Most of us experience work stress, but can too many responsibilities, unrealistic expectations, and personality conflicts at work lead to an experience of trauma victimization over time?

In my years of private psychotherapy practice, I’ve seen several cases where individuals experience signs similar to posttraumatic stress as a result of work problems. In the beginning, I found this slightly odd. I wondered: could negative work experiences really lead to reactions similar to trauma experiences, like war or sexual assault? Lately, in conversations with colleagues, I’ve discovered this is fairly common, particularly in certain professions.

How Your Work Environment Can Leave You Feeling Victimized

I recently interviewed Arkansas professional counselor Rev. Rebecca Spooner, an ordained minister who left ministry to become a therapist. She specializes in counseling pastors and their families, and said that feeling victimized and traumatized by their work environment is relatively common among members of the clergy. Rev. Spooner explained that the demands and expectations of modern ministry set pastors up for personal failure and emotional trauma.

“The paradigms in ministry are flawed,” Spooner said. “A hundred years ago, pastors had four jobs: marry, bury, baptize, and preach on Sunday. Today, ministers are expected to be marriage therapists and grief counselors, organizational leaders, facilities and staff managers, marketing coordinators, community relations specialists, bloggers, motivational speakers, spiritual teachers, salespeople (increasing membership and giving), budget managers, visit the sick, be a friend, and serve on regional committees! It’s completely unrealistic. It sets everyone up for disappointment.”

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These experiences are similar to what’s happening in private companies in recent times, particularly since the economic crash of 2008. Companies have laid off people and expect those who remain to do more work for less pay. New performance measures are adding pressure, and employees are micromanaged. Among the EAP (Employee Assistance Program) referrals I see in my office, stress related to new and unrealistic work performance expectations ranks at the top of the list.

The people who see me for help with work-related stress have complaints that are similar to what Rev. Spooner sees among clergy: insomnia, irritability, mood swings, anger, feelings of disappointment and disillusionment about their career and employer, confusion about why they are unable to meet the demands placed on them, hopelessness, anxiety and fear, fatigue, muscle tension, family problems, feelings of isolation, ineffective coping, and substance abuse. It’s a long list! Work stress is a big problem in America.

Many of us are familiar with trauma reactions after major catastrophes, but few of us realize that a work environment characterized by unrealistic demands, personality conflicts, and limited free time for leisure can, over time, create an experience of victimization.

3 Ways Cognitive Behavioral Therapy Can Help

Cognitive behavioral therapy (CBT) helps individuals shift from perceiving themselves as having little control over their circumstances to becoming empowered to either change outside pressures or learn to cope with and relate to them differently. With practice, CBT techniques can help reduce stress and anxiety, improve mood, and increase confidence.

CBT treatment has helped ministers reduce the experience of stress and trauma caused by the challenges of their profession. These same techniques can also help most people heal from various traumatic and emotionally difficult situations. CBT reduces distress and helps to restore emotional balance. Here are three techniques from cognitive behavioral therapy to use in your own life.

1. Learn to identify the thoughts that increase your anxiety and your self-doubt. A large majority of individuals who come to see me for anxiety therapy are quite surprised when I mention that their thoughts are likely causing their anxiety. Most people believe anxiety is something that happens to them, something over which they have no control. But in fact, how we talk to ourselves about the situations we face has a great deal to do with how we feel. For example, if a minister tells herself that because her church is not growing she is not an effective leader and has failed God, she is likely to feel emotionally upset and believe that she is not capable of growing the church. By repeating self-defeating thoughts in her head, her self-esteem erodes. Eventually, she may just give up trying altogether and become depressed. This is the trick trauma plays on us: it tells us that something is wrong with us and that we are helpless, but most of the time our thoughts are not true.
2. Dispute the thought. Once you’ve identified the anxiety-producing or self-defeating thought, it’s time to dispute it. Here’s an example: “If I don’t grow the church, I’ll get fired.” Let’s examine if that thought is true. In most denominations, firing a pastor takes effort. First, the leadership of the church has to vote that they have lost confidence in the pastor. Then, they have to bring the issue to a congregational vote. In many cases, a national mediator becomes involved to help resolve the conflict and improve the employee/employer relationship between the church and the pastor. So the thought, “If I don’t grow the church, I’ll get fired” is not exactly true. What’s much more likely to happen is that if the church is not growing and leaders are dissatisfied, a conversation will occur about why that’s happening. And hopefully, that conversation will lead to solutions. Notice your own thoughts and question them. Are they true? How do you know for sure? What are some alternative explanations that might be more true?
3. Learn to relax. The third CBT technique that Rev. Spooner uses is relaxation training. When we learn to relax the tension in our muscles and reduce the speed of our thoughts, our brains function better. They see things more clearly. Gen. Colin Powell has a rule. He tells himself, “It ain’t as bad as you think. It will look better in the morning.” That’s partly because when our brains are rested, we see situations differently. Relaxation training can teach you to rest your brain. My personal hope is that one day, we will collectively learn to be realistic about our demands and expectations of people and be kinder to one another. Until then, if you find yourself feeling victimized, excessively pressured, or doubt your worth or abilities, try CBT. It really can help!

