American Association for Physician Leadership

Operations and Policy

The Big Idea: Leading Through Anxiety

Morra Aarons-Mele

August 13, 2020


Summary:

How can you lead with authority and strength when you feel anxious? How can you inspire and motivate others when your mind and heart are racing? And if you hide the fear in an attempt to be leaderlike, where does it go?





How can you lead with authority and strength when you feel anxious? How can you inspire and motivate others when your mind and heart are racing? And if you hide the fear in an attempt to be leaderlike, where does it go?

According to the Anxiety and Depression Association of America, “Stress is a response to a threat in a situation. Anxiety is a reaction to the stress.” Anxiety is fear of what might happen in the future. Sometimes that fear is rational and sometimes not. And sometimes it’s about something that will happen in three minutes (stepping onto a stage to make a presentation, for example) or in 30 years (having enough money to retire).

Globally, according to the Institute for Health Metrics and Evaluation, an estimated 284 million people had an anxiety disorder as of 2017, making it the most prevalent mental disorder worldwide. Recent workplace data from Mind Share Partners, SAP and Qualtrics suggests it’s widespread on the job: Nearly 37% of workplace respondents reported symptoms of anxiety in the past year. These numbers will only increase in the wake of the pandemic.

The good news for those of us who have managed anxiety for a long time is that we were made for this moment. Data shows that anxious people process threats differently, using regions of the brain responsible for action. We react quickly in the face of danger. We may also be more comfortable with uncomfortable feelings. When channeled thoughtfully, anxiety can motivate us to make our teams more resourceful, productive and creative.

In an economic crisis, the anxiety that keeps us up at night may help us fathom a solution to keeping our businesses open. But left unchecked, anxiety distracts us, zaps our energy and drives us to make poor decisions. Anxiety is a powerful enemy, so we must make it our partner.

Whether you have a diagnosed anxiety disorder or are having your first dance with this intense emotion, you can still be an effective leader. But I’ll be blunt: If you don’t look your anxiety in the face at some point, it will take you down. This isn’t easy, but doing it will change your life and your ability to lead others for the better.

ACKNOWLEDGING AND ACCEPTING YOUR EMOTIONS

When you name a feeling — by saying to yourself “I’m anxious” — you can begin to address it. You can learn how anxiety informs your behavior and your decisions and what causes it to surge, which will equip you to manage it.

Take the time to wallow in your thoughts. Let yourself experience the discomfort of fear and anxiety. Play out worst-case scenarios in your head. Allow your imagination to go wild with catastrophe. Cry. Grieve. But don’t turn away.

If the word “anxiety” feels wrong to you, label it whatever you like. Call it “unease” or “temporary uncertainty” or even give it a silly name. Then you can start pinpointing when it appears and why.

When you feel anxious, take note of your physical reactions. Your triggers might be small. You might notice a stomach flip and a spark of dread when you see someone’s name pop up in your inbox. Or they might be bigger. When unemployment numbers skyrocket, you might feel nauseous and unable to focus even though you still have a job.

When an interaction or a situation sets you off, examine why. You might be hesitant to delve into issues from your childhood, but unresolved issues from your past are very much present in how you lead.

It’s also good to understand how you react when triggered. I call these anxiety “tells.” Keeping a journal of your anxiety — when it happens, what triggers it and how you reacted — is a great way to develop self-awareness. Your tells may not always be negative behaviors; for instance, many of us find ourselves connecting with friends and family more during stressful times. When I’m very anxious, I cook and freeze meals!

Many successful leaders react to anxiety by working harder, holding themselves and others to an impossibly high standard or trying to control things that are beyond their power. Some think of it as a “good work ethic,” but often perfectionism and overwork only cause further anxiety — in yourself and others.

Your tells may also be physical. Anxiety can manifest itself as tightness in the chest, shallow breathing, clenched jaw muscles, frozen shoulders, gastrointestinal symptoms, skin breakouts, appetite changes and radical shifts in energy.

Once you understand your triggers and tells, you can start developing a new relationship with your anxiety. Here I turn to advice from the leadership coach and CEO of Reboot, Jerry Colonna: “Differentiate what’s possible from what’s probable. It is possible that everyone I love will die of a pandemic and I will lose everything I hold dear. But it’s not probable that everything that we love and hold dear will disappear.” Try to distinguish your worst fears from what is likely to happen. This will help calm you and give you space to move forward.

Focusing on what’s probable also takes flexibility — the future won’t be what you thought, and that hurts. Acknowledge the grief and anger you feel (at least to yourself) and then make adjustments, identifying the aspects of your vision that may still work.

TAKING ACTION TO MANAGE YOUR ANXIETY

Many faith traditions teach us to accept what we cannot control, without preoccupation or panic. But in the middle of an anxiety attack at work, you probably don’t have time for philosophy. So here’s what to do when things feel completely off the rails:

— STRUCTURE YOUR TIME: A solid body of research shows that an improved attitude toward how you organize and value your time has a positive impact on mental health. And it’s especially crucial when you’re gripped by anxiety.

While you’re at it, try to avoid what cognitive behavioral therapy terms. These are the catastrophic thoughts, self-judgments and all-or-nothing ideas that often accompany anxiety. Also be careful not to overschedule or overestimate your productivity; instead focus on the critical work and leave time to take care of yourself.

— TAKE SMALL, MEANINGFUL ACTIONS: When you feel anxious, an immediate task can easily become overwhelming. Take running a cash flow analysis for your business. When you open up the accounting software, your mind might go to a dark place, and all of a sudden a month’s worth of figures have spiraled into the business tanking and your losing your home. To break that mental spiral, take a small, meaningful action. Organize some receipts or clean up some file folders until the panic subsides. In general, focus on the near term whenever you can.

