Panic; Team Canada and Psychology

February 27th, 2010

Like most Canadians, I was glued to the screen last night following Canada’s Olympic team on its march to gold against the team from Slovakia.  Our national level of comfort was jolted by the Slovaks second goal to close the margin in the third period to a nail-biting 3-2 with minutes to play.  Watching our team lose their composure, as they frantically tried to prevent that tying goal was described by one hockey commentator as panic.  As everyone knows, we ended-up with the victory, but we also panicked.

As a psychologist who has treated hundreds to patients with panic attacks I wondered about what advice I might give Team Canada following their collective panic.

As good clinicians are aware, I would not suggest the seemingly easy answer of “forget about it, there’s another game to play.”

Panic is an unpleasant experience.  By definition, panic is a self-propagating process where specific thinking leads to greater arousal and greater fear.  Panic patients narrow their attention to focus on the catastrophic.  Their decision-making shifts to reducing harm and consciousness moves to a point of external observation rather than being integrated in the flow of current reality.  The problem with “forgetting about it,” is that panic patients don’t; they silently worry about it and live in terror that it will happen again.

Good clinicians help panic patients make contact with what they fear.  They help them face the physiological cues of arousal, the type of thinking they experience when panicked as well as their innate escape-oriented behavioural tendencies.  Psychologists do this with psycho-education about the fear response and the commonly associated thought patterns.  With reassurance and support, they also re-expose patients to cues of their panic allowing from to more dispassionately observe what they previously lived in fear.  “Forgetting about” the experience makes it worse, re-experiencing it under therapeutic conditions makes it better.

Perhaps a hockey coach needs to follow the same advice. The danger is that left unprocessed the memories grow in intensity ready to be unleashed in similar clutch situations.

What to do?  Videotape review by the now composed players could be used therapeutically to rekindle last night’s memories.  Now composed and victorious, re-living the feelings, the decision-making and the desperate actions stimulated by panic can be done individually or as a group.

Beyond mere re-exposure, the coaches might borrow another clinical technique by having the players re-live in imagination what they would have done differently.  Instead of desperate defensive lunges, the players could see themselves taking charge and head-manning the puck up the ice thus morphing the fear into something adaptive.

Last night’s victory was tinged with trauma – the trauma not of losing but of panicking-the re-living of the experience is the only way to ensure effective desensitization.

The metric of success would be the same for both patient and player.  I know that I’ve done my job when panic patients can laugh about their last panic attack.

Go Canada Go!

Dr. Bradley also sees professional athletes in his Montreal coaching practice.

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Employee Recognition: why is it so hard?

February 1st, 2010

Just say: “good job!”  It’s simple, certainly brief and surprisingly effective.

As an occupational psychologist listening to stories of workplace stress and discontentment, I frequently wish that I had a communication pipeline to my clients’ bosses to whom I could whisper the above advice.

For the hard working but often harassed administrative assistants who receive requests, or rather, order after order from bosses with little consideration of the existing to-do lists, such whispered advice would provide obvious relief.  However, I also see C-level executives – people with great organizational power and responsibility who arduously strive to accomplish a myriad of tasks often not to their own level of satisfaction or ideals.  These people often let it slip that they would feel much better about themselves and their own job performance if the CEO would say: “good job,” even infrequently.

As someone whose business it is to deal with workplace problems, the interesting thing to me is why don’t bosses do it more often.  It certainly can’t be blamed on lack of current research.  If you’re a numbers guy then you will be attracted to the research cited by the OC Tanner – a company that specializes in employee recognition;

Companies that effectively recognize excellence enjoy a return on equity that is more than triple that of their non-recognize competitors.

Teams members that can endorse the statement; “my manager does a good job recognizing employee contributions” also typically place in the top scores for customer as well as employee satisfaction.

Employee morale at work is directly correlated with the recognition that their boss provides.

In my experience as an executive coach, I think that supervisors often fail to compliment good performance because they operate under a number of commonly held myths.

Myth #1. Vigilance above all.

Many bosses put more pressure on themselves than required. They define management as constant surveillance, prying their efficacy as a manager on the surveillance of employee errors or omissions.  They are on-guard for mistakes, and when they find them, they pounce. Oftentimes, these managers are not mean or critical people by nature.  They simply have identified management as responsibility for ensuring that things don’t go off-track.

Invariably, this style of management is associated with stress and tension.  The tension is obvious for the workers being supervised since they spend inordinate effort avoiding criticism by not making mistakes, At the very best, employees managed through criticism can only feel relief that they have avoided or escaped censure. Passion, excitement and creativity are not part of the job description.

