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Managing Mental Health in the Workplace

ALLEN R. MILLER, PH.D. , M.B.A.

Director, CBT ProgramsBeck Institute for Cognitive Behavior Therapy

June 24, 2020


About Beck Institute

• Dr. Aaron T. Beck developed CBT at the University of Pennsylvania in the 1960s. In 1994, Dr. Beck and his daughter, Dr. Judith Beck, established Beck Institute.

Improving lives worldwide through excellence and innovation in Cognitive Behavior Therapy training, practice, and research.

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Unprecedented Times

Pandemic-coronavirusRacial violenceBreakdown in societal norms Photo by Edwin Hooper on Unsplash

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Agenda

• Impact of Trauma

• Company/Organizational Actions

Setting the Foundation

Early Prevention

Addressing Problems

• CBT for Individuals• Healthy Lifestyle• Activity Planning• Sleep Hygiene• Decision Making• Relaxation• Distress Tolerance• Acceptance

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Individual Stressors During a Crisis• Quantity and frequency of information

• Financial worries

• Loss of usual routine

• Frustration and boredom

• Inadequate supplies

• Fear for personal safety and health

• Concern for vulnerable family members

• Loss of social and physical contact with others

• Sense of isolation with the rest of the world

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Employer Stressors: Health and Safety

• Compliance with State/Federal Guidelines• Caregivers and vulnerable populations (P&P’s)• Whether or not to provide PPE

on the job• Testing temperatures and

symptoms• Responsibility for employees

becoming sick• Contact tracing• Personal safety and health

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Employer Stressors: Operations• Employees time-off• Need for remote work P&P’s• Employees refuse to return to

work• How to assess quality of work

done at home• Meet customer needs• Pressure to meet financial

targets• Reconcile health guidelines

with need to be productive

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IMPACT OF TRAUMAON INDIVIDUALS

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Traumatic Event

The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

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Characteristics of Trauma

• Intrusions

• Avoidance

• Negative Alterations in Cognitions and Mood

• Alterations in arousal and reactivity

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Intrusions

The traumatic event is persistently re-experienced in the following way(s):Unwanted upsetting memories

Nightmares

Flashbacks

Emotional distress after exposure to traumatic reminders

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Avoidance

Avoidance of trauma-related stimuli after the trauma, in the following way(s):

Trauma-related thoughts or feelings

Trauma-related external reminders

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Negative Alterations in Cognitions and Mood

Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):Inability to recall key features of the traumaOverly negative thoughts and assumptions about oneself or the worldExaggerated blame of self or others for causing the traumaNegative affectDecreased interest in activitiesFeeling isolatedDifficulty experiencing positive affect

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Alterations in arousal and reactivity

Irritability or aggression

Risky or destructive behavior

Hypervigilance

• Heightened startle reaction

• Difficulty concentrating

• Difficulty sleeping

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“Normal” vs. “Abnormal”“Normal”-- experience multiple reactions to abnormal situations

“Abnormal”—experience multiple reactions for an extended period after being exposed to trauma

Chronic Stress—emotional response to a prolonged period ofstress in which an individual perceives they have little or no control

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Quest for Control• We are stressed when we think we don’t

have control.

• Paradoxically, the relentless pursuit of control will increase our levels of frustrationand anxiety.

• There is much we do not have control over.

• It takes practice, commitment, • and humility that we cannot control it.

• When we accept we do not have control over most things, we can work on the things over which we do have control.

https://beckinstitute.org/using-cbt-to-respond-to-covid-19/15


Coexisting Conditions

• Depression

• Anxiety

• Substance Use

• Eating Disorder

• Sleep Disorder

• Posttraumatic Stress Disorder (PTSD)

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• Decline in work

performance

• Deterioration in

appearance

• Disconnected from

others

• Increased presenteeism

Negative Impact on Work

• Increased pessimism

• Lack of confidence

• Lack of motivation

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SETTING THE FOUNDATION

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Establish Credibility

• Revisit values and vision of the

company/organization

• Revise strategic plans (as needed)