— FIND A MINDFULNESS TECHNIQUE THAT EASES YOUR ACUTE ANXIETY: There are lots of ways to do this. One option is to focus on your breathing. Others prefer what’s called “the breathing-exercises-4-7-8-breath.” Either is simple to memorize and subtle enough to do at your desk. When you deliberately slow your breath, it sends a message to your brain to calm down, and your brain then sends the message to your body so that many of the physical symptoms of anxiety — such as increased heart rate and higher blood pressure — decrease.

You can also shift your attention. Focus first on your anxiety, and then slowly turn your attention to something tangible, something you hold in your hand, like a book. By concentrating on an object in the present moment, you can turn the volume of your worry down until it’s background noise.

If I’m full of anxious energy and unable to sit still, or if quiet breathing exercises don’t work, I like to loudly blast a favorite song and dance for five minutes. Some people like to sing instead. Experiment with what works for you.

— COMPARTMENTALIZE OR POSTPONE YOUR WORRY: Sometimes I talk out loud to my anxiety, saying, “Sorry, I’m going to deal with you after I finish my work.” You may want to write the worry down and save it for a specific time — maybe later that day or your next session with your therapist.

— MAKE A CONNECTION: Connecting with others can break the negative thought loop that often accompanies anxiety. Instead of focusing on yourself, you turn your attention outward. Perform a quick, generous act: Check in on a former colleague via text message, or ask a family member how you might help.

Finally, if anxiety is persistent and hampering your days, consider consulting a therapist or mental health professional. Talking to someone trained in helping others manage anxiety may give you additional coping mechanisms to address debilitating symptoms.

LIMITING ANXIETY’S IMPACT ON YOUR LEADERSHIP

Anxiety can impair our judgment. It can cause us to focus on the wrong things, distort the facts or rush to conclusions.

In anxious times it’s important to set yourself up to make good choices. Start by acknowledging that your emotions can make you an unreliable narrator and that you will likely be prone to negative thoughts. Every leader should develop a team of “real talk” peers: people who will provide their unvarnished opinions. You can fill this role for others, too.

One of the most dangerous aspects of anxiety is that it’s “the-contagion-we-can-control" and leaders set not admitting that you’re anxious but instead emitting irritability or distraction, you’re not doing your staff any favors. But how can you be honest with your people in a way that doesn’t strike fear in them? What degree of emotion is appropriate to express?

Ultimately, how much you disclose is a personal decision. But self-aware leaders know when it’s appropriate to be vulnerable. And your staff needs you to be transparent and honest about anxiety and mental health, especially when the future of your company and their livelihoods are uncertain.

Admitting “I’m anxious today” or “I didn’t sleep well” lets everyone else in the room breathe a little easier. (“Phew, it’s not my fault he is so tense.”) And remember, you don’t have to share details; just share the state you’re in.

Imagine you’re in an anxiety spiral from reading news about COVID-19, but you need to lead a staff meeting in 10 minutes. You could open the meeting by saying, “Obviously, the news is getting more upsetting by the minute, but I want us to put that aside for the next half-hour while we go through this call.”

While being positive is important to prevent emotional contagion, you don’t want to give anyone false hope. If you get tough questions like “Is my job safe?” or “Will we be in business in six months?” it’s not your job to divine the future. Say what you know to be true in this moment and affirm the importance of working together and focusing on what each person can control.

BUILDING A SUPPORT SYSTEM

The final step in leading through anxiety is making sure you have ongoing support. This means not only surrounding yourself with the right people but also developing routines that help you deal with bouts of anxiety and lay the groundwork for maintaining your mental health.

Since you want to spare your employees the messy details of your anxiety, you need a place for those emotions to go. Make sure you have a “safe team” of people to whom you can confess scary thoughts. They can include a therapist, a coach, a mentor, a spouse or partner, and friends. It could be an intimate group of fellow leaders, online or offline, who commit to sharing in confidence and making space for one another’s difficult emotions.

Practice self-care, whether it’s sleep, exercise, hobbies, massage, spending time alone or being with people you love. The point is, take it seriously, as if your doctor had written you a prescription for it. Aspects of it you feel comfortable sharing can benefit your team: When you model good practices, others feel permission to take care of themselves, too.

Putting in place the support infrastructure to manage your anxiety will help you ride out setbacks and tough times. It’s a strategy for long-term success and sustainability as a leader. It means you’ll have better workdays, both when things are status quo and during transitions and tough times.

Ultimately, anxiety comes with the job of being a leader. The process of managing it can make you stronger, more empathetic and more effective.

We’re in desperate need of better models of leadership, especially when society tells us that anxiety and depression are weaknesses. A 2019 Mind Share Partners report found that 86% of U.S. job seekers thought it was important for an employer’s culture to support mental health, but only 37% of employees saw their company leaders as advocates for mental health at work.

This time of crisis — in which those of us with a history of anxiety may be experiencing it acutely while others may be feeling it intensely for the first time — is an opportunity to change that perception. You can play a role in telling a different story.

Morra Aarons-Mele hosts The Anxious Achiever podcast for HBR Presents and is the author of “Hiding in the Bathroom: An Introvert's Roadmap to Getting Out There (When You'd Rather Stay Home).”

c.2020 Harvard Business School Publishing Corp.

Morra Aarons-Mele

Morra Aarons-Mele is the founder of the award-winning social impact agency, Women Online,  and author of Hiding in the Bathroom.  She has written for The New York Times, The Wall Street Journal, O the Oprah Magazine, and other publications, and is the host of The Anxious Achiever  podcast.

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Topics

People Management

Resilience

Self-Awareness


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