At the Limits of Resilience
It breathes down your neck: it chokes you. There is pressure on your chest. It sends chills down your spine. Anxiety has many faces. A briefly flare up warns and protects you from danger, but if this unpleasant feeling in the pit of your stomach becomes recurrent or permanent, it can cause illness. The psychological psychotherapist Dr. Beate Muschalla works with such anxieties that often occur at the workplace and analyses forms of therapies.
When patients go to rehabilitation after a heart attack or a slipped disc, physicians and therapists primarily try to make them physically fit again but sometimes psychological conditions also play a role. “What is going on at your workplace? What is troubling you? What is depriving you of sleep?” These questions of physicians are especially important when patients do not want to return to their workplaces despite no medical reason for a prolonged sickness absence. “To admit fears is not easy. When the affected people speak about it with others in a group, their discomfort slowly dissolves,” psychologist Muschalla observes. “They become aware of their problems and learn how to plan concrete steps and develop initiatives of their own.”
In the Research Association of Medical Rehabilitation, the University of Potsdam researcher evaluates group psychotherapy for people with work-related anxieties. She does not do it, as you might assume, in a psychiatric-psychotherapeutic clinic but rather in neurology, cardiology and orthopaedic departments at Brandenburg Klinik Bernau. Empirical studies show that - like for the total population - about one in three somatic patients suffers from psychological problems. The source of such problems is quite often at the workplace. Sometimes chronic backache can conceal an oppressing stress and cardiac arrhythmias can mask a long, agonizing fear of failure.
When patients are admitted to the rehabilitation clinic, Muschalla interviews them in diagnostic sessions to identify such underlying connections. For this she use a Job Anxiety Scale she has developed herself. “The workplace,” she explains, “is a field of life with permanently changing structures, increasing requirements and new technologies. This demands a high degree of flexibility and adjustment. Permanent supervision and sanctions by superiors or rivalry among colleagues can trigger additional fears. In some professions, health and accident hazards are additional, real threats.” This can lead to anxiety illnesses. The affected, the psychologist says, react with agitation, panic attacks, excessive worry or social anxiety.
If Muschalla observes such symptoms during her diagnostic interview sessions, she will recommend a behavioural group therapy offered by the clinic. As a supervisor, she takes part in the sessions of psychotherapist Hadice Ayhan. The patients learn to speak about their fears, develop coping strategies and actively tackle their problems. At the end of the therapy and six months after their stay in the clinic, they are interviewed again: What has changed in your life? Which initiatives have you already taken?
To check the efficiency of the behavioural therapy, Muschalla compares it to a second group therapy that focuses on distraction, leisure activities and pleasure. The hypothesis is that those patients who do not repress but intensively deal with their fears and constructively work on solutions of their problems can return to their everyday working life earlier. This is indeed the aim of rehabilitation in most cases.
Social interest in this matter is growing because job-related anxieties play an increasingly important role in explaining long-term inability to work and early retirement. Contrary to public perception, the prevalence of psychological illnesses is not increasing. “It has remained stable, affecting 30% of people for some decades,” the psychologist explains. “The working conditions, however, have changed. They make it more difficult for people with psychological problems to handle the challenges of day-to-day work.” Constant availability, continuously being overloaded, accelerated work routines through ever-faster information technologies and computerized controlling mechanisms push them to their limits. “The repeatedly attested burnout syndrome is not a diagnosis though,” the researcher clarifies. Behind the assumed burnout there is often latent depression or an anxiety disorder that appears under extreme pressure. “Nevertheless, some patients tend to more readily accept burnout as a reason for being on sick leave. Unfortunately, there is still a stigma attached to anxiety disorders and depression,” the psychologist says.
Muschalla thinks that a prospective solution is to strengthen patients in their skills during therapy and afterwards to find or organize a work environment suited to their capacities. This also means talking openly to their employer or superior about the problems. “Not everybody has to be able to do everything,” the psychologist says, “but everybody can be employed according to his or her strengths.” Individual weaknesses can then be much more easily tolerated in a team. Similar to integration in education: meeting the strengths, weaknesses and limitations of children, we also need integration at the workplace. We need problem-compatible jobs for 30 per cent of the working population, for those people suffering from psychological illnesses.”
Muschalla has been dealing with work-related anxieties since her diploma thesis, a hitherto hardly studied research field. There have been only a few studies about it worldwide. It is beyond dispute that untreated fears can develop into phobias, which make it seem impossible for the affected people to ever return to their workplaces. Muschalla did her PhD on this topic and knows about the necessity of efficient therapies. She regards it a great advantage to be able to do her research in a practice, thanks to the association with the rehabilitation clinics. The evaluation of the group therapy is a real interface project that is equally supported and managed by the neurologist Professor Michael Jöbges, Medical Director of the Brandenburg Klinik, and Professor of Work and Organizational Psychology Doris Fay at the University of Potsdam. In her study on group therapy Muschalla and her team has conducted diagnostic interviews with 1,600 patients and has treated about 300 of them. The group “Stress Management and Self-Assertion at the Workplace” will remain a regular offer in the clinical routine after the therapy study. In a protected environment, it will help affected patients to deal with challenges at work in general and with their own working situation in particularly. There they can train skills that can help them to cope with situations at work and in their everyday life. Affected people will learn individual strategies how to handle situations at their workplace more calmly or less anxiously. In such a protected group, lots of things can be tested ‘safely’ far from the workplace, for example in role plays or little job-trail exercises. The participants especially appreciate the exchange with other affected people, the chance to see that they are not the only ones having such problems and can do something themselves. The therapist does not provide any generally valid advice or recipes but accompanies and moderates the patients’ process of problem solving.
Dr. Beate Muschalla studied psychology at the Freien Universität Berlin until 2006. She received her medical license as a psychological psychotherapist in 2010, specializing in behavioural therapy. For 10 years, she has been working in vocational rehabilitation research. She received her PhD from the University of Potsdam in 2008 with her dissertation “Workplace-related Anxieties and Workplace Phobia“. Since 2012, she has been a research scientist at the department of Work and Organisational Psychology at the University of Potsdam working on the project “Treatment of workplace-related anxieties in a group psychotherapy“, funded by Deutsche Rentenversicherung (the German statutory pension insurance scheme) at the Research Association for Medical Rehabilitation.
14476 Potsdam OT Golm
Text: Antje Horn-Conrad, Online-Editing: Agnes Bressa, Translation: Susanne Voigt