Job Stress Is In Your Head. Literally.

By | January 12, 2016

Or…

Half of What I Know About Employee Health
I Learned from Concussion

Concussion is a movie about employee health as much as it’s about anything.

In the movie, the National Football League goes to great lengths to cover up the harm it allows to be inflicted on its players. The league is motivated by fear of liability and its unquenchable thirst for ever-increasing revenue.

Medical examiner Bennett Omalu, MD, a trained neuropathologist played in the movie by Will Smith, determines that several ex-players who died of unnatural causes suffered from chronic traumatic encephalopathy — CTE. The disease is characterized by long-term damage to specific sections of the brain, where tau proteins surround and choke off brain cells. The damage affects memory, agitation, and anger, and leads to dementia and, reportedly, Alzheimer’s disease. Brain studies were conducted on numerous players who died, including several who committed suicide. Ann McKee, a neuropathologist at Boston University’s CTE Center, reported in 2013 that she’d examined the brains of 46 former football players and found CTE in 45 of them.

Professional football players are employees of their respective teams, and the NFL serves as a sort of trade association for its member teams. For years, the NFL deflected blame for CTE, sometimes onto the players themselves. They pointed their finger to substance abuse (including steroids and alcohol), past history of concussion, and genetics. They downplayed the role of concussion, insisting that “mild traumatic brain injuries are not serious” and that players could safely return to the same game after suffering a concussion.

Ultimately, the NFL agreed to pay $765 million dollars in a settlement with more than 4,500 retired players who sued the league for concealing the issue.  Speaking about the settlement, NFL Commissioner Roger Goodell said, “There was no admission of guilt. There was no recognition that anything was caused by football.”

The settlement included a provision that the NFL would never again compensate players or their families for CTE, which is why, as one example, the family of hall of famer Frank Gifford, diagnosed with CTE post-mortem in November 2015, cannot take action against the NFL.

Football players are an elite group. What does their plight have to do with your job stress?

In another post, Half of What I Know About Wellness I Learned in the First Six Minutes of Joe Vs. the Volcano, I recounted a dialog between Joe and his boss. Joe, it turns out, suffers from “a brain cloud” caused by a black mass running down the center of his brain. His boss insists that Joe stay in the game: “So what!” the boss shouts. “Do you think I feel good? Nobody feels good. I don’t let it interfere with my job!”

Joe’s brain cloud and black brain mass, which viewers are led to believe result from job strain, are the stuff of satire. But is there really a chance that average workers exposed to prolonged job stress suffer brain damage — structural changes in brain tissue with accompanying symptoms?

Yes, there is.

Occupational stress affects signals from the amygdala to the prefrontal cortex

Repetitive stimulation of the amygdala — a result of prolonged job stress — releases chemicals to the medial prefrontal cortex and may cause thinning of the cortex, enlargement of the amygdala and, consequently, a cycle of deteriorating stress modulation, cognitive symptoms, and impaired fine motor function.

In 2014, Ivanka Savic, MD, PhD of Sweden’s Karolinska Institute, published a study that used brain MRIs and showed that prolonged job stress — which included chronic overtime and a cycle of distorted perceptions regarding job demands, abilities, and control — leads to structural changes in the brain.

Compared to the MRIs of demographically matched control subjects, the patients who reported debilitating job stress — and exhibited burnout symptoms like impaired memory and concentration, sleeplessness, achiness, fatigue, and emotional exhaustion — showed abnormalities in the parts of the brain involved with the processing and perception of stress, specifically the prefrontal cortex and the cortex (which were abnormally thin) and the amygdala (abnormally large). These findings were consistent with Savic’s hypothesis that “repeated, chronic stress could lead to damage of the brain areas which modulate stress perception, leading to a vicious cycle with impaired ability to cope with stress.” The MRI findings were supported by documentation of reduced fine-motor skills and emotional regulation in the stressed group compared to the control subjects.

Finally, Dr. Savic concluded, “This condition needs to be considered as a stress illness, whose sufferers deserve proper and swift treatment.”

Dr. Savic summarized her study in her blog post Does Chronic Occupational Stress Cause Brain Damage? (The complete findings were published in the journal Cerebral Cortex.)

While a worker suffering from stress-related ailments may feel, as they go about their business, like they  metaphorically are banging their head against a wall, the analogy between job-stress and football concussions is somewhat tenuous. Here are some ways the two phenomena differ:

  • The research on job-stress-related brain damage is still preliminary.
  • CTE is a result of smashed brains. Job-stress-related brain damage is more subtle, resulting from interactions between an individual’s job and their perceptions, and the resulting chemical activity in the brain.
  • There is no “cover-up” of job-stress-related brain damage that we know of — if for no other reason than most employers don’t know about it.
  • Job-stress-related brain damage has not been linked to behaviors that are as aberrant as those linked to repeated football concussions, nor has it been linked to death (though job stress has been found to be a significant risk factor for cardiovascular disease and death).

But there are some similarities, too:

  • Football concussions cause brain damage. Prolonged job stress also appears — based on preliminary research — to cause brain damage.
  • Just as football’s CTE was originally blamed on players (their drug use, history of previous head injury, or genetics), job stress in the United States has commonly been accepted to be solely a consequence of employee perception and coping skills, with employers turning a blind eye to their own role in creating job conditions that cause stress. Instead of empowering you with more control over your workflow, your employer adds a resilience program to your to-do list. In the absence of a broader preventive strategy, resilience programs are for job stress what football helmets are for concussions: Tools to help you endure more pain.
  • NFL players and everyday workers — as well as the enterprises that employ them — will benefit from having these neurological conditions identified and treated as early and effectively as possible.

Ultimately, symptoms of job-stress-related brain damage may prove to be less severe than CTE. But its burden to society — in terms of economics, well-being, and productivity — may be far greater simply due to the vastly larger population at risk.

 


[In addition to the film Concussion, much of the data and quotes for the CTE section of this post were derived from the episode of PBS’s Frontline: League of Denial — The NFL’s Concussion Crisis.]