rumination, regain control of your attention, and to view the problem from a detached perspective.  Any stress that has been added to the problem – in other words, ruminating about the all the emotive worst-case scenarios – can then be seen as just the thoughts that they are, and can be let go.  You don't let go of pressure, which is the demand to solve the problem, but you can't solve anything with rumination.  Technology, entertainment, design?  Well, entertainment.

Resilience: Inoculation Against Stress

The research programme that underpins the Challenge of Change Resilience programme was based on the fundamental question in science – what's wrong?  We quickly discovered that in the context of stress and stress management, the answer is pretty well everything.  What's needed is a paradigm shift.   There was a time when people were convinced the earth was flat, and despite evidence to the contrary, the shift from a flat-earth to a round-earth paradigm took a long time.  So it would seem with stress management too: ideas like life-events as a cause of stress have been so endorsed by psychologists that people continue to think they're true.  The evidence tells you otherwise: for any so-called 'stressful job' there'll be people who enjoy it and don't find it at all stressful. 

The classic event that's supposed to be inherently stressful is moving house, but all that moving house involves is putting things in boxes in one place and taking them out in another.  There are plenty of people who love moving house!  What moving house does incur is pressure, and hence the critical distinction drawn in the programme between stress and pressure.  Pressure is just a demand to perform, and starts when you wake in the morning and need to get up.  You get to work and need to finish a project before the deadline that day, which is just another form of pressure.

The metaphor we use to describe this in the training is white-water rafting: getting through the first terrifying rapid and then approaching the second.  As you get closer, all that actually increases is pressure.  There's no such thing as a 'stressful' rapid.  Rapids are like deadlines, as they get closer, what increases isn't stress but pressure.  Going back to rafting, what might happen is that half the people in the raft begin to panic as the rapid gets closer.  They've made the mistake of turning pressure into stress, and when this happens the raft will go over and you won't get through. 

There is no training programme that will eliminate pressure, and there doesn't need to be: pressure is a motivator which gets you going and keeps you going. However, pressure should not be confused with so-called 'good stress'.  Defined properly, stress is ruminating about emotional upset, so if you do the job without rumination there'll be plenty of pressure but no stress.  When you respond to demand there is an increase in blood pressure and heart rate, to facilitate action, but this fight-or-flight response is entirely appropriate and is not stress.  Pressure is turned into stress if you go home that night completely preoccupied with the imagined negative consequences of the work – in other words, ruminating about emotional upset, what Mark Twain referred to as the worst things in my life that never actually happen.  That prolongs fight or flight unnecessarily, and all that you're fighting or fleeing from is an imagined thought in your head.

The fundamental research on cardiovascular function and immune function that underpins the Challenge of Change Resilience programme showed clearly that what made people miserable and prolonged recovery from physiological arousal was rumination, and in part, what is needed to shift the paradigm is to stop using the word 'stress' to describe pressure.  How often do you hear people moaning about how stressed they are?  It then becomes a self-fulfilling prophecy, like being told when you're moving house you must be stressed.  You can only claim to be stressed when you're ruminating about emotional upset, which is simply a habit that can be changed. 

Unfortunately, stress is a very contagious condition – you only need one stress-bunny to start panicking about a deadline to put the whole team into a panic.  This is why we focus in the training on resilience rather than stress, based on the principle that resilient people don't get stressed.  People often talk about their 'triggers' for stress, but it isn't the trigger that's important, it's what gets triggered – in other words, how do you respond?  Returning to the white-water rafting metaphor, resilient people are the ones who can negotiate the rapids of life, without becoming infected by ruminating about emotional upset.  Inoculation against stress is as simple as practising the four steps in the programme.