• Clarify (within leadership team)

employees’ roles in achieving the company’s vision

• Recognize the company’s dependence on a healthy

workforce

• Commit to employees’ safety and health

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Self Awareness• Be aware that thoughts and feelings you

express will be observed by and affect others

• How you cope and behave will influence how your employees will cope and behave

• Acknowledge difficulties and demonstrate how coming together can help everyone

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The Cognitive Model

•It is not the situation itself; it is how we think about the situation that affects how we feel and how we respond

•Focusing only on the negative aspects leads to negative emotions and maladaptive behaviors

•Reflecting on our values and aspirations leads to positive feelings

• Optimism is a choice

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Communication at Work• Know your employees for preferred mode of

communication

• Decide in advance what you want to convey and practice

• Tone of voice, posture, gestures, eye contact are important aspects of verbal communication

• Tone, word choice, and content are important aspects of written communication

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EARLY PREVENTION WORK

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Stabilize

Create a Sense of Safety

Create Calm

Create Self and Collective Efficacy

•Create Connection

•Create Hope

Psychological First AidNational Center for Post Traumatic Stress Disorder (2006)

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Tasks for Managers

• Listen /Observe

• Protect

• Connect

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Listen/Observe

• Provide employees with opportunities to talk (Voluntary)

• Thoughts, ideas, emotions• Behaviors• Work performance• Interactions with

others• Participation

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Protect• Inform employees what company is doing to

keep everyone safe• Be clear about P&P regarding hygiene, etc.• Maintain routines, activities, structure, and

limit changes• Be clear about expectations, and rules• Monitor work setting for anything that could

re-traumatize• Avoid promises you can’t keep• Be watchful for bullying/harassment• Take breaks from focus on the trauma event(s)

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Connect• Check-in with employees• Answer questions simply and

honestly• Let them know that others are

also struggling• Empathize• Keep communication open• Restart activities• Find resources• Build on strengths

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Statements to Avoid

• Don’t feel bad• Don’t cry• Try not to think

about it• Let’s talk about

something else

• I know how you feel• It’s God’s will• It could be worse• At least you still

have…• At least (anything)

These minimize the employees’ experiences and diminish their importance

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Fostering Healthy Relationships• Your responses and reactions directly impact your

relationships with others• What do you want my long term relationships to be

like? (Employer, employees, family, friends, co-workers, collaborators, vendor partners)

• What things can I do today that will make it more likely that I will get the result I want in the long term?

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• It’s ok to “clock out” at the end of

workday

• Take a PTO day if needed to recharge

• Create conversations on topics that have

a stigma

• Use phone calls and video to stay

connected

• Increase ‘permission’ to manage their

priorities

• Don’t micro-mange -- have confidence in

your team

Create a healthy environment

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Reinforce Strengths and Positives

• Get back to normal routines

• Make healthy lifestyle choices

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WHEN THERE ARE PROBLEMS

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Report to the Employee

• What I have seen, heard, been told…

• Express concern for the person

• Ask if they will talk about it with you

• Inform the employee if there is a “bottom line”

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Listen to the Employee• Ask for their thoughts about what

you said “What do you think about what I

said?”• Demonstrate that you genuinely

respect the employee• Allow them to talk as much

or as little as they want

• Avoid judgement of their views and actions

• Avoid forming a rebuttal or expressing your opinion

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Listen to the EmployeeListen and pay attention:

• Look at the person … Nod, smile, say “Uh-huh”, “yes”

• Clarify: “What do you mean when you say…”

• Reflective listening:• So you feel…• I hear you saying…• It sounds like…• Tell me if I am getting this right

• Summarize: “What I am hearing you say…”

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It Is a Process• Ground the discussion in what the

employee ultimately wants for herself/himself

• Discuss one topic at a time

• Identify all the possible options for the employee to achieve his/her goal

• Ask “What is the first thing you could do to achieve your vision?”