Individuals who are “symptomatic” of post-traumatic stress disorder (PTSD) may seem sick, crazy, or irrational. They might appear dissociative, clinically depressed, anxious, highly reactive, or rageful (or all of the above). In addition, it’s common for an individual to cultivate a sense of self-loathing for displaying these characteristics. During treatment, both therapist and survivor may agree that these symptoms are a mark of disease, making it their goal to alleviate the symptoms. Alternatively, both may choose to believe that these symptoms are an expression of health versus illness. This could enable more directed treatment, internal compassion, decreasing fear of symptoms, and a relationship between survivor, therapist, and trauma.

According to the DSM IV (American Psychiatric Association, 1994) criteria for diagnosing PTSD includes intrusive memories, thoughts, or dreams of an event, a sense of reliving the event, and intense distress in response to both internal and external cues that resemble an event(s).  Individuals may thus avoid triggers or cues, increase isolation or have a sense of ‘waiting for the other shoe to drop’ (a foreshortened future), and detachment.  Sleep difficulties are common; mood liabiality, and hyper vigilance are also common (American Psychiatric Association[DSM-IV], 1994). When a survivor feels hopeless, confused, and self-loathing because of the manifestations of their trauma, the initial layer of treatment is frequently the unraveling of self-loathing for the expression of symptoms themselves.

To begin to evaluate trauma and develop a relationship with its influence on survivors, we can draw from the practice of narrative therapy and the concept of externalizing a problem, which recognizes that the person is not the problem; the problem is the problem (Playful approaches to serious problems: Narrative therapy with children and their families. Freeman, Jennifer C.; Epston, David; Lobovits, Dean New York, NY, US: W W Norton & Co. (1997). xvii, 321 pp.). PTSD, as a character in a survivor’s life, uses symptoms as tools to protect us, remind us of our core values, and ensure that what happened before won’t happen again. The trauma response could even correspond to the level of violation on self and values; from this perspective, a profoundly disturbing event calls for a profoundly disturbing response. Flashbacks, dreams, invasive thoughts, and triggers provide specific information about the violation the client’s event(s) infringed upon them. These also exemplify the concept of “stuck points” in Trauma-Focused Cognitive Behavior Therapy (Akin-Little, Angeleque (Ed); Little, Steven G. (Ed); Bray, Melissa A. (Ed); Kehle, Thomas J. (Ed), (2009). Behavioral interventions in schools: Evidence-based positive strategies, School Psychology (pp. 325-333). Washington, DC, US: American Psychological Association, xi, 350 pp.)

The aspect of a survivor’s past that is troublesome can be quite specific and idiosyncratic. Groups of people exposed to the same event often are disturbed by different parts of it. Interpersonal trauma such as child abuse, domestic violence, or sexual assault may render someone feeling responsible for what happened to them, feeling dirty or shameful, betrayed, foolish, unimportant, or completely exposed.  Trauma might be conveying to someone that they are at fault for an assault because it wants the individual to have a sense of mastery or agency.  Helplessness is too passive, so self-blame is an acceptable tone to assume. An individual might also begin to associate a traumatic feeling of betrayal with a feeling of foolishness, ensuring s/he does not trust people too easily and maintaining inner safety.

The way in which a survivor expresses their PTSD can vary widely and presentations can be very complex and oppressive.  It is common for survivors to blame themselves for their past experiences, and they often enter into treatment with a great deal of shame because they feel they should have “gotten over it” without help. A therapist can offer some relief from shame by viewing survivors’ symptoms as useful, even critical to their treatment.

Through the process of healing, a survivor can learn to establish trust in self to clearly identify his/her core values, to reflect his/her significance in the world, and to maintain personal safety. The character of trauma will refrain from presenting images (flashbacks and dreams) when the stuck point has been identified, and will cease making statements that the individual is culpable for what happened once there is a demonstration of mastery over the event. It will hold back on invasive, persistent thoughts once the survivor is able to look at the event rather than avoiding it.  PTSD symptoms reflect individual values and provide explicit guidance for healing; if therapist and client are willing to work with trauma, and absorb the information it has to offer, it will not invade with such rigor.