The vigilant manager is not really relaxed either since vigilance demands continuous effort as it sucks the joy from the work place interactions. At the very best, these managers go home knowing that nothing really bad happened at work today, but never do they share the joy of leading a team that willingly goes that extra-mile to achieve excellence.

Myth #2   Recognition fosters complacency.

I’ve seen many bosses who want to recognize good performance, but they’re scared.  They’re worried that if they do reward Jacques for that extra- work he displayed in getting the customer’s order out on time, but maybe Jacques will forget that he still has to meet his quota for the month.  Or, if the boss were to recognize and reward Suzanne for her productivity last month, then she’ll think that she never has to do any better, ever.

Instead of viewing recognition as a facilitator to spur performance to even higher levels, these managers fear that recognition is like a post-coital cigarette – a self-satisfied semi-permanent contentment.

It isn’t!  Appropriate reward and recognition primes workers to be even better.  Recognition stimulates more effort, not satiation.  I’d whisper this to their ears as well.

Myth #3   It’s too simple!

Yes, it is simple but it’s effective.  Many managers perceive employee effort, they want to reward it, but they wait for a big occasion, like the semi-annual bonus or the quarterly performance review. Saying “great job” seems too easy. In the manager’s mind the phrase doesn’t balance with the effort that the employee put into the task.

What can I say?  They’re right.

Often immediate verbal recognition can be brief and simple. It’s not temporally equivalent to the time that an employee probably spent doing the job, but nonetheless, it works. We are social animals, we are built not only to perform but to have that performance recognized by others, especially others that we view as important. We are also social animals with short attention spans; immediate rewards can have an enduring impact.  So I’d also whisper to that boss:

“Don’t wait for the annual review, the end of the quarter or even the end of the

day, when you see something that you like, mention it.”

Of course, there are some caveat that you can read about in journals and texts in management.  Compliments must be appropriate, sincere, and delivered by bosses who are generally liked and perceived as procedurally just.  But, in all my years as a psychologist listening to battle-scared warriors of the workplace, I’ve never had a client complain about a boss that was too complimentary or too rewarding.

When in-doubt, give a compliment.

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Perception of Threat – A Misconstrued Reality.

January 8th, 2010

What have we learned since the H1N1 scare took hold over the last several months?

Now that the incidence rate of the disease is steadily decreasing, looking back it seems that our collective fears outweighed the extant danger.  I think that there is an important message here, namely, that we as individuals or as a society often miss the mark when it comes to perceiving danger.  Psychologists use the term “heuristics” or aids in learning, in this case erroneous heuristics, to examine our biases when it comes to seeing danger.  Let me review two of these biases in regard to the H1N1 scare.

#1 Bias; Discounting the Habitual.

As humans, we have heightened sensitivity to novel events, particularly those drenched in threat. Luckily though, as our bodies would not survive in a constant state of high alert, we adapt. Soon, constant exposure to a particular stimulus gradually becomes just another piece of the cognitive puzzle in our world of tonic stimulation. Our ability to discount recurrent bombardments of stimuli may be problematic however, when dealing with events laced with danger, as we tend to also habituate to their level of associated threat.

In my home province of Quebec, fifteen people will die today as a result of downplaying threat. In fact, 15 people died yesterday, the day before and throughout the year yielding a total of over 6500 annual deaths directly attributable to the particular threat of smoking.  I don’t believe that any newspaper, TV station or any media outlet led their reporting with this fact.  One could only image the media attention if 15 people per day were to die of global warming or radiation poisoning from the tailings of an uranium mine.  Tobacco-related deaths are simply not news anymore, but smoking remains a significant and real danger.

#2 Bias; Small sample sizes.

Ask people to simulate the “heads” or “tails” outcome of a random coin toss and what never appears in their guesses is a four, or even three sequence head or tail repetition.  What these guessers invariably reproduce is a “pseudo-random” sequence where such repeated outcomes are deliberately avoided.  However, this is not so in real life as a sequence of three consecutive heads can easily occur despite the fact that over a large sample, say 1000 coin flips, heads and tails occur almost equally.

Returning to our perception of danger, when we limit our view to small samples – small with respect to a historical time period – we fall subject to this bias.  In contrast, if we expand the time horizon just a little, say going back a mere 150 years, a more accurate perception of danger can be obtained.

