Extreme stressors

Produced by Dr Nathan Smith, University of Manchester

Expert reviewed by Professor Emma Barrett, University of Manchester

Download the printable 1-page PDF version of this brief here.

Why is extreme stressors relevant?

In the line of duty, covid-19 workers will encounter a number of extreme stressors or demands. These stressors/demands can impact upon an individual’s capacity to do their work. In highly interdependent teams, like those working in ICU, the impact of stressors/demands at the individual level can have onward implications for the safety, performance, and health and wellbeing of others, including other staff members and patients. 

Core constructs/concepts

It is important to distinguish between stressors/demands and stress. Stressors/demands (which may result in adversity) are the things that cause a stress response. Stress can be felt physically and psychologically, both in terms of physiological activation and how a person thinks and feels.

There are likely to be a range of physical, physiological, psychological and social or interpersonal stressors/demands encountered by workers responding to the covid-19 outbreak. These might include:

  • Lack of sleep: workers may have to do long, consecutive shifts leaving little time for sleep

  • Tiredness/fatigue: lack of sleep and high workload may result in individuals feeling tired and becoming fatigued

  • Repetition: sustained commitment over a long period may lead to feelings of repetition and monotony

  • Hunger: workers may not have the time to eat or when they do have time be too tired to prepare healthy meal

  • Dehydration: limited fluid intake and additional burden of wearing protective equipment may lead to dehydration

  • Protective equipment burden: this can impact task completion and result in sores due to contact with skin

  • Threat and danger: heightened risk of contracting the virus may lead to feelings of threat

  • Interdependence: working closely with others for long periods and being reliant on each other can lead to tension

  • Cultural differences: integrating diverse teams can lead to challenges around ways of working

When these stressors/demands are encountered alone, they do not usually cause a problem. Indeed, stress can even facilitate high performance when it is perceived as a challenge. The issue is when stressors/demands are combined or clustered together and/or they increase in severity. This can overwhelm an individual’s resources and lead to a significant deterioration in performance, health and wellbeing. For instance, stressors might result in poor decision making, missing important information or lead to frustration and irritability, which could cause arguments with other members of the team. 

Equipping individuals with the resources and techniques to effectively manage and overcome stressors/demands can promote salutogenic (health-enhancing) responses and a sense of satisfaction and pride in completing work despite facing difficulties.

Practical recommendations

  • Workers should be encouraged to think about and develop good sleep routines. This might include limiting the use of mobile devices just before bed and avoiding social media that might lead to raised activation levels. Under conditions of sleep deprivation, napping can help minimise sleep debt and contribute to maintained function. See full brief on sleep monitoring and optimisation here).

  • Caffeine (200-300mg dose) can help overcome tiredness and maintain function. This needs to be carefully managed and should not be used as a way of overriding sleep. 

  • Having explicit checklists and verbal protocols to go through can ensure vigilance is maintained and avoid repetition and monotony resulting in mistakes and other problems.

  • Encouraging a healthy balanced diet is important. Snacking may be helpful if schedules do not allow time for meal breaks.  

  • Monitoring dehydration using simple pee charts is advised and can help staff understand and manage their hydration levels.

  • Food and drink are a powerful psychological tool. Where teams are able to eat and drink together, this should be encouraged. This is a good way of maintaining cohesion and morale.

  • Ensuring that skin does not chafe and blister, as a result of wearing facemasks for example, is important.

  • To reduce feelings of threat, individuals should have an outlet to share their concerns and know that their worries are being noted. Where solutions are possible, these should be quickly implemented.

  • Encouraging individuals to focus on what is within their control and minimise the extent to which they are forecasting to the future can help reduce threat. Focusing attention on processes rather than speculating on outcomes might help.   

  • The importance of self-restraint should be emphasised to avoid interpersonal conflict. If issues are encountered, discussing them in a calm and controlled manner is advised. A psychologically safe environment, created by leaders, will enable open and honest conversations.  

Relevant literature

Barrett, E. C., & Martin, P. (2014). Extreme: Why some people thrive at the limits. Oxford University Press (UK).

Leach, J. (2016). Psychological factors in exceptional, extreme and torturous environments. Extreme physiology & medicine, 5(1), 7.

Smith, N., & Barrett, E. C. (2019). Psychology, extreme environments, and counter-terrorism operations. Behavioral sciences of terrorism and political aggression, 11(1), 48-72.