Work-related stress

The work is still getting done, and that can be the most frightening part. The calls are joined, the emails answered, the deadlines met. From the outside it looks as though you are coping. Inside, the day starts too early, ends too late, and never fully lets go of you. Work follows you into bed. You replay a meeting, draft a reply in your head, check whether something has landed, then check again. By Sunday evening the atmosphere in your body has already changed.

Work-related stress is what happens when the demands placed on you outstrip the resources you feel you have to meet them, and that gap does not close. The body reads sustained pressure the way it reads threat. The stress response that is meant to fire briefly and switch off stays partly switched on. Sleep thins. Concentration narrows. Small requests start to feel intrusive, and a message from one particular person can change the whole day. Stress itself is not a psychiatric diagnosis, but when it runs on unbroken for months it is a well-established route into an anxiety disorder or into depression, and it is worth taking seriously well before it reaches that point.

What keeps it going

The pressure at work is real, but it is rarely the whole mechanism. What keeps work-related stress in place is what you do to manage it. You work longer to stay ahead of the fear of falling behind. You check and re-check to be certain nothing has been missed. You keep the phone within reach in the evening so that you are never caught out. Each of these lowers the anxiety for an hour, and each of them teaches the mind that the threat was genuine and that only vigilance kept it at bay. The relief is what makes the pattern so hard to give up.

Underneath the behaviour there are usually rules you have been living by for a long time. Do not be average. Do not rest until everything is finished. Do not let anyone see uncertainty. Those rules may be exactly what made you reliable, quick and trusted. They may also be the reason you cannot recover, because they treat stopping as failure and rest as something to be earned rather than something a body requires. Cognitive behavioural therapy works on this directly. It looks at the appraisals you make under pressure, the physical arousal that follows, and the behaviours that carry the arousal forward into the next day, and it tests them rather than simply arguing with them.

The evidence base is for the conditions that untreated stress tends to become. NICE names cognitive behavioural therapy as a first-line treatment for depression, and as one of only two psychological therapies it recommends for generalised anxiety disorder, and the same approach is used to interrupt the cycle earlier, while you are still coping on the surface. The aim is not to make you care less about your work. It is to make the work survivable, and to give you back a level of pressure you can actually recover from between one day and the next.

How I work with this

Much of my work as a Consultant Cognitive Behavioural Psychotherapist has been spent in private practice in the City of London over the last fifteen years, with people in banks, law firms and senior corporate roles. These are often people who function beautifully in public while arranging their whole lives around what they are trying not to feel. You will not need to spend the first sessions teaching me why “just set a boundary” sounds naive, or why the problem is not solved by being told to take a weekend off.

I work online with adults and adolescents. Therapy is not a substitute for medical assessment or treatment. I do not diagnose and I do not prescribe. Sessions are fifty minutes, online, and usually weekly to begin with.

I am known for my thoughtful, client-centred approach, combining clinical expertise with practical strategies, and for creating a safe and supportive space where people feel able to open up. Some of the work is about getting through a specific period without losing yourself. Some of it is about understanding why the same pattern has followed you from one high-pressure setting to another, and what would have to change for it not to.