To illustrate my point, let’s expand our historical time machine to example New York city in 1865. Our guide will be Professor Alison Aleiloe and colleagues writing in the American Journal of Infection Control, 2006 describing New York in the following terms:

In the early part of the 1800s, the U.S. fared no better than Europe. Both rural and city dwellers lived in a world of filth. Animal wastes were everywhere on farms, causing boots and clothing to be covered by manure. City streets were used for disposal of food wastes and dishwater, as well as being covered with horse manure. In most cities, free-roaming animals, often pigs, scavenged the garbage, which kept the streets freer of garbage but spread animal waste

The authors go on to describe the disease consequences of living in this urban filth:

In history, it appears that disease and death were so common that only the dramatic plagues and pestilences made an impression on the early writers. This might be the first lesson about our past:

From time immemorial until well into the 19th century, infectious disease epidemics exacted their toll from everyone in every nation—rich and poor, saint and sinner, and city dweller and farmer

Describing the regular epidemics of typhoid, yellow fever, small pox and cholera, the authors then go on to describe the years between epidemics:

In these days, even the ‘‘good’’ years, when there were no remarkable disasters, were still disasters by today’s standards.

The Bottom Line

So, our few cases of H1N1 deaths pale in comparison to what some of our grandparents might have lived through not that long ago. In relation to historical infectious disease trends, the H1N1 “pandemic” illustrates threat embellishment. On its own, dangers posed by H1N1 are worthy of alarm. However, in comparison to current contextual dangers, for example the dangers of smoking, or judging the virus’ impact along the historical timeline of diseases, our fears of the H1N1 virus trickle on overestimation.

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Whatever Happens Is Good

December 4th, 2009

… public health officials face a no-win situation with respect to future disease threats: any level of concern may seem unduly alarmist if an epidemic does not occur, but no level of preparation will be considered sufficient if an epidemic does occur.

Brown and Barrett, The Journal of Infectious Diseases 2008; 197:S34–7

Brown and Barrett’s quote highlights  the dilemma faced by public health agencies as they prepare for H1N1.  Clearly any form of action taken will be met with criticism, giving way to an inevitable  “no-win” situation.  The same prognosis may be made for even the best-conceived plans by Human Resource departments in organizations across North America.  Their best efforts to develop contingency plans for potential absenteeism, promote vaccination among their employees and encourage hand-hygiene habits in the workplace might also be considered in the same negative light – damned if you do, damned if you don’t.

However, I would argue that the H1N1 threat has presented HR departments with an opportunity to promote a sure winner- wellness.

Whether the pandemic materializes or not, fit and healthy employees will be less susceptible to infection and in all likelihood will show faster recovery if stricken.  However, under what is appearing as the most likely scenario, the worst of the influenza may have already passed.  In either case, fit and healthy employees are more productive and less costly employees.

wellness-imageShifting the HR focus to include Wellness, as well as H1N1 prevention/coping, will change the psychological gears in a very positive direction.  Regrettably even the very best HR initiatives that I have seen are based on avoidance – that is, refraining from sneezing or getting vaccinated in order to AVOID the flu.

Psychological research has shown that avoidance worry about illness is stressful in itself. . Avoidance demands vigilance, constant effort, and at best, it’s success only brings our spirit back from fear to neutral.

In contrast, actively doing something about our health makes us feel good. Humans work best and feel best about themselves when they   set goals, develop plans to achieve them and actualize those goals.  Striving for something as important as our health makes us feel good.

While employees are listening, here are some suggestions for HR department to consider as they broaden their H1N1 focus to include Employee Wellness.

Health Metrics, have a lunch-hour biometric assessment of

- body fat

- blood pressure

- strength and flexibility

call it “Accounting for Your Body”

Fitness

- start a lunch-time walking club

- arrange an after-hours or weekend swap of sports

- equipment

Lifestyle:

-bring in a motivational speaker to talk about smoking cessation

-hire someone to explain meditation and its applications

-offer a workshop on stress management

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The Working Environment

November 23rd, 2009

Hand Hygiene Compliance:  The Workplace Environment

We continue our posts regarding the psychological aspects of the H1N1 flu by examining environmental aspects that can facilitate one of the best preventive measures – hand-washing.

#1             Easy Access; If it’s there, it’s used.

If companies want their employees to wash their hands more frequently, then they should ensure that sanitizers are easily available and that the washroom facilities are clean and well-stocked.  Psychologists know that when barriers to entry for a desired behaviour are reduced, participation in that behaviour increases.