• Ask how committed they are to doing the first step and if they will come back to talk with you about how it went

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CBT FOR INDIVIDUALS

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Healthy Lifestyle

Eating

Exercise

Sleep

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ACTIVITY PLANNING

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Activity Planning

• Scheduling• Plan for the week ahead, scheduling healthy activities

• Plan new activities to fill time voids

• Maximize activities that create a

sense of mastery and accomplishment

• Utilize activities that involve

enjoyment

• Review/troubleshoot

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SLEEP HYGIENE

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Sleep Hygiene• Avoid Caffeine, Alcohol, Nicotine, and Other Chemicals that

Interfere with Sleep

• Lighten Up on Evening Meals

• Exercise helps promote restful sleep if it is done several hours before you go to bed

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Sleep Hygiene• Go to bed the same time every night. ...• Get up at the same time every morning • (7 days/week)• A quiet place to sleep. ...• Keep your bedroom dark and cool. ...• Dedicate your bed to sleep and sex, and

nothing else. ...• Turn off all screens 30 minutes before bed • Turn phone off• Limit your daytime naps

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DECISION MAKING

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Advantages-Disadvantages Analysis

Advantages of… Disadvantages of…

Advantages of Not… Disadvantages of Not…

Decision Making and Priority Setting

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ITCH for Problem-Solving

Identify the Problem.

Think about possible solutions.

Choose a solution to implement.

How well does it work?

Muñoz, R.F. Ippen, C.G. Rao, S. Le, H-N, Dwyer, E.V. (2000).Manual for group cognitive-behavioral therapy of major depression. medschool2.ucsf.edu/latino/pdf/CBTDEN/overview.pdf

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RELAXATION

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Benefits of Relaxation• Helpful in managing stress• Helpful in managing

depression and anxiety• May help to retrain the brain

to respond thoughtfully to stress, rather than reacting impulsively

• Helpful to people maintain gains

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•Breathe in deeply through your nose (Four seconds)

•Fill lungs with air—hold for a few seconds (Two seconds)

•Exhale slowly through your mouth (Six seconds)

•Repeat four times

One Minute Breathing Exercise

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DISTRESS TOLERANCE

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What is Acceptance?Acknowledgment of the facts of a situation and realistic limitationsDoes not mean approval, resignation, or passivityIs not anti-change: it is a prerequisite for change!Similar to the Serenity Prayer

•Serenity to accept what I cannot change •Courage to change the things I can •Wisdom to know the difference

Usually involves sadness or grief

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Wise Mind ACCEPTSDistracting with…Activities—engage in any tolerable exerciseContributing—give something to anotherComparisons– compare self to others the same or less fortunate than youEmotions—do things that stimulate different emotions,Pushing away—leave the situation (mentally) for awhileThoughts—count, focus attention elsewhereSensations—hold ice, squeeze ball, etc.

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Radical Acceptance

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• Radical acceptance is about accepting life on life’s terms and not resisting what you cannot or choose not to change.

• Radical acceptance is about saying yes to life, just as it is.”

Hall, K. (2012).Psychology Today

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Is this something I care about?

Emotion Regulation

Breathing & Mindfulness

Plan Activities

Assert Yourself

Cost-Benefit Analysis

Breathing & Mindfulness

Explore Values, Aspirations, Goals

SleepExercise

Eating

Do I have any control over this?

Go find something you do care

about

NOYes

Accept ChangeNo Yes

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Summary• Impact of

Trauma

• Company Actions• Setting the

Foundation

• Early Prevention

• Addressing Problems

• CBT for Individuals• Healthy Lifestyle• Activity Planning• Sleep Hygiene• Decision Making• Relaxation• Distress Tolerance• Acceptance

56


Managing Mental Health in the Workplace

ALLEN R. MILLER, PH.D. , M.B.A.

Director, CBT ProgramsBeck Institute for Cognitive Behavior Therapy

June 24, 2020

managing mental health in the workplace handout version...managing mental health in the workplace...

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