All forms of behaviour can be applied to this simple yet often underestimated phenomenon. Human behaviours are easily influenced by the availability or lack thereof of products. Most obviously, commodity providers make use of this principle to readily promote consumption. Rather problematic illustrations of this principle are replete in the literature on drug and alcohol consumption. For example, when access to beer and alcohol, either through lower price or increased store hours, is made easier, people buy more alcohol.  When snack food is placed close at-hand either on the desk or close by, workers eat more.  Conversely, when people have to get out of their chairs to walk to the food, less consumption occurs.

In theory, most people would use sanitizer, but rather than make people question whether a detour of several feet is worth the trouble, place the sanitizer on a stand in the middle of corridor or just after the door. Easy access promotes consumption, and making sanitizer readily available acts as constant reminder. I recently ran across a study in the American Journal of Infection Control, 2008, authored by an enterprising nurse-manager who borrowed an idea she saw in a mall –a large stainless steel tripod with automatic gel dispensers was placed outside the children’s play area with eye-catching publicity on each side. The manager modified the advertizing messages and placed the same impossible-to-miss hand hygiene dispenser mid-corridor resulting in dramatic improvements in hand sanitizing for hospital staff and visitors.

#2            Environmental Prompts; Tell me what to do.

Our well-connected occipital cortex makes us susceptible to visual cues that control all types of behaviour.  In psychological jargon, this is called visual prompting.  The rest of the world calls it signage.

Psychologists are not just known for jargon, we also measure.  Therefore, readers of the 27th issue of the Journal of Organizational Behavior Management will know that when drivers where presented with a “visual prompt” to drive safely as they exited a garage, the rate of correct turn-signaling at the next intersection jumped over 30%.  Signs also work to encourage stair-climbing, they appear to work even more when their health benefits are made explicit as was reported by Drs Webb and Eves in Health Education Research.

To encourage proper hand-hygiene organizations should use signage to change behaviour.   Here are some helpful links to appropriate signage:

http://images.google.ca/images?hl=en&q=hand+washing+posters&revid=2072946769

http://www.calgaryhealthregion.ca/pandemic/pdf/Pandemic11×17.pdfhttp://www.publichealth.va.gov/flu/materials/posters_hand_hygiene.asp

http://www.washinghands.net/posters-signs-pictures.php

Signage is especially important if we have to change group norms in the workplace.  For example, if critical industries decide to eliminate or reduce hand-shaking, the signs to this effect need to be prominently displayed.  In this way, the interpersonal stress of violating what was previously normative behaviour is significantly reduced.

But, People Make it Complicated; Nothing Like Peer Pressure

I would be remiss to report that despite easy access and witty messages, we humans also respond to pressure.  We tend to do the right thing when we believe that others are also doing the right thing, and when we know that there is a potential that our behaviour might be checked.  Think of income tax and the compliance-engendering effect of potential audits.

In this regard, Barrett and Randle, 2008, reported an interesting study that examined the reasons why nurses might not comply  with proper hand-washing procedures even when they knew the benefits. Here was common quote:

It’s amazing how much you do copy what you see to try and fit in,

especially if it’s your first placement you don’t want to upset anyone.

You mix in with the crowd and do what they’re doing. (Participant 1)

In other words, peer pressure counts. Companies have two choices.  Most creatively, they can use managers and executives as role models.  Think about an intranet YouTube-type video of your company CEO using sanitizer or washing her hands for the required 15 seconds.

Alternatively, your organization can create a company-wide culture that gives permission to employees from all ranks to point-out the short-comings of others.  The question is how to do it?  Probably not by stressing the short-comings such as:

“Why don’t you use your sleeve..”

But maybe by stressing the advantages to the individual:

“It would be better for you to sneeze into your sleeve..”

The H1N1 flu has dragged behaviours that once were clearly in the private and therefore unchallenged domain into the public or company arena.  When an employee sneezes or coughs in an elevator, there is now more at stake.  Companies that take the initiative in helping employees best respond with appropriate but non-argumentative statements will benefit.

And finally, want to get over 90% compliance to proper hand-washing, then The Jewish Hospital in Cincinnati has the solution – Big but apparently friendly, Brother. Here’s the deal as reported in the American Journal of Infection Control where “patient safety leaders” randomly observed all manner of hospital employees, including physicians, vis-à-vis their hand hygiene practices. “Infractions” are noted and the associate informed in a discreet fashion. If things get serious, perhaps it should be considered.

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